Diane:  Although I agree that with good prenatal breastfeeding, strong
personal motivation and family support and good postpartum follow-up by
breastfeeding-knowledgeable healthcare workers, a mother's best chance of
success with breastfeeding is getting out of hospital as fast as
possible, there are a few reasons why longer hospital stays are currently
necessary.  The first is that the above conditions unfortunately do not
exist for most breastfeeding dyads in the USA (and presumably a lot of
other countries) at this time.  That is why a few babies who for various
reasons were discharged within 24 hours without really breastfeeding
adequately and apparently did not get proper outpatient support, were
readmitted with serious complications of dehydration, starvation and
jaundice.  The second is that although there is still a lot of
misinformation in hospitals, many now have at least some staff who are
knowledgeable in lactation, whereas the outpatient setting is uncertain,
at best.  Although there are excellent LLL leaders and other
mother-to-mother support groups available, and there are LC's in private
practice, access is not universal at this time, so many fall through the
cracks as outpatients.  I have no way to quantify this, but my gut
feeling is that a mother's chance of having a breastfeeding problem
identified and helped is greater in the hospital than outside (although I
am very aware that often the breastfeeding problems which are identified
are solved by supplementation; however, they often are by outpatient
physicians also).
Remember that the new laws such as the one in New Jersey allow the
physician to make the judgment about earlier discharge, so that if the
breastfeeding is going well and there are no medical complications
mothers can still leave within 24 hours.  As I understand it, the law merely
forbids an insurance company from forcing an earlier discharge.
I fervently hope that the day will come when all breastfeeding dyads get
the needed education, support and postpartum lactation management help to
ensure breastfeeding success.  I also hope that the trend towards
medicalization of childbirth will reverse.  These things will happen
sooner if we all continue to work for change at our own institutions as
well as with the managed care companies, etc.  Until then, I will support
the longer hospital stays, and have no problem with President Clinton
making it a national policy.  Alicia.  [log in to unmask]