We taught the BFHI to *some* nurses at our hospital, some of whom "got it" and some who did not.  We then taught a 9 hour version to our doctors, who embraced the evidence.  Because of our docs, pacifiers are still available, but in the pyxis for $9--a two fold approach where we can see a trend among who gives them out, and quite a cost for moms.  With the doctors' help, we also have a consent form that includes pacifier use, supplementing for non-medical reasons, and trips to the nursery (beyond the procedures nurses choose to do there).  It's a step in the right direction.  However, there are many mothers who bring pacifiers with them.  :(
I think the pacifier study shows what we know, that even a strong % of mothers in the no-pacifier group still chose to use one.  I feel it's important to recognize their use among some mothers, and then find a way to help these mothers still be successful with breastfeeding even if they choose to use the pacifier.  Things like not using a pacifier to space feedings, avoid use during a growth spurt, etc.  Also, to suggest an age of weaning from the pacifier.  I recommend 4 months, which is also a common time frame among SLPs, when many babies begin bringing objects to their mouths and "talking."  I also share that parents are likely to be as addicted to the pacifier as the baby, but it is beneficial for the baby's development to switch to toys and stop the pacifier at 4 months.  Obviously, there are no studies to show how breastfeeding might be effected when pacifier use is stopped at an earlier age.  But since babies are still breastfeeding (hopefully 100%) at 4 months, it is likely to have a better effect on outcome than using a pacifier without limit throughout toddlerhood.
Amy Peterson, IBCLC
Idaho

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