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flickr/Christine Szeto – Creative Commons License


Those of us who have babies in hospitals think that the staff are trained to help us establish breastfeeding, right?

Well yes, sort of. I have reason to believe that when asked, doctors and nurses would answer that they want to support breastfeeding.

But not all health professionals understand what will help that along. Not all hospital policies and protocols are fully aligned with the evidence. And not all patients will take it upon themselves to learn what they’re up against.

I had my first baby in a city women’s hospital. Over 10,000 babies are born there each year. My second was born in a much smaller hospital, where only 1,300 babies are born each year. Knowing what I know about what breastfeeding support really entails, I’m in a position to comment on practices that could make or break breastfeeding establishment.

Let’s compare, shall we?

Breastfeeding support in the city hospital


The staff provided plenty of misinformation. One of my nurses taught me how to do breast compressions in such a way that I gave myself plugged ducts. That same day, a resident (yes, a trainee, but still a doctor as far as his white coat embroidery was concerned) told me not to let my baby stay latched for more than five minutes at a time, to feed no more than every two hours, and to give a pacifier in case of fussing in between.

Okay, first thing’s first – you feed on demand in the early weeks, period.

Second, if you’ve read only the 4-paragraph breastfeeding pamphlet you get at your prenatal appointment, and that’s all the information you get about breastfeeding ever, you probably bumped into the little tidbit that early introduction of pacifiers might interfere with breastfeeding establishment. Health professionals who are advising on breastfeeding should at a minimum know that pacifiers could cause nipple confusion and are associated with declines in breastfeeding duration.

I think the word should get out that even seasoned pediatricians don’t get much nutrition training, despite all the breastfeeding and nutrition advice they give. But that’s another post.

A fresh new pacifier was sitting in plain view in the bassinet, without any indication that pacifiers may interfere with breastfeeding establishment. The staff should let new mothers know these things.

The lactation consultant missed the boat. She didn’t drop by until we were on our way out. I got a quick consult, but what if something had been off for my baby’s first three days? Best case scenario, I would have asked for a bottle. Worst case, I would have given up altogether.

I was given a gift bag from a formula company. The nurse brought me the version for breastfeeding moms, but it still contained a canister of formula and a stack of formula coupons. Unfortunately, the bag lacked resources and contacts in case I hit a bump and needed help.

Think about it – when you hit a roadblock, it’s so much easier to grab the canister out of the cabinet than to make an appointment with an expert to troubleshoot.

It’s well established that these gift bags negatively impact breastfeeding outcomes. The WHO and other pro-breastfeeding organizations frown upon the practice of giving them to mothers.

Breastfeeding Support in the Small-town Hospital


There was not a pacifier in sight. I didn’t ask for one, but if I had, I’m certain I would have been educated on nipple confusion and the baby’s role in the supply-and-demand mechanism behind milk production.

I was supported by a lactation team. The lactation consultant was not available right away, but the floor staffed more than one breastfeeding counselor – nurses who were training for lactation consultant certification. These women checked up on our feeds early and frequently until I could see the IBCLC. Trust me, they knew their stuff.

Going home gifts didn’t include formula. Baby swag included diapers, diaper cream, perineum care, breast pads…things like that. There were no formula samples and no formula brand names on anything.

And when I asked for a bottle…
I requested a bottle of formula at one point because I was beyond exhausted, my baby was big and feeds were holding her for all of 10 minutes. I planned to give “just one,” so I could get an hour or so of sleep.

I wasn’t just given a bottle. It wasn’t that simple.

One might think I would have been angered by not getting what I asked for, but my rational mind couldn’t help but take over, and I was thoroughly impressed with the surprising response to my request.

My nurse kindly explained to me that she was not authorized to give formula to breastfeeding babies unless the pediatrician prescribed it as “medically necessary,” meaning, baby was showing signs of undernourishment.

Mothers could choose to side-step the doctor only after lengthy education about early breastfeeding, nipple confusion and how mom and baby work together to get mom’s milk supply established. Then, if mothers still wanted formula, the hospital required her to sign a document saying she understands what was just explained. Only then would formula be given.

Even after all of that, formula would be administered with a syringe or a small flexible cup designed for newborns. No bottles or artificial nipples were given.

It’s not like I was being bullied or controlled. I could still get formula if I thought my baby should have it. The decision was mine to make, but the staff would make sure I knew what could interfere with breastfeeding in the early days.

I’m still amazed. And thankful that I was gently guided away from formula.

I could have had a postpartum mom tantrum. But between having a master’s in public health, working for a pro-breastfeeding nonprofit and just knowing a good bit about what it takes for successful breastfeeding establishment, I was nothing less than amazed by this protocol. After so much careful attention to establishing the breastfeeding relationship, how could I get upset? I knew that this was not the norm in hospitals.

The city hospital more accurately represented what happens in most hospitals. Some mothers are lucky and able to breastfeed through it, and other mother-baby pairs run into difficulty with insufficient support to get back on track.

It seems like hospitals are becoming more aware and moving in the right direction, such as taking on the Baby-friendly Initiative and such. My hope is that a well-informed and motivated hospital staff becomes the norm.


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