I have looked at the archives and read a variety of resources, but am 
wondering if one of you can point me to something official that says we 
shouldn't be teaching mothers to time feedings in the hospital. We are in the 
process of redesigning our documentation and teaching. 

We are using the LATCH documentation now and I planned to stop 
documenting minutes per breast, as we have for many years, and only use the 
LATCH documentation for each feeding. One IBCLC colleague believes that we 
should still be documenting minutes. She bases this on her experience and 
refers to the AAP policy statement on "Breastfeeding and the Use of Human 
Milk", which says:
"Formal evaluation of breastfeeding, including observation of position, latch, 
and milk transfer, should be undertaken by trained caregivers at least twice 
daily and fully documented in the record during each day in the hospital after 
birth."
and "Encouraging the mother to record the time and duration of each 
breastfeeding, as well as urine and stool output during the early days of 
breastfeeding in the hospital and the first weeks at home, helps to facilitate 
the evaluation process."

So this does support the documentation of LATCH, but only twice a day and 
suggests that the mother record time and duration of feedings.

The ILCA guidelines for establishment of exclusive breastfeeding do mention 
that "on average, infants will feed 15-20 minutes on each breast at a feeding; 
some will feed longer and some are satisfied with only one breast."  The ILCA 
guidelines also say, "Observe and document at least one breastfeeding in each 
eight hour period during the immediate postpartum period. Document the 
following to assess effective latch: comfort of the mother, condition of both 
breasts and nipples, shape of the nipple on release, signs of milk transfer, 
number of feedings, number of urinations, number and character of bowel 
movements, and daily weight gain/loss." 

These assessment guidelines do not recommend timing of feedings, and 
recommend only one assessment per 8 hour period.

What are other hospitals doing about documentation?? We do have to 
document feedings in some way for the hospital record. I'm not comfortable 
with the idea of only one LATCH assessment per shift being the record of how 
this baby fed. And I am more than ready to be done with having our mothers 
watch the clock when they are breastfeeding.

Edith Davidson RN IBCLC
Western Pennsylvania

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