Laurie and All: I echo your sentiments, Laurie. Yes, breastfeeding is normal
and natural, but we do not live in a normal, natural world. And not everyone
thinks like most of us. I was initially quite taken aback at a comment made by
our unit secretary this morning: "Breastfeeding is normal? I thought
bottlefeeding was the normal way to feed a baby! When I had my babies 36
years ago, I was told that formula was just as good as mama's milk (she hails
from the Deep South) by my doctor, so I didn't even think about
breastfeeding!" She was not being defensive or argumentive - she was
honestly surprised at my statements. She was also shocked that many of the
daily recalls posted on the FDA's (US Food and Drug Administration) website
are for contaminated formula. I think we both learned something valuable
today.
We all come to breastfeeding management from a wide variety of
backgrounds - I think we all need to remember that we need to practice at a
level within our comfort/education zone. I could not even imagine stepping
foot into the hospital setting to practice lactation without my medical
background. I approach hospital breastfeeding management from the point of
view of: How do I help a mother achieve her breastfeeding goals within the
framework of a medical diagnosis (hers or her baby's)? And, sadly, I have to
agree with Laurie in that here in the US there is no such thing anymore as
a "natural normal" birth. My practice setting is about as different as you can
get from Laurie's. I work with primarily upper-middle and upper class white
married women - LLLI's definition of the ideal breastfeeding population. My
breastfeeding initiation rates are 93% - one of the highest in the Chicago
area. My dilemma is how to increase duration beyond the 1st few months -
many of my moms are stay-at-home and in an ideal position to go for
extended nursing. My population is also very well educated and informed and
has a large disposable income. They are ripe for the product manufacturers'
picking. If an item is out there, they buy it whether they need it or not. I
struggle to help them understand that breastfeeding is a normal, natural
process, not something that is medically or economically driven.
One of the reasons I feel that UCLA's Lactation Training Programs were never
widely copied by other colleges/universities (which was the original intent) is
that the 2nd part of the program is restricted to licensed health care
providers. One of the requirements of this course is to see/work with a
minimum of 100 babies with a variety of medical diagnoses (many quite serious
and uncommon), which means the LC needs to be closely working with other
members of the medical team and, honestly, we are not there yet as a
profession. It is expected that one would also be managing breastfeeding
within the scope of practice of one's license. The UCLA faculty feels that
when the student is seeing one of these babies, one is in the medical setting
and needs to be practicing under a license. Nursing and medical students,
when in school obtaining their degree, legally practice under their clinical
instructor's license. I recently received a phone call from a prospective IBLCE
candidate who wants to pursue Pathway F. She is having difficulty finding a
mentor and asked if I could mentor her. I'm having some difficulty with the
hospital with this because she is not a licensed health care provider. If I am
able to mentor her, she will be practicing under my license while doing her
clinical time with me. This is a very gray area legally and one that not many
hospitals are willing to go to.
One of the fun aspects of my job is that I DO get to do the LLLI stuff too.
One of the most valuable services we offer is a weekly moms support group - I
call it Baby Bistro. It is totally run by the mothers themselves - my function
at the group is to hold someone's baby if they have to go to the bathroom or
to take one of the twins, when we have mothers with twins in the group. But,
the managers do not see this as a necessary service and I have to struggle to
keep the group in place from year to year. This is nothing new to LLL leaders.
The consistent feedback from moms is: "If not for this group, I would not
have nursed as long as I have." And, "I live for Fridays and group!"
Sorry for the length, but I'm trying to survive the attempt by new managers to
take giant steps backward, instead of forward!
Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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