Amy, this is a situation when a good doctor in charge writing strict orders
is helpful!  Obviously, there's been lots of discussion about docs writing
bad orders/banning LCs, but here's a good opportunity to use your physician
"power" for good.

Our diet order for breastfeeding babies clearly state, "No glucose water,
formula, or pacifiers."  This is a diet ORDER, not a diet SUGGESTION.  If
mom is asking for supplements, nurses need to explain why healthy babies
really don't need formula, and/or at least notify you that mom is having
doubts.

Nurses would be horrified if we made a surgery patient NPO, and someone fed
the patient a steak, or wrote an order for diabetic diet and someone brought
the kid a Coke slushie.  They need to view "breast milk ONLY" diet order in
the same vein.

Suzanne

Suzanne Berman, M.D., FAAP
[log in to unmask]
Plateau Pediatrics
(931) 707 8700 voice
(931) 456 0802 fax
(931) 484 9511 after hours



Date:    Sat, 14 Aug 2004 22:21:51 -0500
From:    Amy Kotler <[log in to unmask]>
Subject: the physician is in charge?

I just got back from the hospital- my first newborn since I got priveledged
in
April- saw mom this am and she was really going to BF no bottles etc... we
discussed nipple confusion and her sister is currently BF'ing and attends
LLL
meetings- so she was going to lend support- but I see on the chart- "Breast
&
Bottle" and that she did get half an ounce twice today- the RN's in the
nursery
were telling me how they think breast and bottle is the best thing and thats
how they did their own children and they never had any problems and how what
they see is mothers whose baby is loosing wt and having low d-sticks and
they
have to convince them to take formula- I was trying to explain to these
nurses
how they just happened to be lucky and research bla bla bla-

anyway- what I've always felt since I was in a 3rd yr Med student in 1995
was
that the HOSPITAL POLICY is LAW and the nurses are the police who uphold
these
laws

the RN's were insisting to me that it was the mother who wanted the bottles-
at
first they also said that she was going to be in the nursery over night- but
then I said that I thought we (the mother and I ) had discussed in the
morning
that she would nurse over night so then on rechecking her notes she said
that
she was mistaken, the baby would "go out at 1 and 3"

How do I approach this mother tommorrow w/out sounding accusatory "What
happened? Why did the baby get the bottles yesterday?"

Amy Kotler MD FAAP
Dover Pediatrics

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