Catherine,
I would be happy to share some of my experiences in teaching nurses.
The health ministry in Israel has been running courses to educate nurses
all over the country, and I have taught in most of them. The nurses you
describe, I lovingly call the "dinosaurs".....those who have been in the
profession for millions of years, know all there is to know about
breastfeeding and really have nothing to learn. And if so who am I to teach
them? I am a NN ( non-nurse) starting out at a disadvantage. BTW most of
them failed miserably in breastfeeding their own children and this is the
root of the problem. they may become a little aggressive, in which case we
have to let them know that the system failed them and we want to correct the
system not to fail new moms.
One very effective method I have found is not to attack them and tell them
how much they do not know.......to inform them very gently and discreetly
how much they do not know. I ask those who have been in the profession for
more than five years to stand up, then those who have been for less than ten
to sit, less than 15 to sit, etc. At the end you are left with the
dinosaurs. Now we have to give them lots of love and credit and get them on
our side. I start with the fact that they have probably seen lots of
changes in medicine over the years: we used to remove tonsils in every kid
who sneezed more than twice, or we used to think that fat babies and
children were healthier. We have seen changes especially in maternity
nursing, and I give a few examples: remember when we used to have moms put
abdominal girdles to get their muscles back in shape and today we know that
this is harmful? Or remember when we used to put moms under full anesthetic
to deliver them, and today we try to have the mom as alert and interactive
in her birth as possible? At this point all the heads are bobbing up and
down in consent.
Now you start to drop the bombs:
In breastfeeding there are many things that we know today that we used to
think differently about once.
Once we thought moms had to sterilize their nipples before breastfeeding? We
used to give them cotton balls with alcohol, and now we know that there are
glands around the nipples that do the work, in fact we even tell moms not to
wash their nipples with soap?
Once we thought that babies know how to tell time, and we tried to program
them to feed every four hours, we even set certain times for breastfeeding
and today we know that breastfeeding should be baby-led according to hunger
cues, and at least 8-12 times a day.
Once we thought that if the mom breastfed for more than 5 minutes on each
side in the first few days that she would get sore nipples. Now we know
that if the baby is latched correctly, she can feed indefinitely and if the
baby is latched wrong, even one second is excruciating.
Once we thought that babies should feed no more than 10 minutes on each
side, but now we know that this deprived them of the high-calorie hind milk.
Once we used to think that moms need to drink liters, now we know....
Once we thought that the only way to see if a baby is eating is to test
weigh them...
Once we thought that we had to hold the breast in the cigarette hold to
clear the baby's airway...
Once we thought that babies who had jaundice should get water...
Once we thought that babies need artificial milk in the early days until
the milk comes in...
Once we thought that a woman with a breast infection shouldn't
breastfeed.........
OOOOh boy did we get it wrong.
Now the truth is that NONE of us ever thought this stuff, but we have to get
them on our side, right?
ETC, ETC..you get the drift. What you see in the faces of your students is
this quite troubled look as if to say.....wow, I am giving real outdated
information, I better get my act together and change. I should even pay
attention to this lecture cause I may learn something.
I have a whole long list of "Once we thought"s if any one wants, but I am
sure you can think of lots. It is basically the whole list of myths that
are still being spouted by HCP's.
If you want to give me some general "Once we thoughts" in medicine, I would
always be happy to add some to my repertoire!!
If you start that way, you will find that your students become educated in a
way that does not threaten them or humiliate them, because only they know
that they are out-dated ( well, we also know, but they don't think that we
know.)
If you want more info, I would be happy to share. I think this is to long
for Lactnet already.
Good luck and let us know how it goes.
Esther Grunis, IBCLC,NN
Lis Maternity Hospital
Tel Aviv, Israel
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