Monday, May 01, 2006

Nursing

I suspect most of you have heard of the many benefits of breast feeding, so I won't repeat those here. Suffice it to say that it's superiority to formula feeding is well established. Although breast feeding is natural, it frequently takes some instruction to get it going right, or perhaps I should say it can be easily subverted if not handled correctly from the beginning.

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.

35 Comments:

Anonymous Ariella said...

Interestingly, I recently read a law review article that advocates for breast milk donation by lactating mothers so that kids who are in the neonatal units can have access to breastmilk in the event their mothers are unable to breastfeed.

I think the issue you're writing about is a very important one, but I think it's important to look at the other side of the coin, also. I'm specifically referring here to the lopsided dichotomy that exists when a white woman is a "stay at home mom" and a black woman stays home "because she's on welfare" (please note I don't think those stereotypes are true; this is just what people seem to think).

I think it would be incredible for minority women to breastfeed more often, and not only for the health benefits of their children. In addition to those palpable benefits, there are also monetary benefits to breastfeeding (i.e., it's free!). This is probably some crazy liberal idea I'm about to spout (and entirely unimplementable, to boot!), but wouldn't it be nice if breastfeeding women could get some kind of subsidy in order for them to get adequate breastpumps and childcare so that they could continue breastfeeding even if they had to go back to work.

Sorry this is so long, but I feel very strongly about this issue. There's an even MORE interesting debate on whether HIV positive mothers should breastfeed because the statistics bear out that even if a child is breastfed by their HIV positive parent, less than 10% of those children will end up with HIV in the end (esp. if they're treated simultaneously with antiviral cocktails).

Oh and: I think nurses who don't push breastfeeding on ANY mother should be reprimanded by the hospital. Are they all working for Similac?

2:19 PM  
Anonymous Anonymous said...

One of the issues to consider for a neonate mom is that many times the delivery has been tramatic. They don't feel like pumping right after birth. i hear you. i agree. But, what i see more often is that they are offered but not ready yet.

Moms who have just had C-sections or a tramatic birth are miserable at best when by the beside of the baby.

Now, perhaps there needs to be more attention given in the birth center section.

3:57 PM  
Blogger Flea said...

Ariella,

You are living in a dream-world! You think giving away pumps and subsidizing childcare is going to promote breastfeeding? Sorry, I'm just a dumb pediatrician so you're gonna have to break that down for me.

best,

Flea

4:51 PM  
Blogger Amy Tuteur, MD said...

As an obstetrician, I find this to be a really tough issue. I have always enthusiastically promoted breastfeeding, and, of course, I have gotten a lot of positive response to that. However, I have also gotten a fair amount of negative response, too. It often goes something like this: "I don't want to hear about breastfeeding. You're just trying to make me feel guilty."

I am certainly in favor of postpartum nurses supporting breastfeeding, but I suspect that the key to breastfeeding is commitment. If you are determined to breastfeed then you will be able to do it. If you don't really want to do it, you will find every excuse in the book explaining why you HAD to quit.

If I had a nickel for every time I've heard "I didn't have enough milk",(which is almost never true) I'd be rich indeed.

6:01 PM  
Blogger Kristina said...

I love this post, I love to see physicians value breastfeeding!

Could La Leche League get involved somehow?

7:31 PM  
Anonymous Anonymous said...

Tell me about it!
As a Doula and lactation educator I see it all the time. And I'm the one that has to pick up the pieces and hand mom the tissues grrr!

We need to adress this issue of "guilt" too.
The fact is artificial infant milk is substandard and has lasting detrimental effects on infant (and mom's) health. So yes. moms who choose to feed AIM are choosing to raise the risk to thier children. just like those that don't put their kids in car seats, or smoke during pregnancy or around their babies etc... Of course there are a few moms that have been sexually abused or what not that cannot stomach nursing (or pumping) for them that would be too much to ask and unhealthier probably in the long run. I get that.

Have you read How Birth Practices Affect Breastfeeding? We need to get the OB's and L&D nurses/PP nurses on board here. But the AAP itself can't get it together. (seen the recent SIDS/Pacifier quidelines?/ AAP LA dinner sponsored by formula co...)

For us in the trenches,,,, take advantage of the new Prolacta company pumps. A great pump for free if you donate as little as an ounce!
My hope is that Prolacta and it's insane prices will help raise the value of human breastmilk from a biz perspective.

7:51 PM  
Anonymous FRECTIS said...

Breastfeeding as the norm is another reason I appreciate my role as midwife. I can recall once in 7 years I have had a client decline to breastfeed and incidentally that experience was jaded by just the support she received in the hospital following her first birth and as Neonatal Doc complains of in his original message.

8:29 PM  
Blogger Sarabeth said...

I can honestly say that any amount of support helps a mom breastfeed. I wasn't one of the moms that was determined to breastfeed, but I was willing to give it a chance. The nurses listened to me, helped me figure out the latching on and better my holding techniques. The best intervention was a home visit after I brought the baby home. That nurse was the one who realized that a nipple shield was needed. If I had not had that support, I wouldn't have continued with the breastfeeding.

Getting those nurses to support the moms would be the best course of action.

10:04 PM  
Blogger Clark Bartram said...

To compare giving a child formula to not using a carseat is ridiculous. Shame on you anonymous. There are a lot of things to see in this world outside of the tunnel.

Also, and this is to everybody, what evidence is there that pacifier use effects a child's ability to breast feed effectively. Furthermore, in my experience the hispanic community breast feeds longer than any other and typically both breast and bottle feed from the beginning. How is this reconciled with the militant view of many lactation consultants that any bottle feeding or pacifier use ruins breastfeeding.

Breastfeeding is hands down the best thing for infants and it should be supported appropriately. But using scare tactics based on flimsy evidence and emotion is inappropriate. I don't have a problem with pacifiers they make for less stressed parents. Less stressed parents take better care of their children.

11:08 PM  
Blogger Dream Mom said...

It's great to have a physician supporting breastfeeding!

I had Dear Son in a suburban hospital 14 years ago, wanted to breastfeed, and made that very clear. I started breastfeeding him shortly after birth (don't exactly know when) and at some time thereafter he was sent to another hospital. I had a c-section and they gave me Tylenol with codeine in it so I can't say they were very used to supporting breast fed babies when they give the mother that! I ended up going to a hospital in the inner city later that week to be with Dear Son (they refused to transport me WITH Dear Son when they transferred him medically!)and was breastfeeding him, along with some other Mom's in the NICU. I don't remember much of a difference between the city and suburban hospitals in terms of supporting breast feeding, but I will take your word for it.

I do remember that society didn't support it much. There never seemed to be a place to breast feed your baby in a restaurant (other than in the bathroom) that most people were comfortable with. I breast fed for about three months, then gave it up.

I know that today, when a young woman is pregnant, and I ask her if she is going to breast feed, the answer is almost always no. I have a hard time with this. Young women today seem less in touch with their sexuality and don't seem to want to do this. Their bodies were created for this! And yet, they think if they give them all of the material things, that somehow, that makes them a good mother. Interesting.

P.S. Hope you are having a good conference. Have a safe trip home.

12:30 AM  
Blogger Kelly said...

Clark, you may be right, but when it comes to scare tactics, some peds (probably not you, Flea) have the method down pat.

Haven't you heard: "Well, Mrs. Smith, your 2 week old just isn't gaining enough (VERY debatable in MANY instances), so you need to suppliment to help her start gaining"?

HOGWASH! Why don't they tell the mothers that they need to up the b'feeds? Why don't they encourage them to call La Leche, so that they can make sure the babe's latching on properly? Why do they make the babe come in 4-6 times a MONTH in order to weigh and reweigh the poor thing, all the while giving the mom the idea that she's just "not adequate" when it comes to feeding the child?

NO, new mothers especially are inundated with negative feedback about the efficacy of their b'feeding pursuits. THAT is a tremendous scare tactic---and I see it work MUCH of the time.

And how many mom's have I seen go into labor with the idea to b'feed, only to come out of the hospital bound up and carrying bottles?

More times than I can count. Neonatal Doc is right---it's a problem. At least in AL. I don't know about where everyone else lives, but I suspect we're not the only ones.....pacifiers and bottles don't scare nothing, compared to docs insinuating that a mom doesn't have enough milk. Where's the evidence for that???

12:40 AM  
Anonymous Anonymous said...

Who's in a tunnel?

In the lactation Educators, IBCLC's are trying to change how American's (here)view breastfeeding. I now look at this differently, instead of BF being "superior" or better or best. It's normal. The other is an imitation, and a lesser one as everyone agrees.
That sometimes draws ire but it is true.

Many of those hispanic moms still have relatives who breastfeed around them to support them- they are still a breastfeeding culture.
There is so much wrong information about breastfeeding I can see why Amy is peppered with such comments. I ask those moms what they think about breastfeeding. Carefully worded with time to listen to the answer, all sorts of insane old wives tales and medical inaccuracies come out.
I'm talking about full term babies here:
There is much evidence that
Pacifiers reduce the duration of breastfeeding. I'm sure you're hospitals IBCLC can provide you with the individual citations.
but this could be a start, with references
http://www.bfmed.org/ace-files/protocol/mhpolicy_ABM.pdf
http://www.breastfeedingbasics.org/cgi-bin/deliver.cgi/content/Normal/pacifiers.html
http://www.who.int/child-adolescent-health/publications/NUTRITION/WHO_CHD_98.9.htm

1:03 AM  
Blogger Amy Tuteur, MD said...

Of course breast feeding is superior to bottle feeding and most women are very much aware of that. The majority of women leave the hospital claiming that they are going to breastfeed, but very few are doing so a month later. Interestingly, almost everyone who is breastfeeding at 1 month is still doing so at 6 months.

The problem is in large part cultural. The culture that is the problem (in my opinion) is the American culture, which values self over others and disdains sacrifice.

Breastfeeding requires commitment because it requires sacrifice. It often hurts at the beginning, and it can be difficult to learn. It takes time and it takes energy. It requires mothers to live according to the baby's schedule and not their own. Additionally, most mothers of infants work and pumping is an incredible drag.

That's why (to my mind), I got complaints about making women feel guilty. No one ever tried to argue that bottle feeding was equivalent to breastfeeding. Everyone knows it isn't. In this society, that's not enough of a reason to sacrifice time, energy and freedom to do what you want when you want to do. How do we change that attitude?

7:00 AM  
Blogger La Lubu said...

In this society, that's not enough of a reason to sacrifice time, energy and freedom to do what you want when you want to do. How do we change that attitude?

Ahh, but Doc, in areas of the U.S. where breastfeeding is uncommon (like here in the Midwest), it's breastfeeding that is seen as the selfish, all-about-mom act! No kidding! I was one of those mothers determined to breastfeed---and yes, it was demoralizing to pump and pump, and just get a little trickle in the bottom of the cups (so, I upped the frequency of my pumping, and turned down the volume on the damn pump, which was shredding my nipples, and voila!--the milk came in! But this took about a month, and it's not surprising to me that many NICU moms do give it up before reaching that point---what with all the other stressful events going on).

But back to the point---there is a tendency around here to think of breastfeeding as something only "crunchy granola" moms do. And there are others who think women should never breastfeed in public (I had developed quite the "c'mon---fuck with me!" glare, given in response to people who would look at me like I was the most revolting person in existance for feeding my child---and yeah, I was discreet, and yeah, there was a helluva lot less breast shown while I was breastfeeding than say, on the average tank-top wearer). I've heard women who work in offices complain about treatment by coworkers---that by having a private place to pump, they are being given "special treatment" and must think they're "all that". There's an overarching attitude that it's breastfeeding moms that want the whole world to revolve around them, and if you are determined to breastfeed, you have to steel yourself against these hostile attitudes. There's not much cultural support.

For myself, I found that support online, in the form of the old "hipMama" boards (which unfortunately, no longer exist---that place was a godsend, and let me know I wasn't alone!). I also had support from female relatives who had breastfed, but again, that support was at a distance (I don't live near them!). On a daily basis, it was me against the world---on any given day, about 15-20% of the folks are downright hostile, and another 70-75% think you're really weird.

It probably helped that I was taking my pump to the construction site---I wasn't hassled about getting a "special place" to pump. On the other hand, I was questioned a lot on why I'd want to "go through all that trouble." Which was weird to me; I think of the bottle as being more of a hassle than pumping. I was placed in the "educator" role; the benefits of breastfeeding haven't really been publicized as much as people in the medical field assume. And breastfeeding is far from normalized in U.S. culture at large.

Seems like breasts are only to be used for advertising, and that's a whole 'nother post altogether!

7:59 AM  
Blogger La Lubu said...

oh, and if you visit "Alas, A Blog", you can find several breastfeeding threads (use the search engine there). One of the most memorable to me is the one where breastfeeding was compared to public defecation. That attitude is still more present than not in most areas of the U.S., and another reason why breastfeeding moms are viewed as the selfish ones---that we selfishly want to expose the innocent public to our disgusting, filthy, just-like-yanking-down-your-pants-and-taking-a-hot-steaming-shit-on-the-sidewalk, shameful act of feeding our child from our own icky, non-corporate-approved bodies.

8:06 AM  
Blogger Cherrie said...

la Lubu, you have it right there! I live in Oregon, where being 'crunchy granola' is a source of pride to many. Yet we still run into the amazing attitude that nursing is equal to public defication. (thankfully not often) Check out a local blog that started when a Mother was asked to leave, rather than breastfeed in a grocery store. http://reluctantlactivist.blogspot.com/

11:04 AM  
Blogger Clark Bartram said...

Anti-breastfeeding such as those mentioned in these comments are beyond absurd. They anger me to no end. It's funny that there are such differet attitudes from region to region. In Nashville, I have never come across feelings like this. While there may not be as many moms feeding their child in public as in California but I have seen several, at public events with lots of people, and did not notice any bad looks or hear any snide comments.

I work with many pediatricians at all levels of training, and many medical students, and I have never encountered one who acts in the ways mentioned in some of these comments. I have heard the vast majority be very supportive of breastfeeding. Just yesterday I heard a student say to a mother of a child with jaundice that the baby didn't need formula just more frequent breast feeds. I told her she was exactly right.

I just think that there are too many variables at play to warrant the extremely harsh anti-pacifier views that I come across quite often. I don't recommend their use but I would not, at least not at this point, specifically counsel to not use them if a parent so chooses. Anecdotally, my daughter was bottle fed in the nursery, used a pacifier from day one, and breast fed like a champ except for the occasional bottle of pumped milk so daddy could have a turn to bond. That's not evidence, just an anecdote.

11:29 AM  
Anonymous Leah said...

Just a new mom (4 mo old) here and I need to chime in with my thoughts. I'm 33 years old and growing up, despite having TONS of babies in the extended family...there wasn't a lot of breastfeeding going on during the 70's. My mother bf'd me but she was largely unaware of the finer points of breastfeeding. I DID'NT KNOW how to feed my baby! Sure, I had OB and nursery nurses helping me correct my baby's really poor latch (he tooks weeks to get it)...but when his blood sugar went wonky I was handed a NG tube, syringe and a bottle of formula. So my husband and I finger fed him 30 ccs and I kept putting him to the breast. I kept this up for weeks. He lost weight - a lot. The Ped (bless her) was very helpful, but I too heard "supplement" from nurses and the Ped. Finally, we turned to BFing, pumping down both sides afterwards and then fingerfeeding that too. I was an exhausted emotional mess and all too often my poor husband stumbled from bed in the middle of the night to console both me and my son while I sobbed and wailed "I JUST WANT TO FEED MY BABY!"

A home health nurse called and sent me to another nurse and lactation consultant. They were wonderful! They actually didn't do much but be supportive and to pooh-pooh what the PED & nurses had said. They reassured me that Boy would get it if I just kept up with it.

I was willing to give BFing a try for at least a little bit and I'm SO glad I stayed with it. Caring for and breastfeeding my newborn really reminded me that we're mammals and nursing and cuddling are basic and important needs. I have a roly-poly, active, giggly little guy to show for it. And he's a champion nurser.

I pump at work and he grudgingly accepts bottles at his grandma's and that's been a hassle BUT I can't see giving him anything else but EBM.

And I'm open with my four, much, much younger sisters and my 14 yo daughter with I nurse him. I tell them about let downs, fore/hind milk, one side leaking, latching and I don't cover my breasts up to nurse when it's just us girls in the house. They're gonna know how to feed their babies!

Recently, a co-worker's daughter had a baby at 33 weeks. I urged her to push BFing her grandson...even offered my own stash. Co-worker came back to thank me as telling her daughter about my trials and tribs was encouraging; that it can be done and it won't always be so difficult.

I never thought I be a BFing fan yet I'm a strong advocate now.

1:56 PM  
Blogger sailorman said...

I expect docs to be a bit cynical.

Bit I hate it--as does my wife--when the la leche folks start their own personal brand of overwrought pontification.

Yes, BF is good. That's why we did it. But of the various things that affect your child, if it the most important? Can you even promise me it's in the top 10 for every child? And if not, how on earth can you make a pronouncement like "everyone should BF"? It's simply ridiculous.

3:01 PM  
Anonymous Anonymous said...

Whatever happened to having informed parents making their OWN decisions?

BF vs. formula feeding is a personal decision that can affect one's time, money, workday continuity, babycare sharing among caregivers (and thus sleep schedule), other children, body issues, stress levels etc. I wouldn't say that BF is necessarily the right decision for all families.

Personally, I am doing both BF and formula feeding at 6 months postparum. It is what is right for my family.

10:26 PM  
Blogger Awesome Mom said...

"BF vs. formula feeding is a personal decision that can affect one's time, money, workday continuity, babycare sharing among caregivers (and thus sleep schedule), other children, body issues, stress levels etc. I wouldn't say that BF is necessarily the right decision for all families"

I very much have to agree with this statement. My first son was born with a heart defect and developed feeding issues due to his long stay in the hopital. Needless to say breastfeeding did not work but I was able to stumble into a good pumping schedule and establish a decent supply for him. I kept at it becuase of his medical issues, I wanted to do everything that I could to help him be strong and make it through his surgeries.

#2 comes along and ends up getting his first bottle of formula hours after he was born while I was struggling to recover from the medications given to me after my c-section. He tongue was also unable to move into a correct latching position becuase it was tied to the bottom of his mouth. None of the nurses noticed this and I was in severe pain from his latch. It was not cliped until days later and by then he was used to the bottles that were pushed on me to top him off after "nursing" (it was more like nipple mauling). Some kids may be able to go from bottle to breast with no problem but not my son, he started screaming at the sight of my breast.

The nurses knew that I wanted to nurse badly and yet they kept pushing the formula on me and making it seem like it was no big deal. I was pumping too, but I knew from my previous expirence that there was no way that I could establish a supply while taking care of my two kids. Now I could wallow in guilt and beat myself up, feeling bad that I am "abusing" my son by not feeding him breastmilk or I could get on with loving and taking care of my children. I choose not to feel bad about my choice and I am glad that my peditrican is not trying to make me feel like I failed my son because he is not getting breast milk.

12:35 AM  
Blogger NeoNurseChic said...

I'm a neonatal nurse in a major city hospital, and breastfeeding is always an interesting issue. I would never force it on a mother that didn't want to breastfeed as there are a variety of reasons why she may choose not to, but I definitely do my best to support those who want to breastfeed. Our unit was recently renovated, and we have a breastfeeding lounge now for mothers with several large comfy chairs, tv, a water cooler, screens, educational literature, etc. If a baby on our unit is medically stable enough, a mother can take the baby to the breastfeeding room if she wishes to have more privacy.

My first tactic is to talk to new mothers, and more specifically, YOUNG mothers about the reality of breastfeeding. I was walking a mother back up to her floor the other day, and we talked about the differences between tv/movies and reality when it comes to breastfeeding. Milk takes time to come in. You must pump every 2-4 hours, even at night. Drink plenty of fluids. Babies do not necessarily just "get it" when it comes to breastfeeding. The last statement seems to be the source of the greatest amount of frustration between new moms and their infants. Lots of times, a new mother's mother will tell her stories about how easy it was to breastfeed, etc - and then the new mother is distraught when the infant cries at the breast or can't seem to latch on, etc. It definitely takes more work than pop culture would have us believe!

From the nursing side of things (and by nursing, I mean RN nursing... *wink*), the biggest obstacle for me and others in my situation to overcome is the fact that we're trying to teach breastfeeding and we've never done it. I understand the concepts behind "football hold" and all the other positions, techniques, etc - but do I really know what it feels like? No... It's not easy to teach something so personal if you have absolutely no personal experience with it! However, I try my best and consult more seasoned nurses (and nurses who have breastfed!) when I run into difficulties in teaching. Fortunately, I did work as an extern in post-partum for awhile during school, and my maternal-child rotation was at a suburban hospital where almost every mother breastfed. I had the opportunity to shadow a lactation consultant for a day. My goal is to help the mother feel comfortable, no matter what her choice.

Then there's the whole issue of breastfeeding a preemie, which is something I have a particular interest in. I've worked with mothers who had infants at, for example, 25 weeks and want to breastfeed. These infants have spent weeks on various types of ventilators (and we won't even get into some of the mechanical problems to the mouth that ET tubes can cause over time!). Sometimes, the infant has had to switch between breast milk and various other formulas due to caloric needs. However, I feel that if a mother wants to breastfeed her preemie, every effort should be made to help her do so! Chances are, the preemie isn't going to become a champion breastfeeder while in the NICU because it usually takes time, but there are a variety of resources available and lactation consultants who also specialize in helping mothers of premature infants who are able to do home visits. I do think it's important to initiate skin-to-skin contact between parent and neonate as soon as the infant can tolerate it - this really is the precursor to breastfeeding and has such a vast variety of positive physiologic and psychologic effects on both parent and neonate.

Here are a few links to resources I've personally relied on when trying to educate myself so that I can better help mothers who wish to breastfeed their premature infants. Hope they may be of some help to those of you who also work with this population, too!
http://www.lalecheleague.org/NB/NBpremature.html
http://www.preemieparenting.com/momscorner/bf/pp126.htm
http://www.preemieparenting.com/momscorner/breastfeeding.htm
http://www.preemie-l.org/bfaq.html

Take care,
Carrie (NeoNurseChic) :)

12:48 AM  
Blogger Ex Utero said...

Hi Neonatal Doc,

Sorry I missed you at the PAS meeting. This is a great discussion line. I pretty much agree with what NeoDoc and Dr Tuteur have said. I don't necessarily disagree with the ever skeptical Dr Bactram. And of course, my lovely wife is a three time expert on the topic. There's not much I can add, except this:

Breast milk also has a very important role for premies. Even though they are often too young to breast feed, breast milk has been repeatedly and convincingly proven to prevent gut disease and death if used instead of formula as the primary form of enteral nourishment in extremely premature infants. So L & D nurses should receive puntative action when they don't pass out those pumps to mothers of premature babies. It is a matter of life and death. Even a few weeks worth of milk may be enough to avoid a lethal complication in their infant.

10:34 AM  
Blogger Ex Utero said...

I missed Neonursechic's post. I just wanted to say that was a great post too.

10:37 AM  
Blogger Janae said...

It wasn't until I breastfed both of my kids, did I realize just how dedicated my mom was for breastfeeding my preemie, baby sister in 1981. Shortly after my sister's birth she was taken to Children's in Denver since the NICU in Montana didn't have the technology to care for my sister. That first week my mom who was still in the hospital because of an infection, had to get her milk supply up without the benefits of a baby and with a pump. Then, during the months that my sister was in the hospital, my mom pumped every couple of hours, froze the milk, and would then drive it 2.5 hours to the hospital every other week. I'm sure have a supportive nursing staff encouraged my mom to keep it up.

Without any question breastfeeding is best. Nurses should be educated to help the mothers. Bottles and pacifiers shouldn't be offered without the parents' consent. We had to deal with nipple confusion after the nurse gave my daughter a nipple to suck on during the PKU. It was a horrible week trying to get that sorted out. I'm grateful that I have a supportive pediatrician and pediatric allergist who both encouraged extended breastfeeding since both of my children have dairy allergies. Extended breastfeeding is bit weird for California even. My children nursed for 30 months and 27 months, and it was a great experience for our family.

12:19 PM  
Blogger NeoNurseChic said...

Just to clarify - nurses ARE educated about breastfeeding - far moreso than the general public. Nurses are, for the most part, some of the very best advocates for breastfeeding, especially when it comes to preemies. Just because there are some out there who are falling short of expectations doesn't make the whole bunch bad.

With respect to pacifiers - during painful procedures such as heelsticks, circumcisions, IVs and other events, many hospitals use a pacifier dipped in sucrose. Sucking on this allows the infant to release its own natural endorphins to help relieve pain. It isn't just used to "keep the baby quiet" as some mayh think. It truly is used with the intent of relieving pain. That being said, the sucrose can be dropped on the front of the infant's tongue if the baby is unable to suck or the parents are completely against the pacifier. However, sucking does also aid in relieving discomfort for those that are able.

Also, as a NICU nurse, I can understand parents who don't want their child to have a pacifier, but for infants who are there for several weeks and endure countless painful procedures (let's face it - every heelstick is painful to them as well as a variety of other things...), the pacifier is a way for them to help self-soothe. For many families, the reality is that they cannot be at the bedside at all times, even when they want to be. The pacifier is a way to offer the infant comfort during times when it may be distressed, especially during prolonged hospitalizations.

We also use the pacifier to help babies learn to feed. When preparing to feed a baby either by breast or bottle that has been NG feeding for some time, we offer the pacifier while the NG feed is going in to help the baby learn to suck. I have yet to see an infant who was using a pacifier for quite some time have a problem when then attempting to breastfeed.

I would (and have) always respect parents' wishes if they don't want their child to have a pacifier. But, there's more to the story than nurses just offering a baby a pacifier to keep him/her quiet, with blatent disregard to breastfeeding mothers, etc. If a parent doesn't want their child to have a pacifier, we place a sign at the bedside so that someone doesn't give the baby one by accident. Every effort is made to respect parents' wishes while their baby is in the NICU, at least at our hospital, as we know that it truly is a very stressful and difficult experience for parents.

1:18 PM  
Blogger neon88 said...

I believe that pediatricians, neonatolgists, and everyone caring for infants should agressively and actively promote breastfeeding. If we are passive then BF rates decline. There are too many forces - societal, economic (WIC gives free formula) - NOT to BF. And to promote BF is costly. The hospital needs to pay the salaries of Lactation Consultants and they do not generate any income. The LC's keep an eye on all staff - nurses , residents and pediatricians. They do follow up and provide a resource after discharge from the newborn nursery and NICU. And I am not shy about it. I tell new NICU moms before or at delivery that they need to provide BM if they are able. At least while the infant is starting feeds but not necessarily after discharge if they are resistant. Education needs to start in the OB's office well before delivery. All this can be expensive. All hospitals have pediatric departments and nursery committes, don't they? That's where it needs to start. My 2 cents.
neon88

3:35 PM  
Blogger neonataldoc said...

Thanks, everyone. After reading all these comments, I've, um, sort of forgotten what the original post was about.
Neonursechic, if you think you have trouble explaining breast feeding because you've never done it before, imagine the problems we male docs can have....
And I agree with ex utero and neon88. For premies, supplying breast milk can be a life and death thing and needs all the support possible.

4:02 PM  
Blogger NeoNurseChic said...

But as a male doc...are you teaching it? ;) Having to explain is one thing - but having to actively stand there and teach it...well - I'm still not entirely comfortable with it, but I try to learn new tips from every nurse and lactation consultant I've observed teaching. Whenever I pull a nurse in to help me teach breastfeeding, I always remain with the patient too. I'm learning as well so I can help my other patients!

Now the one or two male nurses on our unit, on the other hand - not sure what they do when they need to teach a mom to breastfeed. They probably ask one of us women-folk... :)

8:12 PM  
Anonymous CG said...

Thank you thank you for saying the things I think every day I go to work. I am a post partum nurse (formerly an NICU nurse) and I see supplimentation far too often. Nurses at a hosp I used to work at would actually give babies bottles and never tell the mothers, just to keep the kid quiet "so the mom could sleep". I have seen nurses hear a mom needs help breastfeeding and will walk in the room with a bottle in hand, ready to give the kid a bottle before even trying to help. It seems no amount of education can get through to some of these nurses. I know there are good ones out there, and hopefully soon, the good will outnumber the bad.

1:15 AM  
Blogger That Girl said...

Ive finally got over my mad about this whole issue to focus on what bothers me.

My son had a heart defect. He could not breastfeed. Most likely, he would never breastfeed.

For me, when he came home, it came down to this - I could pump for 1/2 hour every 2 hours and spend less time with my ever-crying child, or I could formula-feed and hold him whenever he cried.

I would like to suggest this - if you want to see an increase in BF moms, start with language.

Stop equating bottle-feeding with formula-feeding. Otherwise, moms who would pump for their kids will be even more likely to stop pumping - after all, if Formula feeding=Satan and bottle feeding=formula feeding then why bother to pump?

You do a disservice to pumping moms every time you use this language.

8:31 AM  
Anonymous Anonymous said...

Ariella, WIC gives free breastpumps, and extra food for nursing mothers.

And my personal experience certainly corroborates the good nurse/bad nurse phenomenom. My daughter had two nurses, one who wouldn't call me when she needed to eat, the other who straddled me with a jury rigged SNS to try and get her to latch.

12:45 AM  
Anonymous Anonymous said...

{insert wild applause here)

By the way, breastfeeding rates amoung women who have midwifery care for their births are higher than those who see an OB. Especially if they have a homebirth.

11:23 AM  
Anonymous Anonymous said...

I'm sorry, but as a lactation consultant, I can say that few nurses really are all that well trained in breastfeeding. If I had a dime for every piece of lousy advice given by nurses I had to correct with a client, I would be a rich woman indeed.

And pacifiers do have a negative impact on breastfeeding. The action of nursing at a breast is much different than sucking on an artificial nipple or pacifier. It is much easier to suck on a paci than on a breast and babies learn poor sucking technique, and spend less time at the breast. In turn they don't drain the breast as effectively and the breast makes less milk.

Read here http://www.lalecheleague.org/NB/NBNovDec95p172.html and here http://www.kellymom.com/bf/start/concerns/pacifier.html

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2:04 AM  

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