I NEED your help!
I was a victim of "Kick the Dog Syndrome" today. Oriental couple took 4 day
old baby to the hospital last night because he looked jaundiced. The bili came
back at 13. The doctor told them it was something in mother's milk that caused
it (gave them a Ross handout that "proves" it) and took baby off the breast. I
see them this morning. I tell them that there is no need to stop breastfeeding
"but the doctor told us and this paper (which they produced to show me) says
it's something in her milk." I made a comment about the information being from
Ross and started to explain the difference between breastmilk jaundice and
normal newborn jaundice. The mother blew up in my face in a room full of
people saying all kinds of not so nice things about me very loudly and
demanding to know my full name.  I apologized gave them my name in writing and
went on to the next patient. [The Ob/Gyn nurse practitioner talked with the
now loudly sobbing mom at length about how little time doctors get in
breastfeeding, and called me the best in the business. Tuurns out they were
really angry with the doctor they saw last night  I was flattened and
flattered all at the same time]
Some moms there were sympathetic to me after hearing what they did. One was
afraid to tell me that she gave bottles because she didn't want to give baby
the colostrum but the baby is nursing great right in front of me. Once I told
her that was OK she calmed down. I leaned forward and told her, "I'm not
really the breastfeeding police," and she smiled.
What happened today is the straw that broke this camels back. This junk is not
isolated.  Day after day of patients being told something different by every
HCP and nurse that walks into their room is wearing all of us LC's down. We
are playing clean-up 90 percent of the time.

Someone is giving babies with mec aspiration a first feeding of sugar water
before they are allowed to breastfeed. What black hole did that creep out
from? All of a sudden moms on mag sulfate can't breastfeed for 24 hours after
the last dose.  Babies are given bottles immediately after birth if they don't
latch on right
away often against the mother's wishes.  Moms have been told "you can't nurse
until you see the LC" (One lady waited 8 days until she saw the LC and asked
"is it OK to nurse now?")  If mom doesn't get the baby to nurse immediately
and WELL or if the baby is crying, moms have reported being "threatened" with
having the baby taken away from them and force fed bottles in the nursery.
Others have been given graphic, cruel descriptions of gavage feedings as
"threats" to get mom to give baby a bottle .  Moms tell us that the nurse
specifically told them not to tell the LC that they gave a bottle because we
would get mad (makes it hard to track down problems not to mention the trust
issues involved).

We are documenting these incidents and they are becoming more frequent. So far
it appears that the problem is universal, not just one or two uninformed
nurses.
We've been having quite a problem with our staff nurses lately.  There is a
passive aggressive behavior pattern of totally ignoring helping with
breastfeeding all together.   Staff nurses have  become openly hostile toward
the LCs, even our past advocates have joined the fray.  "You talk the talk but
certainly don't walk the walk..."  began a conversation between a once
supportive head nurse and one of the LCs.  The gist of this scene was the
nurses feel LCs need to be in the hospital 24 / 7  and nurses have no time
for; nor responsibility toward breastfeeding support.

The nurses claim their patient loads are so heavy that they  don't have time
to help with breastfeeding, "other things take higher priority."   We have
in serviced the staff so many times that they should be able to handle simple
latch on problems in their sleep.  The LATCH system is part of the charting.
Supplementation is supposed to be documented but often isn't.  Our certificate
Of intent for Baby Friendly status sits on the floor behind a filing cabinet.

We all worked as  OB nurses for years before becoming LCs and infant feeding
was part of the job, just as much as peri care is.  The attitude is beyond our
 comprehension.

We currently have  210 births per month.  The birth rate is supposed to be
increasing by 80 to 100 deliveries a month before December, so things can only
get worse if we don't intervene now.  Plus the number of moms attending
prenatal breastfeeding classes has dropped sharply.

The patients are complaining about the lack of breastfeeding support on
surveys.  And it's not just showing up on the  hospital exit surveys but also
from Peds and OB clinics.  Every lactation related complaint severely impacts
our department and LCs aren't responsible for their dissatisfaction.

We have reached the  end of our rope and the knot is coming untied.  We are
all stressed out because every mother comes in sobbing.  Breastfeeding isn't
working because of minor, preventable problems. (nipple preference,
engorgement, abscesses, untreated thrush, areolar edema from epidurals, LOP
from sleepy babies or tight mouths from hours of back labor and pushing with
the epidural running)   Our weaning and exclusive breastfeeding rates have
dropped below national averages.  If it wasn't for love of the moms and the
babies all 3 LCs would quit in a heartbeat. According to what we should have
in Full Time Employees (FTE) we are well below what is called woefully
understaffed. We are all in burn out mode.

There isn't going to be a quick fix to this but we need some opinions.
Staffing  LCs 24/7  is out of the question for administration (even though LC
salary and benefits are a lot less than a staff nurse's salary).  We drafting
a written letter of concern to administration and need input from all you wise
ones.

*********
1.  Did these VERY overworked and understaffed nurses get lazy because the LCs
are around?
2.  Do you suspect breastfeeding isn't the real issue?
3.  Assuming staffing levels is the real issue what can an LC do?
4.  Does every mom need a lactation consultant?  (I remember an article title
like this somewhere.  If you know the reference please share it.  I need it
for ammo).
5.  Where should we concentrate our efforts: administration, staff, specific
individuals, moms, epidurals?
6.  Is this a common problem-- some sort of a life cycle in breastfeeding
support?
7. What would you do?

Any suggestions are greatly needed and warmly appreciated.
TIA
Teary eyed and ready to retire (Jan still what to open a book store?)
Marie Davis, RN, IBCLC