Greetings,
I will try to make this short.We are preparing to implement our last of the new Breastfeeding Guidelines at our Hospital, "Supplement only when medically indicated".  I have been tracking our rates for about 3 years with chart audits. It was easy to get supplementation out of the delivery area....no evidence for it! For about 21/2 years we have had NO supplementation in L&D unless medically indicated. About 2 instances per audit all with medical need documented, usually low BS...like really low...12 or 15 and usually a late preterm.
On our Mother Baby Unit we have about a 50% supplementation rate on average with very little documentation. Our goal is to reduce this to 20% with 100% documentation. This goal was based on the Kusuma(2009) article in JHL that stated that the incidence of Near Term Wt  10% loss was 18% and it was a figure I picked out of my head as being reasonable for a first goal. We will have some infants that need supplementation. What number that is we will only know when we do this for a while.

To implement this we have a comprehensive program starting with prenatal parent education....prenatal classes and handouts in the MD offices and on the MB unit. In all fairness to the nurses, who in our unit do a pretty darn good job of trying not to supplement and to support breastfeedin, are pressured by the mothers/families to give supplements. I will ever remember a situation in the nursery. A grandmother called asking for a bottle for her breastfed grandchild. The nurse very nicely stated that she would come out to help the mom with breastfeeding and the gm shouted, "Just bring the damn bottle!!"
This will be followed by mandatory online CE for the nurses which I wrote on this topic and a CME to be given to the Pediatricians in May. Chart audits will document the % of supplementation and whether the nurses charted a medical need...or that they educated the mother and she still wanted the formula.
I have tons of documentation that supports not supplementing. The most fascinating is the research on the relationship between weight gained in the first week and obesity later in life. If breastfeeding is the norm, then babies are not supposed to get much to eat the first few days! Perhaps we trigger some metabolic process that causes us eat more, gain more weight when we give the baby more than a few cc's per feeding. 
Will let you know how this all turns out.
Carol L'Esperance, Albuquerque, NM

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome