I've recently come back on line, our hospital now celebrating that we
are the 30th in the country to be granted Baby Friendly Certification
ta-da!!!!
Thanks to all of you who responded on and off list regarding that little
baby's fractured femur - I apologize if I wasn't able to answer
everyone. So much helpful, thoughtful information =)
I am feeling the need to comment on the (somewhat nasty) discussion
occurring on list. First opinion, then fact, then approach.
1) Opinion - I believe that everyone without exception on this list is
committed to doing what's best for all babies. Just because they take an
alternative view - or because they are more dogmatic - doesn't change
that commitment. I also believe, without question, that breastfeeding,
especially according to the WHO guidelines that Kathryn cited, is the
optimal way to feed.
2) Fact - relative risk does NOT give cause and effect results. It's a
ratio of the rates of X in exposed and unexposed populations. So when we
say that the relative risk of SIDS in babies who are formula fed vs.
babies who are breastfed is 2, we're saying that 2 times as many babies
fed formula die of SIDS than babies who are breastfed. We're not saying
formula feeding causes SIDS. It's the same with any other parameters we
use. Yes, we have enough information to thoroughly document that formula
increases the risk of many, many diseases but, with the exception of
formula improperly reconstituted or mixed with contaminated water, we
can't say formula causes these. And in the case of reconstitution or
contaminated water, it's not the formula itself, anyway.
3) Approach - I can't encourage moms to breastfeed enough! However, not
all moms agree with me and I still need to work with them and support
them as much as I can. In order to do that, I can't make them feel
guilty for not doing what I know is right - they won't accept me. I need
to praise them for all the positive things that they do.
When a mom who does not want to breastfeed starts hearing why it's
important and asks "If I just give my baby colostrum will that help?"
"YES!" I say, "How wonderful that you would do that for your baby!" Then
as she hears more in the group she says "Well, what if I just breastfeed
my baby for two weeks and then stop?" "Absolutely - that would be
great!" And finally when another mom says "I think you're really
starting to think you might breastfeed" and she replies "Yeah, but I'm
afraid I'll like it and won't be able to stop" I say "That's the idea!"
(This truly happened in a group). But I think if my initial reaction was
that colostrum wasn't enough, I would have lost her and that would be
one less baby breastfed.
When the mom I had last week confided in me that she wanted to
breastfeed but won't be able to because she had a breast reduction
(wrong kind of cut for breastfeeding) as a teenager, I still need to
support her - not only in helping her see that she's still a good mom
and isn't making her baby suffer but also in helping her through the
grief she's experiencing in not being able to nurse.
So I've gotten my 2¢ in. It's nice to be back and doing some critical
thinking but right now I'm off to work on ways for staff to celebrate
Baby Friendliness.
Joan Edelstein, DrPH, RN
Professor of Maternity Nursing
San Jose State University
Perinatal Education Coordinator
Kaiser Permanente, Hayward
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