I have been giving various inservices for prenatal programs and just did
one for the hospital.

I always start with a self-attachment video - it may be short or long
depending on the audience and the time I have, but this gives them a
framework of the goal we have in mind....

Although I usually have limited time (2 hours), I STILL start with a
HISTORY of why we started giving formula - there are various books,
including Money, Milk and Madness that can give you background.  (Usually
show slides of the madonna to give a historical perspective)

I also always mention WHO, UNICEF and the marketing code.  I even mention
the "gifts" that nurses get that would be considered unethical via the
code.  This opens some eyes and at least makes them more aware that
recieving gifts - from whatever source - can make you give the appearance
of impropriety.  (I don't say  that it IS improper - just that it appears
so - don't want to make too many enemies!)  I use the slide of the
Pakistani mom with twins at the beginning of this and a picture of a mom of
twins (boy and girl also) that I helped at the end - they were BIG and
BEAUTIFUL at 6 months - and only 2 ounces apart in weight even though the
boy had been much smaller and had to be in NICU, mom had pumped and both
were exclusively breastfed.

Then I discuss (or bring out from them) the risks of NOT giving mother's
milk to the baby.  Just got the list of formula recalls from Marsha - THANK
YOU - so this will be part of my handouts.

Then I do a short section on anatomy and physiology - but speaking in terms
that they can apply - this is where baby would latch on and HURT and get
little milk vs. here is where it would be correct.  This is why breasts and
alveoli need to be stimulated early and often... etc...

I also show a good attachment video at this time so they can again see
where the goal is (and to break from hearing me talk too much).

I use lots of Kay Hoover slides - so they can see lots of nipples and
breasts so that they won't look too shocked the first time they see a
bifurcated nipple or a raspberry-like one. I discuss how to deal with
inverted nipples.   I also show them some engorgment and tongue-tie slides
as well as some short parts of Dr. Jane Morgan's video showing the U hold.

All the time I am stressing cue feeding and unlimited skin to skin contact
as just "the norm"...

I end with resources available in the area and how to access them, and what
handouts they can give to the moms so that they know when to call.
_____

Does this work?  No, not always - just got involved (too late) with a baby
who had to have a double transfusion due to a bili of 30 at 7 days - no one
had referred her even though baby had SUCH a tight tongue-tie the tongue
only makes a V when she cries...  

Yes, Friday was a bad day....

Jeanette Panchula,BSW, LLLL, RN, IBCLC
Vacaville, CA

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