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I am a registered nurse in a birthing center and I was infuriated by the comments in the breastfeeding tips story "Let it Flow" (December/January 2006). Author Carole Anderson Lucia states that keeping the baby in the hospital room with the mother, instead of letting the baby go to the hospital's nursery, will prevent the nursing staff from feeding a baby formula. We do not give formula ad lib without a mother's consent. Our hospital supports breastfeeding 100 percent and supplementation is only given under a doctor's order or mother's informed consent. Please provide accurate and unbiased information in your future reporting.
-Jennifer Macri, R.N., SOUTHFIELD, MICH.
Christina Valentine, M.D., M.S., R.D., medical advisor for neonatal nutrition at Columbus Children's Hospital in Ohio and medical director of its lactation program, responds: I would like to commend a letter to the editor written by a birthing center nurse. Nurses should be congratulated for supporting the mother and only distributing formula with a physician order or mother's informed consent. It is with such collaborative effort that lactation can be successful. Strategies to incorporate this type of practice can become part of the goals for making hospitals more Baby Friendly. (www.babyfriendlyusa.org.)
Not all practices are yet so patient-centered. There are established evidence that lactation and length of lactation impacts maternal, infant and community health and should encourage all medical providers to evaluate their current interventions and recognize any existing barriers. Known barriers to successful lactation are early feedings with formula, and since experiences postpartum influence eventual feeding practice, Carole Anderson Lucia's report "Let it Flow" (Fit Pregnancy, December/January 2006) emphasized the importance of early skin-to-skin holding and rooming with the mother. Duration of breastfeeding is influenced by both practices. (A great review on literature related to breastfeeding interventions is available on The Centers for Disease Control guide to Breastfeeding Interventions, www.cdc.gov/breastfeeding). Partnership with the bed-side nurse after delivery to enable skin-to-skin holding and assessment of the mother and infant are therefore important. If not a medical necessity, having the infant nearby and not in a nursery helps the mother become adjusted to the infant cues and breastfeeding frequency. Early lactation instructions should be done with an evaluation of the mother-baby feeding. A bassinet by the mother's bedside can be used to ensure close proximity of the infant. Frequent checks by the nurse should be done when a lactation consultant is not available. Clinical judgement and safety are of course paramount to a successful outcome for both mother and baby and should never be overlooked. The Academy of Breastfeeding Medicine has many helpful protocols and a Model Breastfeeding Policy available on their website (www.bfmed.org).
Christina J. Valentine MD
The Ohio State University, Clinical Assistant Professor, Medical Advisor, Neonatal Nutrition and Lactation Program, Section of Neonatology, Children's Hospital,
From "Letters," June/July 2006