Re: the conclusion of the recent study that "hospitals that find decreased
lactation success in parturients receiving epidural anagesia reexamine their
postdelivery care policies".
Well, that's all well and good, but one of the problems is that hospitals
are really not in the best position to evaluate the "success" of their own
breastfeeding policies & practices. Babies are sent home so early that the
hospital personnel really don't know whether BF is established at all.
Having been the hospital LC, I *know* how hospitals conclude whether their
lactation program is successful or not; they have stats on how many
mother/baby dyads were "breastfeeding" at time of discharge. Unfortunately,
this category includes all the moms that *want* to BF, or are "trying" to BF
but haven't yet got things working smoothly, as well as the lucky ones for
whom all is going well.
Well, I think the conclusion of the study needs to be reversed: epidurals
should not be done routinely UNTIL hospitals have *fixed* their BF
standards, policies, and procedures, INCLUDING ADEQUATE FOLLOW-UP AFTER DC!
(Yes, shouting!)
I see all the time babies that go home not having ever had an effective
feeding at the breast; all the hospital policy requires for discharge is
that the baby take in enough to pee & poop. So you get babies that haven't
learned how to nurse at all. The first hours are spent in a "wait & see what
happens when he wakes up" mode, then there is suddenly a big flurry to get
the baby to nurse, and then the final stage (what I think of as "panic
mode") sets in while all hands are on deck trying one feeding method after
another to get the baby to take *anything* so that the baby will pee. So the
poor little thing gets all kinds things of stuffed in its mouth, in those
last crazy hours before discharge: finger feeders, bottles, soft-cup
feeders, syringe & tubing, dental syringes, whatever the nurse-of-the-day
happens to favor. So the baby gets a few ounces in, wets & stools, and is
pronounced to have established feeding skills. The mom is told to "keep
trying". The family goes home, the baby still doesn't have a clue, the
parents get in an increasing state of panic and discouragement - hopefully
remembering that rule #1 is "feed the baby", but not necessarily - and
either gives up BFing because "it didn't work" or ends up in the doctor's
office with an insufficiently-fed but over-tortured baby on day 5 or so,
where they are told that the baby must be supplemented with ABM, and we all
know where that goes...Or, if they are smart & lucky, they call an LC, who
ends up crying in her pillow at night in frustration with the whole system.
When I worked in the hospital, I did the best I could to get babies on, be
sure that moms knew who to call for help after DC, and assure that the
parents knew the basics of what they needed to know to at least not
interfere with the process. Then, when I worked at WIC, I began to see the
"beyond hospital discharge" picture - and I can assure you that the hospital
personnel would be shocked!
-----Original Message-----
From: Patrica Young [mailto:[log in to unmask]]
Sent: Friday, July 02, 1999 6:58 PM
Subject: Re: epidurals & bf
Dear Kathy, I've mentioned before (check archives) that what is in this
report is what I observed in 2 different hospitals (MI & NJ).
I'm not in favor of epidurals because I think they are dis-empowering and
because we see so many BF problems, but you can't beat the article authors'
conclusions! Fix postdelivery care policies, especially if you plan to
sell lots of epidurals! DUH !
>We recommend that hospitals
> that find ***decreased**** lactation success in parturients receiving
epidural
> analgesia***** reexamine ****their postdelivery care policies.
Sincerely, Pat in SNJ
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