Hi lactnuts
I am thinking about developing a very short, 1/2 page bf "care Plan" to clip
to the front of the nursery nurses' clipboard. This is to write out very
distinctly the plan of care for the bf dyad, and the point is to eliminate
the bf-sabotaging practices that still so frequently occur in our hosp. For
example, recently an LGA baby w/ glucose 28 (confirmed by lab) was
supplemented formula w/ a bottle. The same day, a baby who experienced very
long, difficult labor induction due to maternal diabetes and macrosomia was
born w/ tachypnea (10 lbs b.wt.). He was being fed by gavage but then the
nurse gave a bottle as first nipple feed to see how he tolerated it (RR
60-70 at this point). Of course I could not believe this, and asked why the
baby was taking a bottle; if he did not need to be gavaged, he could go to
breast. Would all this make you want to resign? It does me.
The care plan could say:
Pt/family goals: exclusive bf
Pertinent findings on assessment: colostrum easily expressed (or I like to
chart ample colostrum).
Care plan:
Frequent unrestricted bf, rooming-in.
If MD orders supplement due to low bld sugar, the supplement is to be given
at the breast w/ supplementer tube or via finger feeding (parent to choose).
No artifical nipples/bottles (we don't have pacifiers - thankfully!).
Care plan initiated by: xxx, ibclc
Do any of you use such a thing (care plan) and if so can you share w/ me or
give ideas? Thanks.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e.USA

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