Judy stated,
<< We too use the #of days old/#of wet diapers guideline for moms at
 discharge.  Also tell them to expect yellow stools by day 4.  Sorry, Dr.
 Jack about using numbers, but I do feel some inexperienced moms do need
 a clear cut way of evaluating that things are going well.

 We also discuss listening for swallows and assessing satiety as
 important issues. >>

I agree these moms desperately need guidelines.  I still shudder over the bad
press breastfeeding got on July 22, 1994 with that dreadful article in the
Wall Street Journal by Kevin Helliker -- and the subsequent fallout on 20/20
on August 8, and the article in Time Magazine on August 22...not to mention
other newspaper and journal articles including headlines such as "Are we
being bullied into Breastfeeding?"  (Redbook).  For those of you too "young"
to remember these articles, the thrust was that at least 200,000 women in the
US ran the risk of starving their infants because they couldn't make enough
milk -- the stories that ran were focusing on the pressure women have to
breastfeed and how they were told to just "keep at it" with no guidelines as
to how to know their babies weren't getting enough.  If I had just 5 minutes
with a mom -- which isn't always enough to observe a feed -- I would at least
teach her that the baby needs to breastfeed (not just hang out, not just
"nurse") at least 8 times a day in the first few weeks, have 3 or more yellow
poopy diapers and 6-8 or more good wet diapers a day, and IF that wasn't
occurring, to check with her HCP.   And I'd give everyone a diary so they
could note the above, along with some guidelines about "Breastfeeding is
going well if...." and "Call me if....."  We can talk all we want about not
burdening moms with numbers and all this sort of stuff, but while parents are
in the "formal" acquisition of parenting, they all want numbers and
guidelines.  These ladies haven't grown up w/ breastfeeding.  They haven't a
clue as to what to look for or when.  Most of them have medicated births,
sleepy babies, and HCPs that observe them with the baby "at" the breast from
the door and pronounce that all is well.  Or they encourage the moms to let
the baby spend the night in nursery so mom can get some rest.  Or they ask
the mom how long the baby "breastfed."  Clueless mom, who doesn't realize
there is a difference between hanging out and breastFEEDING, says, "15
minutes on each side" -- HCP charts a "good" breastfeed, and everyone goes on
their merry way.  I'd love it if all the mothers were taught everything
appropriately by all staff -- nurses, pediatricians, patient care techs, OBs,
family physicians -- but that isn't always the case.  I for one am committed
to not having a single one of the moms in our practice be a repeat of the
devastating stories of 1994 -- and the next batch that came in 1998.

Jan B -- in sunny & WARM Wheaton!!
RN, MA, IBCLC
www.bsccenter.org

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