I was writing an email to an friend of a friend who is expecting twins
sometime next year and I realized that I have a mental "scoring system" for
the likelihood that a mom will be successful at breastfeeding, exclusive or
partial and for how long. This doesn't go into specific problems like yeast
and mastitis, but is more stuff you can get a feel for when they are in the
hospital. It's interesting to see how the positives and negatives do or
don't balance out in people I've worked with. It seems to my experience that
the first listing under "positives" carries the most weight. What do you
think?

Gail S. Hertz MD, IBCLC
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POSITIVES
Mom wants to breastfeed
Dad wants mom to breastfeed
Grandparents and other family members supportive
Grandma & sisters breastfed happily [notice this is not "successfully"]
Mom bf previously happily
Mom read about bf before delivery [relates to Mom wants to bf]

Breast changes during pregnancy
uncomplicated non-induced vaginal delivery
no meds in labor
healthy baby
full term baby

baby to breast within first 30 minutes
baby room in with mom
baby skin to skin with mom
baby held by mom
lactation support if problems do occur

help with other children and housework
stay at home mom
mom has place to pump at work
bf supportive caregiver while mom away

NEGATIVES
Mom ambivalent or not confident
Dad ambivalent or negative
Family not supportive
Grandma or sisters had bad experience with bf
Mom previous bad experience with bf

thyroid problems
previous breast surgery / radiation
previous breast injury
previous sexual abuse
nipple anatomy issues

induction of labor
c-section
epidural or other meds in labor
lots of iv fluids in labor
difficult birth [baby needed interventions]
multiple birth
premature baby
early term baby
sick baby
infant of diabetic mother
baby with congenital defect [cleft, trisomy 21]

baby not put to breast before first sleepy period
mom not holding baby
baby in nursery
formula supplement when not medically necessary [esp. >15cc]
poor or no lactation support

no help at home with housework and other kids
minimal maternity leave
no place at work to pump
poor quality pump
job with no or unreliable breaks [like residency]
baby caregiver unsupportive

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