I have to add one thing to this conversation (goodness, I think I'm
approaching my 3 post limit!) - when we see moms who are not following our
suggestions re: pumping frequency, I think we also need to consider the care
plans we're giving them. I've been shadowing an outstanding RLC on our
postpartum floor, and while the advice she gives is excellent, it's almost
always exclusively verbal. I'm sure many patients go home not sure of what
exactly she said, especially when the care plan is complicated. She often
finds recommendations are not being followed very precisely when she calls
for follow-up - I think this is because it's hard to remember all of the
details, esp. for a pp family.
I would recommend formal written care plans as often as practical - with
very specific timelines and sequences of events. I know we don't want moms
to feel too scheduled or have them watching the clock, but a written order
to "pump 15 minutes following each feeding, do not let more than 3 hours
elapse between feeds except at night" is clear enough without being too
proscriptive (in my opinion).

Just my .02
Kirsten Berggren, PhD, CLC
www.workandpump.com

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