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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?

 

 

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16 Comments Post a comment
  1. Oh man, I hear you sister! I find those barriers to be the same barriers at my hosptial too. Especially the “skin to skin, unlimited breastfeeding opportunity for the first two hours”. In my hospital I work on LDR where we have our postpartums for about 2-2.5 hours. In that time I am expected to do everything else under the sun but keep that baby skin to skin on mom. I am more pressured by the charge nurses to give the baby a bath than to make sure the baby has breastfed. Everytime I give report to the postpartum floor I feel like I am on the defensive as to why I didnt do x, y, or z (which can wait!) instead of keep that baby skin to skin and breastfeeding!! It’s so frustrating! I like your idea of reformating the nursing documentation form to require a reason for not putting baby to breast. I think I should bring that up at the next staff meeting! Keep on keeping on!

    ~The other Melissa 🙂
    http://www.nursingbirth.com
    http://www.nursingbirth.com

    May 19, 2009
    • Birth_Lactation #

      ~Melissa–I am sorry for all the moms and babies… and your frustration of course but glad to know that I am not alone and to hear someone else dealing with it. We deal with a lot of the same OB issues you describe as well..I can pretty much put one of my docs names in instead of yours and the stories would be alike! We have LDR’s also but some of the L&D nurses push the baby over to nsy once it’s an hour from birth..”well he’s an hour old already and I want to get mom out”! Very sad. We do most of our own vag exams…no residents… no waiting. I have been revising forms my whole career. I started to just do it one day…. then asked where the paerwork was to submit the change. I’ve learned to forge ahead with some things, wish i could have better compliance with breastfeeding policies. Healthcare professionals don’t seem to honor recommendations for that like they honor recommendations for prevention of EOGBS disease from CDC for example… I’ll be at it till I retire. Thanks, Melissa

      May 19, 2009
  2. I don’t have any good suggestions for initiating change. However, I am very glad that there aren’t any formula bags distributed in local hospitals, and that many hospitals are pursuing ‘Baby Friendly’ status. I think that without wholesale buy-in from the top down it can be very difficult to bring about lasting change.

    And it’s important to focus on the progress that has been made. Even if it’s slower than we would like, it’s important to acknowledge how far we have come.

    May 19, 2009
    • Birth_Lactation #

      You are right…focusing on the positive is good! I’ve been doing that.. I wish we could even submit a letter of INTENT to become baby friendly. i went to a conference in October and many of the participants felt the hospital needing to pay for formula was the biggest deterrent away from achieving Baby friendly status. I thought I could use this forum to tap in to some of those who may have gone thru this. I’m only hoping for consistent appropriate information and techniques! Thanks Amber!….Melissa

      May 19, 2009
  3. I don’t have any ideas either, but I wanted to say that I admire your perserverence in this. It sounds like you have taken a slow and steady approach (or at least it’s become that way) and that may be the only way to make progress – one little step at a time. At least it is progress!

    May 19, 2009
    • Birth_Lactation #

      YES…yes… one step at a time. I am happy for the progress we’ve made, I get increasingly frustrated when it seems we may go backwards due to weird things…staff changes etc.. That is what prompted me to write this… looking for ideas. Thanks for stopping by again Arwen! And Happy Memorial day.. to you and all you those you know. I appreciate you.

      May 25, 2009
  4. Enlist the help of great pediatricians who truly support breastfeeding. That is all I have – sorry. I am not a healthcare professional so don’t really know how to impact the hospital system. Please let me know if there is a way I can help. Best, Katrina

    May 20, 2009
    • Birth_Lactation #

      Yes Katrina, This is a really good idea and I am working on that angle. Thank you!!

      May 25, 2009
  5. I’m not sure how much of this is addressable by a hospital, but I can tell you that it can be overwhelming for a pregnant woman planning to breastfeed. Have you gone into a Babies R Us lately and seen all their breastfeeding products? There’s almost a WALL of stuff, and I am afraid women will think they need it! I keep seeing threads message boards asking “What do I need to breast feed?” Well, you need a baby, a breast, and an arm. There are things that are nice to have, but women are encouraged to buy so much stuff just in case: nursing bras, nursing pads, nursing tanks, nursing covers (GOD I hate those things!), a glider and footrest, a “nursing stool”, a nursing pillow, a breast pump, nursing-friendly bottles, special breastfeeding vitamins, lanisoh, and on and on and on. Of all of that, I personally used a nursing bra, and that was only 1 baby out of 3. Now, some women are going to need all of it, or nearly so, but I find the expectation that she MUST have it to be nonsensical.

    I was also frustrated, with my first, to be lectured by the nurses that since I had had a c-section, I *must* use pillows and I *must* use the football hold. I will give advice now to women who ask it, but first I tell them that the only piece of advice that really matters is “Do what works for you, whether it’s what you *should* do or not.” With that same baby, I annoyed the daylights out of her trying to keep her aligned properly–she insisted on flopping over on her back and nursing with her head turned to the side.

    Now, when my youngest daughter was born, she was the only one I had vaginally so she was the only one I had the opportunity for skin-to-skin contact with. And the first time I offered her the breast, she wanted nothing to do with it! She was still busy howling her indignation at the whole birth thing. But God bless those nurses, they gave me time with her and at the second offering she latched right on. I am confident several ounces of her birth weight was colostrum. 🙂 I did have her taken to the nursery that night so I could get some sleep, BUT they brought her to me right away when she got hungry! I was awoken at around 4 in the morning by the sound of a crying baby getting closer to my room and the nurse hit the door running. (I know crying is a late indicator of hunger, but I also know they got her to me as quickly as they could.) Those nurses had knowledge and dedication–of course, Hawaii is the most wonderfully breastfeeding-friendly state.

    May 21, 2009
    • Birth_Lactation #

      Sabra, thank you so much for all your insights and your story! I agree that there is too much paraphernalia out there causing mom’s to think they need it! I have a lot of the same approaches as you. We can recomend or suggest to the mother, but ultimately, it is her choice and her experience. Maybe you can ask some of your Hawaii nurses to send me tips on what more I can do! Thank you, thank you again!

      May 21, 2009
  6. deliveryqueen #

    Pregnant women need to educate themselves on the fine art of breastfeeding. When I worked as a labor and delivery nurse, I found myself encouraging many woman to at least try it. I would always list the benefits such as passing on antibodies to the baby, ease of availability, free milk etc. I would often say to them…..If poor women in countries around the world can do it, you can do it to. Attitudes reguarding breastfeeding need to change. In order for more hospitals to become baby friendly hospital, nurses attitudes need to change. I have seen too many breastfed babies given bottles pacifers when they should have been taken out to their mothers at night.

    May 22, 2009
    • Birth_Lactation #

      Hi deliveryqueen! I’ve been following your blog and doula training! Good for you! You are so right. Education is critical.. sometimes changes are made by educated women demanding better care and provided services. The culture of our society can greatly impact what direction healthcare takes. I keep working on attitudes of healthcare providers and nurses… that’s my problem too. I need some fresh ideas if you have any. Thanks

      May 25, 2009
  7. Besides continuing efforts to educate your co-workers and influence your hospital’s policies (both of which are steeply uphill battles, I gather from what you’ve written), I can only think of two things:

    1. I don’t know how the hiring process for nurses works, but could you get on the interview committee and quiz applicants on their knowledge of breastfeeding, and encourage the hiring of the best ones?

    2. Are there childbirth classes around that you could prepare some breastfeeding handouts/materials for?

    May 29, 2009
    • Birth_Lactation #

      Peggy~ Thanks so much! Those are two excellent suggestions!! I have never thought of the first..but that is easily implemented. The second… I was a guest speaker at all the childbirth classes in town when there were several.. I then had my own BF classes thru the hospital which were canceled after 2 years because of $$ the almighty dollar… (another barrier to say the least). Now the hospital has a breastfeeding section built in to the mainstream childbirth classes and I have lost touch with those in charge..they keep changing hands. I will look into that again, Thank you!! 😉

      May 29, 2009

Trackbacks & Pingbacks

  1. Catching up with the community of Birth Advocates… « It’s Your Birth Right!!
  2. OB Docs and Nurses Scoff at Homebirth « Stork Stories… Birth & Breastfeeding

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