Posts tagged ‘lactation’

Aug 12

Initial Low Milk Supply: A Breastfeeding Story – Case Study

The History:

One typical busy morning coming on shift, one of the couplets I received report on was a 3 day post-op C/S mom and baby who were scheduled for discharge this same morning. She had been a long 3 or 4 day failed attempt to induce a vaginal delivery for fetal macrosomia (big baby) at 40 5/7 weeks before the C/S. Lots of IV’s, lots of Pitocin… all before the birth.

Her baby weighed 10 lbs 4 oz at birth. We got in report that his glucose sticks had all been over 60 initially so they were stopped early on. His exams were normal. His total bilirubin this AM was 11.3 at over 72 hours of age. He was “breastfeeding only” (*sigh*from the nurse giving me report). She then expressed a concern that he was down 10% from birth weight weighing 9 lbs 4.5 oz today. When I asked her about the feedings, she said he’s been nursing beautifully all the time but nobody’s had time to stay in the room and watch him feed. I asked about the output and she reported he’s been voiding, the last stool was a couple shifts ago. Then the nurse added “We told her you were here today, Melissa, she has a lot of questions for you. ”

I was able to juggle some things around, have staff cover some of my other responsibilities temporarily to make this a priority. Since I am a general staff nurse, there are often more pressing situations. Fortunately, today I was able to manage the time to see her right away.

I went in and introduced myself to Meg*, Brad* and their son Mikey* (*names changed). They had indeed been waiting for me. Breakfast was underway and Mikey was asleep in his crib. I asked her a few general questions in a relaxed manner about breastfeeding first to try to establish some background: Mikey’s energy level, drinking pattern, feeding frequency, and diaper checks. It is important to gather information and observe the feeding in the process of a full evaluation to determine adequacy of feedings. The information I got was concerning. He spends a lot of time at the breast, falls asleep quickly, not very energetic with every feed, not much change in her breasts at this point and no stool since yesterday. I did not tell her I was concerned at this point, nor did I mention the weight yet. I asked if I could check him now and if it would be alright if I observed the next feeding.. We determined that should be with in the next hour. I talked about feeding cues and asked her to get me if Mikey seemed ready to eat before I came back. His vital signs were normal, jaundice not too significant for his age, diaper contained a small amt concentrated urine, and Mikey went immediately back to sleep. I felt he was OK at the moment and needed to go do a few other things with other patients.

At this point I am feeling pulled in different directions because Meg’s situation could easily take hours of my already busy morning. I am upset that this has possibly been going on the last 3 days and hasn’t been evaluated properly, now it’s day of discharge! How do you do the proper evaluation, give the needed gentle support, make possible feeding plan arrangements in fragments of time? This is what I am trying to change…in my opinion, we the hospital, helped contribute to this situation of possible inadequate feeding and supply… we need to help her! I talk to the charge nurse and it’s cleared to keep my coverage the rest of the morning.. good thing L&D was quiet!

Mikey’s doctor comes in and thankfully it is a partner who is very pro breastfeeding and open minded to try options a mom may choose. I gave her report on his physical status, VS, weight, earlier glucoses, and the Bilirubin. I summed up my plan to evaluate feeding quality but suspected he has been ineffective at the breast & milk supply/production may be delayed. I added that I was going to check his glucose if he had low energy level, and encourage pumping or expression for the mom and get that milk into the baby as well as encouraging her to stay for a few feedings to work with me. The MD was happy with these ideas but requested he be supplemented (complemented) with formula at all feedings now until his weight came up. She supports the theory (as I do) that the birth weight can be somewhat inflated with all the pre-birth IV fluids mom rec’d and some of what he lost may be fluid. The MD said that if things were better by afternoon, he could go home. She went out to examine him at mom’s bedside.

I went in for my feeding observation a little while later. Meg now knows his total weight loss and feels very upset. I give her a lot of support and agree with the doctor that some of that could be fluid. I then find out..Meg is an RN here at my hospital on another floor! It had not come up in conversation! So now I know she is even more worried because we nurses always think the worst! I do my best to think simple and encourage her to do the same… it is very early and we can turn this around quickly with a strong approach.

My Evaluation:

Good independent maternal positioning, holding and offering of the breast
Nipples erectile, breast tissue soft, pliable, small amts colostrum expressed–> mom reports her breasts were “swollen first 2 days”
Latch fairly adequate but not optimal-> improved greatly with football position and instruction on asymmetrical latch approach (I’d like to say here that I have a” if it’s not broke don’t fix it” attitude. I don’t correct a latch for a mom who has no pain and good milk transfer, we talk about it in case it may come up for though)
Mikey very sleepy at breast, difficult to maintain latch, no milk transfer observed–>breast massage during feed tried without improvement
Due to continued low energy level (suspected caloric deprived state causing sleepy ineffective feeding behaviors) a bedside glucose was checked. Result was 49.
Diaper dry–> the previous concentrated void was only his 2nd in last 24 hrs No stool last 20 hrs and that one was dark.

The mother’s feeding plan:

Many options and teaching points discussed with Meg including the need to boost caloric intake –>starting right now, methods to get her milk or formula into the baby avoiding bottles, a vigorous pumping plan to augment breast stimulation, alternate breast massage, how to observe for swallowing and milk transfer at the breast etc.. I also discussed with her how in my experience, sometimes it is like magic once the baby regains up to birth weight… they just take off!

She chose:

Cup feed formula now while she pumped –>Mikey would not cup feed so we used a syringe, 18 cc, repeat glucose 62
Pumping round the clock, double pumping –> Meg rented a hospital grade pump for home use
Keep close eye on feeding cues, put Mikey to breast in football w/ latch process discussed earlier
Closely watch signs for milk transfer, correct feeding activity while at breast, sucking rythym 1 or 2 sucks /swallow ( Brad was very involved in this process of learning the observation techniques)
Use breast massage/ compression while baby @ breast through feed to increase milk transfer
Goal of min 8 effective feeds in 24 hr..wanted to try for 10 –>agreed to feed expressed milk or formula 1/2 to 1 oz after each feed first 24 hrs until re-weighed next day
Have as 1st 24 hr goal: to see 3 -4 increasingly wet/clearer diapers and at least 2-3 good sized stools
Return to MD for F/U bili and wgt check next day
Call IBCLC for eval in next few days if weight not adequate and not independently breastfeeding/output within safe parameters for age

The follow up reports:

DAY 1 (In hospital) Mikey fed 3 more times in the hospital at 2 hour intervals. Each time he had about 15 to 20 cc of formula by syringe. Each feed was improved but not adequate quality of milk transfer. Meg pumped 4 times before discharge not getting much first 3 times but 4th time she got almost 10 cc! Mikey had 1 conc wet diaper and a med sized dark stool. We re-weighed Mikey prior to discharge and he was 9 lbs 5.5 oz. Meg left the hospital late that afternoon while I had been called to a STAT C/S. She was determined to go home after all the time she had been there! I called her later and she was on target with her plan.
DAY 2 (first 24 hrs home) Seen at Peds office. (reported to me from MD) Bilirubin 10.6, weight–> 9 lbs 7.5 oz! Baby more energetic, better quality feeds reported. Meg still power pumping, now getting 1 -2 oz per pumping and giving to baby with syringe and only used formula occassionally if no breastmilk. Had 3 wet and 2 stools since discharge, stools lighter in color. MD arranged F/U weight visit for 2 days, will arrange IBCLC if no strong improvement before 2 more days
AGE 6 1/2 days Seen at Peds office. (reported to me from MD) Weight–> 9 lbs 11 oz !!! Meg having fairly same routine but not always pumping if she feels Mikey had good milk transfer. She reported increased breast fullness, 6 wetter, lighter urines and 4 mostly yellow stools in each of the previous 24 hr periods.
AGE 2 weeks I don’t have MD office reports but Meg called me to tell me Mikey was 1o lbs 7 oz at his 2 week check up and nursing a lot better EVERY feeding!! She was still attached to her pump, gradually decreasing the sessions, just felt safer to keep going with that. If she gets milk she was still giving it to him. This was her security blanket and she was happy doing it. She was very proud of herself and crying happy tears! 🙂

Meg’s case was a beautiful example of HOW a situation can turn around quickly. An individual mother’s determination coupled with a productive plan can produce these results. All situations are different.

Every mother and baby deserve our best!

Aug 7

10 Comments

A Formula Rep turned my Maternity Leave Injury into a new career as an IBCLC? Really?

My contribution to this fabulous Carnival of Maternity Leave , is a story of how during my maternity leave, an injury occurred leading to a career change specializing in Lactation… ! It starts with the birth of my third and last baby…… A girl….. (after 2 boys) was also born by C-Section.. a first for me.

Well– first, let me back up a few years… I’ve had a potpourri of maternity leaves. I have been a Maternity/L&D/Nursery since the mid 70’s. I always worked full time and had never entertained thoughts of staying home with my children once they were born because the USA didn’t assist in providing any type of viable option for families who rely on two incomes or single moms with one income. Prior to FMLA, maternity leave was pretty much up to the employer as far as I understand it. The USA doesn’t offer any paid leave (unless offered by individual employer). For my first baby in 1979- I took 7 .5 weeks and went to a weekend 12 hr shift job which at least allowed me 5 days each week with him.

When my next baby was born in 1985, I worked at the same facility I am now. We were allowed to save up ALL Vacation, Holiday, and Sick time to be used collectively with your hospital allowed 12 weeks off. I was able to have 5 1/2 months total, partially paid time to be with my new baby. Since he had to have surgery at 3 months, I needed that time and could have used more.. My leave was actually supposed to end on Christmas day (YUK).. however, they graciously allowed me to come back on the 26th… also his first day in Day Care. 😦

So back to my third baby in 1988~I had had a C/S — (that’s another story). I had to be hospitalized for 10 days after the surgery with a whopping infection. A fresh incision and chills with a temp of 103.8 do not go well together! [Nurse Curse] Anyway, I made it thru–> healed and returned to life as a mother of three. The same type of collective accumulated paid hours were allowed withthe hospital’s offered 12 weeks. I didn’t have as many hours saved up as last time but was hoping for the best length of time. One day in church, I held my little 2 month old baby girl on my shoulder with one hand, while using the other to hold the hand of my active 3 yr old boy as we made our way down the aisle. Suddenly, my boy squealed with delight and whipped over in a different direction. I held my daughter and did a sudden twist and reach for my son as he squirmed away. I immediately felt something “give” in my back.

It took a few days for me to feel the true extent of the injury. I thought it was just a little pulled muscle. After a 5 hour drive to my sister’s for a family visit, I ended up writhing on the floor with the unstoppable intractable “fire hot poker” pain of full blown sciatica…. all down my right side. I had to go to the hospital ER away from home, unfamiliar doctors, for help and drugs! Boy, I needed relief. As explained to me by the doctors… this was not the same as sciatica from many other causes. This was a swollen inflamed sciatic nerve… we didn’t know why yet. The only thing helping at that point was medication and ice.. a lot of ice. I still insisted they give me meds I could take while breastfeeding, so they weren’t too strong.

I got home, went thru an MRI and diagnostic process, different doc’s, different opinions. I had a disc “blow-out” with”free extruded disc fragments” at L5-S1. Some felt surgery was needed immediately, others said to wait. After careful consideration, we decided to wait and do some conservative type treatments with oral and epidural steroids. I still had to heal well enough to work, though. I spent many nights crying and wondering HOW I could work ??? How could I go and be on duty…running all over to keep up with the pace, helping people thrulabor and delivery…respond to emergencies…how?? I could barely care for my family! I called many friends while I was on periods of bed-rest and had various treatments during the time I had left of maternity leave. (I eventually did have to extend the leave a couple weeks for more recovery. I ended up witha 5 month leave altogether). I was searching for ideas.. visions of something less physically taxing which could combine my knowledge of labor/delivery/postpartum and neonatal care….. and allow me to continue working. I was, after all, the major bread-winner in our family!

Finally, a friend came up with an idea. He was actually a formula and drug rep for Ross labs.. TRUE!! But he was a friend, had heard I was hurt and stopped by the house to see how I was. He was a rep to many hospitals in the NorthEast and had exposure to what else was going on– what other hospitals were doing. This was 1988, only a few years after the emergence of the Lactation Consultant profession. I had never heard of it. Sometimes word traveled slowly (by pony express) and things changed slowly in my little neck of the woods. He encouraged me to check it out and gave me phone numbers of LC’s at some of his other hospitals. I was really excited! I called a few and found out more about the lactation profession and the relatively new Board exam given every year in July to gain the credential of IBCLC. I was actually naiveenough to think I could take the exam with my current knowledge base! HA! (Unfortunately, this is what many nurses with a little experience think…we think we already know it all! Ha!)

I called one of the LC’s at a hospital not too far from me. We talked a while and I had my eyes opened as to the extensive and vast knowledge base needed to become a lactation professional. I launched a quest for the best way to gain this knowledge. I joined LLL and went to meetings. I made home visits with the local LLL leader. I wrote many letters, made many phone calls searching for some type of education program. (remember– no Internet back then!)

Finally I found the perfect program for me. There was a correspondence course offered to be done all through the mail and phone calls designed to be an 18 month course. It was a Lactation Consultant Course offered by BSC Breastfeeding Support Consultants! (the link shown is for their current course) Back then, you could be called a Certified Lactation Consultant after completing the clinical practicum and final exam. Because of continued back problems, I started this course in early 1989, had to take a few months leave from the course and completed it in early 1991. I then went on to continue studying and sat for the IBLCE exam in 1993 earning my IBCLC status!

I have always continued to work as a staff nurse. I found a corset style back brace and found the best balance possible between family, back pain, work and more pain. I was able to get the pain subdued with steroids to carry on with life. In 1992, during a particularly gruesome relapse, I eventually consented to a myleogram… something I had previously NOT wanted. They also did a CT scan while the dye was in place. These tests showed my right Sciatic nerve had been pushed way up out of place by the disc material. I consented to surgery by a fabulous neurosurgeon the very next day. It turns out, the disc was actually adhered to my sciatic nerve!! He had to meticulously excise it off the nerve!! My post-op pain was minimal compared to the pain I had before surgery. I was able to go back to full duty in 8 weeks!

Over 20 years later, I am still working as a staff nurse and am now a CLC… Certified Lactation Counselor. Becoming a breastfeeding professional has enhanced and fortified my life! I am immensely happy I have gone down this road. To think it all came about as a suggestion from a Formula Rep!?!?!

Hope all had a great WBW 2009!!

Aug 1

6 Comments

August is here! World Breastfeeding Week Aug 1-7

World Breastfeeding Week

WBW Theme Logo 2009

WBW Theme for 2009
Breastfeeding: A Vital Emergency Response
Are you ready?

OBJECTIVES OF WORLD BREASTFEEDING WEEK 2009

To draw attention to the vital role that breastfeeding plays in emergencies worldwide.
To stress the need for active protection and support of breastfeeding before and during emergencies.
To inform mothers, breastfeeding advocates, communities, health professionals, governments, aid agencies, donors, and the media on how they can actively support breastfeeding before and during an emergency.
To mobilie action and nurture networking and collaboration between those with breastfeeding skills and those involved in emergency response.

RATIONALE

Children are the most vulnerable in emergencies – child mortality can soar from 2 to 70 times higher than average due to diarrhoea, respiratory illness and malnutrition.
Breastfeeding is a life saving intervention and protection is greatest for the youngest infants. Even in non-emergency settings, non-breastfed babies under 2 months of age are six times more likely to die.
Emergencies can happen anywhere in the world. Emergencies destroy what is ‘normal,’ leaving caregivers struggling to cope and infants vulnerable to disease and death.
During emergencies, mothers need active support to continue or re-establish breastfeeding.
Emergency preparedness is vital. Supporting breastfeeding in non-emergency settings will strengthen mothers’ capacity to cope in an emergency.

Source: http://worldbreastfeedingweek.org/

What we are doing…….

At my facility we are working on action plans to include breastfeeding support in our exisiting disaster response plans. We are never immune to disaster…. we just had a tornado here on July 29th with a lot of damage, small flooding and many homes with loss of power and clean water.

We are promoting WBW with staff and physician education as well as small gifts to new moms congratulating them on their decision to breastfeed!

WHAT ARE YOU DOING???? I really would love to hear your stories and your efforts so that we can share ideas.

Jun 21

29 Comments

Little Old Men… & Nursing in Public

Welcome Readers…to my first Carnival of Breastfeeding post!
This month’s topic is “Nursing in Public”.
Links to all the Carnival Posts are listed @ the bottom. I’ll update this as more are posted.

Keep checking back and Enjoy!!

My first baby was born in sunny Florida during a particularly hot stretch in May 1979. Although I was an OB nurse, I knew very little about breastfeeding other than what my older co-workers had taught me—which was not all that correct or very helpful information. Luckily, I had a great friend who was nursing her 3 month old at the time my son was born. She really showed me the ropes. It just so happened that she was the one who took me home from the hospital. We had to stop at the store for a few items so we went in to a “Publix” supermarket with both babies in our arms. My newborn son began fussing to nurse soon after we hit the air conditioning.

I said.. “I’m going to have to go back out to the car and nurse him.”

My friend says “Oh..You’ll do no such thing.. You’ll die in that heat.. Just hook him up and keep shopping so we can get finished and out of here!”

Me- “Nurse him in here?”

Friend- “Well if he’s hungry.. yeah!.. (after looking at my face) Oh stop worrying about it..go over to a deserted aisle, get him hooked on and put your receiving blanket up near his face… nobody will know!”

Me- timidly…above the louder howls.. “Alright, be right back..”

I found the most private place I could. I started cursing that complicated “wonderful nursing bra” I just had to have. (Remember..this is 30 years ago… this bra is now an antique!) My skills handling newborns allowed me some grace as I attempted to multitask by stooping down, prop my loudly crying baby on my partial lap, use 2 hands to fiddle with the damn nursing bra, then get him back up near my finally free boob and latched on.

Ahhhh~ quiet, happy, drinking baby!

Still stooped down, I peered slowly behind me — expecting that a large crowd must have assembled. Somewhat surprisingly, everybody was just going about their business and I happily realized that noone was looking at me! I stood up, made sure I wasn’t showing anything, and walked off with my happily nursing baby to find my friend.

It’s amazing how many people want to see a quiet baby as opposed to a screaming infant!

A sweet little old man stopped me first and asked me how old my baby was….”3 days”, I replied. He peeked in for a closer look and he actually didn’t get it right away.. “I can’t really see his face.”.. I said “Well- he’s feeding right now.”.. He just said..”OOPS….sorry about that! Well he’s a cute one!” then walked off.

The next person who stopped me was again.. a sweet little old man. He was very smiley and jolly. He asked all about the baby but didn’t lean over to look like the other man. I quickly said he’s nursing now and then answered all the small talk. He never seemed uncomfortable about it at all! That probably gave me a lot more confidence. We parted ways and I finally found my friend. She gave me an approving thumbs up, asked me to hold a basket with my other hand and said we were almost done.

Another little old man stopped us by the register to ask about both babies. We gave him all the small talk answers and let him know my son was nursing. This guy was a real sweetie, commenting on how lucky kids were that moms were starting to “nurse their young” again and ‘good for you.” He never tried to look in at my son. He didn’t seem embarrassed by the process at all. He was the coolest guy!

I left the Publix Supermarket on my way home to begin my life as a mommy…. with a little public education bonus. Encountering those sweet little old men while feeding my baby and receiving their positive type feedback was the gentle support I needed. I went on to feel empowered to nurse in public for all three of my babies… Those little old men were just so supportive! ~ When my baby was hungry, he needed to feed and it really didn’t matter where I was at the time. Thank goodness for my friend’s wisdom and support to go for it!

I became a lactation professional while nursing my last baby. It was then, only after I really became more aware of issues surrounding nursing in public that I actually took any kind of public action to empower other moms. I’ve done lots of different little things as the years have gone by. I want to mention one fun way that I thought I could help gently re-educate some of the “new” sweet little old men of this day and age. Our local paper has a lot of little retired guys commenting back and forth on various local articles. I’m guessing their age and status by all the things they say. I took this opportunity to possibly educate some of these forum readers about breastfeeding rights in public. Every once in a while, on the forum, I put out a little snippet on nursing in public… and sit back and watch what they have to say in reply! It’s quite fun!

Here’s an example I wrote on a long forum discussion a couple years ago on a breastfeeding article:

On another note, regarding a reader reaction in the forum, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breast-feeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. It is sad that the public opinion of a baby breast-feeding (the most natural way for him to eat) is something that should be done in private … yet young girls are encouraged by media to bare more and more skin. Of course being discreet while feeding is important, but I can assure you, most girls in a tiny bikini are thinking more about “tacky exhibitionist behavior” than a mother breast-feeding her baby. August 1-7 is always World Breast Feeding Week. The theme this year is “Welcome Baby Softly,” focusing on the importance of the first hour or two after birth. Learn more about it. I would love to see the paper do an article on that.

This one provoked a few responses in both directions and sometimes there were a few people who actually thought out loud that …gosh maybe I was right… never thought about it that way…etc..

Here’s an example I wrote on a recent article about the appropriate % amount for tipping :

I have never left an establishment without tipping– however, I also tip according to service up to 20%. If there are unkind reactions to small children in a FAMILY establishment, they will be getting a bare minimal tip for sure!! I do my best to keep my children behaved with table manners AND respect other patrons… but fact remains, they are children! I cannot possibly be prepared for every behavior or an accidental spill. In addition, my breastfeeding baby may be hungry.. By PA law, I have the right to nurse my baby in a public place wherever he and I are allowed to be. I am discreet.. I am protected by law… I don’t need an unkind comment from servers. They do not get a 15-20% tip if nasty, unkind or disrespectful comments have been made about my children or my breastfeeding baby!

This provoked a foray of comments ranging from ‘good for you’ to ‘you should be in the back booth…controlling kids etc..’ Sometimes the opportunities to educate others come at unexpected times but produce amazing results!

On a few occasions, other readers were supporting my comments and

helping to educate those sweet little old guys with me!

😉

Carnival of Breastfeeding Post Links (Check back for updates)

PhD in Parenting… Would you, could you nurse in public?
Lucy & Ethel Have a Baby…. (Boobs) Out and Proud
Dirty Diaper Laundry… Breastfeeding in Public- Talents- I haz it
Kim through the looking glass… Here? At the restaurant?
Grudgemom… Nursing in a room full of people you know
MumUnplugged….. Aww, is he sleeping?
Massachusetts Friends of Midwives……. Nursing in Public: Chinatown, the Subway, the Vatican, and More
Mother Mary’s Soapbox…… Breastfeeding Oriana
Tiny Grass….. Nursing in Public as an Immigrant
Mommy News & Views….. Breastfeeding in Public
Breastfeeding 1- 2- 3 ……Nursing in Public: To Cover or Not to Cover
Chronicles of a Nursing Mom…. Why Worry about NIP?
Warm Hearts Happy Family…. Breastfeeding and the summertime
Blacktating ….. Thank you for Nursing in Public
Motherwear’s breastfeeding Blog ….. Get kicked off a bus for nursing in public? Here’s how to respond
Musings on Mamahood…….. NIP, no tuck
Mama knows Breast….. Products That Can Help You Breastfeed In Public
BabyREADY …… A wee NIP in the Park!!
Tales of life with a girl on the go….. Planes, trains and automobiles – we’ve breastfed in them all
Breastfeeding Moms Unite! …… Nursing in Public: A Fresh Perspective on Nurse-In’s
Never a Dull Moment… ….. Breastfeeding Hats? YES! Nursing Covers? Uh… Not So Much
Breastfeeding Mums…… Nursing in Public- What’s a Breastfeeding Mother to Do!!
Hobo Mama ….. Easy, discreet way to breastfeed a toddler in public

May 19

16 Comments

Breastfeeding Barriers

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?