Thanks to all of you who responded to my request for references on
problems that can be caused by giving abm when it is not needed. The
hospital librarian is still looking up some of the articles for me. I typed
up the one page "Just One Bottle" article which I think summarizes a number
of potential problems very well. My partners and I copied the article for a
Mother/Baby and Admissions Nursery educational bulletin board; before we
put it up, our boss saw it and said it is "controversial" and she wants us
to have a forum to discuss how comfortable/uncomfortable the staff nurses
are with the info before we circulate that information. (We were not
planning to give it to parents; just to staff). :-(   {How do you spell
Aaarrrrgggg!?}
     One of the M/B nurses (an experienced nicu nurse) is very much
concerned that our taking a strong line to avoid abm unless ordered for
medical reasons will result in many dehydrated babies. She says some nurses
will just give bottles without recording it (we know of one case where this
happened) if we keep trying to keep tabs on the abm that is given. (Making
a "big deal" of it.) She says she'll get the pediatricians to order "may
bottle or finger-feed at night" or something similar whenever she feels it
is advisable.
     We are keeping a list of the moms who call back with babies who have
been supplemented in the hospital and are having problems at the breast
once they get home. Don't know if those statistics will help show people
more of the big picture. We also give every BF family a log sheet to record
feeds, wet diapers and stools from discharge until the 1st wt check at the
peds office, and are explaining the importance of being sure the baby is
getting milk.This issue is causing a great deal of stress on the job for
all of us. Does anyone have any ideas about helping to solve this? Our
lactation program is 1 yr old, and has been very well received by families,
and for the most part by the staff nurses until now.
     I'm sure many of you have been in a similar place. How do we know
which battles to fight, and in what order?? Some fear we will undo the good
our program has accomplished if we make too much of this issue. I'd
appreciate any words of wisdom. Thank you all again!
Anne Stiller, RNC, IBCLC