I wanted to add a few thoughts regarding the 24 hour discharge. It looks as
though we will be moving toward the 24 hour discharge this summer because of
major cuts to hospital budgets.  I remember Kitty Frantz saying that when
they introduced the 12 hour discharge in California breastfeeding success
increased!  It removed mothers from detrimental practices! However they must
have had some good community services as well.

In Ottawa we have limited community services, PHN's only visit high risk
moms, there are some "breastfeeding drop-in's mostly coordinated by PHN's,
but those mothers without transportation or not highly motivated do not use
them.

A colleague of mine is a labour and delivery nurse and an IBCLC and she
spends time with her breastfeeding mothers to assist with the first feed and
has found that in two years only two babies did not latch, one because of a
traumatic delivery and apgars of 7& 8, she noted that even after this infant
stopped being grunty it still did not root or make the normal attempts to
latch, the other was a mother with inverted nipples and she was not given
the time to spend with her trying to evert the nipples with a pump. She
finds the infant will often attach itself while she is explaining to the
mother what to do, she also notes some infants need longer than others to
attach.  When attached they will actively suck for 30 -40 minutes if
unrestricted. She finds that L & D nurses do not see themselves as part of
the process of breastfeeding, that is the role of the post-partum nurse.
She is often sabotaged in her atempts to work with these mothers, they will
send her to a coffee break and when she gets back the infant has been
"shipped" to the nursery! As a nurse I feel outraged that other nurses would
do this.

The window of opportunity for correct latch, suck is that first hour or so,
we know it is associated with successful breastfeeding from research.  It
also provides the mother and infant with positive reinforcement.  Research
tells us that infants who are separated from their mother in this period
have more disorganized suck patterns.  Therefore it would seem to me
appropriate to work hard at changing the policies and practices in the
labour and delivery area and get these nurses to recognize what a major role
they have in the process of successful breastfeeding.  They need education,
polices must be changed to give the mother and infant unlimited access and
so on.

At the same time these nurses must be taught to recognize those infants and
mothers at risk for difficulties with breastfeeding based on the delivery
history, these are the ones who perhaps should not be discharged at
twenty-four hours or who required extra community support and supervision.
We still must develop more coordinated hospital/community liasons and
community programs for our new mothers.

Thanks for letting me sound off!

Susan Moxley IBCLC
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