In a message dated 10/31/01 5:11:46 PM, [log in to unmask] writes: I think the following statements made a lot of people feel defensive. Having worked in 2 hospitals, and extensively with the NICU, I concur with Mary Kay Smith who said that we should all find an opportunity to experience the NICU. It is very difficult to try to balance the fine line between preserving life and protecting long-term quality of life. I think it is essential to have someone like Melisa who continues to support the mother in her mothering choices while medical people support the baby in getting well. IMO, NICU (and PICU) nurses are an amazing group of people. I have seen them cry when babies got well, when they got sicker and when they died. I have seen them mother a baby abandoned by parents who couldn't parent a child so sick and I have seen their frustration with very unhealthy parenting and their deepest support for loving mothers or bf'ing. And, I personally will always be deeply grateful to the PICU nurses who cared for my son in intensive care years ago, advocating for my choices, even in conflict w/ the doctors. But, I also think that the experience of outsiders is valid and important. I have often seen mothers' experiences dismissed as "just perceptions". The fact is that critical decisions might be made based upon "perceptions". I think that medical professionals need to care about the experiences of families and LC's or LLLL's or anyone else in the NICU. In my experience, defensiveness tends to take over and little attention is paid to these concerns. The complaints Melisa has are the same complaints I heard over and over again from our clients in the NICU, so I know they are real. Not every single doctor or nurse supports bf'ing, and of those who do, many still rationalize away real protection of bf'ing in NICU settings. Melisa said: << We worked to get the mom a pump, more like fought to get her a pump.>> I have had to do this, even having full access to the hospitals. << Mom has colostrum (as she has been pumping it and giving it to the NICU nurses who are doing God know what with it, as they aren't feeding it to him). >> I cannot tell you how many times mothers told me they had no idea what was being done with their milk. Sometimes, they just didn't realize where it was in the feezer, etc, but sometimes it was thrown away (sometimes the mother was told the colostrum was too little to save!). I even saw a nurse give AIM while the mother left the bedside for a few minutes and left her bottle of marked breastmilk out for the nurse. These things do happen. << This morning one of the NICU nurses noticed she was having trouble getting him to nurse and offered her a substance to put on her nipples.... IT WAS CHERRY FLAVORING!!! The NICU nurse said that they had been putting it on the pacifier to get him to take it. >> Clearly, this has also happened in other hospitals, but even if no one else had spoken up, why would we doubt Melisa's experience? B/c we wish it wasn't true? Ann wrote: << But I think there is more important problems for this baby. As I understand the progression of the labor and delivery, this child was in trouble long before in came to the NICU or received a pacifier (flavored or not).>> This may be true, but it doesn't mean that it becomes okay to interfere w/ bf'ing or gut health just b/c the baby's immediate medical needs are pressing. This is an attitude I often see in NICU, a diminishing of the importance of a mother or LC (or peer counselor)'s complaints b/c the baby is sick. As if bf is nice in the NICU, but the rules don't really apply there. Well, they do apply and are often easily supported. I have had clients make themselves available almost 24 hours to avoid pacifiers--which is their right. I have also heard them roundly criticized for doing so behind their backs. When a friend's toddler was in PICU, a nurse asked me "Why is she pumping, she doesn't really think he will live, does she?" The multiple levels of what bf means to a family are often completely dismissed in NICU. <<This sounds like a VERY traumatic birth, that should have been a C/section, and screams of Cephalic-Pelvic-Disproportion or CPD. >> It sounds to me like Valerie's concerns about the cascade of medical interference b/c of GBS is valid. CPD is almost always a bogus diagnosis and GBS is, as Teresa said, nowhere near as likely to cause death as most mothers are frightened into thinking. I don't think that there is any benefit in arguing where the problems come from, esp as a way to again diminish the concerns about interfering w/ bf and attachment. << Better a feeding tube for a few days and mom pump than no baby at all.>> I think everyone would agree with this, but in the meantime every effort should be made to prepare this dyad to nurse. Marian wrote: << It is certainly unfortunate there appeared to be a lack of communication and explanation to the mother and this is a good reminder to all of us who work with mothers whose baby's are sick that not only should we ensure proper care of the baby but adequate explanation, support and practical input such as helping her to sort out pumps and expressing.>> I agree completely. And I also believe that nurses should treat the counselor the mother will work with when going home w/ respect and as an ally and be willing to learn from her, as well as teach. In all research I have read about parents' experiences in NICU, the nurses' ownership behaviour towards babies has been cited as a major issue for parents. Parents tend to cooperate (comply) far more out of fear than from informed agreement with treatment plans. Not only fear that the baby might die, but fear that the baby will be taken from them or they will be viewed as bad parents or lose all control of the baby. In my experience, very little informed decision-making happens in NICUs. So, my suggestions to Melisa are to try to continue to support the mother in the NICU. If there is an LC on staff, try to get her support or that of any other nurse who seems willing. Ask questions, rather than making assumptions (like where can the mom store/find her milk?), as if you expect it has been properly handled. Do not let the mother see you acting on assumptions--you can easily lose credability. No matter what your relationship w/ the mom, she will choose the NICU over you (they control the baby), so don't pit yourself against them. Keep offering options, but remember that your best bet in helping her is to maintain a trusting relationship. Let the staff know you would like to learn from them--I have found most to be very willing teachers--they have to teach parents who know even less than you all of the time. And good luck! Jennifer Tow, IBCLC, CT, USA *********************************************** 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