I have developed the response of being suspicious of what comes next when I
see or hear the words assertive or advocate. I have often used these words
and consider myself to be an advocate for clients. However, I also know what
it feels like to be faced with agressiveness and an adversarial relationship.
Perhaps, one problem is the confusion between assertiveness and
agressiveness.

These feelings first popped up with the post that home birth is illegal in
Georgia. Home birth is not illegal, but lay midwifery licenses are not being
granted. I am old enough to remember licensed granny midwives, and we had a
lay midwife speak to us in nursing school. What is happening in Georgia is an
adversarial relationship between the lay midwives and some health care
providers, especially physicians. The Board of Nursing did support not
granting direct entry midwifery licenses. Many Certified Nurse Midwives
practice in Georgia. I know several lay midwives.

The other sad messages are those about unsupportive hospital staff. Would it
be possible to work with all those involved to find alternatives to anger?
For example, do families ask about alternatives to sending mom home on
Christmas eve without baby? When the baby is not discharged, our hospital has
a policy of discharging the mother, but letting her remain in an available
room. The mom must be breastfeeding. If her baby is not in the Special Care
Nursery, she must room-in. The hospital does not charge, and supplies a guest
meal tray and linen. Mothers have used this service for one to three days.

There is a group called Community Breastfeeding Coalition in this area. It
has members from WIC, hospitals, other health providers, and at one point,
LLL. We not only promote and protect breastfeeding, but try to solve problems
and support each other. Many of the WIC offices offer good followup and
support for families.

Relationships between physicians, hospitals, and LLL in this area have varied
from good to merely tolerable. Our hospital is a LLL Resource Center.
Discharge packs include a telephone number for local leaders, and we post the
meeting dates, but some LLL members exhibit a very strong anti-hospital
attitude. I have a good relationship with the leaders. Most nurses just
mention to clients that LLL exists.

Anyway, my soap box is that I always want to do something about a frustrating
situation. Complaining to other Lactnetters is a way to express some
frustration, of course. I do face a lot of frustration trying to make things
better. I am likely to be viewed as a person who rocks the boat instead of a
mediator. I don't want to come across as critical, but sometimes I feel like
offering, "Would you like some cheese with that whine?"

I really learn a lot from LACTNET.

Becky Engel, RN, IBCLC
Staff nurse/ Lactation consultant
Family Care Unit
Athens Regional Medical Center
Athens, GA, USA