Hello Fabulous Lactation Consultants:

 

In the past I have gotten wonderful help in writing hospital policies from
this list. I got great help and suggestions last year in writing a policy on
breastfeeding and assistance with lactation on medical floors rather L&D,
Mother-Baby or Peds. Again I want to thank you, thank you and thank you to
all who helped me with that.

 

Here I go again with another request: NYU Hospital has the certificate of
intent to become Baby-Friendly and we are putting together the pieces now to
request an inspection. I have been asked to put together a protocol
regarding Hand Expression. I feel a bit stuck because I think the how of
Hand Expression is easy to cover but I'm having trouble with the when.

 

I know Baby-Friendly feels that every mom should learn Hand Expression. I
teach Hand Expression in my daily Breastfeeding class on the Mother-Baby
Unit but not every mom goes to that class. I'd love to know what others
think.

 

Our patients are very motivated to breastfeed and want to learn what they
need to know usually. But I often feel getting TMI is a problem. How do
people feel about requiring Mother-Baby bedside nurses to teach each
patient? When would this be done? What are the immediate reasons people feel
are important to teach Hand Expression?

 

We have a plethora or Classic and Symphony pumps on the floor to give to
pts. when baby is separated. What I see is Mother-Baby nurses teaching Hand
Expression to pts. in order to "prove" mother has colostrum and I think
sometimes this backfires. We are a highly medicalized institution and moms
who deliver without an epidural are rare. Occasionally, we have to wait to
get a mom on a hospital grade whose baby is separated from here because
Central Supply is backed up with orders for attachments but usually there
are attachments on the floor. I can see this as being a reason to teach Hand
Expression first.

 

We have highly conservative Docs who recommend formula supplementation
immediately in the DR with "Big" and "Small" babies. Although we have a NICU
Nursing committee working on educating these Docs I feel like this may be
one of those things that we may need to just let go of trying to control.
Meantime I can see Hand Expression before using a hospital grade pump might
be helpful in these situations but I am really not sure. When these babies
remain sleepy and don't want to nurse as much as we'd like since hospital
grade pumps are so plentiful I wonder if its just better to get them on
these and worry about Hand Expression if she's not letting down with one and
teach her to do it if she gets anxious about "not having enough milk". 

 

Love to hear others thoughts!

 

If anyone has a policy that they've already developed that they are willing
to share please send it to: [log in to unmask]

 

Thanks!

 

Barbara Holmes RD, CLC, IBCLC, CD(DONA)

Nutritionist

Board Certified Lactation Consultant

Labor Support Doula

(646) 431-0209

 


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