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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