There are other factors: a highly transient, often undocumented Hispanic
population. At least 1/4 of them never return for the 1-2 day follow up
pediatric visit. Many others who do come in  for the 1-2 day visit, never
return after that. If they are still in town, they come in only if the
baby/child is sick or if he needs shots to enroll in school. Then there are
those who use the Emergency room for all their health care, returning 1-4
times a month for a year or more!

Add to that, our Legal Dept & Quality Control people are giving full
attention to jaundice, especially the bili level at <24 hours of age,
because JCAHO says it's a Sentinel Event if jaundice gets worse after
discharge. So, if it's borderline and climbing, no matter how slowly, they
keep the baby an extra day or two. If just one baby has a problem
post-discharge & JCAHO dings the hospital for it, that means the loss of
MANY $$$$ in federal & state funding. At least that's my understanding of
the situation.

When a baby comes back to the Peds floor 3-5 days after birth with elevated
bili, 18+, I constantly have to deal with the nursing staff who insist baby
go back under the lights after 30 minutes of feeding. It has happened that
I'm just getting mom to realize what a good feeding is, and to feed on
baby's time, not the hospital's time. That is sometimes 40-60 minutes to
reach blissful contentment. I keep mom distracted from the clock while we
talk Supply-Side Breastfeeding. Before this hospitalization, breastfeeds
were 15 min, followed by formula. If a bili pad is in use, I have mom keep
it under baby so the nurses don't get too upset about the extra time out
from under the lights. After seeing baby blissed out like that, or
"borracho con leche", she often continues to feed on baby's time until baby
becomes "milk drunk". That's when mom finally KNOWS she has enough milk &
she really can make baby happy at the breast.

> Good Heavens!  8 or greater may not be normal, but they aren't totally
> pathologic!  Adequate follow-up needs to be undertaken.  The level needs
to
> be checked and infant feeding assessed (is it really happening, is
> colostrum/milk being transferred?)

Who knows? Many of them nurse only when we are in the room to assist. But
if we have to leave the room for some reason, baby is off the breast &
being stuffed with formula, no matter how content baby was at breast, or
how many deep suckles baby made during each bout. She knows she has no milk
because she can't feel it with her hands. It's hard to figure.

Officially, hospitals in Mexico support and encourage BFing to the point
that it's rare that a mom does not BF there. But when they come to the US,
nobody has any milk for the first few days. Could it have anything at all
to do with our govt. programs that give away powdered formula?

--- Phyllis Adamson, IBCLC
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