Kathy Birt's post about how her hospital handles BFing preemies gets me all
stirred up (again!) over this issue of "whose baby is it anyway?". This heat
is not directed at you, Kathy, by any means - I've been there, I know that
you are just accurately describing what happens at your hospital.

But how long will BFing be something a mother or baby or nurse or LC needs
to have a doctor's "permission" for? Now, I understand that with a fragile
or ill or very premature baby, it does indeed need to be a doctor who makes
the recommendations as to whether a baby is ready for PO feeds, or gavage,
or how much volume, or that sort of thing; I'm not questioning that aspect
of their involvement. (Well, not much, and willing to give them the benefit
of assuming good intentions...) But we KNOW that BFing is less stressful
than bottle feeding, in terms of increased pO2, improved heartrate, body
temp, brain waves on EEG, all those parameters we can measure and use as
guides. And we KNOW the difficulties that babies have when they aren't
allowed to nurse as early as possible and in addition have to contend with
feeding by all these other devices. Under what possible authority would a
doctor have the right to say "this baby may be fed by a bottle, but not at
breast"? I don't think so! I am increasingly unwilling to just accept that
this particular decision is the doctor's to make. (And, as we know, I no
longer work in a hospital - lucky for us all, isn't it!) If a baby can be
held by the mother, that baby can go to breast; even in circumstances where
we don't want the baby getting much milk at the breast, we can control that.

Can you imagine the ruckus there would be if the situation were reversed, if
doctors were routinely accorded the authority to say "this baby MUST go to
breast; bottle feeding is far too strenuous at this point, and would
jeopardize her condition. Maybe next week, when we see how she does at
breast, the mother can try a bottle if she still wants to."!? Which would
make more sense, when you think about it.

Cathy Bargar, RN, IBCLC Ithaca NY

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