Nancy Wight,

Thanks to you and the other member of the ABM for getting out reliable
info on management of hypoglycemia and blood glucose testing.

For those of you who practice outside the hospital environment, perhaps
this will help you understand why nurses do so many things that don't
seem to make sense to us.

Severe hypoglycemia can cause seizures, brain damage and death.  OB
nurses have a very high risk of being named in a lawsuit or at least
having to give a deposition in one.  We are told, "It's not IF you will
be sued, it's WHEN you will be sued."  Because of the way the legal
system works, a "jury of your peers" is really a jury of those who had
nothing else to do and could afford to come to court for the $10-12 a
day often paid to jury members or who didn't know how to get out of jury
duty.  Juries members are likely people with a low educational level.
It is very unlikely they will be doctors and nurses.  If a baby is
damaged, the suit is very likely to be settled out of court for millions
of dollars, even if the doctors, nurses and hospital were not at fault.
If the mother cries in front of the jury and one expert witness says
what was done might have cause the baby's problem (e.g. brain damage or
death), the parents will almost certainly win.

Until more people sue (and win lawsuits) for problems caused by
interruption of breastfeeding than sue for babies who have seizures,
brain damage or death, many doctors and nurses will err on the side of
treating the hypoglycemia.  Also, consider the fact that nurses are
judged on the basis of what a reasonable nurse in the community would do
in similar circumstances.  THE COMMUNITY IS THE STANDARD, not research.
So if every other hospital in your community treats glucose levels
before 40 based on reagent sticks (despite the fact that this
contradicts evidence-based practice), you probably face less risk of
liability by conforming to the community than of conforming to the
evidence.

Another reason for nurses being quick to feed babies based on low sugars
is that they don't want to incur more work for themselves.  Giving a
bottle of formula immediately raises the blood sugar in most cases.
This prevents the nurse from creating more work for herself--central
glucose sticks, maybe an IV, possibly a CBC and blood culture, all very
time consuming procedures on newborns.  The staffing levels in most
hospitals make this a daunting possibility for most nurses.

Hospitals in the US that have overcome these difficulties are to be
commended.  The Academy of Breastfeeding Medicine is to be commended for
giving direction to doctors and hospitals in this regard.  The Ameican
Academy of Pediatrics is also to be commended for the policy statement
on breastfeeding and the use of human milk.

As Kathleen would say, these are our opportunities disguised as
impossibilities.

Bonnie Jones, RN, ICCE, IBCLC