Linda Bubeck asks for input to help her in a frustrating situation at work.  Despite step 9 in BFHI's ten steps stipulating that breastfed babies should not be offered artificial nipples or pacifiers before breastfeeding is well established, other alternatives have fallen into disrepute in her unit where most new mothers are discharged within 48 hours after birth and many babies have not attached at the breast even once before that time.

Linda, you write that supplementation is common even before transfer to postnatal ward : "Low blood sugar is the most common reason for supplementation and if the baby was born by C-section mommy is not available."  You also mention that pediatricians sometimes recommend expressing breastmilk and bottle feeding it to see exactly how much a baby is getting.  Evidence based practice does not include measuring the blood sugar level of healthy newborns, nor measuring the intake of healthy babies at the breast.  A baby whose intake is so critical as to need monitoring and measuring should never be cared for on a regular postpartum ward, it should be in intensive care and not a candidate for discharge home within 48 hours.  If the baby is not in need of intensive care, the intake is up to the baby and the pediatrician should be able to trust the baby to tell you whether it is satisfied.  

While I can well understand your frustration over the effective ban on finger-feeding, it seems to me there may be an even more effective way to work for a solution, by reducing the need for supplementation.  

Is the hospital cognizant of the other nine steps? If so, they may be receptive to bringing practice in accordance with more of them, such as getting mothers and babies together as early as possible.  There is good research to show that babies have poorer state regulation when separated from their mothers - the very care the hospital is practicing is putting babies at risk: for hypoglycemia and hypothermia in the short run, and for breastfeeding failure in the longer run.  Is this what they want?  

Rather than beating your head against the wall of which method to use for getting food into babies who are not feeding effectively, you could do something substantive to get more babies feeding well.  In my experience the absolutely only way to implement such changes is by allying yourself with the users of your service.  Once just one mother has managed to keep her baby with her continuously after a cesarean, it will be a little easier for the next one, and the next, and before long you will have postop staff noticing that they are seeing warm, contented babies and mothers who need less pain relief in their care.  It seems to work best if these staff members 'discover' these things for themselves; I've never found the oh-so-satisfiyng 'I told you so' approach to be very successful in converting anyone to the cause, but seeing it for themselves is incredibly powerful.

Good luck.  Believe me, I know these things are overwhelmingly frustrating and I struggle with some of these things in the (on paper) Baby-Friendly unit where I work too.

Rachel Myr
Kristiansand, Norway

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