Hello all, Just to comment here--one of the reasons that Kathy and I believe
helped our unit become more successful for breastfeeding was that WE CAME
FROM WITHIN.  We were both NICU nurses in this particular unit for many
years.  We had worked nights and Christmas, and gone through many personal
trials and tribulations with these nurses.  THEY HAD RESPECT FOR US ALREADY.
They trusted us not to do anything to hurt the babies.  Therefore, we easily
got buy-in for the things we wanted to do.  NICU nurses, right or wrong,
treat these babies as their own.  They are scared that you, or the surgeon,
or the optho, or the neuro or the intern, etc. will harm their babies.  And,
I might add, not without some very good reasons for that.  Premature or
critically ill infants need special handling and respect for stress cues.
Having seen other medical(and lactation) professionals work with these
infants without any respect or regard for their special issues, I know
exactly where they are coming from......What may seem to be perfectly good
practice with healthy, full-term babies(and I am not entirely convinced of
that, always) probably is not in a preterm infant's best interests.  I have
also seen mothers of preterms(and heard of many other stories in other
hospitals) being treated very roughly by "professionals" whose main area of
expertise is not NICU.  Another issue would be a huge lack of
knowledge...once we role-modelled breastfeeding teaching, positioning and
latch (without shoving it down their throats), the nurses began to do it on
their own.  NICU nurses tend to be well-educated, intelligent people, usually
who've been around forever(we call them fossils), and may not want to listen
to that whippersnapper go on and on about breastfeeding.   It doesn't really
mean that they don't care.  Once Kathy and I started our positions in the
NICU, several nurses "came out of the closet" and started promoting
breastfeeding in a big way.  So, I do agree that many NICUs need lots of help
with breastfeeding.
1. Find nurses(and neos) in the unit who are willing to take a stand--need
more than one.  NICU nurses come in large groups(we have 180! of them).
2. Have them openly discuss breastfeeding and MILK  in a positive way, citing
references as they go.  The science of breastmilk will really grab their
attention.
3. Leave research-based articles around in the break room.  Take Cosmo out.
Eventually they'll have to read them.
4. Invite them to see what it is you do with breastfeeding mothers.  When
they refuse, look for scrubs and sneakers on the other side of the screen and
speak more loudly.  They are listening.
5. If your unit does any mandatory education, become part of it.  We've
taught breastpumping, alternative feeding methods including nipple shields(no
fruit or vegetables were thrown), and this year, we'll do assessing latch,
suck and swallow.  Yes, the cart before the horse, but remember, most of them
are just starting to touch mothers' breasts.
6. Have a sense of humor.  Breastfeeding is meant to be FUN!

Really, all kidding aside, this should help.  It won't happen in a year or
two.  I'm hoping that we'll have a 100% breastfeeding friendly NICU by
retirement.  I'm 41, by the way, so there's a really long way to go, but what
strides our NICU has taken!
                                                                       Happy
Holidays to all!

Maureen Allen RN, BSN, IBCLC

Lactation Consultant-NICU

Brigham and Women's Hospital

Boston, MA
PS.  Many of you have emailed me about protocols and policies.  As you can
see, we've been very busy taking care of breastfeeding basics in our NICU.
We hope to have something done for the spring for our conference.  Stay
tuned.

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