Technology from a nurse’s perspective

I am currently adapting to life with a smart phone. I traded in my bulky, old-fashioned cell for a more fancy, streamlined iPhone. Yes, I am slowly but surely entering into the 21st century.

As I personalized my new gadget, I searched “breastfeeding” in the app store to see what it had to offer. I nearly dropped dead when this came up: Baby Nursing. The app’s description reads: Baby Nursing is a simple and intuitive app to help you keep track of your baby’s nursing progress and more! Our easy-to-use timer lets you track your nursing records real-time. Simply press “Start” and “Stop”!

Before I bash the program, I have a confession to make. During Willow’s first several weeks of life, I set my alarm every one to two hours during the night to offer her the breast. I was so concerned that I’d miss her feeding cues throughout my slumber and starve her. Talk about obsession!

All new moms worry about their infants in one way or another. An app like Baby Nursing serves to “subdue” those concerns by offering high-tech solutions. Here’s the problem: when we put gadgets before observation and instinct, we lose the very essence of motherhood. And while most technology is designed around practicality, when it comes to birth and breastfeeding, technology sometimes ends up doing more bad than good.

Even so, apps like Baby Nursing have rave reviews. “Definitely recommending this app to all new moms”…  “amazing”… “easy to use.”

Just how easy it is to juggle a device every time you go to nurse your baby, especially considering how often newborns feed. How long do moms remain attached to the program? For several weeks? Until baby weans? When mom relies on a tool like this, does she really get to know her baby’s language or is she consumed by tracking and counting and recording?

Technological reliance

CarinRHealthy Children faculty Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE has been a women’s health nurse for 26 years. She currently works and teaches at St. Anthony’s Medical Center in Rockford, Ill.

“When we talk about breastfeeding and everything that needs to be done, we feel like we are churning the ocean,” she says. So why complicate things with potentially harmful technology?

Richter suggests creating a shift in U.S. culture in order to curb the use of unnecessary breastfeeding gadgets and intrusive technology in the hospital.

“Our culture is very much into let me do the fastest thing to get the job done,” she says.

Productivity can be a wonderful thing but not when mothers are staged with a false sense of assistance and efficiency.

In the United States, the majority of births occur in a hospital setting which means that most mothers receive (or don’t receive) infant feeding support from their nurses. Breastfeeding support is a core skill for nurses because infant feeding is of new mothers’ greatest concern, Richter explains.

“When it comes to breastfeeding,  we have to remember that the relationship you have with a mother is extremely important especially in the first two weeks,” Richter says.

She tells me that  nurses tend to rely on technology (i.e. breast pumps, shields, supplemental devices) before they use alternative problem solving (i.e. latch assessment, skin to skin implementation, simple encouragement.)

“They are always looking for a quick fix so technology is frequently something they employ,” she says.

During my hospital stay with Willow, I received such inadequate breastfeeding support I still get angry about it 20 months later. I rarely had anyone by my side cheering me on and when I did, it was a hurried. At one point, a nurse forcefully attempted to shove my entire areola into my newborn’s tiny mouth. Unless she was equipped with a shrinking machine, this was never going to happen.

Until I spoke with Ms. Richter, I hadn’t considered why my lactation support was so awful; I simply thought I was dealt a bad hand of nurses.

Pressed for time

Postpartum hospital stays are generally very short, making it difficult for nurses to establish relationships with mother and baby, Richter explains.

Not only that, nurses have other time-consuming demands to satisfy like clinical documentation including mandatory assessments, documentation of daily care plans, documentation of patient learning, documentation of resources, and the list goes on. Electronic documentation makes things even more complicated.

Also consider the nurse who is responsible for four to five mother baby couplets. That’s eight to ten patients relying on one provider.

In a Medical News Today article, one nurse describes her experience: “I didn’t become a nurse to be chained to documentation.”

Electronic programs can take a long time to learn and to integrate into practice.

“Documentation takes up so much of [nurses’] time, it cuts into their ability to set up a relationship with their patient,” Richter explains.

Even so, Richter tells me that nurses really do want to help moms with breastfeeding, they just sometimes feel trapped.

She adds that some nurses take on physician’s work when the physicians themselves are not familiar with new systems.

Still, nurses have a tendency to cling to technology simply because health care in the hospital has become so technology based.

“When we ask them to just do the natural, which is what giving birth and breastfeeding are all about, they don’t feel empowered,” Richter explains.

She says that if nurses don’t have tools at their beck and call, it’s difficult for them to remain hands off. A hands off approach is often the best method when it comes to moms and babies, especially when you consider skin to skin contact.

Effectively implementing skin to skin contact between mother and baby involves no intervention. Richter says this is the number one thing that will lessen nurses’ workloads.

That’s because when baby’s nine stages are allowed to progress organically, breastfeeding problems are often averted.

Because the Baby-Friendly Hospital Initiative nurtures early skin to skin contact and baby-led breastfeeding, nurses’ workloads are potentially lessened when mothers need less technical assistance with infant feeding.

Implementing breastfeeding education

In order to better prepare nursing students for their OB rotations, Richter is working diligently to integrate skin to skin and breastfeeding training into their curriculum.

“It is imperative that nursing students get a good foundation in the fundamentals of breastfeeding,” Richter says.

Ideally, Richter says a lactation professional should teach the breastfeeding portion of the curriculum.

Along with curriculum changes, Richter suggests implementing breastfeeding training with a lactation professional during nursing orientation.

“We have to start before the problems are even developed,” she says.

When nurses aren’t properly trained to support mothers in their feeding choices, lactation consultants become hot commodities. Most hospitals have a severe lack of lactation professionals and that insufficiency presents yet another barrier to breastfeeding.

Richter says she would love for all nurses to be trained as Certified Lactation Counselors (CLC).

When nurses are trained to properly support and assist mothers with breastfeeding, we become that much closer to securing normal feeding goals.

Even more, the CLC training is a valuable way to build nurses’ confidence in their own ability to provide breastfeeding education and support.

“When organizations require a certification such as the CLC, that really bolsters a nurses’ ability to assess and teach [breastfeeding] effectively and efficiently,” Richter explains.

But do nurses express interest in receiving breastfeeding education, or do supplemental certifications overwhelm?

“I believe that any nurse in whatever specialty she is in has a professional obligation to have a thirst for the newest knowledge that improves the care she gives to her patient,” Richter explains. “What I do find with obstetric nurses is that some of them do not see breastfeeding education and support to be within the scope of their practice.”

In actuality, obstetric nurses like all health care providers, play a crucial role in implementing breastfeeding. OB nurses have a special opportunity to allow immediate skin to skin contact between mom and baby to occur.

Fortunately, when nurses have the opportunity to learn about the significance of skin to skin, they’re excited to apply it.

“I see this every time I teach,” Richter says of the CLC course. “Nurses will come up to me after the week and say, ‘If I only would have known about the Magical Hour and its importance, my practice would have been different.’”

I nearly drop dead again when Richter tells me that because of our litigation culture, nurses are encouraged to become certified in advanced fetal monitoring. The lactation counselor certification isn’t promoted nearly as much.

Why is a certification for a hospital practice that heightens the likelihood of c-sections promoted over a certification that has only positive results for mom and baby?

Richter says she believes breastfeeding education and fetal monitoring competence are equally as important.

Encouraging breast over bottle

The evidence is clear that breastfeeding is more beneficial than breast milk feeding. (For instance, babies fed from a bottle are less likely to self-regulate milk intake.) But because of our culture’s obsession with technology, moms also become caught up in the use of unnecessary devices.

Patients then potentially become barriers to nurses’ ability to provide breastfeeding education, Richter says. It’s sometimes difficult for well-educated providers to explain the possible dangers of introducing technology to a breastfeeding relationship if a mother is insistent on a “quick fix”.

Trainings like the CLC course offer professionals effective, gentle and respectful communication tools when presented situations like these.

Perhaps the most common device requested is the breast pump. Pumps can be vital to maintaining a breastfeeding relationship especially when and if mom must return to work.

However breast pumps should not be offered before a breastfeeding relationship is established. Mom’s milk production generally will not respond to a mechanical device the same way it will to her warm newborn. Mom might also become discouraged to see healthy but small amounts of colostrum.

“In reality, moms don’t know how much work pumping really is,” Richter explains. No one is claiming that breastfeeding is effortless, but it is certainly the most efficient infant feeding choice.

Richter says normalizing skin to skin will help get babies to breast versus to breastmilk bottle because moms will continually desire baby at breast.

“There is so much else going on with breastfeeding that a pump can’t replace,” Richter explains. “It’s a sacred time that no one else can duplicate.”

When technology triumphs

Technology is the antithesis of breastfeeding, as Richter puts it.

“What we need to do now is look at any kind of technology to use for the promotion and support of breastfeeding.”

Once mom and baby have established a comfortable breastfeeding relationship, technology can be used to offer continued support. For instance, emailing and text messages offer quick responses when moms need instant answers.

“This is a really big frontier that we need to explore,” Richter says of text messaging. “There is evidence that using the cell phone will be very important in maintaining that relationship.”

(Read more about text messaging and breastfeeding support at: http://lactationmatters.org/2012/01/31/supporting-breastfeeding-with-new-technologies/)

Online breastfeeding communities may also be helpful in extending support. They allow mother to connect any time of day and encourage relationships between mothers in similar situations.

Still, these communities present the risk of rapid spread of misinformation.

“I want to make sure online communities are monitored so that correct information is given,” Richter expresses concern.

She says mothers need to be cautioned about the information they act on. However providing mothers with reliable resources will better suit them to make informed choices.

Even though Kangaroo Mother Care is an effective way to promote breastfeeding in low birth weight babies, technology can play an important role when mother must be separated from her baby.

For instance, Richter encourages mothers to pump until she becomes reunited with her child.

She says it gives mom something to focus on when she feels helpless and alone.

“Pumping helps empower her so she knows that she can do something for her fragile child.”

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