Hi all -- Obeying the scriptures, I am introducing myself.  I am an Rn in
San Francisco, California, at a Kaiser Hospital, which currently is a tertiary
care center for perinatal tx.                                                                            I have been here almost twenty years. In that time, we have adopted 
total rooming in, abandoning any sort of well-baby nursery.  We have always,
in that time, been pro-breast feeding.  The methods in which breast feeding
has been supported have changed through the years, as more and more was
learned.  Our labor rooms are LDR's, and baby is only separated from mom if there are problems.  Baby goes to breast most of the time right off the perineum, but for sure within two hours (again, barring problems).We have a very high start rate, lactation consultants in the hospital on a daily basis, to work with both well and ICN babies, and lactation consultation available in the clinics after discharge.  Also, our nurses in all the areas of perinatal have extensive education and training in breast feeding.  Many of us are LC's with current certification (I'm taking the exam this summer ), though we only have two official full-time (20 hour/week) LC's.
  
        Alas and alack, as good as this sounds, there are problems.  As much
as we support breastfeeding, we do not have alternative feeding protocols -- if
a baby fails at nursing, we must turn to the bottle. (Except ICN, which can gavage at parents' insistence.  I am putting in personal hours helping to create  additional protocols.  While our start rate may be about 85% (the state average), I don't think we have a good continuation rate -- but we are in the process of finding out, and working on improving it.  I am also starting a note-
book with info from lactnet, to share with the hospital nurses.

        On a personal side, I BF my 30-week premie, 24 years ago, bringing
in and sustaining milk supply with the dinasour (Egnel).  I also fed two babies
besides my own with EBM -- as they had GI difficulties that didn't let them
benefit even from Milk Bank donations.  Then I became a nurse.  Over the years
I have "caught" upwards of 500 babies (both by accident and by parental choice) within the hospital setting, and taught thousands of mothers to BF both
in the hospital and out. Recently attended a certification course taught in Florida by Karin & Edith, radically up-dating my information and  practice.                                                                               My other interests include ski-ing, travel, and samba (dance, drumming
and costume design and building).

        Two comments on recent posts:  	

        Re:  Suffocation while at breast.  I recently had a young, not-too-aware, mom with very pendulous breasts that I was helping to learn to breast feed.  The 24-hour + plus infant had not previously latched on in a multitude of positions taught by others.  He decided he was ready about the time I walked in the room.  Mom had him lying over her breast, so most of the breast could fall away from his face. He was nursing vigorously away, and I turned away to clean up the room abit.  I turned around to find a sleeping mom and a baby who was deeply mauve.  I hope I was gentle and reassuring, as I snatched baby from the breast and ran into the next room with all the resuscitation equipment.   He was not responding to stimulation along the way, but finally gave a good gasp and cried when I "dropped" him, quite literally, on to the resus. table.  He remained semi-flaccid for about ten minutes, while his color improved.  As far as I am aware (baby stayed in the hospital for several days for observation, no repeats of apnea) there were no sequelae.  But I always wonder about if I hadn't turned around just then, or if I had left the room and not returned for some passage of time.
	
        Re:  Breast-feeding and abuse:  Karin and Edith, in their lactation
certification course, talked about mothers' protective feelings for their infants
in relation to prolactin levels.   In mice, they had mothers with high prolactin
levels protecting tissue paper against all comers.  I think they actually
cited human studies, but the extrapolation certainly is toward breast-feeding promoting protection of one's infants, therefore a decrease of abuse, or even allowing abuse by others.  (Of course, this has to depend on what the mom's perceive as abuse, as I see too many mom's who do drugs/smoke/drink, and breast feed.) I am looking for the notes from this course which includes a bibliography of studies, and will post ASAP.

        Thank you LACTNET and LACTNETTERS for information and experiences shared, and for this forum for exchange.

        Yours, for a breast-feeding world.  Chanita Stillerman

P.S.  I can be personally e-mailed at either of the following:

        [log in to unmask]
        Chanita.Stillerman @ncal.kaiperm.org