I am in the process of compiling what hospitals use for breastfeeding
discharge guidelines. For example, does a hospital require that a breastfeeding
mother demonstrate two unassisted breastfeedings before discharge? Is there
criteria to document that a mother knows when her baby is swallowing milk? If a
mother/baby pair does not meet the criteria is there a recommendation for another
day in the hospital, discharge with a home visit, discharge with a return to
the hospital's postpartum care center, discharge with a visit to the physician,
etc? Is there criteria to identify mother/baby pairs at risk for breastfeeding
problems, slow weight gain, dehydration, etc?

I am concerned that in the community we are seeing so many mothers who lack
the skills to latch their baby to the breast and have no clue if the baby is
actually receiving milk. The amount of formula supplementation we are seeing is
staggering, both in hospital and post discharge. Mothers interpret fussiness
as hunger, insufficient milk, and the need for bottles. In some hospitals,
rivers of formula are flowing into babies whose mothers claim they don't have
enough milk. Are any of you hospital-based providers using some form of clincial
algorithm or care path that specifies when and why interventions would be
necessary and what constitutes readiness for discharge? I will of course share
everything!

Marsha Walker, RN, IBCLC
Weston, MA

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