Hi Ann.  Well, one way to look at this is here is a doctor who really has
been sold on the benefits of breastfeeding and is determined to advocate for
her patients.  However, I am assuming your patient load includes more people
that just her patients.  Is this correct?  In which case, there ought to be
something your nurse-manager can do to help this doc put into perspective
the constraints of your other duties, etc.  I know that many of the hospt.
based LCs in my city are supervising huge case-loads.  They may be assigned
as many as 8-9 mother-baby pairs per shift.  If they eat, go to the bathroom
and chart, they will be lucky to have time to spend with each pair.  So your
idea of seeing them while awake and ready to feed surely makes sense.  It
might help to show her some of Als work on state behavior.  If infants are
deeply asleep, there's no waking them to feed.  I would also go to the
archives of Lactnet and pull some of the epidural stuff.

In terms of finding a solution other than her babies going home not feeding
(which she should be concerned about) there are a few ideas.  Go ahead and
support the idea of letting them stay longer.  That gives you more time to
work with them.  Also, consider suggesting she hire her own LC who can do
what she wants you to do.  This gal can be in place to see these moms at
home once released.  Show her Marianne Neifert's article in the new
Contemporary Pediatrics -- good cover article with lots of reassuring things
to say about using pumps to keep options open for the infant who can't make
nursing work right away.  It also describes some of the circumstances that
delay initiation of lactation.  Maybe this doctor thinks that just having an
LC makes it all "work".  As you say, it is sometimes tincture of time,
patience, and continued protection of milk supply until everyone is able to
fully function.

An analogy here is the over-use of antibiotics. I'm sure this doc gets lots
of parents who think that bringing their child into see her with a virus is
a guarantee that she will give them meds which will quickly "fix" the runny
nose, cough and ear ache.  Docs used to be happy to oblige until the
over-use of antibiotics began to contribute to resistant bugs.  Now many
parents go home disgusted because they are told the problem can only be
fixed with time,  patience, and trust in the natural recuperative processes
of the body. This advice is no less true just because everyone is
disappointed in it.


Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html