The topic is getting old, but I just want to state that our babies have
unlimited access to the breast after vaginal births (I think 90% or better
in the last 3 months) and we see very little engorgement and the milk comes
in at 48 hours after the placenta falls out, just like it says in the books!
We are working hard at getting cesarean moms and babies together faster.

The key? Staff involvement. We did a workshop based on ILCA's Clinical
Guidelines for the Establishment of Breastfeeding for staff. (Contact me, I
travel!)

And -- two of our PI (Performance Improvement) projects this past year were
--get babies to the breast within one hour after a vaginal birth
--get babies to the breast within two hours after a cesarean (one practice
takes up to an hour to get the mom back to her room for recovery -- we have
had a couple babies nurse in the OR while mom was being stitched up)

Most units are looking all the time for PI projects. Even though it's hard
to get the brick walls to move -- as Barb Wilson-Clay says, "The only reason
brick walls move is because we keep banging our heads against them."

Our PR dept just came to take pix of our 3 IBCLC's and 2 new CLC's  (grrr
gnash) who helped with these projects. I'm writing a nice PR piece for IBCLC
Day.

USE the system on itself. Help staff be their best selves!!!! And then brag
on it in public so administration has to be able to crow about how wonderful
you are - because they and their families read about you in the paper!!

Dawn Kersula
in Brattleboro VT

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