Mellanie,

I can relate to your situation. I work in a city hospital w/ mostly African
American moms, some Vietnamese, and quite a few teens and unmarried moms.
Our bf initiation rates are about 50% and I would say very very few bf
exclusively. I started the program about 2.5 yrs ago w/ rates of 40%,
sometimes 30-something. They have slowly crept up.

The first thing you must remember is that change will take ALOT OF TIME,
probably AT LEAST 5 YRs to see a substantial change. Be very patient. The
ideal world and the real world are very different and you will no doubt
experience much frustration. Remember though that the potential is there to
make a huge difference in a few years and even every day now, more and more
families are getting skilled help and support.

I do not even see the formula feeding moms unless they are undecided, asking
questions about bf, or need help w/ engorgement. I would focus my energies
on the bf moms. The staff will see more successful bf couplets and this will
make an impression on them. The happy moms will spread the word. If I were
you, I would try to do more bf classes. You are right, it is next to
impossible to affect a mother's fdg choice after delivery. I try to reach
them prenatally. Do they attend CB classes. I speak for 1 hour in the 3rd of
4 CB classes. Whether the moms plan to bf or bottle or are undecided they
hear my spiel. I am very upbeat and try to be fun/funny. In the beginning of
the talk, I ask that everyone stay and hear my talk. I say if you want to
leave you can however I ask that you stay (this so the formula feeders will
not leave, saying 'well I don't have to hear that talk becoz I'm not bf'). I
say that sometimes a baby comes prematurely or is sick at birth. I say that
the neonatologist might ask that you provide ebm for the baby. I say that
some infants don't tolerate formula and keep switching and then need to be
bf. I give some scenarios and say that I want everyone to get this info just
in case. Over the years only a handful don't attend. I talk off the cuff w/o
slides or videos or overheads. i do give some handouts. I really try to
engage them and let them ask/debunk myths. So prenatal exposure is very
important. I also have a small bf class/support group.

Within the hospital I like to leave some provoking bf articles occasionally.
Dont' bombard staff with them, but when you find something compelling, share
a copy "FYI - this was really interesting." Be prepared for much resistance
and staff that are very comfortable w/ formula fdg, formula supps. You have
to gently educate them, for example, a poor feeder or premie that is being
supplemented w/ formula, show them about expressing milk and using that,
something they might not have thought of. Good luck and keep us posted.
Write to me if I can help.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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