Breastfeeding! You may remember that Mayor Bloomberg has decided that he wants all New Yorkers to be healthy (but especially the poor ones!) so he's hatched a plan to keep formula away from poor moms in hospitals -- which is to say, he wants the hospitals to stop handing it out for free, like dealers, which often permanently screws up the mother's supply of breast milk, interferes with the baby's learning to nurse, and ensure Enfamil a steady clientele for the foreseeable future. Not for nothing is formula locked up like guns and cigarettes: those shady mothers will steal it in a heartbeat, since they have literally nothing else to feed their babies. Except, of course, for the free, already mixed and heated milk that comes out of their boobs on demand. (Or would.)
So, initially, I thought Bloomberg's plan was another thing that put pressure on moms without offering them support, thereby setting them up for failure and non-moms (or those privileged moms among us whose kids started breastfeeding way back in 2011 and appear unlikely to stop before seventh grade) for another great opportunity to sigh over our lattes that Poor People Just Don't Get It. And I don't do well with the cognitive dissonance of insisting that something is Really Important for you to do, but not, you know, important enough for me to help you. So I started working with the Lactation Coordinator at one of our public hospitals in an effort to actually help the moms breastfeed, instead of just telling them how they should.
Well. Whatever the breastfeeding issues that moms in Park Slope or Tribeca may be facing, if those moms care to deliver in a city hospital, they will be able to lay their burdens down and embrace, instead, the larger issue of Lady, I Got Bigger Problems than You and Your Baby, I'm a Pediatrician/OBGYN/Charge Nurse on a Mother-Baby Unit.
So the first weeks of January were, in part, spent scribbling away a manifesto that hopefully will help frame our breastfeeding efforts in 2013. Because honestly at this point, I'd be advising new moms not just to ask for formula but to hoard it for themselves, since things like obtaining food trays for patients who are no longer NPO are considered low-priority.
Other low-priority items on the average postpartum worklist:
- helping babies latch so they can breastfeed (obviously; moms report that their nurses tell them "the breastfeeding coordinator is on vacation" when they ask for assistance),
- helping parents determine where their babies are and helping them get them back. The hospital not only offers but encourages "rooming in", which is to say, keeping mom and baby together, to promote bonding and prevent bored well-baby nurses from pouring Supersized bottles of formula down baby gullets. However, for any number of reasons, roughly 40 to 60% of mother-baby rooms contain only mothers on any given shift. When moms are asked where their baby is, they usually know "the nursery" (we have three). When asking "why?" or "which one?" or "when are they coming back?", expect a blank, vaguely suspicious look: don't you know?
- giving mothers pain medication. Yes, this includes mothers who have had a c-section. Were you providing care in a nursing education video, a mom who is c-section day one would likely be on IV medication, maybe Toredol or morphine. Or, she may have an epidural still in place, because 1. someone just cut open her body, removed a fetus, and scraped her uterine wall, and 2. her uterus is roughly the size and shape of a deflating basketball at the moment and is attempting to scrunch itself back to the size of her fist so she does not bleed to death.
At your average city hospital, however, the MO is Tylenol 3, PRN. Wondering what PRN means? It means, when you ring your call bell and ask nicely for it. Maybe. Unless I, your friendly postpartum nurse, am angry that you have the audacity to insinuate that I'm not caring for you well, in which case I will badger you into "admitting" that you really just have gas and give you some Motrin instead.
(Why give Motrin for gas? Well, why give Motrin for postoperative pain? I'll leave you to speculate. Let me know if you come up with a plausible explanation that does not rely on the phrase "to [not] give an eff", as I'll want to get that one down).
In reality, while it is fun for moms who deliver at Methodist and Lennox Hill to kvetch about Bloomberg's paternalizing and the feminist implications of telling moms they really should be using their boobs to feed babies, the city law is probably not going to affect them that much. Hospitals that treat patients who show up in L&D with social capital, private insurance, families at the bedside, and/or white skin and white babies typically are already doing what the program asks: encouraging breastfeeding, badgering moms for "medical reasons" why they are supplementing, making the free formula optional. These moms are also less likely to realize, a week post-discharge, that the freebies are gone, WIC only covers 2 bottles of formula, and they now get to divert a sizable chunk of their family's resources to Similac, since they really don't have enough milk now.
The great thing about any kind of standards, however particular, is that it really brings to light a huge number of issues that contribute to the overall failure of a system staffed by people who don't care about what they are doing.
Breastfeeding or no, you should get pain medication after you have abdominal surgery. Your doctor should know whether or not you're getting that medication (but I said 4 hours, PRN, said one resident upon being told that her CS Day One patient had had no pain medication at all since admission to the unit). When you are allowed to eat for the first time in 3 days, someone should call the kitchen and find out why you have no food tray for breakfast or lunch, and fix it.
This should be the case, yes, even if you are poor. Even if you don't speak English. Even if it is your fifth child and you are only twenty-three and your nurse thinks you must just not care about your baby, as she does not care.
It's not. Hence, my manifesto (not this; another, less snide one, sent to my boss during some furtive four-am-moments while the baby slept).
Today: my first day back at the hospital after sending. For the next forty-five minutes, I choose to believe that caring deeply can be enough to somewhat ameliorate the limping, teeth-sucking, ass-sitting indifference which our patients encounter on a daily basis.
In reality, while it is fun for moms who deliver at Methodist and Lennox Hill to kvetch about Bloomberg's paternalizing and the feminist implications of telling moms they really should be using their boobs to feed babies, the city law is probably not going to affect them that much. Hospitals that treat patients who show up in L&D with social capital, private insurance, families at the bedside, and/or white skin and white babies typically are already doing what the program asks: encouraging breastfeeding, badgering moms for "medical reasons" why they are supplementing, making the free formula optional. These moms are also less likely to realize, a week post-discharge, that the freebies are gone, WIC only covers 2 bottles of formula, and they now get to divert a sizable chunk of their family's resources to Similac, since they really don't have enough milk now.
The great thing about any kind of standards, however particular, is that it really brings to light a huge number of issues that contribute to the overall failure of a system staffed by people who don't care about what they are doing.
Breastfeeding or no, you should get pain medication after you have abdominal surgery. Your doctor should know whether or not you're getting that medication (but I said 4 hours, PRN, said one resident upon being told that her CS Day One patient had had no pain medication at all since admission to the unit). When you are allowed to eat for the first time in 3 days, someone should call the kitchen and find out why you have no food tray for breakfast or lunch, and fix it.
This should be the case, yes, even if you are poor. Even if you don't speak English. Even if it is your fifth child and you are only twenty-three and your nurse thinks you must just not care about your baby, as she does not care.
It's not. Hence, my manifesto (not this; another, less snide one, sent to my boss during some furtive four-am-moments while the baby slept).
Today: my first day back at the hospital after sending. For the next forty-five minutes, I choose to believe that caring deeply can be enough to somewhat ameliorate the limping, teeth-sucking, ass-sitting indifference which our patients encounter on a daily basis.
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