I do a brief assessment on all my inpatient postpartum moms. (an office 
consult for low supply would be a more in-depth assessment of course.) I 
ask: have you ever had any breast surgery, breast biopsy, or significant 
injury to the breast? what medications are you on and do you take any meds 
fairly regularly? any hormone problems like thyroid, female problems, ovary 
problems, or infertility issues? do you smoke? do you have any concerns 
about your breasts or your nipples? this is a general screening and takes 
about a minute but you do pick up risk factors and should follow that dyad 
more closely. of course i do a breast assessment too.

one of the handouts i developed talks about developing a good milk supply 
and why exclusive bf is best. it addresses the risks of *unnecessary* 
(replacement) feeds. it says "during your hospital stay, make sure you are 
taught how to position the baby well and how to latch the baby on. You 
should also know how to tell if the baby is breastfeeding effectively and 
signs that s/he is getting enough milk.  it addresses the baby who is not 
latching or is bf very poorly and having mother express for him (and he 
*may* need supplementation - ebm is our first choice) and the last part goes 
something like this " although possible, it is uncommon for a mother to have 
a low supply due to a physical reason on her part. Work with your lactation 
consultant if there are any signs of low milk production or signs that the 
baby is not getting enough. Begin working with her right away!"
I feel this is important to include for the few who will have the problem.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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