I need some quick advice from all you Intensive Care Nursery Lactation
Consultants out there.  We had a baby on the unit, normal vaginal delivery,
who nursed well after birth, then didn't nurse for several hours,then nursed,
then didn't.  Blood sugars done during this time ranged from upper 30's to low
40's.  An IV was started of D10W at 4cc/hour with a good raise in blood sugar,
but still not up to 50.  The ICN caring for the baby (who does NOT support
breastfeeding) stated "I'm going to give this baby some formula!"  Another ICN
nurse who DOES support breastfeeding suggested she NOT give the formula YET,
but instead increase the IV to 6cc/hour and see if that didn't maintain the
blood sugar since it was so close to 50 anyway, and get the mom to nurse.  The
primary care ICN nurse looked at the second one incredulously and stated
something to the fact that this breastfeeding thing was out of hand if she
couldn't tell when to give a baby some formula!  She then went and reported
the situation to our TEMPORARY acting head nurse, a nurse from Intensive
Care/Coronary Care of ADULTS.  Well, at the next staff meeting the acting head
nurse stated that we CANNOT question the decisions of another primary nurse
caring for a patient and brought up this situation where the baby CLEARLY
NEEDED FORMULA, NOT BREASTMILK.  Now I have a question for all ICN Lactation
Consultants out there:  What was the appropriate thing to do here in this
situation?  Increase the IV 2cc/hr to bring the blood sugar up from high 40's
to low 50's or formula.  Of course, the baby got formula and the next blood
sugar was in the high 60's and this nurse reported it to EVERYONE.  By the
way, this baby stablized and went home with mom breastfeeding and we don't
know why sugar fluctuated.  Now for the clincher:  This same temporary acting
head nurse is being encouraged by the ICN nurses to apply for the position of
manager of ICN/Labor and Delivery.  They keep telling her it doesn't matter
that she has no experience in the area because THEY do.  This frightens me
because she will not know when she is getting bowled over by these strong ICN
nurses who are pushing formula and are against the breastfeeding protocol.
FEEDBACK PLEASE.  You can write me at my email if you want.  I also can be
emailed at work [log in to unmask]   Thanks so much everyone in
advance.  Loni Denman RN, IBCLC.