>Where breastfeeding is concerned, evidence-based practice often turns into
>experience-based practice....
>
>The reason for this is that people's personal experience colors their
>feelings, and then their actions, with regard to this very personal issue
>of how to feed our babies.


And how!!!

Here, too.....where babies are *not* generally given formula without
mother's permission, because the 'system' has changed rather quicker
than attitudes, and where attitudes are now catching up...I don't
think any place where formula feeding is the cultural norm can afford
to wait until every last person on staff has an attitude
change....we'd be here till Doomsday. I mean, sheesh....I really
don't care what everyone's attitude is, as long as they behave right!
Part of being professional is to put your personal experience behind
you where it belongs, right?

Our system changed thus

* universal rooming in, so babies are rarely away from mother's care and sight

That's everywhere now, and it is normal.

Slightly less than everywhere came this:

* breastfeeding policies - made with multi-discplinary input - in
place in more and more units, which generally include a stricture
that no formula is to be given unless for medical reasons, and unless
mother chooses it....and (*crucially*)  that use of formula
supplements need to be documented

And in a few  more cutting-edge and Baby friendly or would-be Baby
friendly units:

*  if an HP documents a supplement, she is asked by her manager for
chapter and verse on why, and it is considered to be a serious
professional infringement if no good reason is given (she needs to
show she has counselled the mother on the impact of formula, too)

>  It is an ethics issue...and a serious one.


Absolutely...and where it still happens, I wish the mothers would get
mad about it. Sometimes they don't fully understand the impact of
what has happened, and the ethical side to it....if they do, they are
sad, and if they are mad they don't get mad at the right person.

One interesting aspect that came up at a study day I was at yesterday
was the idea that HPs who give bottles or who advise them, or who
support early solids and so on, feel unable to recommend exclusive bf
because they can't ask mothers to do something they were unable to do
themselves, as it's seen as a high standard to reach...if they
couldn't do it, how on earth can a mother do it?

This is a sort of paternalism, masquerading as 'care'.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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