I'm disappointed in the way the nurses in our post-partum area support breast feeding. In short, they don't, and it drives me crazy. Bottles of formula are given way too frequently to babies whose mothers wish to breast feed. It's just easier for the staff that way. A mother really has to be proactive herself to keep her baby from having a bottle. It shouldn't be this way.
Many of our mothers, when asked if they are going to breast or bottle feed, say they want to do both. That's understandable; they want to be able to have someone else feed the baby sometimes. But when a mother says she wants to both breast and bottle feed, she needs to be given some education in how to best accomplish that. She needs to be told to first get breast feeding well established by nursing exclusively for 2 or 4 or 6 weeks before introducing a bottle. If a bottle is given from the start along with breast feeding, too often the baby doesn't get going well on the breastfeeding and pretty soon the nursing is stopped. Unfortunately, though, when our nursing staff hear a mother wants to feed both ways, they just give a bottle. Educate people? That takes too much time.
Another thing that yanks my chain is when we have baby in the NICU whose mother wants to breast feed. They are supposed to be given a breast pump as soon as possible after delivery, yet when I go to see them the day after delivery to give an update on their baby, they almost invariably have not yet been given a breast pump. Fortunately, our NICU nursing staff has been very supportive of breast feeding and taken up some of the slack.
I have tried and tried to improve this. The nursing management tells me they are going to give more education about it; it seems to me that maybe they should be giving some disciplinary actions, because we have been talking about this so long. But the neonatologists do not run the well baby nursery in our hospital; the general pediatricians do, and too many of them in our hospital don't seem to care either. (That is by no means true of all general pediatricians.)
A study in Pediatrics a couple of years ago suggested that as much as 30% of the difference in infant mortality rates between whites and blacks could be abrogated if blacks breast fed as much as whites. When I used to work in a suburban hospital where most of the mothers were white, the nurses fiercely supported breast feeding. It was hard to get them to give a baby a bottle. Now, in this hospital where most mothers are black and the need for breast feeding greater, we can't get them to not give a baby a bottle. We've got a long way to go until there's racial equality in this country.