Maybe we need to have a World Colostrum Awareness Week too.  In my workplace
there has been a veritable epidemic of hospital-instituted breastfeeding
sabotage, with the refrain at handover between shifts 'and she doesn't have
enough milk yet so the baby's been supplemented with formula' or 'she
doesn't have enough milk [at all, without a hint that this could be a
temporary condition] so the baby is being supplemented with formula'.
Mothers of babies less than 36 hours old will be telling me sort of
apologetically 'I don't have enough milk so I'm having to supplement' and
the proof of their 'insufficient supply' is that the baby wants to suckle
more frequently than three hourly.  Or, to go from the ridiculous to the
completely tragic, the baby will be supplemented if it is satisfied *not* to
suckle for more than three hours, which is taken as proof that baby is
becoming dangerously lethargic from starvation.  This epidemic has arisen as
we send women home before there could be any chance that lactogenesis II has
happened, and there is no sign that anyone in a position of power is aware
of the flawed reasoning behind the supplementation.  The staff who do know
something about normal breastfeeding are really suffering, their voices are
being ignored as they try to point out the errors in our current practice.
And who wants to be the one on duty when a baby actually does suffer from
serious hypoglycemia, in this climate?  We don't have the time to spend
ensuring that each baby is suckling effectively or that the baby looks OK
either, we've been decimated by a poorly thought out reorganization of the
service.
There has been a sharp increase in the number of blood glucose measurements
we are performing on healthy newborns and an inexplicable change in the
attitude of pediatricians to what is an acceptable level for the first day
or two of life, as well as what the purpose of such testing is.  Before, it
was to determine whether a baby needed to be actively fed with something,
preferably colostrum.  Now, it is an uncomfortable procedure babies are
subjected to before administering formula almost without regard to the test
result, and blood glucose levels are expected to be higher than physiology
would dictate if a baby is to be spared formula feeding.
Meanwhile, colleagues continue to bemoan the ignorance of immigrant women
who ask for formula because they have no milk in the first couple of days,
and they look oddly at me when I point out that even WE don't believe that
babies can survive on what they get from ad lib suckling at the breast in
that time so why should we expect any mothers to do so?  I feel like the
last 30 years of my life have been spent on something futile and it's d***
depressing.

Rachel Myr
Kristiansand, Norway, where women and babies (and thereby society) are being
gravely shortchanged as maternity care is reorganized without regard to
evidence or documented need

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