Dear Deena,
        I have spoken a few times about early discharge to MDs, because I
feel strongly that the early discharge puts the breastfeeding 'into their
court', and they stand a good chance of dropping the 'ball'.  I have been
very specific about what needs to be evaluated at the follow-up visit at
day 2 or3. Actually, I just wrote an article that is in the first
newsletter for the Academy of Breastfeeding Medicine that summarizes what I
would say here...I would be happy to send it to you,...you would just need
to send me your address. The hospital based LCs also should have alot of
suggestions...the biggies are that the mother should be "resting between
nursing", and not "nursing between rest periods". Mom should have very few,
limited visits by others so she can really concentrate on feeding, and get
into a groove with her baby. Definitely getting the baby to the breast
within 1/2 hr is ideal...and no pacifiers.  The other thing is that with
early discharge, the mom has no time to learn the facts of breastfeeding..
It is the doctor's responsibility to make sure the patient gets educated
prenatally. I think historically doctors have relied on the hospital
experience as the training ground for breastfeeding, and perhaps that was
OK (not really) for the old 5-10 day stays, but not now!! I am passionate
about the changes that need to come about, and I would love to talk to you
if you'd like.  Oh, and one more thing....try to get them to do the
circumcisions as an outpt when the milk comes in and baby is nursing
well...and delay that first hep B shot if mom is hep Bsneg...I definitely
have seen cases where that shot caused increased sleepiness. I could go
on...Anne Eglash MD