Hi everyone, it has been quite awhile since I have last written so I will
re-introduce myself.  For the past 3 1/2 yrs I have been the breastfeeding
coordinator for our local WIC--recently I wa    s offered the opportunity to
begin a lactation program at one of our two local hospitals.  Of course I
accepted and have found it to be most challenging.  I am currently working
on policies and protocols for bf dyads, developing an outpatient clinic,
and struggling with staff education.  This hospital currently has aprox.
250+ deliveries per month.  Before I accepted the position, the
maternal/child health administration had agreed to my condition that no
formula discharge packs or hand-outs would be given to bf women.  The other
local hospital still gives out the formula discharge packs but removes the
formula for bf women.  My FIRST day on the job, a formula rep comes to my
office to "share" his bf education materials.  I explain to him that our
goal is to become baby friendly and that I am not interested in any of his
materials.  I tried to also explain that this was not just my personal
viewpoint, but also was supported by the WHO and by the AAP.  He tried to
show me some study that had "proven" that formula discharge packs had no
impact on initiation or duration of bf....well, you guys know how the
marketing is done.  He tried to see me at two other times in the past
couple of weeks, but I explained that my decision would not change and he
was wasting his time.  He got very angry with me--he knows that it is
because of me that the bf discharge packs are no longer being distributed.
I went to my supervisor and she said no problem, from now on this rep would
not be allowed on the floor without a pass.  I assumed that the problem was
solved...WRONG!!!!

Last Thurs. the quarterly peds. meeting was held, my supervisor thought
that this would be an ideal time to introduce me to the peds.  When I
walked into the meeting (5 min. early), a couple of the peds were already
talking very heatedly, and I kept hearing "breastfeeding" throughout the
conversation.  The chair of the committee opened the meeting by telling
administration how sorry we were going to be that the formula companies
were going to begin charging us tens of thousands of dollars for their
product.  He went on to say that this poor formula company was really only
being ethical afterall, they only marketed their product to the docs and
hospitals and not directly to the consumer like that other formula company
does.  He said that this company had always supported pediatrics and had
made a great contribution to the medical community.  Then he started
attacking bf in general--how me and the hospital staff make women feel
guilty about not bf, how difficult bf can be for most women, and how we
should not try to influence their decision.  Then he talked more about how
I was not a medical professional and certainly did not have the background
to decide if a baby needed supplementation or not (he routinely tells his
bf moms to supplement with 4 ounces of water per day).  I will spare you
all of the gory details but I really got thrown to the wolves.  I did try
to explain that I do not see bottle feeding moms (though our L&D nurses do
help moms make informed feeding decisions)and that I was simply being a
patient advocate by supporting the women who had chosen to breastfeed.
There were probably 20 peds at this meeting but the chairperson was really
the only one talking (except for when he spoke of making moms feel
guilty--several others agreed with this statement).  I know that many of
these peds do in fact support bf and have orders directly forbidding
supplementation without a medical indication, but of course not a single
one of these peds spoke up--(several peds did call me the next day to tell
me how they thought that my services were needed and that they felt that
the chair had just blown everything out of proportion).

Now, I know what happened here, I just do not know how to fix it.  The
formula rep. went to each of the peds groups and stated how the hospital
had hired some bf fanatic that thought that formula was toxic waste or
something like that.  The rep also showed all of his wonderful bf handouts
that were so up to date that Ruth Lawrence had actually even looked them
over (I swear he told me that).  He explained how much money he could save
the docs with just his patient educational materials alone.  He was very
sneaky about how all of this was done but I guess he was thinking about his
paycheck??

The hospital administration (at least maternal/child health) were very
supportive of me and also very apologetic that I was put into such a bad
situation.  The main consensus was that this particular doc likes to be the
center of attention, blah, blah...  I know that most of the problem with
this particular ped is simply a lack of education--he repeatedly stated
that he knew EVERYTHING about bf and wanted to know where in the literature
it said that water supplements were not desirable for bf infants (hmmm,
maybe the AAP??)  I talked to the ped after the meeting, he kept telling me
that he was not bashing me,that this stuff had been going on long before I
arrived.  I offered to do an inservice for his staff, and he said that was
a good idea, but I really think he was just pacifying me at the time (I
don't think he expected me to talk to him one on one after the meeting).  I
also talked to the nurse practictioner that works for his group about
getting him the AAP policy statement on BFand she told me that she had
tried to give it to him when it first came out and he had told her that he
did not need to read that crap....sigh...  I know that I might not be able
to have all of the peds support, protect, and promote bf BUT this guy is
head of  pediatrics!!!  I am trying awfully hard to be pleasant, not to
come off as too agressive etc, but what can I do to get this guy to at
least look at some bf research??

The other thing that kept coming up at this meeting was the term "Baby
Friendly"--the docs said, so we pediatricians are baby UN-friendly???  Our
hospital staff was also accused by the peds to be recommending bf friendly
peds.  I mean these peds act like women do not even have the brains to pick
a ped that will support bf.  Lots of the women that I work with come to the
hospital already knowing that they do not want their infants to get a
bottle, that they should be able to bf immediately after delivery, that the
babes should stay in the room with them, etc.  Would it be feasible to use
this angle when talking to peds that are not supportive of bf??  Could you
say that since bf rates are up, it would be a wonderful marketing strategy
for them to update their bf education, to hold bf classes for their
prospective patients, and a support group for their bf moms??

I apologize for this letter being so long....I have wished for a position
like this one forever--I don't want to blow it.  I am sure that with all of
the collective wisdom here, some of you might be able to give me some
hints??  Any and all appreciated :)

                                      Pam Holland, BS, IBCLC
                                        Savannah, GA