There is no doubt that evidence based, family centered. etc...is the right kind of care.   I wonder though, for those of us working "in the arena", what is it that we are doing that is making an impact on change.  There is so much discussion but where are the activists.  I would love to know what people are doing in their little (or big) corners of the world to change things.  There are ways to get administrators to listen.  There are also ways to entice Maternity Center managers.  It is a game we play.  Make others feel important - or - better yet if an idea is good - let them think they thought of it!  Then they will really buy in.
We have become who we are through extensive studying, peer discussion, problem solving, conferencing.  In a way that is our indoctrination.  It happens to everyone. Physicians are indoctrinated so are nurses.  We can't "force" people to change. They have become who they are through a long and hard process. The reality of everyday life is not easy. We must be kind and consider everyone in this picture.  How might we do that?   What is our approach?  How are we communicating?  Have we taken time to become credible before we try to engineer change.   Many have.

I work with a staff that knows me well.  Several years ago a decision was made to work towards Baby Friendly USA and Mother Friendly Childbirth.  It has not been easy.  I am the facilitator and have had my eyes opened.  We all need each other. So whatever we do has got to be something that will work for everyone.  Getting to that point is painstaking and requires committment and perseverance.  We can complain about things - that's easy.  Rolling up your sleeves and even becoming dartboard (at times) to lead change is not.  There are many different ways to approach "changing the culture".  We have been working to change for three years.  We are using the Baby Friendly and Mother Friendly Childbirth Initiative because they are actual blueprints to follow and are evidence based.  There are, of course, many barriers and we have made mistakes.  That is where alot of problem solving comes in. Our goal is mother/baby/family centered care. We are much better now than we were three years ago at supporting mothers who breastfeed.  The mentality of the nursing staff has definitely moved forward in time, is much more visionary, pro-advocate too.  That will not change. Our breastfeeding rates seem to fluctuate around 60%.  I will share information that will help others re: the work we have done on these two initiatives.  If you sit back and say that "it could never happen here"    IT WON'T!    It would be nice to hear from Lactnetters re: how they are doing that.  

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