February 11, 2016 | 59 Comments

Muzzling healthcare providers

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Special interest groups are often tempted to muzzle healthcare providers and many do. What’s the difference between Catholic hospitals muzzling healthcare providers who want to talk about birth control, the gun lobby muzzling healthcare providers who want to talk about gun safety, and the Baby Friendly Hospital Initiative muzzling healthcare providers who want to talk about formula feeding?

Author:Amy Tuteur, MD

View all posts by Amy Tuteur, MD →
  • first-time mom

    I’m a first-time mom, due in April, and will be delivering at a baby-friendly hospital. I’m pretty nervous about it. I intend to breastfeed, and don’t have any reason to think it won’t go well, but how will I even know if it’s going well? If my baby isn’t getting much milk, will the LCs and nurses just say everything is fine and to keep going? Who will be able to recognize, and willing to tell me, if my baby is starving/dehydrated? I plan to bring a can of formula and some bottles with me, and won’t have any problem telling some judgy LC to get out of my face while I bottlefeed my baby, but I just worry about how to know what my baby needs.

    • SporkParade

      Go with your gut. It’s normal for a baby to be a bit lethargic in the first six hours of life (birth is tought on them, after all), but it’s not normal after that. If you feel like your baby can’t stay awake to eat, that’s a good time to consider supplementing. Also, if you baby loses 10% of its birth weight, you should definitely supplement (and they should tell you to supplement unless they are completely irresponsible). Lastly, don’t be afraid to demand they give formula if you feel you need to rest. You matter, too, and despite what they may tell you, the first few days aren’t actually important for your supply.

      • Amy M

        I don’t know if this is helpful, but once you know the baby’s birth weight, (and are settled in to your room), figure out what 10% loss would be, and write that number down. Then, you don’t have to calculate with each weighing, just see if the weight is above or below that cut-off. Below, then supplement–you’ll have formula with you, so you can get right on that. Also, bring the ready-to-feed nursettes (tiny little pre-prepped formula bottles. You just un-cap, pop on a nipple, and go). Then you don’t ahve to worry about them making a deal about sterile water, etc.

        • first-time mom

          That’s really good advice! Thank you!

    • nomofear

      Personally, after reading voraciously on the subject before delivering my second child almost a year ago, I went in declaring that I was going to combo-feed. I did not want to starve my newborn on colustrum, risking jaundice, while tearing up my nips before milk had even had a chance to come in, when I could just give her some formula. Additionally, I was not in a BFHI hospital, and I desparately wanted to sleep well those first two nights, so I sent baby to the nursery with permission to formula-feed overnight. I did some nod-and-smile work at the one lac con who visited when she tried to pressure me into room-sharing, but the nurses were all supportive of my choices. If I had to deliver in a BFHI hospital, I would bring a bunch of ready to feed and beg them to keep baby in the nursery overnight, while knowing I might lose that second fight! But at least I’d have the formula in my hands.

      Further supporting actual scientific study that suggests early supplementation leads to higher bfeeding rates, my case of one: I combo-fed til my milk came in, when engorgement pushed bottles to the recesses of my tired mind. When boobs settled down, I offered bottles again, but baby would have NONE of it. She’s ten months old, eats solids like a champ, still bfeeds, and I haven’t had the heart to force her to sleep through the night, so she still nurses at least once per night. No signs of self-weaning yet, despite the dire warnings of nipple confusion.

    • sdsures

      Congrats! I think bringing formula and bottles is a good idea, even if you BF just fine – it’s there as a reliable backup, in case you need it. Don’t be afraid to tell some judgy LC to smeg off if BFing isn’t for you.

      Remember that even if BFing works, you’re entitled to some rest, sleep and recovery. You’re a new mom, not a milk machine.

      (Note: I’m not a mom at this time, but this is my common sense answer. I also have a habit of telling idiots to smeg off when they need to do just that.)

      • demodocus

        Red Dwarf fan?

        • sdsures

          I haven’t seen it yet, but hubby has. Any good?

          • demodocus

            I liked it well enough. They used “smeg” a lot, if memory serves

          • sdsures

            Hubby loves that word.

          • Bombshellrisa

            It is so funny! Lister is the guy who played Lloyd on Coronation street, there is also a Corrie/Redd Dwarf crossover episode in a recent season. My husband is a huge Red Dwarf fan.

          • sdsures

            Does it have canned audience laughter?

          • Bombshellrisa

            I asked hubby and he seems to think it does. There should be another season coming soon, it’s why Craig Charles left Coronation Street–so he could film it.

    • Allie

      It sounds like you’ll be just fine. I couldn’t get LO to latch for 2 days in the hospital (except once for a couple of minutes). We were worried and LO was going from grumpy and lethargic and increasingly jaundiced. Luckily, a sensible nurse came on shift, took one look at her and said “why don’t you try some formula”. She brought us some ready to eat and a bottle and it was amazing. Like watering a droopy houseplant that suddenly springs to life almost before your eyes. It made LO’s cheeks rosy and gave her the energy to keep trying to latch. I went on to nurse her successfully for almost 23 months (hadn’t planned to go that long, but due to her extremely poor sleep habits, I didn’t know how else to cope).So, in my experience, supplementing with a little formula in the first few days, until you both get the hang of latching and your milk comes in, is a sensible plan. You may not need to, and that’s fine, but if you do it’s not the end of the world. Best wishes and stay strong! You’ll know what your baby needs.

  • SporkParade

    Here’s a strategic question for you all for the next time I have a kid. Which is a better strategy: be honest to the hospital that I’m breastfeeding, but I expect them to give formula at night and if I am unable to make it to the nursery, or tell them that I’m EFF and then breastfeed on the sly?

    • demodocus

      Your milk isn’t likely to be in right away anyway. BF when you get home?

      • SporkParade

        That’s a thought, but it’s not very obvious to me when my milk comes in. Also, I think breastfeeding is kind of fun (at least, when you aren’t panicked because your supply is iffy and you’re trying to do it exclusively), so it would be a pity to delay starting just because the nurses are assholes.

    • demodocus

      truly, they should be perfectly fine with “i’m planning on combo feeding from the start” but heaven knows at your specific hospital

      • Megan

        This is my plan, just to tell them I’m combo feeding and then play it by ear depending on how good a nurser baby is and when/if my milk comes in. It will probably take at least 3-5 days (took a week last time!) so I’ll probably only be giving colostrum in the hospital and will probably supplement while there.

    • Old Lady

      I told my hospital I was combo feeding, my hospital asks us our birth plans though, and I plan on bringing in my own formula just in case I don’t feel like being lectured about supplementing when I want to. No way in hell Im waiting until my milk comes in, that may take several days and there’s no guarantee it will be enough. Experience tells me no, but things might be different this time. Anyway, other than becoming “baby friendly” I have no reason to believe they would cause me trouble since they have been really great and supportive otherwise. I think since you have experience with that particular hospital you’ll have the best idea for work arounds. My hospital allows for early discharge now too, so I might have that option if I feel hassled.

      • SporkParade

        My hospital has a checklist when you’re admitted to the delivery room where you indicate your various preferences, including how you are planning to feed the baby. I just don’t trust the nurses to respect my preference to use formula unless I flat-out refuse to breastfeed.

      • sdsures

        Is early discharge a bad thing or a good thing?

        • Old Lady

          It depends on the situation I think. Generally I’d prefer to stay under observation for baby and me a little longer but going home might be better if it would be more restful.

  • Jennifer

    What an interesting perspective….but I don’t agree with it. I have been an ER/trauma nurse for 20 years, and I spend a lot of my time trying to persuade my patients out of wooville…from using essential oils for fevers to placing breastmilk into eyes and ears to “cure” infections.

    But I will admit that the ER may be a different beast. We see everything and everyone and tend to be nonjudgmental and more willing to meet patients where THEY are….and not where we may want them to be. For example….I disagree with hospitals going “smoke free”. Yes…I am fully aware of the risks of smoking…but I don’t think the stressful environment of the ER is where you forcibly change a person’s coping mechanism.

    In addition….we get these poor new stressed mothers in the ER at 0200 convinced that they are already horrible failing mothers (lactation consultants work normal business hours only in my hospital)…so we see the results of the inhumane pressure these mothers are put through.

    Also….keep in mind that if a hospitals adheres to a “baby friendly” policy, nurses can and will get disciplined for presenting alternatives…..EVEN if evidence-based.

    I am happy to hear that despite your misgivings sbout nurses, that you had a positive post partim experience 🙂

    • CSN0116

      Thanks for seeing my point admist all the perceived negativity in my post 🙂 I would boldly agree that an ER nurse and a postpartum nurse are geared toward totally different deliveries of care. Yours sounding much more preferential and humane 😉

      But can you tell me what you mean by this?: “Also….keep in mind that if a hospitals adheres to a “baby friendly” policy, nurses can and will get disciplined for presenting alternatives…..EVEN if evidence-based.”

      Does that mean that a nurse in a BFHI hospital can’t (“can’t”) offer formula, even if baby is FTT or dehydrated or jaundice or mom is breaking down herself, etc.?

      • AA
        • CSN0116

          Ermahgerd, ew.

          I had no idea it looked like that.

          Ew.

          • Jennifer

            Yes…I get nervous whenever 100% compliance is expected for anything.

          • Nick Sanders

            Reading it just makes me coldly angry. Every page just seems to read “Fuck the mother, she’s a milk dispenser”.

          • Amy M

            They seem to have bought into the “breast milk solves all the world’s problems” trope. It blows my mind that an educated grown up could believe that drinking breastmilk acts as a shield against all bad things. It would be interesting to see data in 20yrs or so, about rates of infant illness and mortality, breast cancer, obesity, asthma, etc. {in America, among babies born in BFHI hospitals}. My guess is that rates would look pretty much the same as among babies born in non-BFHI hospitals.

          • demodocus

            Anecdotally, my sister and I were both breastfed, we’re both obese, one of us has asthma, the other had breast cancer in her 20s. And ovarian in her 30s. How much worse would we have been if we’d been formula fed? /snark

          • swbarnes2

            Actually, you should be able to get population-wide data now that’s pretty good, because overall breastfeeding rates increased so drastically since the 1970’s. http://kellymom.com/fun/trivia/ross-data/

            If partial breastfeeding was strongly protecting 25% more children than before, one would think that would be visible in the statistics now.

        • rh1985

          They never stop to think that maybe women don’t breastfeed because of lack of maternity leave, jobs where pumping isn’t practical, they have to work and don’t respond to a pump, mental health reasons, or GASP because they just don’t want to! Nope, has to be because breastfeeding wasn’t pushed hard enough in the hospital and those dastardly formula companies were able to give those eeeeeeeevil samples and that’s totally why the breastfeeding rate isn’t what the lactivists think it should be!

        • rh1985

          And yeah, some of it’s pretty nuts. I just finished the part about skin to skin, which the hospital offered but I declined because I didn’t feel too well. What if 80% of moms don’t even want immediate skin to skin?

          • Kelly

            I declined when asked. I wanted her cleaned up and weighed. I think they had to explain why they would do it as helping with breastfeeding which I laughed and told them I wasn’t doing. I also don’t really see how it could have helped with breastfeeding when my problems had nothing to do with supply and everything to do with my nipples and my kids issues.

          • demodocus

            He came out and they plopped him on my stomach immediately. Didn’t even realize who that old dude was for a long moment. Don’t remember being asked, ‘though DH was all for as much topless snuggling as he could get.

        • rh1985

          Also, seriously? Tube feeding is preferable to bottle feeding? Are they out of their freaking minds? “Any fluid supplementation (whether medically indicated or following informed decision of the mother) should be given by tube, syringe, spoon or cup in preference to an artificial nipple or bottle.”

          Yeah, let’s just make formula supplementation as hard and miserable as possible for the mom and baby lest they be tempted to not breastfeed any longer.

        • BeatriceC

          I’m having to read this in small chunks. Much of it is really peeving me off.

      • Jennifer

        Firstly and sadly, there is a part of nursing culture where you are encouraged to write everyone up for everything. I have never subscribed to this….unless I felt the nurse was a real danger. So yes…..it is a real fear…especially to newer nurses who feel vulnerable.

        My ER docs have even gotten reamed out by LCs for offering/giving formula in the ER. But an MD can blow that off a lot easier than a newer nurse. Some other posters may have better info for you.

        And it makes me sad and angry to read this perception of nurses…you and the other poster. And I will admit…it’s not unearned. Nursing has changed and many newer nurses (with the support of nursing management) have this complex about “just being a bedside nurse”. To me…it’s a calling and the most important part of nursing…we create the climate of the patients whole stay. Every new nurse just out of school is already obsessed with going to grad school or becoming a “nursing leader”….I try to tell them to relax and just learn how to be a good nurse first…but I just get eye rolls.

    • BeatriceC

      Between high risk pregnancies, NICU stays, countless hospitalizations for the boys with MHE, and a mountain climbing accident when I was 17, my sample size of nurses is higher than average. I’d say the distribution of skill and caring is a somewhat right-skewed normal curve. Most nurses are good to great, but when they are bad, they are really, really bad, and very few in the “meh” category.

    • Roadstergal

      The Smoke Free thing is tricky. I’m married to a very mild asthmatic, but cigarette smoke is a heck of a trigger.

      • demodocus

        Dad was a bad asthmatic and riding in a rental car that had been smoked in once months (or more) earlier could set him off.

      • guest

        Cigarette smoke gives me headaches. But I’m cool with well-designed “smoking areas” for those who do smoke. My campus first had smoking areas, which were outside and away from building entrances. It was fine. Then they went “smoke free” and if you wanted a cigarette you had to leave campus – which none of the smokers were willing to do just for a cigarette break. So they just started smoking around doorways, which I *do* have a problem with, because I have to go through those doorways.

      • sdsures

        Me, too.

  • CSN0116

    This is not to offend any nurses who might be here, but they are a beast all their own in BFHI and lactivism.

    I have never had a negative experience with a doctor. I know that sounds far fetched but it’s true. Never. I have never felt pressured, demeaned, disregarded, etc. Never. I find that doctors appreciate questions and input and tend to be very rational people, open to rational input from patients. I get along with my doctors very well and count many as friends at this point. Hell, our pediatrician (actually a PCP because I don’t care for peds) babysits our children on occasion lol.

    Nurses, I feel, become indoctrinated and know-it-all very quickly. (Highly susceptible to woo, perhaps?). In my experiences, this is most evident right after their graduation. I have seen normal women, who used to be very approachable and level-headed, start posting unsolicited advice all over the Internet, fully believing that the little bit of health care knowledge that they have gained makes them some bonafide expert on all things health. I mean, how many times have you read in forums “Well, I’m an RN and…”?

    Nurses also deliver the most direct patient care. So, they get to spend time and be very helpful, or terribly detrimental. They’re also predominently women, and we all know women (especially lactivists) often have this “well I did it, what’s your problem?” -type attitude towards their fellow woman.

    If nursing students are breast is best indoctrinated, therefore more likely to breastfeed their own children, or at least legitimately embrace all the woo – I think they’re more likely to be lactivists themselves. And lactivists providing direct patient care to the newly postpartum and struggling is a recipe for disaster. I think this is why we hear *horror stories* of how nurses treat these patients. And, my grand point – I think a lot of nurses are not pushed to be lactivist-y, I think they’re more than happy to dole it out due to personal interests.

    Added note: It sounds like I’m making a sweeping generalization, bit it’s not my intent. Every single postpartum nurse I had in five babies was wonderful to me and my decisions. I have never been victimized. I’m just trying to rationalize why this seems far too common in the cases of other patients.

    • Azuran

      There is probably a lot of different factors behind all of this.
      The first one might be how open the nursing programs are. Unlike medicine, where it’s super hard to get into, nursing schools are everywhere. Where I live, nursing programs are freaking everywhere, every single school out there has a nursing program and it’s super easy to get into. Nursing school is kind of the ‘fall to’ option for anyone and everyone who doesn’t really know what they want to do with their life or couldn’t get into med school.

      So of course, there are a majority of nurses out there with a real passion and very good knowledge for what they do. But there is a bunch of people who clearly do not have a real interest in their job and not the right set of mind or the critical thinking necessary for it.
      Many nurses probably have a feeling that they are not appreciated enough. After following doctors for a long while, there are probably a lot of things they feel they are totally able to do and get frustrated that they don’t get to do it.

      Some also fall somewhere in the grey area where they have medical knowledge, but just not enough to quite understand how little they actually know. So they might fall for ‘lactivits’ bullshit more easily. Or perhaps they like the additional recognition they get as nurses from fellow ‘lactivist’ when they feel unappreciated by other medical providers.

      Nurses are also the one spending the most time with patients, so if you have a ‘bad’ one, you will see her a lot more than you are going to see your ‘bad’ doctor, so you are more likely to remember the nurse and complain about her. So they are probably overrepresented.

    • TheArtistFormerlyKnownAsYoya

      Your post reminded me of Amy Schumer’s “The Nurses” sketch:
      https://www.youtube.com/watch?v=4u_Hyw80Yqo

      Every nurse I’ve had the luck to encounter has been absolutely wonderful and caring. But it only takes one horror story, when you’re sick/vulnerable and depending on someone else.

      • CSN0116

        LOL this is so horribly accurate. I love Amy 😀

    • crazy grad mama

      All of the postpartum nurses who tended to me after Little Boy was born were wonderful (unlike the LC), but my husband’s family includes a NICU nurse and a postpartum nurse and both are horribly judgemental lactivists.

      • BeatriceC

        What’s funny is that my mother, in spite of being both a member of LLL and being Evil Incarnate on every topic but newborn care, and exactly the type of fundamentalist person you’d expect to be a lactivist, is anything but. She’s actually the one that insisted I stick a bottle in my oldest son’s mouth to calm him down when he was a newborn and we were having trouble sorting out latch. She’d also be the first in line to defend any woman’s right to chose bottle feeding for whatever he reasons are, no questions asked. If it weren’t for my mother insisting that I use a little formula to get over the hump, I probably wouldn’t have breastfed any of my babies.

        • crazy grad mama

          Hooray for that! Yours is also a great example of how the focus on “exclusive” breastfeeding is counterproductive.

    • Commander30

      Anecdotal, but my older brother is an RN and is extremely dismissive of anything woo. His retort towards being told something is “all natural” is “yeah, shit is all natural too, but I’m not ingesting it.”

      Then again, he works in a nursing home, not a hospital (let alone a maternity ward), so make of that what you will. I highly doubt nursing home employees are indoctrinated either way in the breast vs formula debate.

    • guest

      I have unfortunately experienced some uncaring nurses. Some good ones, too, but the good ones were mainly good by not making me cry or ignoring my needs, rather than going the extra mile. I am a person who likes to please, and it’s hard for me when I’m criticized for doing something wrong (or not doing something I was supposed to) when what I was supposed to be doing wasn’t explained to me, and that happened a lot with the nurses.

      • Blue Chocobo

        “criticized for doing something wrong (or not doing something I was supposed to) when what I was supposed to be doing wasn’t explained to me, and that happened a lot with the nurses”

        Oh dear me, yes. Some just really don’t seem to understand that while they do this all day, every day, at the same hospital, under the same protocols, I’ve done it all of 4 times in my life and the “rules” were different each time even though my body and it’s quirks were pretty consistent.

        • Azuran

          Yea, my mom had an operation a little over a year ago. We were just dumped in a room by a nurse. She then came back after 15 minutes and got mad at my mom for not changing into the hospital gown despite never telling her she was supposed to change nor telling her where the gown was.

        • guest

          Sometimes the expectations changed with the nurses’ shifts. One nurse would direct me to ring the nurse as soon as I was done pumping so she could take my milk down to the NICU, the shift changes without me being aware of it and I do what I was told and get a nurse who acts like I’m endangering other patients calling her for that. In the meantime, no one has explained to me how long it’s safe for pumped milk to sit at room temperature.

          In case anyone is wondering, the NICU was on a different floor and I’d had a c-section. I was encouraged to move around as soon as possible after surgery, but getting to the NICU after hours involved taking a public elevator and waiting for someone to then buzz me into the next ward…it was more than I could handled the first couple of days to delivery milk every two hours. But all I really wanted was to be told what to do and how to do it to make the nurses happy. I feel safer when people are happy with me (if I meet their expectations, they’re more likely to treat me well, etc.)

    • SporkParade

      The hospital where I gave birth bragged that all their nurses received basic training in assisting with breastfeeding. In practice, no one could be bothered to help me, but they were ready to resort to gaslighting, withholding medical information and refusing to discuss supplementation when my baby inevitably became dehydrated and lethargic. I’m not quite sure what to do when we have kid #2. On the one hand, the medical care I received during the birth itself was excellent, my OB is the head of the department there, and it’s much more conveniently located than the other option. On the other hand, I really, really wish the nurses who [failed to] take care of us last time would die in a fire.

      • J.B.

        Maybe call the nursing supervisor in advance and be the squeaky wheel. Her response may tell you a lot.

      • Charybdis

        I’d have a frank discussion with your OB about your concerns that are due to your treatment (or lack thereof) last time. Get your pediatrician on board as well, maybe get an order from the pediatrician that states that formula supplementation or straight FF is expected, since last time it took 4-5 days for your milk to come in.

        Maybe since you’ve already had one baby, they might go easier on you, since you know what to expect and how your body reacts. Hope springs eternal, you know. But make it clear that you will not tolerate any pressure to “just try” if you don’t want to. Keep a list of names of those who harass, harangue or gaslight you, so you can give those names to the “patient satisfaction survey” folks. Also keep a list of those who are wonderful and give you all the help they can and mention those as well, as they probably don’t get much feedback like that.