Hi, Jean:  The comment you made about coming from an "evidence-based"
practice to the hospital really grabbed my attention.  I have spent 19
years in a hospital-based practice and let me tell you, hospitals THINK
they ARE evidence-based practices.  HA!  Good luck in your new endeavor
because you are going to need it - have lots of patience and be willing to
play the game to get what you are working for.
Another 2 cents on insurance (makes me think we're dealing with the
insurance companies with this term) pumping and nipple shield use.  Again,
it's so important to remember that a very important (I feel the MOST
important piece) of the care plan is to assess the mother's ability (and
desire) to handle yet another piece of equipment and another minute of her
time.  I have had women burst into tears of relief when I tell them it's OK
that they stop finger feeding, pumping, using shields, shells, etc.  I
remember Kittie Franz's words of wisdom many years ago when I was doing my
UCLA cert:  what do you need to do to put the baby back to its mother's
breast?  I'm not thinking that telling a mother to pump 140 minutes/24 hrs
is allowing a mother the time to put her baby to the breast.
There are always feeding options that need to be gone over one by one with
the mother when developing a feeding plan.  I always explain what is
involved, how much time it will take, and the pros/cons of each option.
Then I ASK the mother what she feels she will be most comfortable doing,
given her circumstances.  We then work out a doable feeding routine
together.  On follow-up, I review how feedings are going for her/baby and
help her revise her current plan or help her move onto Plan B.  I find I
lose a lot less mothers to breastfeeding this way.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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