Amy,

Couldn't you request your own preprinted newborn orders?  We have many docs
who don't agree with everything on the standard orders so have their own set
of orders.  As for pushing breastfeeding too hard-it's part of your
responsibility to promote healthy behaviors in your patients.  You obviously
are very well educated about the risks of not breastfeeding and if you don't
convey that to your patients prenatally they are not making an informed
feeding decision.

We have a Pediatrician who is very verbal about her belief that babies
should be exclusively breastfed and have no artificial nipples if
supplements are medically necessary.  Many of her patients follow her advice
but many don't, and many don't breastfeed their babies at all but still
choose her as their Pediatrician.  I'm sure it is frustrating for her when
babies get sick because they are not exclusively breastfed but she has done
all she can do to influence parents' decision and the rest is up to them.
The nurses are well aware of her expectations and will avoid giving
unnecessary supplements at all costs to avoid her wrath.

We also have a wonderful midwife who actively promotes breastfeeding
prenatally and facilitates moms being successful by using alternative pain
relief measures other than drugs and placing the baby immediately on mom's
abdomen after delivery (the only health care provider in our facility who
does).  She also writes an order for all her patients to have lactation
support postnatally.  Most of her moms do exclusively breastfeed but those
are the types of moms who usually use the services of a midwife anyway.

You could speak with the nurse manager or director of the department to
discuss your expectations for your patients.  You have every right to expect
the nurses to follow your orders or face the consequences.  I can't think of
any other procedure in the hospital where nurses feel so free to ignore
evidence and policy and ethics with no repercussions from management.  You
don't have to be as aggressive as our Pediatrician to get what you want.  If
you tell instead of ask you usually get what you need.  Please don't let
yourself be intimidated by the nurses.  From my experience and observation
they like to "break in" the new docs, see how they will respond when
challenged.  This is your chance to stand your ground.

Another suggestion is to give an inservice to the nurses about the benefits
of exclusive breastfeeding, or risks of not exclusively breastfeeding, or
medical indications for supplementation.  Marsha Walker's "Just One Bottle."
handout is a great one to include with your outline.  Sometimes a little
evidence-based education can enlighten one or two nurses who become inspired
to learn more and pass that knowledge on to their coworkers.  Isn't that how
most of us became breastfeeding advocates?  Good luck in your journey.



Linda Anderegg, RNC, IBCLC

Chicago, IL




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