Are you afraid to Exclusively Breastfeed? Educate yourself!!!
Posts from the ‘My 35 cents’ Category
(image from National Geographic)
As a professional, educating parents and their families about the importance of breastfeeding and human milk for human infants is a priority and a professional responsibility.
It is not about fear or guilt.
It is inappropriate for any of us to imply directly or indirectly to any parent trying to make feeding choices that breastfeeding and formula feeding are equal.
They are not. Human milk is the superior species-specific food for Human infants. The recommended feeding hierarchy from the experts (AAP,CDC, WHO) is Breastfeeding, expressed milk from baby’s birth giving parent, expressed donor milk then properly prepared infant formula.It is also important for health care providers to carefully evaluate each parent baby dyad for feeding adequacy no matter the choice.
The Benefits of Breastfeeding are NOT Overstated as articles currently circling social media would like you to think……
However– There are many parents confused, afraid or unsure. Some parents have developed fear for exclusive breastfeeding due to tragic stories circulating the internet. Those stories are horrible and may not tell the WHOLE story about what happened with that baby. That is important. These tragic stories are heart wrenching. I do not like how the stories are being sensationalized or exploitive of the families. Educate yourselves to learn how to know your baby is getting enough milk always! Learn the babies signals EARLY and listen to the baby. Insist on adequate help and if your baby needs additional milk for some reason of another, GET HELP! Feed your baby. But don’t rule out exclusive breastfeeding. It is the biological norm.We want you to succeed. we want to provide good support. Contact an IBCLC. Find out reasons that may put you at risk for needing additional help. Be informed.
Please do not feel afraid. Please don’t be feeling guilty over your choices. Educate yourself and make feeding choices which are right for you.
I am trying to encourage moms to make informed educated feeding choices and then not feel guilt about their decisions.
REMEMBER – It doesn’t have to be all or nothing!
It is the recommendation for exclusive breastfeeding during an infants first 6 months. If that doesn’t seem feasible to you, then your baby can still benefit from however much or however long you can breastfeed of provide breastmilk. I think that in today’s world, we give a mother all this education about what she should do and then we don’t have all the right support systems in place to really help her!
Here’s what I have found
- Today’s parent is connected to the internet, information and friends by phone, Facebook, Twitter, Snapchat, Pinterest, Instagram or YouTube and “checks in” at least 10 or more times per day.
- The education process to a lot of parents needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.
- With that in mind, try to provide her with the information she needs to make her decision.
- Never overestimate a parent’s desire to breastfeed her infant.
- Never underestimate a parent’s desire to breastfeed her infant.
- Listen to the parent; help them define their true desires and goals.
- Many times, the first question they ask may not be what they really wants to ask.
- The parent’s individual breastfeeding goals, how they defines them, how important they are to them and how they relate them to their actual breastfeeding experience all help define how they measures success.
- Provide professional support to meet these goals.
- Support the parent, support the parent, and support the parent.
HOWEVER THEY NEED OR WANT
I have a story if you are interested. My own history lesson and confession I guess. You might ask what this has to do with birth and breastfeeding– and I would tell you that right now – pretty much everything. The population I serve has dramatically increased the numbers of women of color and multiple […]
The truth of the matter is that doctors, physicians assistants, med students, interns, yes and many midwives plus many nurses working in the mother/baby environment SIMPLY DO NOT have enough education about Lactation and Lactation Management to adequately guide new mothers. It is sad and pathetic. The vast majority of these individuals would rather work with precise numbers and are actually happier if a mom is pumping and feeding her milk in a container to baby.
It is no wonder this has transferred to the vulnerable new mother. WE have done this to her. There is actually a new trend to pump and feed expressed breast milk instead of ever putting baby to breast. I can help you with that. Please know that a large number of these infants do get some formula until milk supply is established. Make an informed choice. These breastmilk-fed babies are not usually exclusively fed expressed milk thru out the first few months. It is a hard job to pump and feed and pump and feed. It is a damn hard job to build and keep up a full supply long term exclusively pumping!! It has been done. You can do it. Mommas are very powerful and they can do it SO if that’s the choice you make then GO FOR IT!!! Give it all you have got. But CONSIDER putting baby to breast and feeding the way nature designed your body. Work with an IBCLC. We need good lactation programs at EVERY facility that provides childbirth services. We need IBCLC’s in the hospital. We need prenatal education about the benefits of breastfeeding so mothers make a true informed choice.
The more I speak with and counsel new mothers, the more I get asked for exact numbers when it comes to feeding instruction. It is no surprise that the number one question on the mind of a brand new first time breastfeeding mom is “HOW do I know my baby is getting enough milk?”
Babies were born to breastfeed
WATCH the baby, Listen to the baby. Look for feeding cues or little things the baby does which tell you he is getting hungry.
Lets make it EASY with very little “rules”. Think of these as TOOLS– not RULES
First: Attachment to breast should be DEEP and COMFORTABLE
Second: Baby needs to do the RIGHT JOB of effective drinking
Third: Baby needs to do this OFTEN ENOUGH each 24 hours…. about 8 for most moms – more is very common- feed on cue
Fourth: By the fourth day ( give or take a day), and EACH 24 HOURS thereafter Baby should be having around 6 ”good” wet diapers and about 3 -4 poops that are starting to turn yellow.
Please KEEP your baby with you at a times!! Just.Say.NO.
Bottom line– Weight Gain. Baby should be at birth weight by Day 10 (or at least on a proven good upward trend) and be gaining about an ounce every day thereafter.
After the first 4-6 weeks. This little chart comes in handy:
If a doctor or nurses first suggestion is to give formula to your breastfed baby—for whatever reason— ask to see a Lactation Consultant, an IBCLC.
These are the only numbers to remember. TRY to stop stressing out.
This blog post is not a replacement for medical advice should you or your baby have an issue. This is applicable to healthy full term infants.
Copyright 2014 StorkStories RN IBCLC RLC
JUST. SAY. NO.
You CAN’T Take MY Baby to the Newborn Nursery!
All too often, we~ as hospital staff in Labor and Delivery- Mother Baby units or the Newborn Nursery, want to take YOUR baby away for this test or that exam saying we’ll be right back. Well it isn’t always that quick- in fact it is RARELY that quick. One thing leads to another and before you know it, it is 1 to 2 hours before you have your baby back.
This is beyond wrong.
We are horrible for doing this.
We need to be a better support system for you.
I am working on getting all staff involved in increasing our exclusive breastfeeding rates. This begins with the first feeding. (well- it really begins with birth interventions but of course that is a totally different post)…….
Your baby should stay with you until he latches and feeds.
Skin to Skin is the best way for him to get accustomed to his new habitat and learn where he will be feeding.
STAY WITH YOU
We can do virtually everything~ all routine newborn exams, procedures and tests at the bedside, with you right there.
Speak up and tell us NO
March 2011 Vanity Fair fold out cover. Olivia Wilde…. Dear Facebook, does this picture offend you? America- why is this ok and #breastfeeding in public offends??
The average consumer may not know what could possibly be helpful in exacting REAL change in our hospital maternity care. I am certainly no expert in this field and would welcome additions or corrections to what I say here….. but I want to offer a little perspective from the inside. Maybe this will help somewhere.
I am a Birth and Breastfeeding Junkie and I am proud. I don’t care if someone recently didn’t like that nomenclature….. That’s what I call myself and how I relate to other like minded individuals. I have a need to know what’s going on in that world. We junkies read and discuss all the current evidence, all the latest recommendations from the WHO, NIH, CIMS, ICAN, ACOG, AAP, AWHONN, ILCA….. and so many more. We love all birth stories and learn from each other. We educate ourselves. We STAY current. We want informed decisions. We want options. We want this type of evidence-based care available where we live. We advocate for those individuals who may not even know there may be another choice. We want to see the women of America have access to respectful quality services everywhere!
Ok –> that said…. When I see new evidence, research or new recommendations; what I have done over the years to offer up any proposal for process improvement or care delivery change including whatever may be needed to implement these changes… is to collect resources, develop a policy or plan and present to docs, manager and staff. The response is usually positive. Sometimes I get a lot of “smile and nod” and “please hurry up I have other things to do I’m not really listening”…. but mostly positive. Sometimes it’s only positive in that “My you’ve done a lot of research..and Good Job!” instead of–Yes let’s do this! The changes are not always adopted and there isn’t a total “Buy-In” from everyone to make it a successful total change in practice. Eventually and unfortunately, because these things aren’t monitored, many practitioners go back to their own comfort zone of past [outdated] practices. Arrghh
There must be a better way.
I was sitting in a Professional Practice Committee meeting a few weeks ago listening to a mandatory (did I say Mandatory?) action plan presentation by the Director of Patient Relations/ Patient Satisfaction when it hit me how there may be more avenues for REAL change driven by the consumer than those of us in the trenches. All of the directors (suits) were there and were required to come up with unit-specific mandatory action plans to improve patient satisfaction and positive perceptions of their hospital experience.
She was presenting an action plan based on the latest HCAHPS report.
What is HCAHPS?? Maybe you know- maybe you don’t. Skip over this if you already know.
“The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS (pronounced “H-caps”), also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.
Three broad goals have shaped HCAHPS.
- First,the survey is designed to produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers.
- Second, public reporting of the survey results creates new incentives for hospitals to improve quality of care.
- Third, public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.
With these goals in mind, the Centers for Medicare & Medicaid Services (CMS) and the HCAHPS Project Team have taken substantial steps to assure that the survey is credible, useful, and practical.” HCAHPS fact Sheet 2010
The reason hospitals are taking these results so seriously is that.. well… I’d like to say they ONLY care about the patient, but they are a business and it comes down to money in reality.
If a hospital scores fall below a certain number in patient satisfaction… they can lose like 3% of Medicare Reimbursement. That adds up to a lot of money really. You may think that doesn’t apply to Maternity Services but it does, ultimately, because that survey goes out to all adult inpatients. If the scores for satisfaction are low for obstetrics, it can throw off everything, and affect the reimbursement to the facility. That, in turn, can affect how much money is available for overall improvements.
Medicare has also started to cut reimbursement to cover the costs of “preventable” conditions, mistakes and infections resulting from a hospital stay in 2009. That is older news so you may already know about that.
The thing is– what the big two Medicare and Medicaid… [The Centers for Medicare & Medicaid Services (CMS)] often set the bar and other insurance companies follow in the private sector. The 2009 National Health Insurer Report Card may give you more information about what is or is not paid. I don’t know much more about that.
HCAHPS is the first I’ve heard of actual patient satisfaction scores steering reimbursement which is transparent and publicly reported. I have heard many pt satisfaction reports but they were never given this much attention. At least in my hospital.. Perhaps I’ve been too much of a Birth Junkie to notice. 🙂
The other big catalyst for positive change is the new JCAHO Perinatal Core Measure Set. The MotherBaby Summit website has an excellent review of these 5 elements, explains them and provides further references.
There are two new employees who only work on JCAHO compliance and data collection. They are looking at the PC-05 Exclusive Breastmilk Feeding numbers and are not happy…. Well — neither am I !! I have been trying to do something about that particular issue since 1988 ! Since these are now factors for regulatory compliance as well as patient satisfaction… Now we are going to do something. I am pleased to announce that we are forming a Breastfeeding Task Force!! YAY! We also have a new Pediatric Dept Chair who is a no bullshit we are going to do it kind of guy… so YAY!
Bottom line: The hospital is sitting up and seriously taking notice about the consumers opinion AND how regulatory agencies are now monitoring things have never been monitored before.
- Action plans are being developed to comply
- The consumer has more of a voice than ever before
Here’s what you can do
Before the hospital:
- Have a prenatal interview with your provider… ASK : Do they have current evidence based practices/protocols in place ….. do their standard orders reflect the most current evidence based guidelines and standards of care…. do the dept members all follow these standards. Do the nurses actually follow these orders….
- Do the same with your pediatric provider
- If you are not happy with the provider and choose NOT to use them, make sure they know exactly WHY… what were the points which caused you not to choose them.
- Have a birth plan and discuss it with all providers, nurses and even mail it to the manager where you will deliver. Ask your manager to please make sure your wishes are communicated with the staff.
- Use words like RESPECT, SATISFACTION, Patient RESPONSE Time JCAHO Core measures.
- Ask for numbers when you have your interviews.. for instance..what are your CS rates? VBAC rates? What are exclusive breastfeeding rates? If they don’t know, ASK for the name of a hospital person who can help you get that information. I am sure they have the numbers.
In the Hospital:
- Get the names of those individuals/ midwives/ doctors/ nurses/ etc who were good and those who were poor caregivers in your opinion. Write them down somewhere and why. Specifics help.
- If you don’t feel your wishes are being honored or disrespected, ASK to speak to a patient representative. There is most likely somebody on hospital staff who has that role and can assist you. Use the words Satisfaction, Respect or what is relevant etc…
- Ask for options if they are not discussed. Don’t rely on a Birth Plan you made weeks or months ago to be always remembered by everyone. Even if it’s right with your records. Different options may be available that weren’t before. For instance, We recently installed telemetry fetal monitoring allowing for increased mobility. If somebody asked a while ago, we did not have that option. You may have to repeat yourself… esp in a very busy Labor&Delivery or Mother/Baby unit. Sorry. That’s the way it is sometimes. It can get crazy but you are just as important as anyone!
After You Go Home:
- You will be very busy with your baby and good or bad… your individual experience will be a memory that could fade over time. We still need to hear what you have to say IN WRITING whenever possible.
- Please Fill out your survey –> it may be long but most are a multiple choice and allow for a write in comment section. Put in the names of the good and the bad!! Please do it.. then actually mail it
- Please make written comments. Include names. Specifics help.
- Please Make Us Accountable. Write a letter to administration (Head of unit, Head of nursing or Head of hospital) include specifics. They HAVE to personally answer to this type of thing first! They get this info long before the surveys. Write for the good or the bad parts of your experience. Including if you make suggestions. It may be monitored or tracked how many times they receive a comment about a certain issue. Definitely tracked for negatives– especially for specific individuals.
- Please also write a letter to the Head of OB or Pediatrics Departments and let them know who else you sent the letter to. Include everything from above.
- If you are certain what you experienced was NOT evidenced based medicine or care…. PLEASE mention exactly what you know.
Thanks for reading this, I hope somebody out there takes the time to give the needed feedback which will help mold and improve our care.
I love babies. I love being a nurse.
I love all the evolution of technology through which I have practiced. I love how I have had to continually evolve myself. I love helping mothers help themselves, advocating for them and their infants, facilitate when needed to support them making their own choices and watch as they evolve….. becoming the best mother they can be!
I know I haven’t blogged lately and it is because I have been having a bit of a rough transition… my latest evolution… in my new NICU job. Orientation is somewhat difficult for me. I had previously been arriving at work already at the top of my game (for the last 25 years or so) and I have now found myself a student…. every. single. day. It is almost like I have gone to a totally new facility! EVERYTHING seems new or different. All new equipment/monitors/procedures/policies/protocols/doctors/practitioners/and staff.
The babies are the same. Since some are much more preterm than we have cared for in the past… their issues are more complex. Some are the same as we have always cared for, but with neonatologists now on board, the approach to the care of these babies is evolving.
I am unlearning some of what I have always known and relearning things in new ways.
I was able to prepare and submit the mission statement and policy on Breastfeeding for our NICU population. The neo’s are extremely awesome on breastfeeding or breastmilk feeding promotion and support! So we have a very good start for breastfeeding support in our new unit. Excellent actually! I am happy to report that since opening our unit, most of the babies thus far have had a total exclusive diet of breastmilk or fortified breastmilk! I think that is fabulous! There have been some moms who after discussion and encouragement to provide breastmilk, wished to formula feed and their choice was supported without further discussion or question. My new co-workers have been very professional about that. There were a few who provided colostrum initially and then decided not to continue. This was also supported.
Coming from my previously comfortable world of lactation in the full term nursery, I find myself on a journey to find a balance between technology and nature…… precision, absolutes and finite accuracy vs the inconsistency, variables, and imprecise intake of an infant at the breast. We are calculating daily the actual fluid and kcal energy intake of each baby and comparing that with the kcal/fluid requirement per kilogram of weight. Changes are then made accordingly. Most of the preterm population is unable to take in their required fluid and caloric needs solely by mouth. Most have parenteral nutrition in the form of a glucose/ Amino Acid protein and Lipid (fats) at first by a central line or an IV (TPN) and gradually switch over to taking all their requirement by their GI system (Enteral). They don’t have the stamina to take it by sucking/drinking and they require a nasogastric (NG) tube so the remainder of food can go in by gravity or feeding pump (gavage feeding).
I actually love learning all this. I thrive on having a detailed clear clinical picture of my patient. I am very detail oriented which is a good thing. Because of this precision, the measurements and the calculations—> actual breastFEEDING is not often seen until much later in the game. I understand this. I do. I want so much to be very helpful at transitioning to full feeds at the breast. I have to wrap my head around it each time (all the while being a student in all other aspects of the infant’s care) researching how to best advise each mother. We range from visits every other feeding to visits once or twice a day. Skin to skin is the most powerful tool I can use when faced with limited exposure or opportunity. Sometimes when the mom is arriving for my patient, I’m involved in other things and unavailable to do anything other than providing some private skin to skin time. Encouraging any licking, suckling or other feeding behaviors at the breast during gavage feeds is also good. When the baby gets more and more ready to take oral feeds… what I’ve seen so far is that they are already preferenced to the bottle nipple. The weight gain has been established, the precision of measurement seems to have become slightly less rigid. It seems that there is adequate physician support to encourage full feeds at the breast. There are hundreds of experts out there who have gone thru this, and reorganized policy and procedure to protect breastfeeding in the NICU.
I have to evolve myself again and re-learn more about transitioning to feeds at the breast before the bottle becomes a primary feeding implement. Once I can find my footing- I hope to be strong and confident enough to start teaching moms and my co-workers.
Breastfeeding is NOT an exact science!
I need to figure out when the exact science of Neonatology can accept that….
into the feeding plan for each individual baby!
A Historical Perspective
This is a part of my comment reply placed to an individual who had commented on The Feminist Breeder’s post “When It Comes to Breastfeeding, We Can’t Handle the Truth”
“There were countless situations over the last 200 years which forced caregivers (whether the natural mother or another individual)to resort to artificial feeding of one kind or another. It is amazing what some of them came up with to try to feed those infants! Necessity was the mother of invention. And many were able to survive. It’s wonderful that they could. Many more, however, sadly died. Many many babies were sickly or died in those times.
You say: “The matter is that formula/breastmilk substitutes became so helpful that people continued for centuries to make it work.” I agree.
But my take on it is that the necessity of an available safe artificial alternative to breastfeeding for those mothers who could not breastfeed their babies took centuries to formulate…to make it nutritious enough and safe enough and to come up with a safe enough feeding container. It was just that.. an artificial substitute.
Gosh– I am NOT an expert on this aspect at all.
I just feel that the heart of this conversation is that artificial infant feeding has risks. Risks that mothers aren’t informed about because society has normalized artificial feeding. Breastfeeding is normal feeding.
No one should ever take away an individual’s choice..EVER…!!!!!
Mother’s simply need better information to make INFORMED choices.
I’m very sensitive and careful in my approach to moms… helping them with information they need to make the best choice for them. Then I will ALWAYS support that mother 100%.
Here’s an interesting historical perspective link for your review from the American Journal of Public Health | December 2003, Vol 93, No. 12
It covers history from about 1890 to early 1900’s.”
Here are some quotes and excerpts from this article published in the American Journal of Public Health (December 2003, Vol 93, No. 12 ) discussing Public Health THEN and NOW.
“Late-19th-century physicians . . . constantly
decried the ‘children with weak and diseased
constitutions belonging to that generally
wretched class called bottle-fed.’ “
“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.”
Abstract: “The medical community has orchestrated breastfeeding campaigns in response to low breastfeeding rates twice in US history.
The first campaigns occurred in the early 20th century after reformers
linked diarrhea, which caused the majority of infant deaths, to the use of cows’ milk as an infant food.
Today, given studies showing that numerous diseases and conditions can be prevented or limited in severity by prolonged breastfeeding, a practice shunned by most American mothers, the medical community is again inaugurating efforts to endorse breastfeeding as a preventive health measure.
This article describes infant feeding practices and resulting public health campaigns in the early 20th and 21st centuries and finds lessons in the original campaigns for the promoters of breastfeeding today.”
I found this article to be very informative and very interesting.
WHAT HAVE WE LEARNED???
Mind over Matter
If you don’t Mind…..it doesn’t Matter!!