I have been following the recent thread that seems to be related to the
Exclusive breastfeeding and breast milk only proponents VS (what is
being perceived as) Non BreastFeeding/breast milk friendly generalized
NICU and NICU staff.  The most recent digest I received contained posts
from Lisa Jones and I am in agreement with her posting.  If you will
tend to note and look back at where the criticism is focused... at those
providing the the intensive and acute care.  I absolutely agree that the
US medical system is far from being as breastfeeding and breast milk
friendly as we should be.  I am only one person at one university
children's hospital medical system and I am doing the best I can with
introducing new ideas, evidence based breastfeeding and breast milk
protocols and policies to help breastfeeding mothers and babies.  Is it
a terribly difficult battle? yes.  Is it frustrating? yes.  Is it time
consuming? yes.  Is it sometimes met with closed doors and empirical
protocol that is not evidence based? yes.  One person cannot make change
in a huge system overnight.  I hope that God blesses me with the bravery
to continue to work at it as well as all of the staff working with the
critically and acutely ill babies that we are all speaking of.  The
point is that TRULY, the amount of physical and emotional energy that
critical care and acute care staff (I am referring to physician, nurses,
lactation consultants, nurses aide etc...) in US hospitals far outweight
the $$ placed on their salary.  Just being in the NICU is terribly
stressful for anyone be it staff employees, parents and babies.  Anyone
who is in a position that is unhappy, there for the paycheck, should
consider a job change regardless of what type of job they have.  Even
more so when working with the fragility of NICU patients, families and
peers.  I do believe that there tends to be a recurring trend on lactnet
of criticism, at times appropriate and many times inappropriate leading
to sensationalism.  Of which I dont feel helps the cause of helping
breastfeeding mothers and babies.  The medical community and lactation
community need to work together and not against each other.  There are
many of us that are blessed with the opportunity to be part of both.  As
someone responded to a previous post of mine, "unless you walk in the
shoes..."  
What I rarely see, is the criticism focused on those that are so extreme
with breastfeeding and breast milk promotion that they fail to recognize
that a situation may need medical attention or continuing a plan of only
receiving milk at the breast or breast milk only.  What about the babies
that are admitted to the hospitals with failure to thrive due to
breastfeeding mismanagement, dehydration due to breastfeeding
mismanagement, seizures due to dehydration and hyperbilirubinemia
related to poor breastfeeding, refusal to take textured foods and
resulting oral aversion related to prolonging introduction of spoon
feedings well into toddlerhood, aspiration pneumonia due to inability to
maintain a safe airway when taking thin liquids at the breast.  There
are many situations that do require medical management and where solely
feeding at breast or breast milk only may not be in the best interest of
the baby.  At times to the detriment of the infant's health because of
refusing or prolonging the initiation of working with medical
management.  I work with these situations all too frequently.  But I
make the choice not to reference as a generalized statement and put down
those in the lactation community against any feeding or supplementing
other than baby being at breast or breast milk.  
Angie Kirkwood RN,BSN, IBCLC, RLC
 


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