Mardrey,

I wish I could say that it is possible for nurses to observe a complete
breastfeeding at each shift, but at least where I work this is a truly
impossible expectation.
- Babies are very sleepy  due to medications for the first 24 hours and usually
don't nurse well, be it vaginal or cesarean delivery
- 3 nurses and 24 babies - not acceptable ratios, especially when you add the
admission and discharge responsibilities, the need to monitor the newly-borns
under the lamps whose mothers are cesareans or whose pediatricians refuse to
allow them to go to the room until they PERSONALLY have checked the baby out.
- Moms want to rest and often are not interested in a lot of responsibilities
until their bodies are their own again (anesthesia and pain medications, etc.
make them feel this way).
- Relatives are coming in giving advice about how the baby is obviously
starving, go to the nursery, demand a bottle, are given a bottle by the
overworked nurse then return to feed the baby themselves (which then makes it
impossible to wake the baby up for the rest of our shift).
- Pediatricians and/or urologists come in to circumcise babies before they have
even had ONE decent breastfeeding - then the baby goes to sleep again after
screaming until he is hoarse - and again my shift ends before a breastfeeding
occurs.
- MANY babies are just born with ineffective sucks which need more than the
usual cursory "just put the baby on your chest and he'll go to it!"
        (You can't always blame the nurse and bottles - many of these babies have
been sucking their tongue, their lower lip or their fingers - and refuse to open
wide and lower the tongue for 24 to 48 hours at which time they are being
discharged!)

Having been an LLLL, an IBCLC,  and an RN I ask that we all respect that each
of these jobs is very difficult.  Each one of us has problems that are hard to
understand  "unless you have walked a mile in her moccasins".  Even the most
pro-breastfeeding nurse knows she is going to be evaluated not only by the way
she helps moms - but that she has completed her work, including charting, by the
end of her shift or the nursing supervisor will be asking why she is being paid
overtime.  (I used to regularly clock out THEN complete my charting to avoid
this!)

At our hospital we are trying to have nurses pulled off the usual maternity or
nursery floor duty and assigning them breastfeeding education.  This is helpful
because the ones who choose to do this are usually the ones who are most
interested. This is not an ideal situation, though, as it gives the regular
nurses the excuse to tell the mom "wait until the eduator comes by" instead of
having her take some interest in the breastfeeding support.

Don't know what is best - am still "pedaling as hard as  I can!"

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico
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