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Posts tagged ‘lactation’

Breastfeeding- Yeah- It’s Not Exact or Precise

Cartoon by Neil

Cartoon by Neil

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 lineWeight 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:

Copyright Nancy Mohrbacher used with permission

Copyright Nancy Mohrbacher used with permission

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

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JUST. SAY. NO. –> You can’t take my baby……

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.

Stay.

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

Thank You

Supporting my Non-Breastfeeding Daughter-In-Law… Part One and a Half

This is a form of general response to some comments/ an “addendum” of more history or “back-story” type of intermission.  So I am calling it Part 1 & 1/2. Part II about the next pregnancy is in the works and coming later this week or next….

I am amazed and thrilled at the volume of interest this post has generated. I’m not a big blog by any means (usually getting on average 35 – 70) hits per day even when I don’t write anything. Now I have over 700 hits for 3 days in a row. For some of you that’s normal… not me. It makes me want to make sure I get this right. Make sure the correct points are being made. Without monkeying around…

Breastfeeding Baby Monkey

I LOVE Sadie. I love her like my daughter. She is a very smart, strong, independent, confident and outspoken young woman. She has a large group of friends to whom she is always supportive, a good listener and would do anything to try and help with all types of situations. These types of things make me respect her tremendously! My son had met her at a party once in college then re-met her a few years later when she was near graduation and he was … well….. a college drop-out party animal at age 23 recovering from knee surgery after a car accident. (** drops head with embarrassed grimace **)  Sadie.. I always say.. finished raising my son. She did NOT put up with any of his shit.  She is responsible for or part of the catalyst (besides the car accident) in encouraging my son to turn his life around. He is now a 32 yr old successful business owner.  They are very much in love. They still talk for hours every day and crack each other up all the time. Lots and lots of laughter and fun!

I am very happy that so many of you understood that I was (and still am) LEARNING the new roles of mother-in-law and grandma. This is a story of my feelings and emotions as I attempted to do the best job I could….. respecting and honoring that my son and his wife were indeed the decision makers as they became parents, helping Sadie understand that she was most certainly going to be respected and supported in her feeding choices……. and learning to let go. I’m glad many of you realized that I knew it wasn’t always appropriate to provide information and advice … but sometimes, because of the professional I am and how important I feel it is for all mother’s &  parents to make informed decisions….. I found it hard to not say something if only for their protection.  I hope you all realize that I am not pushy and try to always be supportive. But I’m human and I can screw up…  I should have asked first what they read or researched about it before talking. As a breastfeeding advocate and lactation professional, I know that it is in my grandchild’s best interest to be breastfed. I also know that it is NOT my decision. This is a story of my journey to deal with all that so close to home and on a personal level.

I wrote this post “Breastfeeding, Bottle Feeding and…. Somewhere In-between…. Why the Guilt?”  two years ago and another.. “**ROAR** on Breastfeeding Guilt “ a little while after. I have a hard time with people having guilt- thinking proper education for informed decisions will cause guilt- others making rude comments about someones choice making them have guilt- a personal guilt anyone has because they don’t feel they did “enough”…. I just have a hard time with all that. I had guilt thinking I went too far with the kids…. (Dave and Sadie). Never did I want Sadie to have guilt because of something I said, how I said it or perhaps acted. It was important to me that the guilt factor was eliminated. There are so many opinions out there and mommy wars and stupid stuff actually (IMHO). We need to be supporting each other. ALL MOTHERS AND BABIES SHOULD BE HONORED AND RESPECTED. We don’t know their story or reasons for any choices they are making.  Some of you have had painful experiences and I am sorry that happened to you. I hope you can move past the memory to be supportive to the next person you meet… even if it’s just a smile. 🙂   For “Mama of 2″…. Your MIL is sounding unbalanced and in need of a psych eval IMHO. Seriously inappropriate! I hope you can throw out her comments with the dishwater (what an old fashioned saying…) which reminds me of an old favorite cartoon: (LOL)

That being said about the feeding issues. I want to talk about parenting. All the years that I have been a nurse sending new parents home with their babies, it has been important  that they are empowered to become loving parents with their own style. I have always encouraged them to discuss things among themselves and decide just what that is. I encourage them to smile and nod at “Grandma” or “Aunt Sue” and do things their own way. I had this same discussion with Dave and Sadie at the very beginning of the pregnancy. It isn’t my place to raise their child or decide what type of discipline for any situation… My role is to fill in while babysitting and try for consistency on their plans. Not to make the plan…follow it.

Push for Real Changes in our in-hospital Maternity Services

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

Project poster inservice example

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.

*Promote NORMAL Birth and Breastfeeding* & more New Year’s Resolution Ideas for all my Co-Workers… Any Ideas?

I am continually working (baby steps- a little bit at a time) on improving what we do to care for the moms and babies in my little neck of the woods. Sometimes it feels exciting, positive and helpful….. but other times frustrating or futile.

Since I have been recently consumed with my newest career as a NICU nurse, I have seen some of my earlier successes of positive changes (on the mother baby unit and L&D)…. slowly. turn. back. to previous bad practices ….. I come over to the units and I see so many of the older traditional care models in place again which we had worked hard to place in a vault! You get new doctors, new nurses, new anesthesiologists etc… and they don’t give a crap about any guidelines or protocols for a natural process! However if the CDC changes their Hepatitis B, HIV or  GBS protocols… they are all over it….  In. A. Heartbeat.

Why is it so hard for these professionals to relinquish control over all aspects of the birth process? Why can’t they look at any of that research? Why aren’t any of the recommendations for encouraging VBAC, discouraging scheduled CS’s without a TOL or keeping mother and baby together while delaying routine procedures taken as seriously?? Why?

I think I know why…I do.  But that isn’t really what I wanted to talk about today.

I want to provide some encouraging – positive – inspirational ideas for my fellow nurses, practitioner or heathcare provider to do what is best for each mother and baby in their car. Even if you all pick just one… it can make a difference. So don’t feel overwhelmed. Just try to add at least one of these to YOUR daily practice.  These suggestions are meant for situations without complications requiring urgent intervention of some kind.

Readers: Please ADD more in comments if you have them!

  • Promote and Preserve NORMAL Physiologic Birth……  Try NOT to interfere. Please really find out what that means if you don’t know. Seriously. (sorry but please… my friends… it’s not about hurrying it up or getting it over with and closing out the chart!)
  • Spend time each month reviewing Evidence-Based practice recommendations and changes with regards to Birth and Breastfeeding. You’ll learn something!
  • SKIN TO SKIN…if you do nothing else… make THIS your project for EVERY mother/baby in your care. If you do this for them– nature can have a chance. Get them S2S at birth and several times each day to help with breastfeeding! (this one is my favorite!)
  • Yes… Skin to Skin can be done in the O.R. Teach your fellow co-workers when just DO it!! Come on TRY IT!
  • Keep a mother’s wishes at the forefront of your plan of care. Her birth plan is very important to her! Advocate for her and empower her. This is her birth, not yours.
  • Advocate and Empower your patient to make truly informed decisions about her care. If she doesn’t have the right information to make a real INFORMED decision, please help her get the information or provide it for her!
  • Embrace the idea and recommend Doulas to your patients. Keep a list of local doulas available and provide them at prenatal visits or out-pt testing.
  • Question the doctor/midwife when an induction and or Cesarean is scheduled. Just ask why and discuss… Bring up points you’ve learned in your reading and find out the practitioners reasons for inducing. There is a way to discuss without challenging. Sometimes –> everyone learns from such a discussion. Perhaps the practitioner will realize his reasons for some cases may not be appropriate.. who knows?
  • Breastfeeding and Formula feeding are not equal choices and remember it is inappropriate to indicate to a mother directly or indirectly that they are equal. She deserves correct information before making an informed choice. Utilize teachable moments to discuss the superiority of Human breast milk as the food for human infants. Show her where she can get more information before making a decision. Honor her decisions once she has made them.
  • Keep the baby with the mother until the FIRST Breastfeed has taken place. Please delay all your routine procedures and help the mother (if needed) to start breastfeeding! This is recommended by ALL the experts.
  • Keep the baby with the mother AT ALL TIMES. Almost everything we do can be done at the mother’s bedside. Think about it.
  • Keep the baby with the mother AT ALL TIMES means at night too. Separating mother and baby so “Mom can rest” had been shown to be a barrier to successful breastfeeding. Encourage frequent feedings based on feeding cues.
  • Teach and empower the mother. Include how to recognize feeding cues, signs of an effective feeding with appropriate latch, and how to recognize an overall good feeding pattern.
  • Support the mother, support the mother, support the mother.

For some more ideas.. I have numerous previous posts about breastfeeding education, support and sited references such as the Coalition for Improving Maternity Services Ten Steps for example and other important issues.

Overheard NICU Nurse “I Don’t DO Breastfeeding”

Sad but true…


I just overheard a comment from a potential new experienced NICU nurse (we open in July!) where she actually said .. out loud .. during her interview to the many interviewers and our manager (who happens to be an IBCLC) …….

“I don’t DO Breastfeeding”

What. The. Hell. Does. That. Mean?

So I thought… perhaps this young girl is just grossly uneducated. Perhaps she is so inundated with the detailed scientific absolutes of NICU management that she was only making comments related to direct breastfeeding. Surely she can’t be talking about actually thinking breastfeeding isn’t the best care for her small vulnerable patients!!

I’m afraid I may be wrong…

I’m afraid she may get hired……

Well– that’s OK… I’ll work to gently re-educate her about breastfeeding while she helps me learn NICU care!

I was wondering how to approach a post about this when I was notified by Melodie (@bfmom) encouraging feedback from her latest post on “Breastfeeding Moms Unite” blog entitled  Do Nurses Learn about Breastfeeding in Nursing School? a guest article by Jennifer Johnson who writes about Nurse Practitioner Schools.

Here was my comment on that post:

Sad but true…
I- of course- had my training a thousand years ago and there was only about a 30 min section of one class covering mostly anatomy & physiology of lactation…. not much on management of breastfeeding. That may have been it. I have no recollection of really helping any mom during my OB rotation in school. The nurses owned the babies back then and they stayed in the nursery most of the time!
My experience at 3 different hospitals from 1974 thru 1981 before I intensely studied lactation has been that a prevailing approach or “policy” was followed by all duty nurses “just because” or “because the doctor wants his moms to follow these rules”.
There was no current research or evidence to back anything up. One nurse then taught the next new nurse this incorrect, outdated information and so on. This practice still exists in many areas and unfortunately, they don’t know or realize they are wrong. The mothers were then given very little if any instruction.. mostly incorrect.  Dated textbooks were the only resources.
Now things are much better in many areas. Lactation education is just starting to be recognized as an important piece for nursing and medical schools. The true recognized lactation experts are IBCLC’s. Those other professionals who have been  formally educated in lactation, and remain current, can provide sound effective management advice. LLLL’s are awesome and also have some good educational background to become leaders.
Nurses today who work with mother’s and babies should and must have sound lactation management education.
Everybody should do their part and write letters to the editor of their paper/ or their hospital’s board to ask for this. JCAHO is now measuring exclusive breastfeeding as a perinatal core measure. This has become a catalyst for change for many facilities. It is for ours. We were given a presentation on this yesterday.
I do what I can. I have annual educational competencies usually coinciding with WBW. I also now have 3 nursing schools which come thru our department who utilize my  PowerPoint Presentations as an education requirement in their curriculum! Good for them !! 

We have so much to do to help spread the word about the importance of current evidence-based lactation education for the professionals of our nation.  Our mother’s and babies depend on us.  Don’t they??? Shouldn’t they be able to??

We need to get it right!


“The American Propensity to Shun Human Milk is a Public Health Problem”

A Historical Perspective

Bulletin: Chicago School of Sanitary Instruction (June 3, 1911)

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.”

“Low Breastfeeding Rates and Public Health in the United States”

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.

Quotes:

“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???


NBC’s “The Office” sends Positive Message to America for Birth and Breastfeeding

I haven’t ever sat through a whole episode of The Office….    maybe that’s why I didn’t ever really like it.  Perhaps I just didn’t “get” it!  This is a smart and funny show. Last night, they had a large viewing audience and great forum to send a positive message to America. They delivered… in a big way! This was a planned hospital birth so I am mentioning what I thought was positive about the reality of how this was portrayed.

Here’s what I liked:

  • Insurance issues … very real for some and guides some of parents decisions
  • Calm approach to early labor …no need to rush to the hospital with first contraction
  • Could be that she just wants another night in hospital but still comes off as a calm early labor
  • Many people in the Office were crazy & nervous except the mom –Pam
  • Pam feasts and enjoys the food while contracting..nobody said you better not eat!
  • I don’t think ever I heard epidural or C-Section mentioned!! (YAY)
  • Dwight decides he wants a baby and makes a contract including the “baby will be breastfed for the first 6 months” after-which he plans to feed some weird stuff but HEY… at least he indicated exclusive breastfeeding to start…right?
  • Pam still doesn’t want to go to hospital when her water broke
  • She showed a real but pretty brief fear of really “doing this” and becoming a parent
  • She didn’t have her ipod w/ birth music.. but this showed she was really planning and preparing for her birth
  • Pushed her baby out! YAY
  • I don’t think I EVER heard epidural or C-Section mentioned!! (I know I already said that but still— 🙂  No talk of interventions!)
  • Breastfeeding was the NORM in this episode! I did not SEE a bottle even though it was mentioned. The roommate was ALSO breastfeeding!
  • Trouble latching in the beginning is a common situation… It didn’t stop Pam
  • THE NURSE! Oh. My. God.!!! What a TRUE portrayal of the inept ignorant rude comments made by the nursing staff at many many hospitals!! (even mine.. but I’m working on that) Good for Pam to question her and stick her plan.
  • A male Lactation Consultant!
  • The fact that they used a Lactation Consultant…. YAY!
  • Great support from new dad Jim… even though it was funny how his facial expressions were not supportive of a male lactation consultant! (did we see the birth attendant? don’t remember)
  • They reach over in the middle of night and grab the wrong baby to breastfeed… I’m sorry—> that was really funny, I hope it didn’t offend any one. It’s not like a nurse gave Pam the wrong baby……
  • They have common new parent issues ie diapering, car seat, not feeling ready to go home etc…
  • Breastfeeding works out at the end of the show and Pam looks incredibly peaceful and happy… 🙂

The funky cover –> hey..it worked for her so really–who cares..?? I didn’t feel like that was a big part of the overall message IMHO.

My rating : Big A+

After the show– I find out via twitter that I actually know the writer and supervising producer! So cool!

(I work with his father who is an excellent Pro-Breastfeeding Pediatrician!)

😎 Psych 😎

What did you think?? The episode is called “The Delivery”. If you haven’t seen it, you can catch it online here.

We Deliver? How about we make it a better delivery?

permission from CartoonStock

permission from CartoonStock

Our Maternity Services

Need Help!

The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful  breastfeeding are very important.

These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers  lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!!  Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….

What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!

This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE
can show you research studies or data which support the ten steps below.

The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

  1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
    • Access to professional midwifery care.
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
  4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;
    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  7. other interventions are limited as follows:

  8. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  9. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  10. Discourages non-religious circumcision of the newborn.
  11. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

I endorse these steps. You can visit their website to also endorse.

Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.

I also would urge you all to visit and give information to The Birth Survey.

How is your birth place measuring up to these initiatives?

Let’s all continue to make this a better world

in which to give birth!!

Prescription and Herbal Galactogogues

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Gotta make more milk!

I have compiled a literature search of the most common presription drugs and natural or herbal galactogoues used for low milk supply.

Check out my comprehensive guest post over at Breastfeeding Mom’s Unite here! I would love for you to visit her awesome site and leave a comment for her (and me)!

Thanks!