Helped me with wording this e-mail

[3girls2luv]

I have to be careful at how I come across because the nurses around here tend to get offende easily and feel like I am accusing them about not knowing about breastfeeding, when in reality they are the ones who are telling the moms to "bf for 15min on each side and since your milk is not in yet the baby may still be hungry and you can supplement with formula to make sure baby is getting enough" I am seeing this unecessary supplementation far too often and I need to get the word out some how so please read this and let me know what you think. Please feel free to edit or change it if needed.

Here is what I have so far:


This issue has come up with several post partum moms and I just wanted to make sure we all help them understand the milk making process. Many moms have been supplementing without medical necessity, they are saying that baby is still hungry after nursing off of both breasts for 15 min on each side. There is no recent study that supports this 15 min theory.

The recent study states that baby should be allowed to end the feeding by letting go or falling asleep and then to offer the other breast and if the baby is still seems hungry then she can offer both breasts again. If we have a sleepy baby that falls asleep immediately at the breast then we need to asses position, latch, as well as how the baby looks. We need to ask about baby's output as well since one wet and one dirty diaper in the first 24hrs indicates that the baby is getting enough.

The instructional guide that is put out by TDH has all this information and it will help you in teaching these new breastfeeding moms what to look for when they are exclusively breast feeding. This will also help moms know how to tell if the baby is not getting enough and she will seek medical attention for her baby if he is not having enough output once they get home.

[CiCi04]

I think that sounds pretty good!

[Earthmama]

Start the letter with praise. "I am so grateful to all of you who are devoting so much of your time and hearts to helping these new babies get the very best start to life possible...

You may end the note with specific examples of how your staff members were particularly helpful - a la "Suzanne did a great job with that cantankerous patient last week, keeping her cool even when she threw the tissue box at her. And Mary, mama of Baby Eva, said she really loved how you girls remembered to bring her fresh water at the beginning of each shift change..."

Or you could start with the personal praise and end with the general praise.

In the middle, try to use the passive tense - and not use the word "you".

From your post: The instructional guide that is put out by TDH has all this information and it will help you in teaching these new breastfeeding moms what to look for when they are exclusively breast feeding.

Revision: The instructional guide that is put out by TDH has all this information and will help in teaching these new breastfeeding...

or when in doubt, use "we/us" instead of you.

It also wouldn't hurt to throw in an "I know you probably already know" before you explain something and maybe a "but I just needed to bring it up again because it's so important/helpful to the new moms that we keep this in mind."

Otherwise your message is pretty clear.
Hugs to you for what you strive to do for those new and growing families. :hug:

[JudyJudyJudy]

EM has a good idea about starting positively.

The recent study states that baby should be allowed to end the feeding by letting go or falling asleep and then to offer the other breast and if the baby is still seems hungry then she can offer both breasts again. If we have a sleepy baby that falls asleep immediately at the breast then we need to asses position, latch, as well as how the baby looks. We need to ask about baby's output as well since one wet and one dirty diaper in the first 24hrs indicates that the baby is getting enough.

I wouldn't put "asses." ;)

Does the TDH to which you're referring have the information about the study you mention? If not, I'd reference the study.

[3girls2luv]

Oops sorry about the asses ;) this is why I need editing. I will fix the intro and the things that EM mentioned as well. Thanks.

[3girls2luv]

Oh and yes the guide does have the information in there and there is also a seperate hand out that mentions it as well. All the moms that I see are given this booklet and all my students get them in class. The nurses (some not all) however are not handing them out in my absence and they are also not familiar with it because they seem to think that a new born should have at least six wet diapers a day even on the first day and that baby should be fed every three hours. We all know that we can not set a clock by an EBF newborn.

[NewMum]

3girls2luv, you are awesome! I love that you're doing this and I think EM's suggestions are wonderful, too. And I LOLed at the "asses" as soon as I saw it. hee-hee...

I really wish we'd had something like that booklet when we had DS. We didn't get much support from any of the nurses except the one who checked us out! thank god for my mom when she was there, but when she wasn't we worried our heads off that we weren't doing it right!

[JudyJudyJudy]

3girls, could you do some sort of training seminar on this?

[3girls2luv]

3girls, could you do some sort of training seminar on this?


Oh I do every six months but only the new grads show up. This last time a few post partum nurses came but its like preaching to the choir because most of the postpartum nurses see me all day and they have learned a lot about breastfeeding from me and when they have a patient that happened to take my bf classes. Nursery and nightshift are my biggest problem. Mondays are horrible because not a single mom is EBF on Monday morning because no one took the time to help them over the weekend and they were worried that baby was not getting enough and they got a bottle. I spend all day trying to get these moms back to EBF then Tues comes along some have supplemented during the night because the nurse wanted mom to sleep so they took baby to the station and bottle fed them instead of helping her latch the baby on. I could go on forever and I am glad I can vent here because it helps me from not wanting to walk away from this job some days. I have been here 2.5 years and I have been here longer than any lactation counselor they have had becuase most of them leave after 2yrs.

[JudyJudyJudy]

That sounds frustrating.

And, BTW, I PM'ed you. I didn't know whether or not you saw it.

[3girls2luv]

I pm'ed you back ;)

[The_Market]

How about an attitude of teamwork? Like, pretending that they already know this, or already believe it, and asking them to help reinforce these mothers getting such crazy ideas from a mystery source.

We've been having trouble with mothers having misconceptions about how to establish a strong milk supply. Many seem to be doubting themselves when their babies want to nurse more than 15 minutes on each side. We know that the most up-to-date evidence (like in this study -attached), as well as recommendations from professionals (like the AAP and ILCA -attached) show that the best way to meet a nursing baby's needs and establish a strong milk supply in the mother is that baby should be allowed to end the feeding by letting go or falling asleep and then to offer the other breast and if the baby is still seems hungry then she can offer both breasts again. Hopefully the attached professional information will help you in convincing these mothers to believe in what is still new information to many people. I'm sure you share my concern that women who want to nurse their babies may be undermining their supply and their baby's latch with unnecessary bottles.

I know that it gets tricky, and mothers can get confused, when we have a sleepy baby and concern about the baby getting enough is an issue. In situations like this, the measurablity of minutes and supplementing can be alluring to an uncertain new mom, especially as this is what she may have been hearing to do from recently outdated resources. In situations like that, it has been found that giving her guidance on how to know baby is getting enough is most empowering. If we have a sleepy baby that falls asleep immediately at the breast then we need to assess position, latch, as well as how the baby looks. We can explain this to the mother, as we do it, so that she knows care is being taken and what she can look for, too. You know to ask about baby's output as well and can explain to the mother that one wet and one dirty diaper in the first 24hrs indicates that the baby is getting enough.

The instructional guide that is put out by TDH has all this information and it will help you in teaching these new breastfeeding moms what to look for when they are exclusively breast feeding. This will also help moms know how to tell if the baby is not getting enough and she will seek medical attention for her baby if he is not having enough output once they get home. I share the appreciation of these mothers as you all work so tirelessly to provide attention and care for their needs. The huge difference good support of, and belief in breastfeeding makes, in the first days, will be realized as we see how improving our rates of exclusive breastfeeding means better overall statistics for the entire unit as well as the satisfaction and confidence of these vulnerable new moms.

[The_Market]

Did you send the email?

[3girls2luv]

I am working on it with one of the NPs who says that she may set a mandatory meeting for the NICU and nursery nurses because she came by my office last week to ask me why the nurses were telling the moms to only nurse 15 min on each side. She too was bothered by that statement so I showed her the e-mail and she wants to make it more formal because she does not think any one will read it if I send it via e-mail.

Market I like what you wrote and if you don't mind can I use some of it?

[Earthmama]

I like what you wrote, too, Market!

And I hope the idea of it being a formal meeting helps to get it to sink in. I really hope it doesn't put them off any.

[3girls2luv]

EM I hope not either but basically the NP will be calling the meeting and she will reference some things from the AAP and other sources and I am going to be there for the Q&A part. We did some research together as well this morning and she is going to put together a survey to see how much they know about breastfeeding and she is also talking about some sort of scavenger hunt that leads to the breastfeeding library that I have put together in my office. She wants to the nurses to teach by evidence based practice and not by what they may have learned years ago.

[SingingMom]

I like the part about improving the overall statistics.

If the nurses are telling the moms the wrong things, they are going to be offended no matter what. They're wrong, and that's uncomfortable. Creating a culture change among the reluctant is very difficult.

However, reminding them that someone is watching the outcomes *might* shift a few attitudes.

[The_Market]

I am working on it with one of the NPs who says that she may set a mandatory meeting for the NICU and nursery nurses because she came by my office last week to ask me why the nurses were telling the moms to only nurse 15 min on each side. She too was bothered by that statement so I showed her the e-mail and she wants to make it more formal because she does not think any one will read it if I send it via e-mail.

Market I like what you wrote and if you don't mind can I use some of it?
Oh, of course. Use whatever you want. I'm really curious to hear the final draft.

[3girls2luv]

I will definately keep you updated. We are going to work on it today if we get some down time.