Top three undermining interventions in hospital setting:
1. Separation of mother & baby. Rec. change: don't!
2. "Panic" (as perceived by mom, on the part of nsg/docs) in the 1st 24 hrs.
or so, if baby doesn't latch & nurse perfectly. Leads to undermining of
mom's confidence, lots of unnecessary worry, & belief that "something is
wrong" with mom or baby. Not to mention unecessary supplementation &
initiation of all kinds of cumbersome fdg. methods (finger-fdg, cup-fdg,
bottle-fdg, etc.) Rec. change: don't!
3. unnecesary use of epidurals & intrathecals for labor & delivery. Rec.
change: don't!
Not meaning to be facetious about the "don't" being the means of improving
the hospital practices. Bottom line is EDUCATION of medical staff & (even
more important, IMNSHO) nursing staff about the harm these practices cause.
We need to enlist these key people in modifying some of the practices
considered "normal" in a hospital setting, and we need to do it not only by
facts and research-based information but by winning them over.
We've often noted here that the attitudes underlying many of our standard
hosp. practices are not particularly amenable to plain old education (as in
sharing of up-to-date, well-researched information). We need to provide the
education and data, absolutely, but it is the way we present it and our
manner of dealing with staff that will win them over. I've found, in many
years of experience and practice (both good & bad), that charm, humour,
empathy, and gentle and loving acceptance of the people who carry the
attitudes we seek to change - while always continuing to teach the subject
material - will make the difference.
We all know how it feels to be told "you're wrong, and you've been stupid to
do ___ all these years. Do XXX instead." Not effective, usually - we might
change the practice, sometimes, if we "have to", but we'll carry a gripe
about it for a long long time, and we won't be whole-hearted even if we
modify what we do. So we won't be effective in transmitting it to others -
inauthenticity will always show through. Where change really happens, in
areas r/t BF education, is in the realm of emotion; people need to feel
accepted and understood where they're at. I wouldn't say this in any arena
other than here, because it's WAY unprofessional, but I think of it almost
as a wooing or a seduction of those you want to reach; you need to convey to
them that you accept them and you find them important, and use every
people-skill that's authentic and genuine for you. But it needs to be YOU
touching THEM, I think - it's that personal, to bring about true real
change. I, for example, have no luck just using "because I say so, because
the research shows..." approach, it just doesn't suit me and it comes off as
ridiculous, though there are certainly those who can use this style very
effectively; I use personal empathy & humor, and a down-to-earth manner,
because that's apparently what I do best, and it works well for me.
Isn't it an interesting question, how to effect change? You'd think it would
be so simple: just present the research, come up with a plan to modify
current practice to match the info, et voila! Ha! If only...
Cathy Bargar RBN, IBCLC Ithaca NY
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