Please forgive me if this message gets posted x2... I don't believe my 
first post went through...

Hello wise ones,

 

While doing rounds on the inpatient unit today I was stopped by a male 
RN who told me that a few patients who were asked to supplement by other 
staff nurses recently refused stating that "my lactation consultant told 
me not too".  He inferred that these patients gave the impression that 
they feel "formula is poison".  He wanted to know what I have been 
teaching in classes.

 

I told him that I talk about the risks of not breastfeeding, and to 
avoid artificial nipples for about 3 weeks to help get off to a good 
start.  I talk about avoiding supplements unless medically necessary and 
if supplementation is medically necessary to avoid  using artificial 
nipples for supplementation.


He said that maybe I should say something in my classses about the need 
for supplementing so they "wouldn't have to be convinced for 20 minutes 
that formula is not going to kill their baby".  I repeated that I do 
mention that occasionally supplementation may be __medically__ 
necessary, and if so, that it is best to avoid artificial nipples.


Then he started to give me a hard time about having a breastfeeding 
diary for all the patients and not a more balanced "breast or formula" 
diary... and that this makes patients feel bad/guilty who are formula 
feeding or switch to formula.  (I did have a separate formula diary in 
the unit, but of course they were out of them at that time). 


He went on to say that he thinks that I should teach about the 
"benefits" of formula and teach patients more about formula in my class, 
because, as nurses it is our responsibility to give patients informed 
consent.  He feels that my class is "one sided" and "your patients take 
everything you say as the gospel truth... they are not able to make an 
informed decision because you are being like the media and only telling 
one side of the story".  He said "what about the patients who quit after 
a day or two and formula feed, why shouldn't they get education before 
delivery?"

 

He also said that I shouldn't use the word "normal" because "normal" is 
a subjective word.  He said that he actually had a 16 year old crying 
because she felt so guilty.

I said that I could share with him some good articles that address the 
guilt issue.

 

A nurse's aid later told me that this same nurse told everyone in 
morning report that if I can't present both sides equally, then maybe 
they don't need my services on the unit.

 

I tried to tell him that most babies are born well fed and that we don't 
have to force newborns to feed every 2-3 hours.  He said that a patient 
was asked to supplement her newborn who had lost 6% in 24 hours and 
refused.  I said that 6% wt loss is not generally a reason to 
supplement. I said supplementation should not be done casually, for 
instance it takes up to 2 weeks for a newborns gut to return to normal 
after supplementation, and he __really__ wanted evidence for that statement.

 

We talked about the risks of not breastfeeding. He said he was part of 
"THE" study  that compared breastfeeding to formula feeding when looking 
at ear infections, and he said "there really wasn't much of a 
difference".  I asked him how they defined breastfeeding, and he said "I 
thought breastfeeding was breastfeeding".  I tried to tell him that how 
breastfeeding is defined can make a huge difference.

 

He says he's a "results guy" and just wants to have "healthy babies".  
He wants me to make a flow chart of what to do in certain situations.   
He says the nurses need to know what to do at 2am when I am not 
available.  On the surface he acted open to education.

But I left our conversation (which was at least 30 minutes) feeling very 
emotionally drained and felt I was being attacked "with a smile".

 

Thank you so much for letting me vent and if you have any suggestions 
regarding how to communicate with this person and the nursing staff in 
general, breastfeeding protocols, etc. would be greatly appreciated.

 

Sincerely,

Renee Mercier

RN IBCLC

 



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