Dear Lactneters,

I work both in a hospital postpartum, and a hospital based outpatient
setting.  My question concerns how to handle the babies who have
difficulty breast feeding in the first 24 hours.  How vigorous and how
equipment intensive are attempts to get babe successfully to breast
before discharge.

The majority of our patients seem to labor with the ?benefit? of
epidurals which may or may not contain duramorph or fentanyl.  This
medical intervention seems to be the slippery slope which leads to so
many more medical interventions.  It's use is contraversial, with most
of the L&D staff, OBs and anesthesiologists resisting any notion that
epidurals could possibly interfer with breastfeeding.

We often have babies who have not nursed in 12-18 hours going home.
Our policy has been if the baby is not nursing well, to start mom with
a manual pump, advise offering breast q2-3 hours and pumping when no
latch acheived, if unable to latch in a 6-8 hour period to supplement
with expressed colostrum.  If no colostrum available and you are at
the 12 hour mark, we suggest abm (I shudder to say this).  OUr
practice patterns vary and the supplement is either given by od
syringe, by feeding tube at finger, by S&S or by a no-flow nipple on a
bottle.  We seldom use cup feeders; our population seems to balk the
most at this device.  Needless to say, by this mark we have a stressed
family fearing that there is something wrong with mom's ability or
with their baby.  We have by this time had a great amount of lactation
staff time involved and usually many pieces of bf equipment.  I fear
that we medicalize bf to such an extent in these instances that
families will loose confidence and choose abms/bottles.  I also fear
that we are over-interventional in what is a normal pattern of infant
behavior just so that we can see it being done correctly before d/ch.
Our average stay is 24 hours for vag and 48-72 for c-sections.  We
have a very low compliance rate with seeking outpatient LC help; there
is a charge for this help from our facility post d/ch.

HELP!!!!  What are your policies?

When do you worry that a babe has not eaten, assuming normal birth
weight & no other signs of illness?

How do you manage to teach postpartum moms about breastfeeding in the
first 24 hours post delivery?

Does anyone have a post d/c f/u plan that patients will comply with?

Thanks in advance
Glenda Deahl




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Glenda Deahl
Editor
Metronome Online Press, Inc.
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FAX (210) 497-7033
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