Off the top of my head, the two best resources for your institution to use to write your parent instruction information are these:
Dr. Melissa Bartick's The Burden of SubOptimal Breastfeeding in the US
<http://pediatrics.aappublications.org/content/early/2010/04/05/peds.2009-1616>

Evidence Report/Technology Assessment
Number 153
Breastfeeding and Maternal and Infant Health
Outcomes in Developed Countries
www.ahrq.gov

As Dr. Alison Steube puts it: "Is it worth it?" and "Can I do it?"
(did I spell her name right?)
Those are most mothers' questions. 
Once your staff internalize and KNOW the information in these and other publications, they are better prepared to individualise their teaching for each mother to address her own versions of these two questions.

Consider developing a Care Plan for each mother to show her answers to these questions.
Most useful versions have both a check list and a narrative area, confined to one side of one page.

Phyllis


---- "Amy Slotten wrote: 

=============
We are in the daily struggle at our institution of providing information to moms who are giving formula to their baby for non-medical reasons while still in the hospital.  The lactation group added some info on the breastfeeding info sheets that we give to moms that lists the risks of even one bottle of formula.  This is a conversation that most of us would be having with breastfeeding moms anyway but this put it out there on paper where the staff also have to confront these facts.  We have had tremendous backlash from staff such that this part of our paperwork was taken out of the new mom packets after 1-2 days.

We would like to ensure that all moms who are breastfeeding are provided with evidence-based information about risks of formula.  The goal really is to decrease the "mother's choice" supplementation that happens for no medical reason.  We generally feel that moms get the message from much of the staff that it's no big deal, has no effect, won't interfere with breastfeeding.  It seems the biggest problem has been that many of the nurses feel that it is not appropriate information given to a mom when a baby really does need medical supplementation and mom isn't able to express enough colostrum.

What do other institutions do about this "informed consent" in these situations?  Having balance so moms understand that there are consequences to supplementation but not having moms who refuse to supplement their late-preterm or SGA baby who isn't latching and has a low blood sugar.  We really do have good policies that state all of these things but don't seem to have the full staff compliance with informing of risks when mom wants to give a bottle to get a little more rest or because baby is fussy, etc.

Any help and suggestions would be great.

Thanks
Amy Slotten, RN, IBCLC
Ann Arbor, MI

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Phyllis Adamson, BA, IBCLC, RLC
Glendale, AZ.
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