First: I work in a tertiary care hospital with a Baby-Friendly NICU with
whom I collaborate daily, to the mutual benefit of infants, families,
certainly to myself and, I hope, to the NICU staff as well.  I've watched it
evolve and improve over nearly 20 years and I know it's fabulous.  I also am
regularly frustrated by some of the routine practices in that same unit,
especially around breastfeeding, and by the authoritarian way of reacting on
the part of the hospital as a whole, about when it is, and is not, all right
for parents to be there with their babies or to have opinions about the care
they get.  And this is a certified Baby-Friendly NICU in a Baby-Friendly
hospital whose staff consists almost exclusively of dedicated, competent,
breastfeeding-savvy people.  The thing is, I still see the ways in which it
can become even better.

After following this thread, I'd like to reiterate what Karleen posted
earlier today.  We have different perspectives depending on where we are in
the world, not to mention where we are in the world of breastfeeding mothers
or of the health services.  I've read every post Morgan has written, and
have not felt that any broad brushes were used, even though I work in a
similar setting to many of you who have taken offense at what she posted. 
It baffles me that it could offend any of us to think that parents notice
the difference between someone who is passionate about their work and stands
up for babies, and someone who is just there because they need the job.  

Nearly all of you have pointed out that staff who lack dedication and
commitment to excellence don't last long in the NICU setting. None of you
has denied that they sometimes land there before it becomes clear that they
are unsuited to the work. If you are the unfortunate mother whose baby was
cared for by such a person, your experience will be colored by it. No matter
how atypical it is for the unit, it is *your* experience and likely your
*only* one.  It may be more difficult to fix on this side of the pond
because of the general shortage of pediatric intensive care nurses and
because of protective legislation for employees in the public sector. 

It seems to me that the strength of emotion in the reactions to Morgan's
posts is a sign that those who are reacting are probably NOT the people she
meant.  Why the vehemence?  Why is it so threatening to acknowledge that
some parents have bad experiences because they actually didn't get the kind
of care you and your unit strive to provide?  More worrisome to me is why it
is threatening that parents question whether a given intervention is truly
in the child's best interests.  If, as I suspect, we feel threatened because
this field is so new that we can't possibly know for sure ourselves, my
conviction is that parents are not only capable of hearing of our
uncertainty, they APPRECIATE candor and openness from us, when it comes in a
context of true caring.  Most of them prefer openness by far to the kind of
pseudo-information we give to people when we just want them to consent to
whatever it is we plan to do to them.  Witness the accounts of how parents
feel threatened into going along with things on maternity wards and in NICUs
because they felt their pregnancy or their baby was like a hostage, or even
like a prisoner of war who could be vulnerable to retribution if they made
waves. 

Please, if you have hung on this far, look into your heart and think about
what makes you react to Morgan's post.  It might be a gift to the families
you serve and to yourself, if you allow yourself to consider the perspective
of the person who isn't thrilled with their care.  Oysters probably don't
appreciate the grain of sand that produces the pearl either.

Rachel Myr
Kristiansand, Norway

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