Rachel said:
"I'd like to see a regulation here requiring that the health services have a system for daily, individual contact by maternity service personnel with every newborn and its family until it is clear that the baby is feeding well (satisfied, growing, exclusively breastfeeding, mother not experiencing discomfort that is impacting on frequency or duration of breastfeeds).  Phone or e-mail contact could be used to determine which families needed an in-person visit."   

I couldn't agree more!  In fact, in our county we created a telephone follow-up system in which a well-trained health assistant made calls to mothers on day 3 (day after discharge), 5-7, 14, 1 mo. and 2 mo.  She not only was asked questions about breastfeeding, but also provided anticipatory guidance.  For example addressing engorgement and later on its disappearance, changes in stool color and the normalcy of frequent and nighttime feeds.  Home visits were provided by me or  public health nurses I had trained.  The rate of home visits was actually lower than we thought it would be, which meant the cost of the program was not as great as expected.  Even so, it was a grant-run project, so when the funds ran out so did this activity.  However, at 2 months these moms were breastfeeding at a much higher rate than the population they were drawn from (WIC).  

I'd highly recommend this type of project be done, with a cost-benefit assessment included.  The reality is, moms are told to follow ____ instructions at discharge - but they are inadequate/incorrect for a baby that is 10 days or 4 weeks old - but they are still "stuck" with the original instructions unless someone contacts them, learns what is happening THEN and provides new information.

It is not the "weight check" that is important - although in the US it is part of our procedures and I would not want to waste my energy fighting this battle.  In my experience, mothers just take it in their stride as long as I explain the results.  

However, in my opinion, it is the information related to the assessment, the education provided by the health worker or IBCLC and the development of a plan the mother chooses to implement that is the important part of the conversation.  The flow of the interaction requires the use of supportive dialogue rather than a "diagnosis and treatment plan".  Unfortunately, many agencies require documentation of interactions that imply that the latter is the "right way" to interact with breastfeeding mothers.  Couldn't be more wrong!

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA 

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