<My from-the-outside, looking-in perception at the moment is that with
<earlydischarge moms are unprepared for engorgement and it throws them <for
aloop.  There is no universal close follow-up by VNA within 2-4 <days so
BFis down the tubes by the time they come into the office at <one-two weeks.

And many VNA nurses don't have adequate training in breastfeeding support!

I couldn't agree with you more.  As a community health CNS and a lactation
consultant, I work for a hospital and developed a home visit program for our
delivering moms.  Approx. 92% of our moms recieve a home visit, and we find
lots and lots of bf problems.  As the milk becomes more abundant, the shape
of the nipple/breast changes, and within two days after discharge, things
are totally different!!  No wonder these little ones have a hard time.  We
see our moms 48 hours post discharge, which is the 4th post partum day.
Many are tearful, and so happy to see us.  When I set up the program, part
of the theoretical framework was discussing how we send many newborns home
from the hospital before adequate feeding patterns are established.  Where
else in the hospital do we send patients home who are unable to eat, or have
lost close to 10% of their body weight??

As I am based in the hospital, I am often dismayed as I read my fellow LC's
bashing hospital practices.  There are many of us here working hard to make
the hospitals more breastfeeding friendly.  Our administration was extremely
supportive of this type of program, and continue to be.  I would challenge
others in the hospital to steadily, patiently bring studies/literature to
the powers that be to consider developing this type of follow-up program.
Early follow-up is essential for breastfeeding success!!

Linda J. Tandy, MSN, RN, IBCLC
Cedar Rapids, Iowa, where it is snowy and cold, bbbrrrrrrr!

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