Ilene, 
When I began working in a hospital I had been IBCLC for 9 years and worke 
d in private practice and private and perinatal clinics. I did not realize 
how little I knew about "newborn" breastfeeding challenges. And all of 
those horrible reports from parents about their hospital experiences with 
breastfeeding began to make a lot more sense, and I did gain a much deeper 
understanding for what the hospital staff face day in and day out when 
assisting mothers with breastfeeding. Of course, to decrease our 
breastfeeding challenges, we need to go back a few steps and change our 
delivery practices! Ah, but that is a discussio n for a different post! If 
you do not already have one, start a multi-disciplinary hospital based bf 
task force. you will have a dedicated body to evaluate policies and 
practices that affect bf in your facility. this body will be able to run 
tests of change and make recommendations for change as you identify those 
needs. The two practices that i think have had the greatest impact on 
breastfeeding assistance in our hospital are skin-to-skin care and 
understanding what "normal" (from a US model of L&D practices!!) newb orn 
behavior looks like. when staff and parents begin to understand 
the "block" concept, i.e., babies sleep and breastfeed in blocks, rather 
than adult standards of by the clock every 2-3 hours, it reduces a lot of 
stress and anxiety, unnecessary supplementation, and forcing a baby to 
breast when he clearly is not ready. and equally important to teach staff 
and parents to watch baby for cues of readiness to go to breast. I teach 
virtually every parent skin-to-skin care and how to sleep with baby in the 
hospital bed in that position. I am very mindful of the meds this 
particular mother is on. i make observations and recommendations fo r 
safety of the infant. i always demonstrate how to cover infant with 
receiving blanket and/or mom's gown. I always prop pillows under moms 
elbows which keeps those hands at right height to rest on baby. I always 
point out that mom should not consider this practice at home if she 
chooses to take sleeping meds after discharge. and i point out the 
disadvantages to bf of a mother taking sleeping meds. I personally do not 
use sweet enticements to encourage baby to latch. At least not at first!!! 
my personal standard is 24 hours with an otherwise healthy term infant. 
Practice practice practice. I note baby's status: weight loss WNL, diaper 
output WNL, everything else is being monitored by couplet RN and i read 
her notes. And, I only intervene at 24 hours becaus e if I don't staff 
will. And my intervention is far more likely to protect bf. I have seldom 
ever seen an infant not go to breast at least 3-4 time s in first 24 hours 
with s2s and watching for cues. I have polled nurses who are nervous. they 
report that they have seldom ever had a baby not g o to breast at least 3-
4 times in 24 hours. If it ain't broke, don't fix it. If baby latches, 
sustains sucking, and mother's nipples are NOT misshapen after a feed, it 
isn't broke. Always, always note pain meds!!! Delivery day c-sect 
reporting no pain but nipples have severe compression ridge after feeds. 
its broke and you nee d to fix it! I seldom if ever see nipples that a 
baby cannot accomodate in their oral cavity! I would not introduce pumping 
if all of the above s & s of adequate b f are in place! she just needs to 
spend lots of time bf and s2s with her newborn! give good dc instructions 
for signs lactogenesis II and for signs of adequate milk transfer and give 
her community resources for f/u. If not seeing adequate bf, intervene and 
protect the bf. I could write a book on just what I have learned about bf 
in hospital practice. In fact, I plan to! Hope this helps and good luck, 
Linda Kingsley, IBCLC

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