Pam: I wish you had directed your "rebuttal" to me, but since you didn't, I
will post mine publicly (although I do not want this forwarded without
permission--if someone wants to see it, then they can go to the archives and
view it). I heard from several IBCLCs attending the ILCA conference in
Mexico that you had posted regarding my post on the triplets (whose moms
came to me prenatally for induction and assistance) and the fact that the
one staff IBCLC on the floor was not going to be working in that capacity
any longer. Much of what I have to say might be taken as antagonistic;
please know from my heart that it is not intended to be antagonistic as I
really want to further our cause--that is to help every baby receive
breastmilk, preferably directly from the breast, for as long as is mutually
desired (and hopefully at least as long as the "one year" statement from the
AAP). I am also responding to the numerous calls I receive on a regular
basis from parents who are shocked at the differences in breastfeeding
policy between this hospital and the surrounding hospitals in Oregon.
Lastly, there have been many hcps in the community who have felt that the
environment towards them promoting breastfeeding has been so hostile that
they have either left their positions and/or left the community entirely.
As someone who attempts to follow the guidelines set in place by my
professional organizations (ILCA, APHA, NCHEC), breastfeeding advocacy
groups (WABA, WHO, LLLI, INFACT, PAHO, etc) and allied HC professions groups
(such as the AAP and ACOG), I am often shocked by the lack of consistency in
the message being promoted locally and by the lack of interest in sharing
information regarding the latest breastfeeding research, as well as policy
which directly undermines breastfeeding. I cannot count the number of times
that mothers call in frustration at the fact that every single hcp they've
encountered has told them something completely different regarding
breastfeeding. Yes, we need to tailor care-plans for individuals, but there
ARE established guidelines, standards and protocols (which I have personally
delivered at my own expense) that continue to be ignored.l
My comment regarding the LC staffing pertained to the fact that there is NO
staff IBCLC position in the Center for Women and Families at this
hospital...not that there is no access to IBCLCs at all. This comment is in
regard to the fact that several yeras ago the hospital made a conscious
decision to eliminate the two (it might have been 1.5 FTEs) IBCLC
floor-staff positions and only recently regained an IBCLC when one of the
RNs took the IBCLE exam. This was in spite of many community letters
directed toward the hospital. As I believe Dr. Newman has stated multiple
times, we would never allow hospitals to staff cardiac care units with RNs
who were not trained in reading cardiac monitor tracings, so why is it
acceptable to have RNs staffing the OB floor who are not trained in
lactation (and the IBCLC IS the gold standard for lactation training, not a
weekend course). I understand that the RNs and other staff sometimes feel
as though their hands are tied, so this is not necessarily directed at them
(although many other RNs have made enormous changes within very hostile
environments).
While I am delighted that there are home health nurses who are IBCLCs and
who make rounds IT IS NOT THE SAME AS HAVING IBCLC staff positions written
into the budget. Having 7 day a week coverage a phone call away is not the
same as having 24/7 staffing with IBCLCs who are there for full shifts.
There are wonderful things accomplished by the home health staff, but they
simply cannot be in all places at the same time and that includes in homes
and on the floor for 1 or 2-3 hour long consultations per mom. I am also
aware of the home visiting program (and you might not even be aware that I
was a very early member of the local Healthy Start program that brought
about the coalition that has achieved this program). Yes, this is far
better than nothing and I know in my heart that those visits have ensured
that countless babies have received breastmilk who would have otherwise not.
Thank you for all you have done in this area.
My intent (and not just locally) is to further sensitize all OB and
Pediatric staff (and women's health staff) to the fact that many hospitals
and their staff in the US have made a conscious choice not to pursue Baby
Friendly status and the underlying principles based in clinical
evidence-based standards. It is not simply "good enough" to just pick and
choose which of these principles and guidelines are convenience or
politically acceptable. We must, as health care professionals and as human
beings fighting for human rights, take a stand and push forward. I urge you
to take a moment a re-read the 10 +1 Steps to Successful Breastfeeding and
then to do everything in your power to further this locally.
"TEN STEPS TO SUCCESSFUL BREASTFEEDING: EVERY FACILITY PROVIDING MATERNITY
SERVICES AND CARE FOR NEWBORN INFANTS SHOULD:
1-Have a written bf policy that is routinely communicated to ALL health care
staff.
2-Train ALL health care staff in skills necessary to implement this policy.
3-Inform ALL pregnant women about the benefits and management of
breastfeeding.
4-Help mothers initiate bf within a half-hour of birth.
5-Show mothers how to bf, and how to maintain lactation EVEN if they should
be separated from their infants.
6-Give newborn infants NO food or drink other than breastmimlk, unless
medically indicated (my addendum: See according to the ILCA Clinical
Evidence-Based Practice Guidelines, the Acad of Breastfeeding Medicine, and
the AAP)
7-Practice rooming-in-allow mothers and infants to remain together-24 hours
a day.
8-Encourage bf on demand.
9-Give NO artificial teats or pacifiers to bf infants.
10-Foster the establishment of bf support groups and refer mothers to them
on discharge from the hospital or clinic."
AND, what many consider to be the essential eleventh component...
11-Adherence to the International Code of marketing of Breastmilk
Substitutes (and all subsequent World Health Alliance resolutions on infant
feeding), which eliminates the acceptance and dissemination by hospitals,
clinics and hcps of all FREE artificial baby milks/formulas.
#1-10 from From the Joint WHO/UNICEF Statement, July 1989
I'd like to discuss this further with you if you are open to the possibility
that there is much more that could be done.
Respectfully,
Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC
--
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC [log in to unmask]
INFANT CUISINE AND MOTHER CARE: Lactation Consulting, Perinatal Health
Education and Attachment Parenting Classes for parents and practitioners
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