I sent this post yest. but it never appeared, so am re-sending:
Bad bedside teaching (rough handling of the baby or the breast, shame-based
instruction, inaccurate instruction on positioning that stresses rules not
comfort, inadequate assessment that fails to identify red flags -- thus
dooming mothers to failure that they blame themselves for, stupid use of
tools --wrong size nipple shields, dumb advice to wear bras 24/7, inaccurate
pumping instruction) I could go on and on. This kind of teaching is worse
than no help at all. With no help at all, at least a mother and normal baby
might muddle along and accidentally get it right, as I did with my first
infant.
As far as good studies to document usefulness of beside teaching,
I like to cite a study done in Zaire: A Avoa, et al, The Influence of
Perinatal Instruction about Breastfeeding on Neonatal Weight Loss,
Pediatrics 1990; 86(2):313-14.
"Educational intervention was provided to mothers only during alternate
weeks. The intervention required 1-2 min. and was given during the immed
perinatal period, ususally in the delivery room." A midwife or senior
nursing student explained that 1) Bfg provides ideal nutrition, 2) drinking
colostrum is beneficial 3) sucking brings in the milk 4) Baby should bfeed
as soon as possible and frequently thereafter. Staff helped put babies to
breast if necessary.
During alternate weeks only standard care was provided.
There was a highly significant relationship between the educational
intervention and postnatal infant weight loss. The 142 babies of control
mothers lost 6.2% of their birth weight as compared to 3.8% of study babies.
"The decrease in weight loss with the intervention was highly significant
for both primips and multip mothers."
I like this study for two reasons. One, there is a measurable outcome for
the success of the intervention, and two, in my experience, fear over
excessive early weight loss is still a major reason why mothers abandon bfg.
And this is so preventable with simple education, better early assessment to
screen for at-risk dyads, and with community follow-up to help moms
transition from hospt. to home.
There is a doctor in SE Asia who teaches with similiar simplicity what he
calls the Rule of the Three Sucklings (wish I could recall his name). They
are 1) Breastfeed early, 2) Breastfeed often 3) Breastfeed thoroughly (i.e.
effectively)
This is what I based all my pre-natal teaching on. I briefly explained what
each of these things meant in practice. I told parents that if they did
these things bfg was likely to go well, but at the first sign of anything
not working they were to call for help and not stop shouting til they got
it. Post natal follow-up indicates to me that most of them hear these
messages and that it does help with early initiation.
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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