Dear Friends:

Mary Westra sends up a distress call.

I've been tackling this issue for years in the 18-hour Interdisciplinary
Breastfeeding Management Course that I teach at the Health Department.

For one thing, it is a HUGE help to offer nursing contact hours. Nurses in
my state must have a certain number of contact hours for relicensure.
Because we are the Health Department, the course is offered for a very low
cost, about one-third of the usual daily conference fee. This is a draw. I
get people calling because they need the contact hours and don't care what
the topic is....I aim my teaching to THEM, those with utterly no interest in
the topic.

"Win-win with skin to skin" is the slogan. Boston Medical Center made a
lovely video called "From Bottles to Breasts to Baby-Friendly" that is
mostly nurse-centered. Audiences are drawn in, because it is nurses speaking
to other nurses. The first segment of this fabulous film (and I have utterly
no commercial or financial attachment to the film, and spent many dollars of
my own money to transfer it to a DVD) shows a newly delivered baby on
momma's bare chest, obviously in the delivery room. One hears staff talking
and bustling around. Views of the dyad are interspersed with nurses speaking
about the process of change. At one point, the mother's blood pressure is
measured, without disturbing the skin to skin. Eventually the baby attaches.
All by itself.

Carol Melcher RN, MSN (who developed the S.O.F.T. program) gave some
wonderful advice in her recordings from the ILCA conference where she spoke.
She is saying that 10-15% of staff will not change. So forget about
them....and surround them with the 85% that do get it !!

Remind folks of the Healthy People 2020 goals for our nation, which are
supported by the AAP and the CDC. I have a great cartoon of 7 women talking
about the reasons that they didn't breastfeed. After talking about
evidence-based practice, I ask my audiences what sort of advice those 7
women would give to new mothers if the 7 were postpartum nurses. I suggest
that the reason nurses discourage breastfeeding comes from a loving heart,
that because the nurses themselves had trouble with breastfeeding, they want
to save their clients any anguish and pain. Hence the "don't bother with
that misery, honey" attitude. I am always looking for ways to praise and
accept and embrace.

Talking about forgiveness is helpful. How awful a nurse could feel learning
that the way she fed her precious baby was wrong, possibly disease-inducing!
(And if her child is sick, she feels even worse!) And she was just following
the medical recommendation. Kay Hoover talks about how many sad stories from
staff that she would hear when she came to teach at a hospital; people have
to tell their stories before they can move on. We have to listen and not
take it personally.

Today, we learn from the past to make the future better.

In one class, I had to stop teaching because the audience of nurses was so
vocally resistant that I had to sit down and listen. They ventilated for 45
minutes about how they couldn't do this, about how their clients weren't
interested,  about how they had to get the L&D room empty quickly for the
next client, about how hard it was and who gave a shit about all this
breastfeeding stuff anyway? I was overwhelmed and felt terrible, like the
world's worst teacher. I wrote to Dr. Barbara Philips about this class, and
she responded with the most understanding and loving and supportive email
that I will save forever. Here's the jist of what she said. "When the class
shares their resistance with you, you are on the path to change. It is a
good thing. Welcome their resistance because it means they are engaged with
you. Listen and accept and validate. Meet them where they are."

The 3-day class is 3 days because of this. The resistance would emerge at
Class 2, and then it would clear and folks could participate and learn and
feel encouraged at Class 3. (I read this in some UNICEF publication.)

There's some fabulous nursing research to share that is very helpful. Nurses
talking to nurses works. I get lots of positive feedback for using nursing
research in the classes.

"Interruptions to breastfeeding dyads on postpartum Day 1 in a university
hospital" by Morrison, Ludington-Hoe, and Cranston Anderson (JOGNN2006,
35(6):709-716  is a must for this type of work. Ask the class how many times
from 8a to 8p a new dyad is interrupted. People *never* guess the average
number (54). Then ask, "who interrupts the most?" It is medical and nursing
staff. Then ask "Who is second?" The class usually responds 'visitors' but
no, it is housekeeping and dietary. It is a shock for some nurses to realize
that THEY are the cause of the interruptions. (I've gotten some nasty
feedback about that!). Funny, because when I worked in L&D, and postpartum,
I remember long complaint sessions about "all those visitors won't leave the
new mother alone". It is US (the staff)  making the problem....just as Dr.
Philips says in the film. How in the world could a new mother feel safe
exploring the use of her breasts when she is never alone with her baby for
more than 9 minutes (for half their time alone together)?

Here's another good nursing research study: "Kangaroo Care at Birth for
full-term infants November/December 2007Walters, Boggs, Ludington-Hoe et al
MCH page 375"  There is a lovely comment in the article about how nursing
workload was not increased, and physicians found skin to skin to be
analgesic for mothers during perineal repairs.
 *
*
All the S.O.F.T. stuff is another useful bit of nursing research. Do a
google search for S.O.F.T and you'll get to where you want to go.

One more  helpful piece of nursing research is:
"Skin-to-skin care with the father after cesarean section and its effect on
newborn crying and pre-feeding behavio*r" Birth  2007 Jun;34(2):105-14*
Lovely for staff to see how dad can help with skin to skin after a cesarean
section.

Biological Nurturing (Laid Back Breastfeeding) is a great, albeit expensive,
DVD. Showing nurses how a baby can breastfeed while sleeping is a great
stress reliever. How much effort have nurses spent trying to wake sleeping
baby? I remember struggling with that. Well, you don't have to wake the baby
to feed it. You can spoon feed newborn milk on a spoon. You can put the baby
to breast and let its reflexes take over. Dr. Suzanne Colson's video clips
are priceless for teaching.  Another segment of her DVD that is helpful is
the clips showing babies waving their arms and legs around while the mother
is sitting in a fixed upright position, trying to breastfeed. Many nurses, I
was one, have held infant arms and legs to help breastfeeding. Just having
the mother lean back. so the baby stays on her chest without the mother
having to hold it makes a HUGE difference. Audiences pay a lot of attention
to these video clips because it gives them tools for their toolbox.

I think one reason nurses are resistant is because they lack the skills. Who
wants to help someone do something if one has no clue how to help?  It's so
much easier to stick a bottle in baby's mouth.

When one nurse stands up in class and says "I used to hate breastfeeding"
and then goes on to tell a story about how s2s made the difference, the
tipping point occurs in that class. That is a miracle to witness; I wish I
could bottle it!

Another great study is "A Pilot Study of a Nursing Intervention Protocol to
Minimize Maternal-Infant Separation After Cesarean" JOGNN 2009;
38(4):430-442 Nolan and Lawrence.  The creative folks in this institution
rearranged their operating room so the infant warmer was aligned with the
head of the operating table, so the mother could see her baby all the time.
They did a bunch of other cool stuff too, to promote curiosity and
attachment. Check it out.

I've spent a long time on this post.....it is what I have learned from the
trenches, one nurse at a time.

warmly, and Happy New Year to us all!

Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

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