Jean:  Tina Smilie may not see the numbers of these women that you see in 
WIC.  I know I don't apparently see the numbers of problems that others 
report.  If mom/baby do lots of s2s ASAP after birth (and that ASAP may be 
several hours post-birth.  We certainly do not have birth nirvana over 
here, not with last Monday's C/S rate at 80%! Today's a mere 64%!) the 
baby "gets it" early and when mom begins to show signs of extreme fluid 
overload a couple of days further down the line, it appears to me that the 
baby is better able to handle it.  I also don't tend to see the extreme 
that you apparently do.  I believe it is because if the baby gets into a 
consistently good nursing pattern, that then lessens the extreme 
breast "engorgement", and again, both mom and baby tend to panic a little 
less and are able to work their way thru this period.  I don't get a lot of 
these types of phone calls/office visits post discharge and I hear back 
thru the community/my support group that our duration rates are probably 
higher than the "national" average.  I also don't believe that our private 
practice LCs in the area see any more, and I suspect maybe even less of 
this problem, the the average.  Please feel free to correct my thinking, 
private practice colleagues!
I wholeheartedly agree with Nils Bergman.  Skin-to-skin works!  It either 
prevents some of these comon problems completely, and certainly lessens 
their severity when they do occur.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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