Guest blogger Ashley Baker, RN, BSN
I am the mother of four little ones. I am also a registered nurse with a bachelor’s degree in nursing and seven years of clinical experience. Of that experience, I have spent almost six years dedicated to units such as mother/baby and labor and delivery. Over the course of my professional life, I have become passionate about patient advocacy, as I have witnessed many families receive care that was certainly not evidence-based, nor in any way empowering. I have observed families accepting whatever diagnoses, treatments, interventions and rationales that were given to them by their healthcare teams–often without realizing that they were being given outdated care or, even worse, false information. These experiences have inspired me to pursue a master’s degree in nursing, specializing in nurse-midwifery. My driving force is the promise of educating and empowering women and their families so that they have a voice in their evidence-based care.
I have had a wide range of infant feeding experiences with my four little ones. With my oldest, I was convinced by my son’s family that breastfeeding was gross, so I shouldn’t even try. When he arrived prematurely, a lactation consultant shared valuable information that led me to pump for him. I pumped for two weeks, but then contracted mastitis and ceased my efforts. With my second child, I was remarried and had completed my nursing degree. After that, there was no question: I planned to breastfeed. Six weeks into that breastfeeding journey, I could not find the source of excruciating pain that plagued our nursing efforts, despite seeking ongoing help and support. I ultimately stressed myself dry and mourned the loss of that breastfeeding relationship for quite some time. With my third child, I refused to let anything stand in our way; I was going to breastfeed, come hell or high water! Despite many, many bumps in the road, we made it until three weeks shy of my daughter’s third birthday. We only stopped then because I was pregnant, and breastfeeding was causing significant contractions. I now have a four month old little lady named Locklyn who will hopefully nurse as long as her heart is content.
We are a military family. In January of this year, we were assigned to a new (and slightly remote) area in northern Virginia. Because I was to scheduled to begin a new labor and delivery nursing job rather quickly, we rushed to acclimate our daughter to taking a bottle in preparation for her attending daycare at the Child Development Center (CDC) on base. Luckily, she was able to stay home with her dad for my first week of orientation and he was eventually able to get her to take a bottle. It took him three days to achieve a successful bottle feeding, and only by keeping a shirt of mine close to his chest and positioning her in such a way to mimic nursing did he succeed. On the fourth and fifth days, he was able to get a better feel of her feeding pattern, and she was taking two ounces every two hours or so.
Daycare at the CDC began on January 29th. Locklyn had never been away from both Dad and mom for more than a couple of hours. We knew she would have some adjusting to do, and we specifically spoke to her teachers about our concerns at the daycare’s required orientation class. We also explained that she also was not yet using a pacifier and I explained the need to keep working on this, especially since she was an exclusively breastfed infant. We also discussed the concept of paced feeding, which her surprised teacher said she had never heard of in her 20 years of childcare experience.
As expected, Locklyn was still struggling to adjust at the end of first week and she was fussing quite often. The CDC’s resolution for this was to feed her more at each sitting. I brought in articles from KellyMom
with linked professional peer-reviewed sources that explained why Locklyn may have trouble adjusting and why it was perfectly okay to eat smaller volumes, and at a slower pace. I also brought in an article explaining responsive feeding
. We also pointed out in the articles that helping her adjust to pacifiers to would meet her instinct for non-nutritive suckling and that it may require spending a little extra time attempting to soothe her, since it was all so new to her little self. We were told by the classroom providers that “we can’t pace feed, it’s against policy. We can’t spend more time with her, we’re short staffed. If she cries and we can’t fix it, we must feed her more. Send more milk.”
Surprised by such adamant resistance, we attempted to explain that more milk could be detrimental to breastfeeding, and that larger volumes weren’t the answer–especially given that she was taking two ounces every two hours at home without issue. The response? “Well, some moms just have to supplement with formula. I have a baby younger than yours that takes almost 5oz per feeding. Your child is hungry.” We decided to present another possible solution, based on the flow speed of her bottle. We had been sending two different kinds of bottles, one with a slower flow than the other. I suggested that I would send the one with the slower flow. We were told our baby was not tolerating the new bottles and would only cry with them, even though all of the reports sent home state she took the full bottles. I later learned that other staff confirmed she took the bottles just fine. At this point, I realized that it was a matter of convenience for the staff–slower flow meant more time required with my baby, and they didn’t want to spare that time.
I was flabbergasted and requested a meeting with the director. We sent 2.5 ounce bottles with instructions that she should still not be eating more than every two to three hours. We encouraged the staff to try more soothing techniques before solving every problem with forced feedings. At home on the weekend, Locklyn easily adapted to taking a preemie bottle, which she consumed slowly. After using this bottle for many feedings, including a feeding by a babysitter, we were excited to see that this bottle was working wonderfully for her. We sent those bottles to the CDC on Monday and awaited our Wednesday morning meeting.
By Tuesday afternoon, the director had left a message on my phone informing me that the bottles we sent were not acceptable because our child was not actually premature. I was told that I had to send age-appropriate nipples for a four-to-five-month old, despite the fact that my daughter was barely three months old. She claimed that Locklyn was struggling with the bottles and not receiving sufficient nutrition with the nipples and that I was going against their standards and regulations. I didn’t actually hear this message until after our Wednesday meeting, thanks to a phone malfunction. Had I heard it, I would have been prepared for the continued resistance to supporting the needs of our breastfeeding child.
The meeting on Wednesday was an absolute disaster. The director was determined to convince us to back down from our requests to feed our daughter based on research-driven evidence and situational appropriateness. We were told that the CDC staff had to feed infants based on U.S. Department of Agriculture guidelines that suggest that infants should eat 4-6oz at every meal. We were instructed that a doctor’s note would be required to continue using the preemie nipples and a special inclusion panel would then be held to determine if the facility accommodate our daughter’s special requirements. It was implied that the likely result would be that the facility would not be able to accommodate her needs. While the director didn’t provide copies of any of the policies she cited, she did print out and highlight a document that claimed that failing to provide the bottles, nipples, and milk that she requested constituted abuse and neglect, and that we would be reported to Child Protective Services for starving our child. Instead of coming to our meeting ready to listen, learn, and exchange ideas, she seemed to have come prepared to tell us that if we didn’t stop advocating for feeding our daughter in a way that facilitates continued breastfeeding, then we would either be kicked out of the center or reported for child abuse and neglect!!
Through online support and encouragement, I filed an online complaint using the military’s Interactive Customer Evaluation (ICE)
system, found out who her supervisor was, and obtained the actual USDA updated recommendations
. As it turns out, the USDA information that the director provided was not current or accurate. The newest guidelines state
“Fill the bottles with the amount of breastmilk the baby usually drinks at one feeding. Some babies may consume less than 4 ounces at a feeding. The mother can freeze some bottles with 1 to 2 ounces of breastmilk for times when the baby wants some extra breastmilk.”
The director later admitted, “I knew you would eventually find that. I was just hoping you wouldn’t.” By the next morning, the director’s supervisor had contacted me and brought me in for a meeting. He was horrified by what he heard and confirmed there was not a specific policy on requiring specific bottles or nipple flows. to be used. He also reassured us that even if a doctor’s note was required, that it was an easy accommodation and we would not be kicked out. He was insistent that flexibility from his staff was, and will always be, essential to quality childcare. He expressed interest in learning more about how he could help meet the needs of breastfeeding babies so that they could continue to be exclusively breastfed.
The supervisor begged me to wait it out and promised that he’d be making drastic changes at that CDC. For several weeks, there was an air of tension every time we dropped off or picked up our daughter. But we are happy to report that the supervisor was true to his word. The CDC director is no longer employed at our facility, the staff has become extremely supportive, and Locklyn is thriving!
Looking back, I could have turned tail and run from the situation. I could have given up and removed my child from that center to avoid these struggles. Instead, I stood my ground and I fought for change. That change is not only for my daughter and our family. It is for all of the other families who don’t know when they are being given bad information or who feel as if they have no other choice in how they advocate for themselves and their little ones. Advocacy is stressful, heartbreaking at times, and is often difficult uphill battle. But it’s necessary for inciting change and progress, and I, for one, will remain committed to continuing to advocate for better care for all of our families.
Ashley Baker is originally from central Arkansas. She is a mother to four tiny humans, a fur baby and a beta fish. She’s married to an active duty Navy cryptologic technician (whatever that means since he can’t talk about it). In between the many moves across country every three years, Ashley and her family greatly enjoy outdoor adventures. A licensed registered nurse since 2011, Ashley later obtained her Bachelor of Science in Nursing from the University of Arkansas at Little Rock with a nursing specialty of women’s services. She is passionate about evidence-based practice and advocating for patients to receive the kind of care they desire, delivered without judgement or reservations. Ashley is currently enrolled in graduate school to become a certified nurse midwife.