I second Nikki's great ideas!
>> My wish list for OBs would be for every OB to recommend breastfeeding to
every pregnant woman they see. <<

This would be number one on my list too! I might also emphasize that OBs be
particularly mindful of their wording regarding a woman's choice to breast or
bottle and suggest rather than asking directly to choose, try "do you have
any questions about breastfeeding?" This puts the emphasis where it should be
and potentially leaves the choice more open for future discussion. Also,
whether the client seems decisive or not, I would ask OBs to offer a couple
of powerful handouts detailing health benefits while stating "this is
something I ask all of my patients to look over before making their
decision". In the instances where the Mom seems determined to bottle from the
start, reinforce the need to return to the possibility several times over the
course of prenatal visits AND after delivery. As a hospital nurse and now as
a VNA nurse, I have happily been involved in many instances of "changed
minds". Let them know that this happens and that they have a powerful and
important voice in the process!

>> Evidence doesn't support prenatal nipple exams as being all that helpful.<<

I agree! And even if they were, I'm not sure that a "nipple diagnosis" by an
OB would translate well into practice as they typically don't get very
involved with the practical aspects of breastfeeding.

>>The third thing I would put in an OB's promo packet would be a list of
local resources: nursing mother's groups, LCs, pump rental stations. <<

Absolutely!! And encourage Moms to take advantage of VNA home visits. Here in
Massachusetts they are offered to all Moms who leave the hospital within the
"early maternity discharge" period AND to all new Moms in general under one
area HMO plan. Remind them to ask (when the VNA nurse calls to schedule the
visit) for a nurse with IBCLC credential or at the minimum, experience with
breastfeeding issues!
What a great oppurtunity!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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