Barriers~
Even the word itself is foreboding.
Breastfeeding advocacy, lactivism, promotion are important to combat what is really a public health problem and should be a public health priority. ~Breastfeeding should simply be the norm.
“Today’s medical community recognizes what their
predecessors knew a century ago—that the
American propensity to shun human milk is
a public health problem and should
be exposed as such.
“Today’s medical community recognizes what their predecessors knew a century ago—that the American propensity to shun human milk is a public health problem and should be exposed as such.”
American Journal of Public Health | December 2003, Vol 93, No. 12
It should be SIMPLE~
It is one thing to talk or write a lot about breastfeeding advocacy and promotion… but WHAT does that really do to break down the hospital barriers. Even with some good ideas or some well-written plans & protocols(ie. as recommended by The Academy of Breastfeeding Medicine)…. I’m here to tell you, all that does very little to actually change an individual health-care professional’s actions. There is a critical void in the practice of appropriate breastfeeding management strategies and breastfeeding support from the health-care arena.
Working with barriers day-in and day-out can really open your eyes to what some of us, as lactation professionals or advocates, are dealing with on a daily basis. Many of us are ill-equipped to attempt to enforce evidence-based management guidelines. There must be better support from the management of each facility, organization or Health-System. It needs to start at the top…. to say we now have an evidence-based breastfeeding policy is NOT enough. I believe it starts with each individual being responsible and accountable for their own practice.
Action Taken~
I have written about how Breastfeeding was taught to me in nursing school and what our scary hospital policy looked like when I got started in this profession.
I have written an article published in a local parent magazine to coincide with 2007 World Breastfeeding Week supporting practices to keep breastfeeding SOFT and SIMPLE.
I have been working on so many different ways to try to keep it SIMPLE… trying to reduce barriers. I have written countless competencies at work while trying to gently re-educate my co-workers. I have developed several PowerPoint presentations, poster in-services, poster displays etc.. to try to help my fellow staff members AND physicians fully UNDERSTAND the superiority & importance of breastfeeding and the use of correct evidence-based management advice, assistance or feeding plans. I have learned to be gentle and patient in the process….one step at a time.
I want to keep it simple for the mother…I’ve tried to work on a simple bottom-line approach to eliminate any maternal barriers of feeling overwhelmed or confused with too much or conflicting information.
I don’t want mothers to think they have to “study” to pass the breastfeeding test….to “perform” correctly!
I encounter a variety of moms from vastly different backgrounds. There are huge differences in their own individual breastfeeding expectations and goals. We have a large breastfeeding/bottle feeding combination population at my facility. I’ve struggled to balance quality promotion and proper education to both mother’s AND the staff. I continue to to educate with acceptance of all individual mom’s actions. I have written about my approach and maternal guilt.
I wrote:
Never overestimate a mother’s desire to breastfeed her infant.
Never underestimate a mother’s desire to breastfeed her infant.
Listen to the mother; help her define her true desires and goals.
Support the mother, support the mother, and support the mother.
This is what I have learned and how some of my approaches and strategies have evolved over the last 20 years so that moms and staff alike will listen. I have written these same things at work…. They are hearing me now. I have to say that at least they are listening and some are talking the talk. How do I get them to walk the walk? Only a select few truly care to try. The following is some of what we still deal with…
Continued Problems …. Persistent Barriers ~
- Getting the baby skin to skin in the birthing or delivery room–very inconsistent
- Accomplishing the first breastfeeding in the delivery area (I even revised the nursing form to REQUIRE documentation of a reason WHY not breastfed….) Most common reasons..attempted, mom tired or mom declined. I have to wonder how often it’s really encouraged…and are they trying to help?
- Some staff still thinking they have to give that “test” feed of water
- Keeping a healthy baby in the nursery for hours under “observation” while nurse gets all adm paperwork done
- Giving handouts to mom but not talking to her, not listening, not helping
- Telling or directing mom firmly, like it’s an order… often with incorrect info- “you really need to feed that baby, wake him up every 2 hours no matter what”
- Inconsistent observation of latch and feeding progress (At least some are really good at this!!)
- Giving partial bits and pieces of correct info mixed with misinformation and not accompanied with actual assistance…… then reporting to me “I said just what you taught me, Melissa!” (A challange to gently correct)
- Keeping babies away from mother’s…esp at night so “she can sleep”
- Incorrect use of formula— given for so many many reasons that are most often because of all the problems above…… sometimes mom asks for formula…. but a little detective work, proper evaluation, assistance and education can possibly help avoid the formula
- Not understanding the unique characteristics and needs of the ‘near term’ infant.
- Being understaffed when busy… we always have a mom/baby dyad with some need for frequent breastfeeding evaluation and assistance when we are crazy busy….they often get lost in the shuffle
- Staff members not helping a mom because they tell them to wait for me… I am a staff nurse with multiple duties who happens to be a lactation professional.
- The discharge diaper bag from formula companies. ***SIGH***
- Doctors giving conflicting out-dated feeding management advice
- Doctors scheduling the first baby F/U visit for 2 weeks on first time breastfeeding moms
- Persistent Lack Of Management Support and Enforcement of Exsisting Evidence-Based Policies and Protocols which I feel leads to staff apathy
I have been patient, really patient. I have seen progress…real progress. I feel so frustrated to be still dealing with some of these barriers. It is overwhelming and exhausting. I haven’t been trying to do everything alone. I have “duplicated” myself several times. Some of those individuals are still here, others move on to other jobs, others become apathetic over time. Then we get new people who look at things differently with comments like… “This is what we did at __blank___ hospital..”
What do you suggest could help with the real change……the implementation process??
How do I get them to walk the walk???
Please comment and make a suggestion… Do you have a good one I haven’t tried?
TheFeministBreeder
StorkStories..... 