Thoughts inspired from the discussion about hospital culture

[Guest guest]

Dear Colleagues:

This is an amazing discussion. Thank you Tow for your articulate

writing and formalizing the topic.

Communication between people is always a challenge. What one person hears, and

then tells another, changes. Remember the kindergarten game of " Telephone " ? Who

was it that posted about working with a mom as a hospital LC, and have that same

mom calling for help from a LLL, who was that same hospital LC. The mother

reported things that the LLL/LC knew hadn't been advised. Classic example.

Hospitals are factories. As such, they are subject to the rules and regulations

that govern factories. I believe it is good to keep working to make those rules

and regulations accepting of breastfeeding, particularly when I am seeing more

and more physicians (students, residents, and attendings) seeking breastfeeding

education. If all that gets formula out of hospitals, we have done excellent

work. If all that gets skin to skin to be routine, we have done excellent work.

Mothers are stressed beyond their physical, metabolic, psychological and

energetic reserves in hospitals. It is amazing that as any women are

breastfeeding.

Everything that is happening to breastfeeding in hospitals has happened to

childbirth education and to birth; i.e. being gobbled up by the factory.

I published an article in Midwifery Today,( " The Missing Squatting Bar. " back in

the 90s, about the struggles childbirth educators were having with their mission

to educate versus being respected by hospitals/physicians. One example: Our

local birth factory called the head of a private childbirth education business

and virtually told her to stop teaching about the risks of pitocin, " because we

use a lot of it here. " Don't want to upset the parents now, do we? And if she

hadn't complied, all the physician practices would have stopped referring their

clients to her for classes and her business would have died. What I hated most

about teaching childbirth education classes was the agonizing egg walking, the

fear that I would say something that would get back to my bosses and get me

fired.

Paolo Freire, the great Brazilian educator, said something like this: " Education

either liberates or oppresses. It can not be used to hold the status quo. " We

can either teach mothers what really works, or teach them to listen to their

doctors.

What is happening with breastfeeding now is particularly wonderful. Our

government, via the CDC, has gotten some of the truth about birth (wonderful

mPINC study) and breastfeeding. This has fueled change in the new JCAHO

guidelines in their perinatal care set. This has fueled the awarding of grant

monies. And then you have all of us, at the other end of the health care

spectrum, working hard, speaking truth and working our way into the system. Now

we have the Academy of Breastfeeding Medicine!

What is helping too is that there is no money for health care. We can't afford

to have sick babies. We can't afford to have our young people so fat that 25% of

them can't serve in the armed forces. This terrible situation is getting

attention that will be helpful to our efforts.

Hospitals have been, are, and will probably always be factories and they can

continue to improve.

One sign of this in my area is that I gave a Grand Rounds about breastfeeding to

Obstetricians (residents and attendings) at one major teaching institution. 2

weeks later, I was asked to give a Grand Rounds by another....the word had

spread. This is wonderful and a sign of our changing times.

Just my drops of newborn milk....

warmly,

Nikki