Thank you all for your reactions and very positive support after my bizarre reprimand.

To answer the common theme of statements toward my institution and my department manager:

My manager does indeed commend me for my concern for and care of my patients.  She also supports our decisions when we defer circs or keep moms that extra 24-48 hours to get good breast feeding going.  She is very pro-breastfeeding; but also very CYA conscious with wanting protocols in place, and wanting to make sure follow-up is in place, which has both its plusses and its own drawbacks.  I think it must be very hard to create change in a very large institution that must connect up to many outlying networks -- as opposed to being a hospital that is its own entity.

I work at Kaiser Hospital, in San Francisco, which is an HMO with its own clinics and hospitals here and in surrounding areas, as well as allying with some hospitals outside of the city for in-patient care.  At the moment, each Kaiser has its own nursing protocols and procedures -- some of the Kaisers actually do have alternative feeding protocols in place.  And our hospital is also working to establish the same, both in NICU and in the perinatal unit.

We have two LC's officially hired to the perinatal unit, who are only paid for 20 hours a week.  Their job includes all the staff education ( and all the nursing caregivers on the unit have had an 8-hour inservice on lactation and latch, and use of LATCH scores), seeing the patients with breast-feeding problems, returning calls on their warm line, and developing projects, such as enhanced protocols, etc.  To make their job even harder, they have a different set of priorities than their boss, so they get pulled in two different directions. 

 Their personal priority for this year is to establish the guidelines and teaching and followup for the alternative feeding methods.  I have been of some help in this, by accumulating cup-feeding protocols from around the country (thank you all who have sent yours), pulling the r than more.  That will remain to be seen.

Once again, I feel very supported by all of you.  Thank you for the chance to vent, for the positive comments and the communal scream.

Chanita, San Francisco