Hello,
I work nights on L&D.  The other night I was taking care of a woman who
had had a c-section for HELLP syndrome.  She was 2 days pp and had been
on mag.  She was pretty sick, but improving.  Her baby was born at about
35 weeks, a little peanut of slightly over 4 pounds.  Well, I asked the
mom if she was breastfeeding and she told me yes, but that she was only
doing it once a day because she had been told by the ped and the nursery
nurses that the baby used too much energy and calories getting latched
on and had to be formula-fed by bottle for all the rest of the
feedings.  I am so sick of hearing this kind of crap.  I've read so many
times on Lactnet that its the responsibility of the hcp to provide the
evidence that breastfeeding should be stopped, limited or interrupted,
but that's not what happens.  And when I suggest that perhaps the
patient should demand this or question what they've been told, they look
at me as if I've gone insane.  Its especially difficult working nights
because the md's usually aren't there for me to talk to and the other
nurses agree with the orders.  In addition, the baby isn't my patient,
the mom is, so I don't really have much pull when it comes to the orders
written for the baby.  Is there ANY evidence that a baby will "wear
herself out" by breastfeeding?  Doesn't it make more sense that if a
baby gets tired breastfeeding, she will stop and go to sleep?  These
people act as though breastfeeding is an athletic event equal to running
laps around the nursery.  I am a reasonable person, I understand that a
baby at risk might need to have more calories and feed frequently, but
this garbage that I hear more and more frequently is really irritating
me.  Does anyone know of any research stating the calorie expenditure
during breastfeeding?  Any suggestions for responding to these protocols
without sounding like an angry lunatic?  At present, the only thing I've
been able to do is shout out, "ON WHAT IS THIS ERRONEOUS OPINION
BASED?".  Of course, nobody has an answer for me.  Its amazing to me
that our patients come in with their birth plans and doulas and are
fairly vocal about their wishes regarding the delivery, but then they
relinquish all the feeding decisions to people who, IMHO, are giving
them poor advice (not all, but enough to irritate me).  I try really
hard to be a patient advocate, but I can't do it if the patient puts the
md on a pedestal and blindly accepts everything he says without
question. I think its incredibly unprofessional to tell the patient,
"Well, your doctor is WRONG.", because it undermines the relationship
and sometimes I don't have all the facts needed to even form that
opinion, but I have no trouble telling the md, after getting all the
facts, "I think you're wrong about this.".  Its unfortunate that I am
put in the position of having to provide evidence that its okay for the
baby to breastfeed, but this is the real world.  The md can write any
orders he wants, and parents don't demand explanations or justification
for them.  Sorry to rant, but this one really ticked me off.
Katy Giller, RN
Boulder, CO