Good afternoon,
I will try to compose my thoughts succinctly on this. Also I know I have
commented on the RN/IBCLC and the clock issue in the past, they do come up
again and again, and it doesn't hurt to revisit these issues.

First, it is so true that RN/IBCLC's or *any* IBCLC employed in a hospital
setting is aculturated to the medical model, or even more significantly,
*restricted* in her practice by the medical
model, the nursery staff who may have more control over the feeding plans,
and the MDs and DOs who really do have full control (sadly, often it's not
the parents). This is a source of GREAT frustration to most hospital-based
IBCLCs.

Here are some recent examples: 34 wk twins, experienced mother who has bf 2
prior children, mother comes for every daytime feeding til 9pm. Doctor
ordered bottles after each bf, because babies lost approx 1 oz after a day
of bf. (I like gavage feeding small, early premies and allow ad lib bf - but
I'm not in control). The doctor in question is our most bf-friendly.
Baby with 16 glucose, confirmed 8 in lab, bottle fed all night per MD
orders, no access to mother (yes IV fluids were done too). Another case -
supplementation with water for physiologic jaundice (yes, this antiquated
practice still persists). The IBCLC working with these dyads has to do some
difficult side-stepping to support the mother and promote the bf, and
offering options and suggestions to doctors, but keeping a good rapport
going with said doctors. Gradually we do make changes. Some might see this
as the IBCLC practicing in a non-evidence based or non-supportive way, but
it's not the case.

Now re the feed timing issue, most mothers ask us about the frequency of
feeds. We discuss with her normal ranges. Again, remember, the babies in
hospital are often born medicated, quite a few elective inductions, and with
barriers in place in the hospital culture, like mandatory hearing screens
and things that separate mother baby (albeit unnecessarily). I really
believe many mothers are clueless (don't take this the wrong way), but they
have NO experience with bf, esp. in Mississippi and other places with low
rates and where bf in public is quite rare. They really want to have an idea
when and how long babies feed. We often have mothers tell us the baby fed
for 1-2 sucks or 1-2 minutes and went to sleep. They want to know if this
was a feeding. I do give info on babies feeding patterns etc. We do ask the
parents to wake the baby if he is not feeding at reasonable intervals and
feeding effectively (teach all the signs); if the interval is more than 3
hrs or so in the first days (most moms in hospital 2 days including c/s). We
recently had a f/u visit where the mother had not bf the baby, nor fed baby
anything for 24 hrs. The baby vigorously drank 2.5 oz pumped from mother and
mother pumped another 2.5 oz, would not latch.
Also a 36 wk infant recently was not bf, just put her mouth on the nipple,
and was not being given anything to eat. The baby was rooming in and treated
as a well baby, mother post c/s and very groggy, was offering the breast and
even a bottle, no intake.

If you ever want to see my handout of what I teach mothers and what I give
them in writing, feel free to email me at work
[log in to unmask](many of you have gotten this in the past) and
you will see what I say re
timing, and everything else. And I welcome any feedback that you would give
me.

Laurie Wheeler MN RN IBCLC
Hospital-based
Mississippi USA

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