I sent this privately to Christine - and now feel the need to share with
others.
JP
Christine
You are so right! I also have had "growth" foisted on me with changes in
work situations and venues - the moms, babies and environment are so very
different - and if you have someone who has worked in hospitals for 20+
years, vs. someone coming in now from the community (as you and I did), then
you also have a difference in expectations. Your employer's requirements
are also very different and we have to work in the situation we find
ourselves. I worked in St. Louis just when epidurals were starting - and
clearly saw the differences in behavior of both the mothers and the babies.
Now many hospital staff rarely see mothers and babies who have not received
medical interventions of some sort.
When giving presentations I acknowledge these differences, and encourage
each group (prenatal, L&D, Postpartum and community) to find a way to create
networks among themselves to share and learn, such as participating in
Breastfeeding Coalitions where case studies can be shared, ending up with
brainstorming on how to improve education for mothers, family members,
providers, etc. These opportunities also allow us to see each other face to
face, and then makes it easier to call each other when we question what was
done and why. Of course that question needs to be made in a "can you help
give me a background on this situation" not a "WHY did you..?
As for the mom, I NEVER criticize what an LC or Nurse has done in the
hospital to the patient! It does no good to the mother except add to her
stress, and does not change what she needs to do NOW. If she asks me, I say
"I don't know what I would have done in that situation, as I wasn't there -
and you and your baby are totally different from the time she/he saw you.
Let's see what we can do now."
.and the reality is, I DON'T know what I would have done right then and
there, at 2 am, or when MD said "get this kid fed" or when family is at the
door needing to take her home so they can go to work, etc..
I truly believe we need "Rehabilitation centers" -equivalent for many moms
whose families are not near or able to provide support, and who need a day
or two more to recover from childbirth and to get to know their babies and
increase their confidence. Discharge in the US is far too quick, we all
know they can't remember anything we said! One day I heard 2 LCs talking
about a mom who had been discharged - and they saw her and her husband,
hours later, with him pushing her and the baby in a wheel chair around the
hospital. She was refusing to go home!
Maybe nipple shields would not be used as much if hospital staff KNEW there
was going to be someone evaluating and helping this mom and baby within the
next 12 -24 hours.but if they fear this is the ONLY opportunity to get this
baby latched, and after that they go into the "black hole" of care, where
neither Pediatric nor OB services will perform adequate lactation assessment
and appropriate interventions, they use whatever tool they feel will
accomplish milk transfer RIGHT NOW and provide referrals, but they really
rarely see "the rest of the story" thanks to the silos created by (at least
the US) the medical care system.
Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA
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