Hi Everyone,

Thank you to all who responded to my last note about BF documentation.  I
mentioned before that we are hoping to make our pedi newborn breastfeeding
orders more breastfeeding friendly.  Our current feeding orders are
insufficient and tend to sabatoge the BF relationship.  However, because we
nurses are making suggestions to the pediatricians we are trying to be
extremely diplomatic so we won't be called breast fanatics (which I consider a
compliment in some respects!)  We just want to optimize a mom's chance for
breastfeeding success.

As it stands now we are proposing the following:
1. Put the baby to breast within the first hour after birth and then on
demand.
2. If after 2-3 poor, attempted or zero breastfeeding attempts, began pumping
every 2-3 hours and offering EBM via alternative methods.  If that volume is
insufficient (<5 cc's) offer 1/2 oz. of Nutramigen or Alimentum. Continue
offering the breast every 1-2 hours.
3. If breastfeeding sessions remain poor after 24 hours refer to a lactation
specialist. (We have 4 IBCLC's on staff who work as staff RN's, but
unfortunately not as LC's, but that's another story!)
4. No supplementation with water, G5W or formula without order from
physician/NP or mother's documented consent. (she will have to sign a consent
form listing the risks of bottlefeeding)
5. Pacifiers may only be given to breastfed babies with parents' permission
noted by a green dot placed on bassinet card. (The nurses will have to ask
first. Of course we'd like to just get rid of all pacifiers and have parents
bring their own if they so choose- but that's another battle for later)

I have each proposed order documented with numerous references- in fact it was
difficult to limit the number (I'm up to 50) out of the hundreds that are
available.  What I can't find is some specific reference citations for
recommending the Nutramigen or Alimentum. My nurse manager remembers reading
or hearing something about them being the "best of the worst" if indeed
something needs to be given.  I searched the LACTNET archives and came up with
nothing positive to say about either- as a "supplement".  My nurse manager
knows that our pedi's are not going to agree to just give EBM however small an
amount, if pumping not very successful and we figured we needed to have
something to offer instead of formula (eventhough I know that Nutramigen
contains bovine protein).  I'm really torn because we both agree that nothing
but breastmilk is best and that normal healthy term infants don't need
anything but colostrum/breastmilk, but we are looking for a compromise.  We
have an extremely conservative pedi group and know what we are up against.
Believe me if we get any of the proposed orders implemented we will have
gained a lot of ground toward helping our moms and breastfed babies.

I guess I'm asking if anyone knows any positive sources for offering N or A or
have any further suggestions.  You can email me privately too if you wish.
([log in to unmask])   I welcome the input.  TIA
Merrilyn McNatt, APRN, FNP, IBCLC
In sunny but brisk CT!