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**ROAR** on Breastfeeding Guilt

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(Image found at Google Images)

**ROAR**

The Mommy Wars over feeding babies continue..I guess it won’t ever be truly over. I’ve been following a discussion over at NursingBirth on  “Why Educating Our patients is a Professional Responsibility and Not about Guilt.”

I thank her for quoting me and including thoughts I wrote on what I have learned over the years talking to, educating and helping mothers.

I have re-posted this earlier segment  “Breastfeeding, Bottle-feeding and Somewhere In-between… Why the Guilt?” This post is about what I have learned speaking from a professional point of view. As a professional, it is inappropriate for any of us to imply directly or indirectly to any mother 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 mother’s milk, expressed donor milk then properly prepared infant formula. That’s why NursingBirth’s post is so important to understand. Reading the comments……

There are STILL moms out there confusing the issue.

All or most of this discussion is NOT directed at any mother who tried to breastfeed under any circumstance and wasn’t able to at all or wasn’t able to fulfill her individual goals. I applaud all your efforts for trying to give your baby the best food you could. I am so sorry that you experienced the difficulties you have. Your situation is not what this discussion is about. I think it’s very possible that advocates and some professionals lack sufficient skills to help you deal with the loss of a breastfeeding relationship. If breastfeeding is important to you then you would truly go through a grieving process and guilt would most likely come into play somewhere along the line. We do that to ourselves a lot as women anyway. I did personally experience that guilt. I had wanted to breastfeed my last baby for a full year and was unable to because of personal health problems. I had a lot of guilt. This discussion is NOT about these situations. Let’s stop making it about that. Please!

This mommy war guilt discussion as I see it is one where a mother who chooses to formula feed defends her choice and lays claim that those who are promoting or advocating breastfeeding make her feel guilty.

Guilt comes from within an individual if they feel they haven’t done what they “should” or wanted to. Guilt is a very strong emotion. NursingBirth has a great description of guilt as does The Feminist Breeder in “Mommy Guilt- Its all about Perspective.” It would be a good idea for guilt-ridden moms to read these articles. Those professionals or advocates who I have mentioned here or in my re-post are trying to do a good job of making sure people have the information to make educated decisions about health care issues.  Any professional who intentionally tries to make a mother feel guilty isn’t being very professional. If there is an advocate out there continually finding moms feeling guilty, perhaps you should change how you deliver the message. I said in this earlier post about how one single word can make a difference:

“She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??”

None of this changes the facts. Like it or not, breastfeeding is and will continue to be a major Public health Issue to the point of a public health crisis! As professionals and advocates, our work is not finished. I think sometimes that those speaking out against advocates get in the way of facts and put their personal opinions or views out in front and totally distort the issue. I read on someones blog this week (TFB) a great quote by Daniel P. Moynihan: “You are entitled to your own opinion, but not your own facts.” and I loved it!

According to this article from the American Journal of Public Health:

“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.”

I am still going to promote breastfeeding. I am still going to provide appropriate factual information to the mothers in my care and support whatever feeding decision they make. I will never be pushy. I will gently encourage those on the fence to give breastfeeding a try. I always support the mother.

But more people need to talk about the importance of breastfeeding.

Because it is

Important.

Don’t be guilty

Stop it

*ROAR*


Repost~ The Guilt trip~ Breastfeeding, Bottle-Feeding and…. Somewhere In-between…. Why the Guilt?

There has been so much discussion circulating in the blogosphere right now about breastfeeding.  I thought I’d add my 2 cents because….I have an opinion and….. I have just a little experience in this field both in study (2 year Lactation course, IBCLC for 10 years, current CLC) and in practice (35 years).

I thought I knew so much in 1988 after nursing 3 babies and assisting others for nearly 15 years. I actually thought I could just take the IBLCE exam based on my experience!

I was so ignorant and naïve!

I started to talk to some IBCLC’s and my eyes were opened wide to the real world. Up to that point, at that time, (I sadly and guiltily admit) I had no idea about the volume of study and research in the field of lactation. I had NO idea just how wrong we were doing things at my hospital.

I launched into a lactation course, soaking up all I could, 3 years of study preparing for certification. I set out to change the world… at least my world. I wrote big proposals for the hospital. I applied for grants to fund a lactation program. I developed education competencies for the staff. I started breastfeeding classes. I thought everybody shared my passion, that they too would want to learn …. because I was right!!

Instead I was the target of all the boob jokes you could think of and I had almost no support. My ideas were rejected left and right.

Long story short…it took me a long time to come to terms with accepting small changes, taking baby steps…..continuing to do the best job I could with each mother-baby couple and to keep a positive outlook. I needed to remain realistic about how much I could actually accomplish one step at a time. Slowly I began to have people under my wing trying to learn. Yeah!

I learned a lot about how to approach physicians, co-workers, managers and most of all …. mothers.

I am not an expert in journalism or critical analysis so this is my opinion of what is going on right now.

There have been some irresponsible journalists, those who have a bigger platform than most of us, writing negatively about something they have not studied or truly researched. They are expressing their opinion and including an emotional component which has, in my opinion, gotten the reaction they hoped for from breastfeeding advocates as well as those who concur with the authors. More hits, more readers. I feel they have twisted the facts to benefit or support a point they want to make. I read some of them.. other’s I really just scanned then brushed off so I don’t know everything that’s been said. On the positive side, these articles possibly give us a larger platform to provide correct information to a larger public in reply.

I read a lot of blogs and I really respect and admire all the research that many breastfeeding advocates put into their fabulous posts. These are educated women who are trying to provide current accurate information! (@phdinparenting, @bfmom, @MommyNews , @JakeAryehMarcus, @blacktating ,@AmberStrocel, and so many more). I applaud their passion and breastfeeding advocacy. They are doing a very important job. Breastfeeding IS very important and deserves advocacy, protection and support! There are still large scores of women out there making choices with only tiny bits of information, who really do not know the important benefits of breastfeeding. It is because of this, and because we still haven’t met the US Dept HHS Healthy People Goals for 2010, that breastfeeding advocacy needs to continue. I have been there, advocating in a time where I faced great adversity and a lot of negativity. I am bothered that it still exists…and exists now in so many new ways.

I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??

Over the years, I have learned this:

  • It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
  • The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
  • The education process to a mother 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 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.
  • Many times, the first question she asks may not be what she really wants to ask.
  • The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
  • Support the mother, support the mother, and support the mother.

Here are the top 3 responses to the feeding choice question pertaining to breastfeeding at my facility on admission:

  • “Breast and Bottle”
  • “I’m going to do both”
  • “I’m going to ‘try’ to breastfeed”

To each of these I respond very positively with something like… “Great! Tell me what you’ve learned about breastfeeding.”     I will then ask the mom a few questions to somehow find out her true wishes.

Then I say  “We will support and honor however you wish to feed your baby.  I’d like to give you some information so you can really understand and then tell us what you’d like to do.”

I explain some things,  i.e.: how the milk production works, the importance of early feeds etc.. and how formula introduced at that time could  interfere with the process of production, the baby’s ability to latch properly and so on… I usually end with..”We usually recommend to  focus on breastfeeding for now and then offer bottles later after milk supply is established if that is how you’d still like to manage feeding”. ETC…ETC….  Here’s what I then see:

  • There have been so many mom’s who — after a little  bit of information decide they would like to focus on breastfeeding. There have been many who totally fell in love with it.
  • There have also been many who really didn’t want to breastfeed after one single feeding.
  • There are many many still that like to breastfeed and bottle feed in combination right from the start. If they have the right info and understand how things may progress… I still say “Good for you!”
  • I have seen many continue that way for months and they are very happy with that.
  • I’ve seen many mom’s “partially” ( I don’t like to say it that way) breastfeed and feel very proud. I say “good for you!”  They don’t think of it in terms of “exclusive” or “partial”… It’s more like any breast at all…. is breastfeeding vs. no breastfeeding at all.
  • There have been many who also never wanted to try until all of a sudden they see milk leaking!
  • I’ve worked with mom’s where I can see tremendous improvement in her situation, I think she’s going to keep going…but she decides to totally quit. I simply praise her for all her efforts and help her feel proud of herself.
  • I’ve worked with mom’s who have hardly put forth any effort to overcome small obstacles, I think they will probably quit outright… Then..I find out they are the ones exclusively breastfeeding down the road.

I got a comment from a breastfeeding mom @TheFeministBreeder that I absolutely have to share. She describes her own experience in the full comment and on her new blog post.  She comments:

“Yes, I think that’s the most important part – informing a mother of any and ALL benefits/risks to supplementing, and helping them work through the option they choose.  But to tell a mother to supplement without explaining that it could undermine her efforts is just plain mean.  And too many medpros are doing it.  I’m glad there are more nurses like you who will give out the real information to empower a woman to make her own choice.  My smart friend always says ‘It’s not really a choice if you don’t have all the information.’ “

For those mom’s really trying to breastfeed and struggling, there’s more than I can say right here to cover that. I’m sorry for your struggles and hope it gets easier for you. It is important to have a skilled competent support person assisting you who listens thoughtfully and helps you get to the root of your problem… and helps you define and realize your goals. If you are experiencing guilt from your struggles or from not being able to fulfill your goals, desires to breastfeed….I think that kind of guilt is different from what I’m trying to discuss here. I am not a an expert on that. It is valuable to get the best help out there that you can as soon as possible.

I’m adding this after reading some comments on other blogs.. When approaching a mom to observe or assist with the latch process…. Permission is a must! I ALWAYS ask the mother if she would like any assistance with the latch or if  I may observe how well her baby is latching….. If that answer is yes… The next question is ALWAYS.. May I touch your breast? (if that needs to part of the process). I prefer to help moms by having the mom and BABY do the latch. I try to keep my hands out of it.  All nurses and LC’s should practice this. I am sorry for the mom’s who aren’t asked permission to be helped or touched.  😦

One of my favorite things I like to say to any breastfeeding mom is:

“Try not to make any final decision when it’s dark outside”.

On another note, regarding some reader comments on various blogs about public breastfeeding, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breastfeeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. There are volumes of video footage and photos all over the place… even on billboards. It is sad that the public opinion of a baby breastfeeding (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 breastfeeding her baby. Why aren’t law-makers focusing on any of that?

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

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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!!

Hope all had a great WBW 2009!!

WBW~ Breastfeeding in a Personal Disaster…. C.Michael’s Story

SendPicture14 August 2nd…..Today is my son’s 24th birthday. Yeah…I’m old 😉 This is not really the theme of WBW but I will take this opportunity to tell his breastfeeding story on his birthday.

In 1985, I gave birth to my second son. C. Michael. He was 37 weeks and behaved like many     near term babies… Breastfeeding got off to a slightly delayed start but then was awesome and without problems! Yay!

I wish C. Michael’s physical health was the same way.

C.M. was born with craniosynostosis.  Specifically, saggital craniosynostosis. Infants skull bones are purposely NOT fused together at the time of birth so the head can mold as baby makes his way down the birth canal and into the world. The different skull bones will overlap easily along the suture line so as to fit thru the pelvis. These bones then gradually reshape and the sutures eventually fuse.

My son’s saggital suture line was prematurely fused…causing a misshappen head. When there is a premature fusion, the growth can only occur parallel to the fusion. The saggital suture goes from the anterior fontanel along the top of the head to the posterior fontanel. Parallel growth would cause his head to be really oblong, or football shaped.

We took him to 5 doctors to decide if we would have corrective surgery… Yes that’s right…. it had to be OUR decision. Although this is a birth defect and causes a visual deformity, it does NOT affect healthy brain function UNLESS there is fusion of more than one suture and growth is impeded. So it is cosmetic surgery.

We decided to go ahead with the surgery at age 3 months and had everything arranged at CHOP (Children’s Hospital of Philadelphia). The craniofacial team was amazingly supportive. I was so very scared. My husband and I could not sleep. I hadn’t been able to sleep well since he was diagnosed. How many new mom’s tell you the baby is sleeping but they can’t sleep??? I’m not going to get into the whole surgical procedure… but the  main point of this story is how breastfeeding not only provided C.M. with the best nutrition and immune system protection, it also saved me thru my son’s ordeal.  My husband was able to pre-donate blood so we both felt like we were doing everything physically possible as his parents to help him tolerate and recover from this major surgery.

I was so pleased to be able to sleep right next to him in the hospital. We had to go in the night before and the he was not allowed anything after 4 am… he could nurse up to that point. I woke him to nurse around 3 am. It was very bittersweet. I was crying and he was happily nursing, not know what was coming next. It was difficult just to see the IV placed, let alone the actual surgery.  I was so grateful and happy they had done alot of pre-op procedures the night before when I could nurse him after each study. Now , when they wheeled him off to the OR, I was almost happy he had been slightly sedated because as hard as it was, I could never have handled him screaming at that point.

While he had the surgery, I headed first to the pumping room to try and get as much milk stored as possible. I had not been able to pump well before this so I had limited expectations. It was the first time I had used a hospital grade pump so I had much better volume than I expected. I stored a couple bottles and was feeling actively involved in his recovery already!

They called us to meet him outside of recovery a couple hours later. It was very difficult to see his head swollen and heavily bandaged. He had had a blood transfusion once already in the OR and they expected he would need more. Apparently the bone edges ooze when cut.  We took turns with him until he wasn’t groggy any more, then, once awake…. I rarely left him.  I was told he had to have a little bit of an electrolyte solution in a bottle first before I could nurse him, just to make sure he didn’t vomit.  He was ready to nurse in about another hour. They took him out of the crib, with his massive head bandage, black and blue eyes and 2 IV lines….place him in my arms and we gently rocked and nursed.SendPicture12

I felt completely lost, even as a nurse or especially as a nurse…. because seeing your child like that is very difficult. I kept thinking all the worst possible complications would happen to him. I wanted to keep him safe, protect him. I struggled with tremendous guilt, thinking I must have done something to cause this to happen… It must have been my fault.  Many parents go thru that, I’m sure. Breastfeeding him thru the hospitalization, two more blood transfusions and recovery period helped me feel like I was actively healing him. My husband felt similar thoughts because they used his blood for the first 2 transfusions. It was an empowering feeling.

I’ll close by saying that finally being finished with the decision process, the surgery completed (sucessfully I’m happy to say) and on the recovery road also cured my sleeplessness.

The night nurses at CHOP laughed at me! There I was, sleeping right next to my precious brave 3 month old post-op son…and they had to wake me up to tell me he was crying to feed in the night.  😉

What a handsome guy now!

What a handsome guy now!

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Mama needs “ME” time…. How do you guys do it all?

Birth and Breastfeeding Blog? I haven’t been doing much blogging.. Hmmmm……I feel somewhat guilty…….I mean I feel like I have a lot going on in my life… but ~

I don’t have small children….. mine are grown and gone… for the most part.

I don’t work 5 days a week….I work 3..but they are 12 hour shifts

I barely cook… at least no really complicated meals… I’m not a crunchy (didn’t even know what that word meant) organic earthy person.. I try to eat well but — the easier, the better…or frozen 😉 is ok with me!

I don’t scrub-clean my house….. I like things orderly so I straighten, manage the dishwasher, blow the dust off frequently used areas, but hey, I gotta clean the bathroom.. that’s a must.

My husband does all my floors and his own laundry….. everyone in my house has always done their own laundry. My husband is just NOT a needy guy at all! He’s my dreamboat.

I’m not really married to my work… so to speak — but I’ve always taught my family that I have to care for people all day long at work…so they need to be independent where they can and help care for all their own needs. Mama is always available for the important stuff or talks.

Mama simply needs “ME” time..and a lot of it! It renews my spirit and rejuvenates my energy. Sometimes I feel like a selfish be-otch.. but I KNOW I need it. I’m worse with out it.

Today I worked on several work projects here at home…  Some PowerPoint, outlines for projects in my Clinical Expert Applicant Curriculum…. Specifically on Evidence-Based Practice and research;  Project participation within my organization… (searching for compelling ideas to stir up others enthusiasm); Community involvement; Cultural Diversity; Service Excellence and Preceptor/Mentoring of new nurses. Just a little somethin-somethin.

Oh and I forgot to mention a little thing called.. WORLD BREASTFEEDING WEEK !!   August 1-7  (more on that very soon)

A lot of the blogs I read contain regular well researched posts. I have over a hundred posts still to read in my reader! I want to tell my stories but I don’t always have the energy to figure out ways to tell the essence of the story and change enough to protect the identities.

So I do a lot of thinking and dreaming about what I’ll write on this blog — without really writing. Don’t give up on me yet.    If you are looking for something really cool or inspiring..I have it inside me head.. I do… it’s in there — still waiting to be gracefully typed with two fingers….

BUT

I’m probably watching a movie, reading a book or going out to lunch.
Fellow Bloggers… How do you pour it out on to the pages? I have a fairy tale impression of you all.

JUST HOW do you guys do it all?? Come clean with me.. are you all magical self-less supermom wizards?

OB Docs and Nurses Scoff at Homebirth

My community hospital’s views have never been in favor of any type of home-birth… whether it’s with a skilled professional  practitioner or a skilled lay midwife. There could have been some free unassisted births going on but we were not aware….  As I grew-up in this profession, I learned first from my experienced counterparts…then I began to educate myself and learned a lot from mothers and babies.  The doctors and nurses I worked with were all stagnant in their knowledge in my early years. They were satisfied with how things were.  I was young, I had an open-minded philosophy and an eager quest for knowledge.

In the later 70’s, just when we began to have mothers speak out and request a more natural childbirth, I had a few friends who enlisted the aid of some lay midwife in the region and arranged for homebirths. They all had a really nice birth experience without a single complication. Perhaps that was why I was open to the idea even though I was not personally involved. Besides some of the truly prepared couples who came in and had incredibly beautiful births….. that had been my first exposure as an alternative option to the knock’em out–pull’em out births I had been working with on the job. I knew my friends were very low-risk and had done their homework. 

   However, the hospital’s exposure to a homebirth in those days was only if the homebirth went awry for some reason or another and they came in our doors seeking help…  here’s what the docs and nurses would say to one another :

  • “Can you believe she planned to deliver at home???”
  • “How could she take take a chance like that with her baby?”
  • “The reason people started coming to hospitals to give birth was because mothers and babies were dieing at home….she must be crazy or totally insane!!”

   We’ve had planned homebirths come in for various reasons, as I am sure other facilities did…. (keep in mind that in my area, the usual birth attendant was a lay midwife). The situations bringing the mother to the hospital were often scary and upsetting for her. The most common were:

  • Fetal heart rate decels with or without meconium stained fluid 
  • Lack of progress with pushing mostly after many hours..
  • Higher than normal bloody show or bleeding–possibly abrupting
  • Breech, brow or face presentation
  • Retained placenta

Often the OB’s didn’t handle themselves well.. certainly not professionally. We had this one OB who would call for the OR to be opened before he even examined the patient or evaluated the situation…..regardless of why they came in.  And he often actually yelled at the mother, in the middle of her scary situation.

“Your baby will die if we don’t do an emergency C/S right now, why did you let this happen!”

Most often the backlash was directed at the midwife who cowered in the hallway- uninvited by the staff, left alone detached from her patient. She never left the unit though until she was afforded the opportunity to visit and speak to her patient. 

The two significant situations I remember which would fall in to statistical data for morbidity were:

  1.  An abruption which resulted in a crash C/S upon admission and a neonatal resuscitation with good response….(final apgars 3@one min then 7@ five min) positive overall outcome, no long term sequelae.
  2. A birth where the father (a chiropractor) was the birth attendant for his wife, a multip, encountered a shoulder dystocia and the baby ended up with a displaced fractured left humerus. That baby was in a crib with traction to realign the bone. The child went on to be an honor student at a local university after homeschool.

I feel that instead of the midwife or mother receiving hostility (or even the mother being wisked away to the OR without a trial of something if the baby was deemed stable..)~ the staff should have behaved in a compassionate professional manner, acting on any urgent situation with consideration that this mother is now experiencing not only labor but fear and grief over the loss of her beautiful planned birth.

Despite all the negativity from the staff, we never had a seriously bad outcome from attempted homebirths arriving on our doorstep.  We still have attitude problems, probably always will~ just as we do with breastfeeding.  I wish they could  look at it from my perspective. Those who choose homebirth today have better information to hopefully make an educated informed decision about their birth options and choose wisely. I really like Ricki Lake’s “The Business of being Born” among other’s. I hope those choosing homebirth are truly investigating all these options, deciding what is best for them and not making any decisions out of “anger at the system” or any sort of revolutionary zeal.  

  There is so much out there for medical professionals to be aware of other than what goes on in their tiny little realm, their little part of the world. My co-workers and doctors need to be better informed.  

Any one bad outcome (which most certainly happens in the hospital)  does not mean that every homebirth is a bad idea.

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?

 

 

Breastfeeding, Bottle Feeding and…. Somewhere In-between…. Why the Guilt?

There has been so much discussion circulating in the blogosphere right now about breastfeeding.  I thought I’d add my 2 cents because….I have an opinion and….. I have just a little experience in this field both in study (2 year Lactation course, IBCLC for 10 years, current CLC) and in practice (35 years).

I thought I knew so much in 1988 after nursing 3 babies and assisting others for nearly 15 years. I actually thought I could just take the IBLCE exam based on my experience!

I was so ignorant and naïve!

I started to talk to some IBCLC’s and my eyes were opened wide to the real world. Up to that point, at that time, (I sadly and guiltily admit) I had no idea about the volume of study and research in the field of lactation. I had NO idea just how wrong we were doing things at my hospital.

I launched into a lactation course, soaking up all I could, 3 years of study preparing for certification. I set out to change the world… at least my world. I wrote big proposals for the hospital. I applied for grants to fund a lactation program. I developed education competencies for the staff. I started breastfeeding classes. I thought everybody shared my passion, that they too would want to learn …. because I was right!!

Instead I was the target of all the boob jokes you could think of and I had almost no support. My ideas were rejected left and right.

Long story short…it took me a long time to come to terms with accepting small changes, taking baby steps…..continuing to do the best job I could with each mother-baby couple and to keep a positive outlook. I needed to remain realistic about how much I could actually accomplish one step at a time. Slowly I began to have people under my wing trying to learn. Yeah!

I learned a lot about how to approach physicians, co-workers, managers and most of all …. mothers.

I am not an expert in journalism or critical analysis so this is my opinion of what is going on right now. 

There have been some irresponsible journalists, those who have a bigger platform than most of us, writing negatively about something they have not studied or truly researched. They are expressing their opinion and including an emotional component which has, in my opinion, gotten the reaction they hoped for from breastfeeding advocates as well as those who concur with the authors. More hits, more readers. I feel they have twisted the facts to benefit or support a point they want to make. I read some of them.. other’s I really just scanned then brushed off so I don’t know everything that’s been said. On the positive side, these articles possibly give us a larger platform to provide correct information to a larger public in reply.

I read a lot of blogs and I really respect and admire all the research that many breastfeeding advocates put into their fabulous posts. These are educated women who are trying to provide current accurate information! (@phdinparenting, @bfmom, @MommyNews , @JakeAryehMarcus, @blacktating ,@AmberStrocel,  and so many more). I applaud their passion and breastfeeding advocacy. They are doing a very important job. Breastfeeding IS very important and deserves advocacy, protection and support! There are still large scores of women out there making choices with only tiny bits of information, who really do not know the important benefits of breastfeeding. It is because of this, and because we still haven’t met the US Dept HHS Healthy People Goals for 2010, that breastfeeding advocacy needs to continue. I have been there, advocating in a time where I faced great adversity and a lot of negativity. I am bothered that it still exists…and exists now in so many new ways.

I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend?? 

 

Over the years, I have learned this:

  • It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
  • The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
  • The education process to a mother 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 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.
  • Many times, the first question she asks may not be what she really wants to ask.
  • The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
  • Support the mother, support the mother, and support the mother.

 

Here are the top 3 responses to the feeding choice question pertaining to breastfeeding at my facility on admission:

  • “Breast and Bottle”
  • “I’m going to do both”
  • “I’m going to ‘try’ to breastfeed”

To each of these I respond very positively with something like… “Great! Tell me what you’ve learned about breastfeeding.”     I will then ask the mom a few questions to somehow find out her true wishes.  

Then I say  “We will support and honor however you wish to feed your baby.  I’d like to give you some information so you can really understand and then tell us what you’d like to do.”  

 I explain some things,  i.e.: how the milk production works, the importance of early feeds etc.. and how formula introduced at that time could  interfere with the process of production, the baby’s ability to latch properly and so on… I usually end with..”We usually recommend to  focus on breastfeeding for now and then offer bottles later after milk supply is established if that is how you’d still like to manage feeding”. ETC…ETC….  Here’s what I then see:

  • There have been so many mom’s who — after a little  bit of information decide they would like to focus on breastfeeding. There have been many who totally fell in love with it.
  • There have also been many who really didn’t want to breastfeed after one single feeding.
  • There are many many still that like to breastfeed and bottle feed in combination right from the start. If they have the right info and understand how things may progress… I still say “Good for you!”
  • I have seen many continue that way for months and they are very happy with that.
  • I’ve seen many mom’s “partially” ( I don’t like to say it that way) breastfeed and feel very proud. I say “good for you!”  They don’t think of it in terms of “exclusive” or “partial”… It’s more like any breast at all…. is breastfeeding vs. no breastfeeding at all.
  • There have been many who also never wanted to try until all of a sudden they see milk leaking!
  • I’ve worked with mom’s where I can see tremendous improvement in her situation, I think she’s going to keep going…but she decides to totally quit. I simply praise her for all her efforts and help her feel proud of herself.
  • I’ve worked with mom’s who have hardly put forth any effort to overcome small obstacles, I think they will probably quit outright… Then..I find out they are the ones exclusively breastfeeding down the road.

I got a comment from a breastfeeding mom @TheFeministBreeder that I absolutely have to share. She describes her own experience in the full comment and on her new blog post.  She comments:

 “Yes, I think that’s the most important part – informing a mother of any and ALL benefits/risks to supplementing, and helping them work through the option they choose.  But to tell a mother to supplement without explaining that it could undermine her efforts is just plain mean.  And too many medpros are doing it.  I’m glad there are more nurses like you who will give out the real information to empower a woman to make her own choice.  My smart friend always says ‘It’s not really a choice if you don’t have all the information.’ “

For those mom’s really trying to breastfeed and struggling, there’s more than I can say right here to cover that. I’m sorry for your struggles and hope it gets easier for you. It is important to have a skilled competent support person assisting you who listens thoughtfully and helps you get to the root of your problem… and helps you define and realize your goals. If you are experiencing guilt from your struggles or from not being able to fulfill your goals, desires to breastfeed….I think that kind of guilt is different from what I’m trying to discuss here. I am not a an expert on that. It is valuable to get the best help out there that you can as soon as possible.

I’m adding this after reading some comments on other blogs.. When approaching a mom to observe or assist with the latch process…. Permission is a must! I ALWAYS ask the mother if she would like any assistance with the latch or if  I may observe how well her baby is latching….. If that answer is yes… The next question is ALWAYS.. May I touch your breast? (if that needs to part of the process). I prefer to help moms by having the mom and BABY do the latch. I try to keep my hands out of it.  All nurses and LC’s should practice this. I am sorry for the mom’s who aren’t asked permission to be helped or touched.  😦

 

One of my favorite things I like to say to any breastfeeding mom is:

“Try not to make any final decision when it’s dark outside”.

 

On another note, regarding some reader comments on various blogs about public breastfeeding, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breastfeeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. There are volumes of video footage and photos all over the place… even on billboards. It is sad that the public opinion of a baby breastfeeding (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 breastfeeding her baby. Why aren’t law-makers focusing on any of that?

Scary 1975 Breastfeeding Policy

 This story is about

VINTAGE Breastfeeding information

NOT Current Information

 

1979 Father wearing gown and mask to attend feeding

1979 Father wearing gown and mask to attend feeding

 

I have attempted to give an overview of our Maternity Ward as it was when I started to work there. I mentioned how “Once delivered, the baby went to the nursery and became the immediate property of the nurses, only to be seen from a window and allowed to be with the mother at token intervals. The poor little baby was often keep without food/ only water for the first 12 hrs. (Breastfeeding was something only the hippies did.)”

The thought process, as I was instucted even in nursing school, was that most newborns needed to rest after birth, and didn’t require food for 4 to 24 hours. They felt that postponing food would allow time for the mucous to be cleared from the throat and the baby would be allowed ample rest after the exertion of birth and all that handling by doctors and nurses as they provided the necessary care.  My nursing school textbook (Marlow, Pediatric Nursing, 4th ed. 1973) even goes so far as to say that this lag time would allow the mother sufficient rest before giving her infant the breast because….. this first offering is…… difficult. ( Oh… You’d better rest up, dear…)

Another thought process that unfortunately is still around today was that the nurse should not encourage the mother to breastfeed over bottle feed…. least she arouse or cause any maternal guilt feelings. My old textbooks all did list some basic benefits of breastfeeding and proclaimed this as the ideal food. Ie: easier to digest, natural diet for the newborn, convenience, availability AND the provision of identified and unidentified substances which may be protective.  The nurse should provide the information to the mother but not encourage her. They felt prepared formulas (Evaporated or whole milk formulas with added carbohydrates) OR the newer commercially prepared formulas were an “equal” substitute. We did have a full formula preparation room in the nursery with a refridgerator, range, sterilizing equipment etc. When I started, the Similac and Enfamil reps had already just hooked up the hospital with the marvelous free individual bottles of their products which were piled high on top of the former work area for formula prep. I don’t know when they actually stopped making it themselves.

Our 1975 Hospital Policy & Procedure  *

  • We start with NPO (nothing by mouth) for 12 hours.  Then feed one feeding of sterile water to confirm the infants ability to swallow.
  • If the baby has excessive mucus secretions, he should be fed 5% glucose water (G/W)  every 4 hours for the next 12 hrs before his first breast feeding.
  • The father may be present for feedings provided he is properly gowned, wearing hat and mask and has scrubbed hands.
  • For the first breast feeding,  teach the mother to cleanse her nipples with the cotton ball (soaked in a Benzalkonium chloride solotion) and teach proper latch-on techniques where-by the mother should cradle the baby near her breast, stroke his cheek so he turns and assist him to “grip” the nipple when he opens his mouth. Place the baby at both breasts for no longer than 2-3 min each side to avoid sore nipples. Feed the baby 5% G/W if he is still hungry when removed from the nipple.
  • Feedings should be every 4  hours, the mother should cleanse her nipples as above before each feeding.
  • If the baby should cry within 3 hrs of his last feed, he may be offered more 5% G/W.
  • The time spent at breasts should gradually increase to 3-5 min each feed for the first 2 days then continue to increase up to 10 min each side by the 4th day. When her milk begins to flow and the baby will actually be receiving milk.
  • Instruct the mother to pay close attention to which side she began and ended each feeding so she can alternate which side to begin the next feed.
  • Babies will usually require 6 feedings a day for the first several weeks.
  • Once lactation is established, she should be instructed to limit a feeding to 20 – 30 minutes total per feeding. The baby gets 90% of his milk in the first 5 minutes, any additional time is for his enjoyment. Some babies may “cling” to the breast after feeding and may need to be removed. Teach the mother to use her finger gently in the babies mouth to break the suction and remove him.
  • Babies may be taken to the mother for a breast feeding “on-demand” if so written on the chart by the physician

 

(*This is a combination of information I have from a scanty old policy,
what I remember
and interviewing some older former colleages about what we all actually did.)

If we were unable to get a baby to latch on, we had one tool available to us at the time. We had a hard rubber nipple on a glass base shield that we placed over the breast/nipple and we used the same timing of feeds.  We would only help a mother pump her breasts if she was engorged. The only tool we had to assist her with this was a bicycle horn hand pump. 

There were some pediatricians who were starting to be flexible and improve the approach to breastfeeding in a more natural sense, encouraging initiation earlier and more frequent feeds “on-demand”. There were more professionals opposed to that train of thought and continued their same practices.  When the women started coming in and requesting a better approach to feeding…. they were sabotaged by the nurses who then fed their infants “white water” while in the nursery so these babies would sleep until the next designated feeding time. 

This was 34-35 years ago and I still work with nurses today who have some of these thought processes behind what they do. Many of the older physicians, if taught anything in Med school, were taught similar management protocols. It is such a difficult retraining, re-educating process that some of us face. 

Just last week.. a brand new RN/BSN asked me how the newborn was supposed to survive on colostrum alone?

She was blank faced dead serious. 
I started my answer with…”You are not the first nurse to ask me that very same question and it’s a good question. Here’s why etc……..”
I hope I answered her well enough so she can someday teach the next one and the next…..
We really need much better Lactation Education 
for our Doctors and Nurses.
They should not be so uneducated or ill-equiped 
to properly care for and advise the mother’s in their care!