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Becky Krumwiede <[log in to unmask]>
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Lactation Information and Discussion <[log in to unmask]>
Fri, 4 Aug 1995 18:39:19 EDT
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Hi Glenda,

I've struggled with these same issues and haven't come up with any good
solutions, but I'll share what we do.  Our average stay is 1 day for vag and 3
days for c-sections.  Our epidural rate is only about 15%, but most moms have
had at *least* one dose of Nubain.  Our induction rate is horrendous, at about
45%, lots of PGE gel and pitocin.  We have one big advantage over you in that
outpatient consults are free, and we have a twice-a-week postpartum support
group in which we do a lot of mini-consults and follow-up.

Our official policy is that if baby hasn't nursed by 12 hours of age, mom should
begin pumping (always with the electric).  Lots of skin-to-skin time is
suggested, but I'm trying to get away from the nurses trying *too* hard to get
baby nursing if he/she is not showing any signs of interest.  Any colostrum
obtained with pumping is usually fed with a syringe since amounts in the first
day or two are usually small.  If no colostrum is being obtained by discharge,
or baby is fussy and vocal, they go home with a few small bottles of Nutramigen
(we don't give out formula bags to BF moms).  We use cups or bottles later if
the problem is persistent.  We seldom fingerfeed, and don't find supplementers
at breast to be helpful at this point since the usual problem is that baby won't
latch on.

I try to find possible explanations for baby's behavior and share that with the
parents so they understand that this is most likely a temporary problem that
will improve as baby is less groggy from meds, his headache gets better, he
recovers from the circ, etc., etc.  I'll also spend some time just working with
positioning (how to get comfortable, where she needs pillows, how is she most
comfortable holding baby, how to hold the breast to facilitate latch on) even
though baby is asleep, so that WHEN he does wake up she knows what to do.  Most
often we arrange for mom to go home with an electric pump, unless she doesn't
want it, or if I have a hunch baby will be awake by the next day (like a baby
who does nurse effectively after birth but then doesn't do much).

The teaching part is really hard--we have open visiting, which makes it worse.
The parents who've been to the prenatal breastfeeding class are pretty easy,
since you're just reinforcing.  They do pretty well.  When we have to start from
scratch, we do what we can and know we're missing a lot.  We have several videos
which we try to get them to watch.  <<If you're reading this, Linda Smith, yours
is a favorite.>>  We do have a book that goes home with them that tries to cover
the basics, and have a "hotline" number to call with questions.

The postpartum support group has really been the lifesaver--it's been in place
for 5 years but we've been at 1-day stays for only a year.  It is not
specifically for BF moms, but the attendance is usually 80% BF.  It meets for
1.5 hours 2x/week and attendance is usually over 20 moms.  (We do 100
births/month, 63% BF initiation.)  Is there any chance your hospital would be
amenable to starting something like this?  The mothers LOVE it, it's great PR
for the hospital, and though you can't do the kind of thorough evaluation you
can in a 1-to-1 consult, it would certainly give you a follow-up vehicle.  The
doctors ALSO love it--saves their staff time.

Sorry for so long--

Becky Krumwiede, RN, IBCLC
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