I agree with Kathy and Cathy, and I couldn't find the original post. While
I'm outraged that we sometimes convey the message that the baby belongs to
the hospital and not to the parents (as Cathy points out) I'm a strong
proponent of having protocols, which is the issue here.
A protocol is different than a policy or a procedure. If the protocol
writer understands these differences, he/she writes a protocol that is
designed to give clarity, yet flexibility. The "permission" issue becomes a
non-issue if the protocol is well written. A protocol is NOT an order.
The only way a protocol is successful is when it is discussed and agreed
upon by members of an interdisciplinary group. Everyone must get their
objections out on the table before the protocol is written, and before the
crisis happens. In the long run, this is much more effective than the night
nurse doing one thing, the neonatologist ordering another, and the
lactation consultant wishing for yet another.
Personally, I believe that *not* having a well-written protocol breeds
communication problems and ultimately, decreases the quality of care.
>Kathy Birt's post about how her hospital handles BFing preemies gets me all
>stirred up (again!) over this issue of "whose baby is it anyway?". This heat
>is not directed at you, Kathy, by any means - I've been there, I know that
>you are just accurately describing what happens at your hospital.
>
>But how long will BFing be something a mother or baby or nurse or LC needs
>to have a doctor's "permission" for? Now, I understand that with a fragile
>or ill or very premature baby, it does indeed need to be a doctor who makes
>the recommendations as to whether a baby is ready for PO feeds, or gavage,
>or how much volume, or that sort of thing; I'm not questioning that aspect
>of their involvement. (Well, not much, and willing to give them the benefit
>of assuming good intentions...) But we KNOW that BFing is less stressful
>than bottle feeding, in terms of increased pO2, improved heartrate, body
>temp, brain waves on EEG, all those parameters we can measure and use as
>guides. And we KNOW the difficulties that babies have when they aren't
>allowed to nurse as early as possible and in addition have to contend with
>feeding by all these other devices. Under what possible authority would a
>doctor have the right to say "this baby may be fed by a bottle, but not at
>breast"? I don't think so! I am increasingly unwilling to just accept that
>this particular decision is the doctor's to make. (And, as we know, I no
>longer work in a hospital - lucky for us all, isn't it!) If a baby can be
>held by the mother, that baby can go to breast; even in circumstances where
>we don't want the baby getting much milk at the breast, we can control that.
>
>Can you imagine the ruckus there would be if the situation were reversed, if
>doctors were routinely accorded the authority to say "this baby MUST go to
>breast; bottle feeding is far too strenuous at this point, and would
>jeopardize her condition. Maybe next week, when we see how she does at
>breast, the mother can try a bottle if she still wants to."!? Which would
>make more sense, when you think about it.
>
>Cathy Bargar, RN, IBCLC Ithaca NY
>
--
Marie Biancuzzo, Perinatal Clinical Nurse Specialist
PO Box 387
Herndon VA 20172
Phone 703-748-0092
Fax 703-758-0891
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