Laurie, Gail, Arly and Rachel made a lot of good points


What happened was I went to the mothers room before going to the nursery- anyway
if the baby was there I would examine there- I just sat down and asked the mom
"how did it go yesterday?  The bottles were given in the day infant was born
6:30 am so was only in the first 12 hrs- she said she gave the bottles twice
b/c she couldn't get the baby to latch on- but later in the day the baby
finally latched and she nursed her at night- so I was basically just nodding my
head and tried to encourage her that she will be able to make enough milk for
her baby and that her baby won't starve- she's going to do the "Diaper Diaries"
tonite

It happens to be that this hospital the "Mother Baby Unit" is a closed unit but
the nursery is still very far from the mothers rooms literally around the
corner and down a hallway- it seemed to me that they had a lot of babies in
there- and crying- the babies "come in" at 11 pm for bathing and weighing
etc...- then some go out some don't- how is that done differently in Baby
Friendly Hospitals?- You could wheel the scale around and weigh in the mothers
room- the "bathing" could even be done in front of the mother- it would be a
great learning experience! How antiquated is that thought process? I just
realized- its like saying- we are going to take care of your baby for you!
Quoting Arly Helm <[log in to unmask]>:

> In a survey I conducted in Utah, 25% of the nurses felt formula was so
> important to a baby's well-being that they would give formula even if the
> physician or mother specifically said not to.
>
> By experience I learned that there are some staff members who feel so sorry
> for the breastfed babies (who seem to get fed so little compared to
> formula-fed babies) that they will take any opportunity to feed them, truly
> feeling that they are looking out for the babies' welfare better than the
> misguided mothers and doctors who want the baby to be exclusively breastfed.
> They can be strengthened in this belief if there is one physician who
> vocalizes the same beliefs, though he be only one physician of many.  And if
> there are other physicians who "go along with" mothers' desires to
> exclusively breastfeed but don't get excited if the babies are given
> supplementary formula, this weakens the argument for the importance of
> exclusive breastfeeding, which again influences the nurses in their
> decision-making.  If afterwards, she hears, "Well, OK, of course you had to
> feed the baby," this makes it more likely that she will choose to supplement
> an "exclusively breastfed" baby in the future.  Surely the nurse receives a
> lot of mixed messages with regard to feeding.  Exclusive breastfeeding is
> still seen as the exception in many facilities, permitted only in special
> circumstances and jettisoned as soon as the road gets bumpy.
>
> Another loophole is that babies are to be breastfed unless there is a
> medical indication otherwise, and medical indications include going a
> certain number of hours without eating (4, 6, or...) and hypoglycemia
> (numbers may be set higher at some facilities than others); as well as more
> subjective criteria related to how the baby and mom look.  In a common
> scenario, with a baby crying in the nursery, the nurse may use her judgment
> to decide that the mother's need for rest precludes feeding, even if the
> mother (and her doctor) has asked that the baby be brought to her.
>
> There are other pressures leading to supplementation. In hospitals where
> nurseries are a fair distance from the postpartum unit, or where the
> territory is divided between postpartum (mothers') nurses and nursery
> (babies') nurses, it may be physically or socially easier for the nursery
> nurse to give a bottle than to take the baby out for a feed. Social
> pressures within the hospital culture (as elsewhere) are powerful.
>
> Staffing is another issue.  I often had nurses tell me that they had too
> many babies in the nursery to be taking one out to the floor, and what did I
> want them to do?  Let the baby scream? I do think there is something quite
> wrong with giving nurses a bunch of babies they can't feed and making them
> feel as if they can't give them back to the person who can feed them.
> Clearly warehousing babies and limiting staff leads to unwanted and
> unnecessary supplementation.
>
> And then there is the training issue. In one California hospital I observed,
> they had excellent policies and protocols regarding supplementation, but the
> nurse manager seemed to be the only staff member familiar with them.  Status
> quo kept the system functioning as it had been before the new protocols were
> written.
>
> The physician is in charge, and writes the orders, but it is the nurse who
> interprets and carries out the orders all day and all night long. The nurse
> has to sort through all the messages, possibilities, and barriers, and make
> decisions in the moment as to what to do.  We would all benefit if nurses
> had a single clear message, and a way to follow through.
>
> Arly Helm, MS, IBCLC

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