I have recently started filling in for the regular LC in our hospital one
or two days a week and I am coming upon a number of practices and beliefs
that I want to have good responses to as I have not heard of these twists
before and don't think they are supported by either research or practise.
Please, can you help me find references or your experiences with the
following:
1. One nurse told me that a patient, who is hand expressing her colostrum
for a baby who is refusing to nurse, and doing it more effectively than
with the pump, should pump anyways because the pump provides more
stimulation to build up her milk supply than emptying her breasts.  Do you
think that emptying the breasts is separate from nipple stimulation to
increase supply?  What kind of explanation, research support can I give
this nurse and the mother, who doesn't want to do both?
2.  We have quite a few babies who have no suck or rooting for a day or
two, whether due to IUGR, epidurals or other factors.  I have heard several
nurses say that they think a baby learns to suck better from a bottle than
with finger feeding, especially one with a NUK nipple.  These nurses have
worked postpartum for many years and have a lot of experience.  Does this
tend to be the case for starting to develop suck, because it is easier and
rewarded quickly or do those of you who have worked with these types of
babies think that the nurses are just seeing swallowing as being sucking
and that it leads to more difficulty getting the babe to the breast in the
long run?  As an aside, cup feeding is banned from being used here as some
physicians feel the chance of aspiration is too great (arggh).
3.  The hospital policies are all in place to make this a breastfeeding
friendly hospital but the staff do not follow them.  The manager is giving
lipservice to breastfeeding support and is doing as little as possible to
change the current situation as possible.  There is no one who follows up
to tell the staff when they are giving inappropriate care or information
but I was chastised for suggesting cupfeeding to a patient, even though it
was very successful in getting the baby onto the breast after classic
nipple confusion.  How do other hospitals go about following up with "old"
nurses who have no interest in learning anything new or in changing their
practises.  Policy has to become practise for it to work.
I would like all the input you can give to help me face these challenges.

Jennifer

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