Hello All,
Can't resist weighing in here, since I have worked for 2 1/2 years now as
one of the LCs in a big busy Level III medical center.  I do feel we are
adequately staffed so that the support we are able to provide to mothers and
babies amounts to far more than lip service in my facility.  I know this is
in contrast to many hospital LCs who have to constantly explain "I'm a
person, not a program."  Educating the staff (from CNAs to staff RNs to
docs) so that info given at the bedside is consistent helps prevent a lot of
problems.  So does supporting and expecting the bedside nurses to provide
support to mother-baby dyads who are having a normal experience
breastfeeding.  This should be universal in all hospitals and is supported
by Step 2 of the WHO/UNICEF Ten Steps.

What no one has raised in this discussion so far is the issue of how changes
in obstetrical practice impact the early breastfeeding experience; and how
this increases the workload for hospital LCs.  When I started my nursing
career in 1987, elective induction of labor was a rarity.  So the majority
of babies were delivered after spontaneous labors, and we did not see lots
of 37-38 weekers who  were not developmentally ready to integrate their
reflexes into the complex task of feeding.  My hospital did not offer
epidural analgesia, we used stadol IV or people got paracervical blocks --
thus we saw far fewer moms with edematous breasts and nipples from large
boluses of IV fluids.  Use of the vacuum extractor tended to be confined to
emergencies.  Now we see lots more use of the vacuum for moms whose urge to
push is diminished due to epidural analgesia, and it's not uncommon to find
babies who have been vacuumed out of a c-section incision -- in order to
keep the incision shorter.  Let me make it perfectly clear that I am NOT
bashing obstetricians here.  They are doing more inductions because mothers
are demanding them, and they make shorter c-section incisions for the same
reason; in fact, I have heard that several OBs have had mothers make
complaints to the Board of Medical Examiners b/c they felt their incisions
were too long.  And even when a complaint is reviewed and found to be
frivolous, it stays on a doctor's record permanently in my state.

The fact is that due to the increase of all these interventions, babies and
mothers are having a harder time establishing breastfeeding now than they
did fifteen years ago.  And amazingly no one is studying the impact of these
interventions on initiation of breastfeeding!  Those of us who do research
or have influence on someone who does, need to start getting studies funded,
and published, not just in JHL, but in some of the major medical journals as
well.  What if JAMA or the Green Journal (ACOG's journal) were to publish
some research on these topics?  That alone could change practice enough to
reduce the workload for hospital LCs.  And to whomever suggested getting
moms into support groups prenatally, I completely agree.  Education for moms
is crucial.  It would really help if they got info regarding the pitfalls of
choosing to induce at 37-38 weeks.
Thanks for listening;
Martha Johnson RN IBCLC
Eugene Oregon
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