"Is that really what it's like in a hospital, you have to have an entire
meeting to convince people to follow simple instructions?  To convince them
not to disobey direct orders?"

Wendey, that's only the tip of the iceburg of what it's like in a hospital!
This particular battle (the "feeding"- or "assault & battery", as your
friend has put it-of breastfeeding babies in the nsy) never seems to end. In
the hospital where I worked, I can't begin to describe the extent of the
battle. It took MANY YEARS to get the peds (and there were only a few, maybe
8-10, total, at most)to agree to the need for such a policy (put into
practice as standing orders, with parameters for which a BF baby *could* be
given a bottle and defining what could be in the bottle). I repeat, MANY
YEARS! That happened, finally, in '93 or so. To my knowledge, the policy of
the department and the MD orders are still being routinely ignored, mostly
by nurses who GENUINELY (I am convinced they are sincere in this, not just
doing the easiest thing or any other less-than-sincere motive) think they
are acting in the best interests of baby and/or mom.

I used to think that once the staff were educated and made aware of the
facts that attitudes would change, that when presented with the information
about the damage a single formula feed could do to the gut of the newborn or
the latest studies about blood glucose levels and all the rest they would at
least comply with the policy, if not have an epiphany and say "oh, maybe I
was inadequately informed, and now that I know more I'll change my
practice". I'm no longer so confident. I don't think that this particular
battle will disappear.

OB nurses are usually women, and most of them are also mothers. Given the
formula-feeding culture we come from (in US & Canada, anyway), and given the
importance to our own self-concepts of our "mom-selves", this remains an
area that is exceptionally resistant to change, at least by the
straightforward means of education about the facts. (Like the doctors we so
often complain about on this list...hmmm). Show a woman that a new type of
detergent actually cleans her clothes more effectively, for example, or a
new type of brakes stop the car more safely, and IF she can afford it, and
IF she shares the value of the new "thing", she'll buy it. But we don't seem
to be able to as readily change our attitudes about real core values. For a
woman, an awful lot of her self-worth is tied up in how she raised her
child(ren), and an awful lot of that has become tied to how she fed/cared
for her babies. So if she didn't breastfeed, and/or (ESPECIALLY) if she
"tried" but didn't have the help she needed to overcome problems, and if
this woman/mother is also a nurse on an OB unit that's "pushing" BFing (and
that's how it's very often seen, trust me), it's very easy for her to become
defensive. The whole concept that BFing is really important, and that the
hospital policies should reflect that importance in its support of BFing for
those who "choose" to do so, feels to that nurse/mother/woman like an attack
on her. (Goes to the whole "making women feel guilty discussion", about
which plenty has been said, IMHO.) So she RESISTS! And feels noble doing so.
She does what she thinks is right. She will have justifications for
circumventing the "policy" (which carries less weight with her than what she
believes to be the "truth"), or she'll "forget", and there will be a
thousand reasons why she was justified in giving that bottle of ABM.

Why isn't there a consequence to the nurse who does this? There will be, if
parents complain enough so that the word gets to the "unit managers" or the
administration or whatever. But usually they don't, because they are tired
and overwhelmed and we all know what life with a new baby is like. Unless
they have a strong advocate, the issue tends to get dropped before it gets
to the ears of the higher-ups.

Why don't the nurses reinforce the pro-BF policies among each other? Well,
see above, for one thing. Co-workers on a nursing unit have a complex
relationship among themselves, and tend not to "rat each other out". In my
experience as a hospital nurse, there's an us vs. them dynamic that operates
to keep nurses able to work together smoothly (as they have to be, to some
extent- nursing is an intimate kind of profession, and women who are nurses
tend to be more-than-average sensitive to each other. Patients come & go,but
co-workers are there day after day, year after year, and nurses spend more
waking time with them than with their own families.)So there's a "code of
silence" kind of thing that goes on, like you hear about with cops (a very
similar field, in many ways). There is also a tendency for staff nurses to
be fairly united in a kind of contempt (that's too strong a word, but I
can't think of a better one) for "the doctors" and "the managers"; it goes
like this: "we" are out there in the trenches, on the front line day after
day, while "they" are off in their ivory towers and they don't know...)

Well, this is a long answer, but it's such a complex phenomenon. How do we
change it so that it becomes the straightforward thing it should be (BFing
babies are BF.period.)? If I knew, I'd write the book! But I know that it's
not that the nurses (or doctors, or whoever) are stupid or ill-intentioned,
and it's not just a simple matter of providing education and developing
policy. I also know that WE HAVE TO CONTINUE TO DO THE EDCATION AND DEVELOP
AND ENFORCE THE POLICIES, despite whatever else is going on in our deep
murky collective psyches. As we on this list know - so is this just a case
of preaching to the converted? I hope not; I hope to shed some light on
what's going on with the un-converted, so that we don't just get entrenched
in our own perspective.

Thanks to all who have read this long exposition. It's important to have a
place where I can safely say some of these things.

Cathy Bargar, RN, IBCLC