Dear Tricia,
When I worked in the hospital, I paid a great deal of this culture of 'how
to breastfeed like you are formula feeding' and it always intrigued me.
One staff educator pointed out that 'back in the day' the formula companies
paid for all of the staff education for the whole floor.
I think the real issue is that the staff had replaced numbers of this and
that with REAL patient assessment. I think because I am and ER trained
nurse, I spend a lot more time with hands on assessment of the baby and
questioning of the mother. In this sue happy hospital culture, we need
quantifiable data.
Our standing orders said that the baby had to be *offered* the breast every
3 hours. So this is what I would tell mothers, especially one who have the
baby in a bucket across the room, or sending to the nursery. More times
than not, everyone is missing the early feeding cues and the baby misses
out because she gets frustrated and goes back to sleep.
1. I do think it is normal for babies nurse every 2-3 hours those first
few days (weeks). I think babies have a very strong instinct to be on his
mother, even if it is just a few sucks. This pattern is sorely skewed in
hospitals who separate mother and baby. I've had and been at some
homebirths where the baby does take a good 4 hour nap after birth and may
take a few more, but for the most part babies are on or with their mothers
nursing far more often than you typically see in the hospital.
2. As far as research, I would try to find information about separation
and breastfeeding rates. This is why the baby-friendly hospital initiative
is so important.
3. I don't know that you can explain 'normal' feeding patterns to hospital
staff. Hospital feeding patterns is all they know, so that is what is
normal. I always tried to get the staff to watch 'orgasmic birth' (as a
joke) to try to start thinking outside of their own experiences. It takes
an entire generation to change the culture of these type of things. I
think we are really just beginning.
As far as supplementing because of a 'missed' feed, I did tend to encourage
parents to get a nursing session in every 3 hours or so. When it was just
a few sucks, I would say 'partial feed' to garner a few more hours. If it
was going on 4 hours and the baby was simply not interested, I have mom
express into a plastic spoon and feed it to the baby. This kept everyone
happy, and sometimes the baby would wake up. I found this to be
the biggest success in changing the culture. Supplementing does not
necessarily mean bottle and formula.
This sort of stuff really interests me because we tend to forget that we
are all part of a system that manifests things many different ways. If I
ever go back to school, I want to be an anthropologist and study the lost
tribe of hospital nurses.
Melissa Senf, RN, IBCLC, LLLL(retired)
www.melissalactation.com
For those of you who work in hospitals, I'm wondering if this is an issue
for anyone else out there. RN's that tell moms to bfd every 2 to3 hours
instead of on-demand, and scare new mothers if the baby has slept more than
3 hours and convince them to give formula because baby missed one feed.
I think breastfed babies do not nurse every 2 to 3 hours, especially in the
first few days, I think they tend to cluster feed more often. Often, many
babies do not nurse as frequently during the first 24 hours, many are very
sleepy, but then they will feed more frequently on the second day. I
personally do not worry if the baby nurses just 5-6 times in first 24
hours, but they then wake up more and nurse frequently on the second day.
Has anyone else noticed this too? But then they should be bfding at LEAST
10 times per day.
I am looking for information or studies to back this up, for MD's and
RN'sat my hospital who still really want to tell women to breastfeed
every 2-3
hours. IMHO, it really sets the mother's up with false expectations of how
their babies are going to breastfeed during the first couple days. Then
they are frustrated when the baby "is fussy" after feeding, and the baby is
missing lots of feeds because mom is missing feeding cues. So baby doesn't
get as much colostrum as he should, maybe starts to develop jaundice, and
then breastfeeding is blamed. Or mom supplements with formula "because she
doesn't have enough milk."
First of all, we need to be telling these women to breastfeed on demand or
on cue. Secondly, that when the baby is awake they will probably breastfeed
almost continuously, the same way that they continuously swallowed small
amounts of amniotic fluid in utero, then they will sleep for awhile. And
babies won't starve if they don't eat a lot in the first 24 hours, but I
think they should be getting to the breast very frequently by the second 24
hours.
So I'm wondering -
1. Am I right about this feeding pattern? What is the typical feeding
pattern in the first few days?
2. Is there any research to back this up?
3. How do you explain normal feeding patterns in hospital to new mothers?
4. And lastly, how do you document feeds in hospital?
I don't like our forms at all, first they say "breast" and "bottle" in
column format, so we should not be giving forms that say bottle on them to
bfding mothers. But secondly, just putting down a time for a feed is
difficult to do, I think, for breastfeeding because when it is going well,
often the baby will nurse almost continuously, sometimes for a few hours
and then sleep for a long time. How do you document that to make RN's and
MD's happy? Any forms that are more compatible with the normal course of
bfding in the early days?
Thanks for your help
Tricia Shamblin, RN, IBCLC
On Mon, Sep 16, 2013 at 9:57 AM, Judy LeVan Fram <[log in to unmask]> wrote:
> Tricia writes:
>
> "I don't like our forms at all, first they say "breast" and "bottle" in
> column format, so we should not be giving forms that say bottle on them to
> bfding mothers."
>
> Ah the "it's one or the other, they are pretty much the same" language.
> Would it read more clearly to say "breastfeeding" or "not breastfeeding"
> and
> write in details as needed? A simple change that normalizes
> breastfeeding...
>
> Peace,
> Judy
>
> Judy LeVan Fram, PT, IBCLC, LLLL
> Brooklyn, NY, USA
> [log in to unmask]
>
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