Hope this works!
---------------------
Forwarded message:
From:   [log in to unmask] (Anne Eglash)
To:     [log in to unmask]
Date: 95-06-10 09:45:18 EDT

Hi everyone, I decided to retype my article on Email so every one can see
it..please feel free to criticize, correct or praise the piece!!
MANAGING THE 24 HOUR DISCHARGE AND BREASTFEEDING

      Twenty-four hour hospital stays for routine deliveries have become
increasingly common as insurers look for ways to control costs. In many
cases hospitals and the physicians caring for the mother and baby have not
transformed their services to meet the challenges of early hospital
discharge for the breastfeeding dyad.
Many physicians have traditionally relied upon the hospital nurses to teach
new mothers how to latch the baby on to the breast.  Not uncommonly, when
the baby did not latch on properly the first day, the second day in the
hospital provided an opportunity for the nurses to continue to help with
breastfeeding or to call for additional expert consultation.  With
discharge at 24 hours or less, a great many babies leave the hospital
before having achieved successful latch on.  Unless new mechanisms are set
in place to insure the safety of the breastfeeding mom and baby,
breastfeeding may fail and the baby may become ill.
Just as we do not allow a postsurgical patient to go home with an ileus,
given the inherent risks of dehydration and malnutrition, we should not let
a newborn go home without establishing a plan that will insure close
follow-up to maintain optimal nutrition. Strategies that can promote the
health and success for the breastfeeding mother and baby in anticipation of
the 24 hour discharge include:
-Notify all pregnant women about the need for a prenatal breastfeeding class
-Have the baby latch on to the breast ideally within 30 minutes after birth
-Delay elective procedures which could be done as an outpatient, such as
circumcisions and vaccinations until the baby has latched on well and milk
is in
-Provide frequent and consistent breastfeeding guidance by all health
providers
-Identify babies and mothers at risk for breastfeeding problems prenatally
and before hospital discharge
-Avoid bottle supplementation
Upon discharge at 24 hours, the physician following the baby should see the
baby at 3-4 days of age to assess a) interval weight change, b)
stooling/urination frequency, c)frequency and duration of nursing episodes,
d) baby's state of alertness while nursing, e)appearance of colostrum or
breastmilk, increase in breast fullness, or engorgement f) skin for icterus
and turgor, g) observation of the baby's latch on and suck at the breast,
and h) to answer mother's questions/concerns and provide reassurance and
encouragement.
Red flags that indicate need for further assessment and intervention, the
assistance of expert breastfeeding consultation (depending upon the
knowledge base and understanding of the physician), or the use of possible
supplementation include:a) greater than 10-12% decrease in weight since
birth b) fewer than 8 nursing episodes in 24 hours c)lack of breastmilk
appearance or breast fullness by day four, c) extremely sore nipples d)
fewer than 6 stools and eight wet diapers a day once the milk is in.  If at
this visit the milk is in and the baby is doing well by the above criteria
(including the observation of a latch-on and feeding), a phone follow-up at
1 week followed by a 2 week visit is optimal.  If the milk is not in by
days 3-4, a return visit by days 5-7 should be considered.   THE END

(please note that this was written for physicians...I personally talk to my
patients or see them on days 2,3, and 4, because I am also a LC... I should
have been more specific in saying that if the baby hasn't latched on upon
discharge that the mom should have a LC visit on day 2)