Banning the Bottle

From The Floor

Banning the Bottle

Breastfeeding is the best choice, but must it be the only choice

By Genevieve M. Clavreul, RN, Ph.D.
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While having dinner with friends recently, our conversation turned, as it often does, to healthcare issues. The topic this particular evening was the tendency of policymakers and hospital administrators to devise worthy-sounding policies that turn out to be impractical or even counterproductive in actual practice. A case in point is something that has become the media’s current healthcare topic du jour: breastfeeding.

As many of us have heard, the New York City Health Department has launched a program called “Latch On NYC,” a so-called voluntary breastfeeding initiative promoted by Mayor Bloomberg. Under this program, which starts Sept. 3, 2012, 27 of the 40 hospitals in New York City that deliver babies will stop handing out promotional samples of infant formula except for medical reasons or at the mother’s specific request. Furthermore, the program calls for hospitals to provide the city with detailed records of the number of bottles of formula in stock and in use. Formula must be signed out like medication, and nurses are required to educate mothers on the benefits of breastfeeding each and every time the nurse signs out formula. In short, each bottle will be accompanied by a lecture, something I’m sure every New York mother is looking forward to.

This type of initiative is fast becoming a national movement, and some hospitals plan to take it even further than the ones in New York. One of my friends, a practicing OB/GYN in Northern California, reports with great frustration that his hospital is about to implement a 100 percent breastfeeding policy. In short, no formula is to pass the lips of any newborn infant.

Before we sic the lactation police on this exasperated physician, let’s take a moment to consider whether the goal of breastfeeding 100 percent of newborns is really desirable, much less feasible. No one will deny that there is a slew of research affirming the benefits of breastfeeding, and I can’t think of a single healthcare provider or mother who doesn’t see breastfeeding as the first and best choice for infants. However, should it be the only choice?

When Natural Isn’t Enough
I can think of numerous situations where breastfeeding might not be appropriate or even possible. What about a mother who suffers from mastitis or has had a bilateral mastectomy and is simply unable to breastfeed? What about mothers who suffer from infections like HIV/AIDS or hepatitis that are transmissible through bodily fluids? What about gay men who adopt an infant, or parents whose newborn was delivered by a surrogate? How can a hospital expect such families to meet a 100 percent requirement for breastfeeding?

Another consideration is that breastfeeding isn’t always sufficient. Some mothers simply have poor-quality milk — it’s rare, but it does happen. Also, the caloric needs of some infants, particularly micro preemies, can outpace their mother’s ability to produce milk. It’s common knowledge among NICU nurses that one of the most common reasons micro preemies fail to thrive is that they aren’t getting enough calories from their mother’s milk, requiring either the addition of powdered human milk fortifier (HMF) or the use of special pumping techniques to increase the milk’s fat content. (See the Jan. 5, 2012 issue of the Journal of Perinatology for more on the latter practice.)

Even if the breast milk is of good quality, an infant may not take enough of it to stay properly hydrated. A good friend of mine who had made a commitment to breastfeed exclusively nearly lost her first child to severe dehydration. After her son ended up in the hospital NICU, she conceded that formula was not the enemy and started supplementing his feeding regimen with formula whenever she recognized the signs of dehydration. Infants being treated for conditions like jaundice also need more fluids than most natural lactation can provide.

As a PICU/NICU nurse, I’ve seen many caring, dedicated mothers break down in tears of frustration and despair when they fail in their attempts to breastfeed their children. As a mother of four, I’ve experienced that frustration myself: I tried to breastfeed my first two children, but turned to bottle-feeding after developing mastitis each time. (Any woman who’s gone through two bouts of mastitis is hardly looking forward to a third or fourth case!) Should we compound that anguish with the overreaching expectations of hospital administrators and politicians?

Good Intentions

After 40 years as an RN and more than 50 years as a mother, I’ve learned that a one-size-fits-all approach isn’t always a good idea, particularly for something as important as infant nourishment. It also arouses my ire whenever common sense gives way to near-religious zeal, which has been the case with the breastfeeding movement in the past few years. Formula isn’t some potentially life-ruining drug that must be regulated like a narcotic — there is no black market for infant formula! What does it accomplish to make an anxious first-time mom feel like a criminal? The brilliant minds that crafted these policies had the opportunity to set more realistic and attainable targets, but opted instead for unrealistic and burdensome standards.

As for the New York initiative, I wonder what impact this standard will have on the time nurses have to provide care, guidance and education to all of their patients. With medical costs already spiraling out of control, will the hospitals adjust their staffing ratios to account for the extra time required to provide the mandatory education that goes with each requested bottle of formula? How will it affect the morale and job performance of RNs when they realize that the city of New York doesn’t trust them to do something as mundane as handing out formula without constant monitoring? And how will mothers respond to this heavy-handed propaganda campaign? What’s next, a special hotline where the good citizens of New York can report mothers who fail to subscribe to the “Latch On NYC” program?

I say this to all the proponents of breastfeeding: You are correct, mother’s milk au naturel is best. However, when a perfectly legal and reasonable action like bottle-feeding requires a lecture and a stack of forms, something is wrong. As nurses, we should encourage women to try breastfeeding and if possible continue doing so after they bring their little bundles of joy home. In the end, though, it is the mother’s responsibility to choose the best way to feed her infant, and as healthcare professionals, we should respect that right.  

Geneviève M. Clavreul, RN, Ph.D., is a healthcare management consultant who has experience as a DON and as a lecturer on hospital and nursing management.
 

This article is from workingnurse.com.

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