"do I need to view at least one bf before
d/c for each of our mom's or do I depend on the nurses
taking care of these moms to report any problems. I do
see each bf mom but it is difficult to be there when
they are nursing"

JoAnne--my colleagues and I used to really try to see each inpatient baby at
the breast, but with the current volume of phone calls and outpatient
consults, it's become impossible.  We rely on the nurse's report and what mom
tells us when we do rounds.  Especially on the day of discharge, if baby has
been nursing reasonably frequently, and mom answers all my questions "right"
I don't always see the baby at the breast.  I usually ask if baby is latching
on well, how her nipples are feeling, if she feels strong tugging when the
baby nurses and whether she hears the baby swallowing.  Usually if the
nipples aren't getting damaged with "strong" tugging (rules out babies who
are pretending to nurse by sucking their own tongues, for example) and mom
identifies swallowing, the baby is nursing relatively well.  If mom's nipples
are damaged, baby has lost a significant amount of weight, mom is having
trouble latching on without help, etc., I'll make sure I see what's going on
before she leaves.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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