Dear Friends:
    I totally agree with Ruth Fiedler's lovely post  about letting the dyad 
work out the breastfeeding from the beginning, given a  warm safe and private 
environment.
    Here is a protocol of sorts that I have developed  for the postpartum 
ward:
 
 
 
An easy way to  help a mother: 
1)      Ask  permission to enter her room after identifying  self. 
2)      Once in,  notice baby and praise or offer congratulations 
3)      Wash  hands 
4)      Ask mom  how the birth was 
5)      Ask if  we can get the baby into the conversation about bf 
6)      Describe  s2s and how this gets baby into conversation 
7)      Ask  mother to get into a position where she would go to  sleep 
8)      Give her  enough time and encouragement to do this. “Really, show me 
how you would  sleep.” 
9)      Pull  drapes, turn off lights, turn off TV, close door to room. 
10)   Have partner undress baby down to  diaper (If no partner, ask 
permission from mother to first touch, then undress  baby.) 
11)   Partner place baby on mother’s bare  chest if mother is reclining, and 
next to her, with baby's face next to  nipple/areola if mother is side-lying. 
12)   Both are  comfortable. 
13)   Baby usually rests after some  slight stirring. 
14)   Continue conversation about birth  or breastfeeding or history or other 
children or who baby looks like: as long as  conversation is sincere and you 
are truly interested. LC to be sitting next to  mother's bed. 
15)   If, after 20 minutes, baby is still  deeply asleep, teach mom to hand 
express. Collect EBM in spoon and give to baby.  Or collect in TB syringe, 
label and save for later. 
16)   Leave them tucked in  together. 
17)   Come back later if  possible. 
18)   The other path is that baby moves  to breast and attaches itself and 
starts suckling. This takes MUCH longer than  anybody wants. Baby may tell story 
on the way to the breast. S2s nourishes baby  and reduces caloric 
expenditure; explain this to the  mother. 
19)   Marvel at new miracle if B is  nursing. If baby has a cluster of feeds, 
reinforce this pattern’s normalcy.  Remind mother that her job now is to be a 
placenta, and let the baby wean off  the continual feeding and constant 
heartbeat  gradually. 
20)   Suzanne Colson calls this biologic  nurturing. She says it can occur if 
dyad is clothed. It can, I am sure. But  breastfeeding will be learned more 
easily if there is no clothing  in the way. 
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
www.breastfeedingalwaysbest.com

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