"What this means, in effect, is that if we can't get baby to breast before they send it home without this help, they want it sent home on the bottle..." Or the alternative - they won't send home a baby that hasn't learned to nurse effectively yet. Perhaps a discussion with this neonatologist might help him to understand that the hospital's (i.e., *his*) responsibility is to ensure that all babies who are discharged from the unit are able to latch on & nurse appropriately. Most insurance plans, HMOs, etc. won't pay for babies to linger around indefinitely (not to mention that it's not good for the baby to do so!) - and since infant formula is NOT the equivalent of human milk, I don't see where he has any real alternatives but to discharge infants home with the optimal alternative feeding method possible. What that method will for any given baby, in any given circumstance, varies, but it's foolish to try to insist that it will be a bottle in all cases. What makes this doctor think it's up to him, or by extension to any of the hospital's employees or agents, to dictate to parents the manner in which they supply their children with nourishment? If he's not "approachable" on this issue, if he doesn't get it despite your most non-aggressive and respectful discussion, I have to say that I think I would just go ahead doing what I know is in the best interests of my patients, without making a huge stink about it. After all, you have professional ethics and liabilities of your own to adhere to. I know there will be responses from others that this is underhanded, sneaky, unprofessional, etc., etc. But in all honesty, this is a "rule" I would defy, either openly (which it sounds like you may not be in a position to do) or subtly. Parents are absolutely entitled to the full range of information about their options for feeding their non-nursing hoping-to-be-breastfed babies, and this is not this physician's call to make. The analogy that comes to mind is the fuss (now many years ago) over a gag order prohibiting health care professionals from discussing options for terminating an unwanted pregnancy with their pregnant clients. Not acceptable. Not supportable. Wrong. But maybe this guy is just not well-informed, and once you explain it to him maybe he'll change his tune. I would definitely approach the subject with respect and knowledge - arm yourself with appropriate citations & studies, esp. any you can find from other physicians. And don't be afraid to meet with him as one professional to another! Cathy Bargar, RN, IBCLC Ithaca NY *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html