As part of the training of childbirth instructors I facilitate we review the developmental tasks of pregnancy. The taking-in phase which is essentially the first 24 hours - 3 days depending on whose theory you are embracing, Rubin or Amant, is a period in which mothers are often very receptive to teaching. The subsequent period of taking hold involves further adaptation of the maternal role and reduced reliance on outside help, assistance and education.?

However...a few things to consider. Rubin's research was done in the 60's, Amant's in the 90's. There have been considerable changes to typical maternity care provided in N America (just speaking from my personal perspective here). An increased cesarean rate combined with briefer postpartum stays and a somewhat geographically fragmented family circle have left postpartum women in considerably different circumstances from when these studies were performed (particularly Rubin).

And....postpartum fatigue, pain, and simply the volume of visitors can interfere with comprehension and retention. 

My own personal experience providing lactation support in a very busy?mother baby unit is that although these women and their families are often 'generally' very receptive to breastfeeding education shortly after birth, they are quite likely to be sleep deprived, and using pain medicine that definitely interferes with their retention and comprehension. They are also discharging so quickly that they may underestimate the amount of education they may find beneficial until they go home and sometimes regret not asking their visitors to excuse themselves so they may focus on the education they are being offered.

Our lactation department has a large outpatient clinic and we often make referrals and outpatient appt.'s before our inpatient mothers are discharged. We sometimes have to laugh because the document that is completed in the hospital setting and brought to the clinic for the subsequent appt. is lengthy and consists of a decent amount of data collected from both the mother and infant's chart and the contact with the patient on the unit floor which ideally and often includes a breast exam and observation of a feed, latch score, education offered, etc.....this is all the result of a decent amount of time personally spent with the patient.

Sometimes the LC faclitating the outpatient consult will ask the patient about their experience in the hospital and some of these patients don't even recall ever being seen by anyone in the lactation department! This is despite the fact the outpatient appt. was scheduled by the LC who consulted the patient in the hospital and completed the entire 8 1/2 x 11 page long documentation, recorded health history, noted any interventions,?evaluated a feed, and brought all this documentation back to the clinic! :)

Just last week our department secretary told us a story about a??clearly sleep deprived, yet thoughtful father who called and explained his wife was so exhausted he was wondering if he could just bring the baby to the lactation appt. by himself in order to let his wife sleep! Thankfully the secretary and?the father all shared a sense of humor after she patiently described the benefit of having the mother present for her lactation consult!

Clearly, theory demonstrates that new mothers and fathers are often eager sponges for absorbing information in the immediate postpartum period, however there are lots of obstacles that have the potential to interfere.

Michelle H. Kinne ICCE CD(DONA) CLE
www.DoulaDiva.org



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