Informed Consent

People in the medical profession are taught that patients must always give INFORMED consent. All too often, that is not done.
What exactly is informed consent? It is the patient giving their consent for a procedure, surgery, medication, whatever after they have and understand the pros and cons and have all their questions answered.
One prime example of this in the maternal child field is the AFP (alpha-fetal protein) test that is done between week 16-18 of pregnancy. It is a blood test that detects a protein in moms’s blood that can indicate a higher probability of the baby having a neural tube defect or Down’s Syndrome.
Unfortunately, there can be false positives with this test. Lets talk about what happens if the test comes back positive:
1. Mom gets a call from the doctors office
2. Mom is told the AFP is positive and baby may have a birth anomaly.
3. Mom is told that to find out for sure, she needs an amniocentesis.
4. From that moment on, mom will worry for the rest of the pregnancy and after. It will stay in her mind that her baby is not ok.
5. There are risks to an amniocentesis, though small.
6. Mom then has to wait for the result.
7. If the test shows the baby may have an anomaly, parents then have to decide if they want to continue the pregnancy.
8. As I said, even if the test comes back normal, the joy of the pregnancy is taken away, at least a bit.

Mamy people say that the test should be done so the parents can be prepared. As the parent of a mentally and physically disabled child – you can NEVER be prepared.

There are many moms who ask questions or do research and decide against this test. These parents have made the decision to have their baby – no matter what.

My point – informed consent is very important and the responsibility of the medical profession. And patients need to ask questions and get answers they understand.

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Nutritive vs non-nutritive sucking

I feel I need to add to last nights blog entry.. I did not clearly define the two types of newborn sucking.
Nutritive is fairly obvious. Baby sucks to get nutrition.
Non-nutritive is a little more confusing. This is when baby sucks to self sooth, to relax. Baby will do this himself by sucking his thumb or hand – the reason hands should never be covered!!! Baby will also suck at the breast to sooth, and will usually relax and fall asleep. This worries new moms as they think the newborn should nurse for 20 minutes – or whatever number the nurse says. Please breast feed the baby not the clock.
If baby is nursing well, it is fine to offer a pacifier as this will help to satisfy non-nutritive sucking needs.
Hope that helps to clarify.

Prenatal Preparation for Breast Feeding

There is so much misinformation about preparing to breast feed. Let’s discuss and correct some…….

Forty years ago, when I was a new nurse, I went to a conference and one of the workshops was about breast feeding. I learned later that the workshop was sponsored by a formula company. The speaker told us some interesting things – all would cause a new mom to fail at breast feeding. 

  • Pregnant woman need to toughen their nipples to prepare for breast feeding. Suggestions on how to do this were to hang a wet washcloth to air dry and then use the washcloth to vigorously rub nipples twice a day. Also, to brush nipples with a toothbrush. OUCH!!!  We know that this is, of course, unnecessary and dangerous. This rubbing removes natural oils and dries out nipples. And, nipple stimulation can cause uterine contractions (nipple stimulation causes releases of oxytocin, the hormone that causes contractions). 
  • Another suggestion – pump twice a day with a manual pump to “pull out nipple”. Again, unnecessary and dangerous. 

There is only one thing that I suggest – check for flat or inverted nipples. Very simple. In your last trimester, stand in front of a mirror. Gently pinch your areole, behind your nipple. Your nipple should protrude out. If it retracts or flattens, that may cause a problem when our baby tries to latch on. The fix: buy nipple shells ( not shields). Shells have detachable back, one with a small hole, one with a large hole. Put the one with the large hole away – you might use it after the baby is born. 

 

Wear the shell with the small hole (your nipple will fit through the hole) a couple of hours a day, inside your bra. The gentle pressure will break the adhesions that cause flat/retracted nipples. When the problem is fixed, stop wearing the shells. Check weekly and if the problem returns, start wearing the shells again.
One last thing, if you have flat or retracted nipples when you start breast feeding, no problem. There is a fix then too – using a pump before you feed to pull nipple out, or temporarily using a nipple shield while nursing to have baby help pull out the nipple.
I hope this information is not too confusing. Please contact me with questions: dkemp4586@att.net

Tale of Three Breastfed Babies

I had 3 pregnancies, 3 children and 3 very different breast feeding experiences. 

First, a son, was born when I was 20 years old. I was a year out of nursing school and working at a pediatric office. I knew a few things about breast feeding, took an expectant parent class but breast feeding was not even mentioned in that class. I breast fed my son for the first time about 6 hours after his birth ( I had to lay flat for that long after a spinal anesthetic for a forcep assisted birth – the way births were done in 1975). The baby was given formula in the nursery and I received no help from the nurses. Once home, I attempted to breast feed often, but also gave formula (I did not know any better). At 3 weeks old, my baby became ill with a URI and ear infection. This illness went on for 3 weeks and breast feeding was difficult. At 6 weeks, I stopped breast feeding. 

Baby number 2, a girl, was born 3 years later. This birth was drug free. I kept the baby with me all during my hospital stay, she breast fed on a regular basis like a champ. I experienced 2 cases of mastitis during the first 3 months of my daughter’s life. I was told by my OB to stop breast feeding while on antibiotics and I followed these instructions. I was fortunate to get back to breast feeding after following this incorrect advice. My daughter stopped breast feeding at 9 months of age. She was given a sip of juice from a cup and liked that. She never had a bottle..
My third pregnancy was in 1982, another son. I knew this was my last pregnancy and I planned to do “everything right”. I would have another intervention free birth, breast feed immediately after birth, hold him all the time and so on. Unfortunately, Matthew was born with multiple physical anomalies. He was taken at birth to the nursery, I did not see him for hours. To shorten the story for now, Matthew had facial paralysis. He could not form suction to breast feed. He also had a soft cleft palate defect. I pumped breast milk for several days but could not keep up. I was taking care of 2 young children and traveling to the Children’s Hospital an hour away to visit Matthew. Matthew was fed formula through an NG tube, he could not suck.
I grieved breast feeding Matthew for a long time. Then I realized that there are several ways to feed a baby. Of course, breast feeding is best but that is not always possible, or the choice that is made.
Moral of this story – breast feeding is best but not the only way to feed a baby. A mom should make this decision after informing herself through discussion and research. Informed consent is so important in all areas of medicine. And I found in my career as an RN, that informed consent is often not applied.

Breast feeding

Aside

After counseling hundreds of breast feeding moms, I know that how a baby is fed is a very personal choice. And a choice that needs to be made with accurate information, given by a professional. And NOT advice from other moms who have had bad experiences. This advice does not have to be in person, it can be by phone, or even in a blog!!! But it must be ongoing throughout the breast feeding experience. That is one of the many reasons I started this blog.