I am the LC at a small community hospital, about 350 births per year. The two most common reasons for supplementation are maternal request, usually a mom post-op, uncomfortable, ambivalent about breastfeeding in the first place, and unfamiliar with normal newborn feeding behavior. We try to talk them through it, unless if it comes to a head on the night shift. Supplementation, while rare at our hospital, is more likely to happen on the night shift. The most common medical indication would be weight loss at or fast approaching 10% while we are still waiting for the milk to come in. In that situation, mother would be encouraged to pump to fully or partially replace formula supplement, and we would have mother baby skin to skin. Again, when milk is "delayed" mother is usually post op, uncomfortable. 
 
It is rare, a couple of times per year, that I hear of a nurse suggesting formula for a non-medical reason.  
 
All babies room in.  We might take a quiet baby out of the room should mother request so mom can shower or sleep undisturbed for a bit, that baby will be right out with us at the desk, in their crib, or, if fussing, in arms. There are no babies in our "nursery," certainly not any crying ones. 
 
However, occasionally when a mother is overwhelmed by baby "constantly" on breast, but baby's weights voids and stools are good, some RNs will suggest a pacifier.  We just discussed this at staff mtng yesterday.  I don't get to make every call, the mothers and RNs do, so while it is not what I would do, or would like to have happen, at this pt we are looking at the pacifier as a useful tool of last resort.....preferarable to a formula supplement anyway.
At the meeting one RN said mothers aren't exhausted from their babies, they are exhausted from all their visitors.  So true.  So we are looking at educating parents prenatally about visitors, and tightening up our policy (which is very loose, in the spirit of allowing our pts access to the people they love)
We are also teaching other ways to settle a baby, ala 5 s's. Although, if baby's sucking needs have been met at the breast, it becomes the 4 s's. 
 
We are striving to create a culture of breastfeeding
 
Kristen Panzer, MS IBCLC
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