Winnie reminds us to ask why mothers are too tired to have their babies with them at night, even for feeding.  I quote from her post: "It is good that we seem to have stopped considering birth as a medical condition, but in the process we seem to have also given the message that a new mom doesn't need the same kind of rest as, for example, a surgical patient."

And I will remind everyone that in most countries we are working in, as many as one mother in three, or even more, *is* a surgical patient.  It's so backwards that just when we stopped doing a lot of physical care tasks for mothers, we also started doing a lot of other things to them that put them in much greater need of the former care.  Units that make real room for families, with the chance for a significant other to room in with mother and baby, go a long way to making up for this loss, and at least in Norway the families who are offered this form of post partum care are much more satisfied with their stays than women who are at the mercy of the resources on the ward for any help with care.  A partner can cuddle a baby, change it, bring it to the mother, and just keep her supplied with loving companionship, and the partner is even happy to do so!  Rarely do ward staff have time to just hold a baby so a mother can get an hour of sleep, and mothers need to know that the baby will have to wait its turn if the staff are otherwise occupied when baby awakes.

There are a couple of studies showing that mothers don't sleep any more or any better if the baby is in another room.  If the baby is next to the mother, she may not be disturbed by other babies crying outside her room, because she is tuned in to her own baby, and doesn't need to be on alert for every cry in the corridor the way most mothers are when the baby is in the nursery.

Closing the nurseries is a necessary, but not sufficient, first step.  Nights are always a problem, and the people who prefer to work nights are often solo players rather than team members, who like night work because nobody checks up on them and they can do things the way they've always done them, so there will be more resistant staff on nights than on other shifts.  That's why Baby-Friendly assessors prowl the wards day and night, and why the interview samples of staff must include people on night duty.  

Unless the leadership on the ward makes it a stated goal to eliminate inappropriate supplementation of breastfed babies, you are fighting a losing battle.  It's hard enough when you have management on your side, believe me.  But once you get the majority of the staff on board, they will act as correctives to the multi-resistant die-hards by constantly requiring them to explain what that baby is doing on their lap being fed something other than breastmilk, from the breast.  Don't waste your energy trying to change the attitudes of the chronic supplementers among your staff (and I'm willing to bet you know who they are by name).  Just see to it that they become a marginalized minority, preferably with sanctions to be imposed whenever a deviation from procedure with no plausible explanation is found.  They can keep their destructive attitudes as long as there are measures in place to control their destructive behavior.

We did an intensive awareness campaign about the capacity of the newborn stomach in the first few days of life, and it helped some too, if only to remind everyone that a restless, non-happy baby is not necessarily asking to have a load of milk put down its gullet, and that what the breast holds is enough as long as the baby has unlimited access to it.  It also seems to help mothers to shift their thinking from number of ml of milk, to 'keeping the baby happy'.

Good luck,
Rachel Myr
Kristiansand, Norway

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