Janice wrote, in part:
"Everywhere I look I find breastfeeding relationships sacrificed on the
infamous altar of ignorance by their OBs, by their children's doctors, and
by the hospitals. What would be an effective strategy to address this?"
As a fulltime hospital-based LC(the only one for about 1800 deliveries a
year), I have figuratively beat my head against the "wall of ignorance"
surrounding breastfeeding more times than I can count. When I first started
in my position fulltime 8 months ago our breastfeeding initiation rate was
approx. 53%. Today I compiled our stats for the past three months in
preparation for our state inspection and for joint commission.
We are now up to 65%!!!! I am thrilled but will not be satisfied until it is
at least 75%. My next task will be determining how long these moms/babes
continue the nursing relationship--I have a feeling I won't be quite as
encouraged by that stat but I'm doing my best.
When I first started in this position, I went home nearly every day shaking
my head in wonder about how little doctors, nurses, etc understood about the
breastfeeding relationship, especially their role in either sabotaging or
facilitating a successful outcome. I realized I could not solve the problem
alone, so I enlisted the most influential partner(s) I could -- the mother
and her significant other. I am fortunate in that I have a supportive
manager who has given me virtually free-rein as far as lactation is
concerned. I teach all prenatal breastfeeding classes and some childbirth
classes so that is where I empower these mothers to choose an HCP for their
baby who not only "says" he/she supports breastfeeding but who demonstrates
that support in the plan of care he/she implements. It has amazed me how
powerful a knowledgeable and confident parent can be.
for instance, we have one older, established pedi who routinely orders ABM
supplementation for wt loss, jaundice, etc. no matter what stage of
lactogenesis -- 1day or 1 month. If the bilrubin was 10 -12 on day 3 after
delivery ( and sometimes even lower) he routinely had the mom stop
breastfeeding for 24 hrs or until a dramatic decrease occurred. Needless to
say, I was perpetually in a state of rage and frustration. Now, without
mentioning names in prenatal bf class, I give research-based info on
jaundice and forewarn them that there are still those pedi's who function on
"the way I've always done it". I inform them of the obvious-- YOU ARE THE
PARENTS and YOU HAVE THE RIGHT, EVEN THE OBLIGATION TO ASK QUESTIONS
REGARDING THE COURSE OF YOUR BABY'S CARE!!! I also encourage them not to be
"militant" (which some of you may disagree with but I've found gets better
results)but instead to be a "collaborater"(sp?) with the HCP always
reserving the right to make the final decision. It is amazing how this has
worked for these parents -- they come armed with facts and this pedi has
done a complete turnaround, rarely recommending bf interruption.
His only request is that bf be observed by the LC if there is any question
regarding adequate intake. This may seem a minor victory to many of you but
I see it as a minor miracle. The other very important reason so many more
moms are choosing to breastfeed is the attitudes of the nurses and our
ancillary personnel including our housekeeping staff. Just today, I was
standing outside the room of a new mom who 6 hrs before had delivered a 30
wk 2#9oz baby boy and who had planned to bottlefeed ABM. She had had a prior
delivery at 27 wks and had not bf that baby, either. The housekeeper was
cleaning her room all the while extolling the benefits of providing
breastmilk to a premie and how "wonderful it feels to provide the one and
only thing no one else, including the nurses and neonatologists, can provide
for your baby -- your own precious milk." I had to refrain from running
into the room and planting a kiss on the unsuspecting housekeeper! A few
minutes later, this mother called out and asked to talk with someone about
breastfeeding. She is now double- pumping with the electric pump and
beaming that she obtained 15 cc of colostrum the first session! That
housekeeper made an impact on that mother that the neonatologist and the
nurses could not make. It just reinforces that everyone can make a
difference in our struggle. BTW, I nominated the housekeeper for the
"employee of the month" award on our floor. This incident just
demonstrates why I love what I do! Sorry this is so long, but I just needed
to share tonight.
Warmly,
Jan Morton RN IBCLC in almost warm NE Ohio
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