The first 48 hours in the hospital are so important for setting the stage for continued breastfeeding. Exclusive breastfeeding at discharge is associated with longer durations of exclusive breastfeeding post discharge. With supplementation rates over 50% in many hospitals, the chapter on challenges during the first 48 hours?in my book was designed to help clinicians facilitate exclusive breastfeeding and avoid unnecessary supplementation. I lecture extensively on the clinical management during the first 48 hours and inevitably there are some very?eye opening?comments from participants regarding their hospital's hypoglycemia protocols or?how long to let baby go without a feeding. So many of the mothers and babies that I have seen in the community have been discharged without anyone checking to see if the baby was swallowing or if the mother knew how to tell this. The last home visit I did revealed a baby who had never actually fed during the hospital stay, no written breastfeeding plan, a visit from the hospital lactation consultant 1 hour before discharge, 16 little?bottles of formula lined up and ready to go that had been given to the mother by the nurse to "tide her over" until the milk came in!

We can do better than this. 

Marsha Walker, RN, IBCLC
Weston, MA



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