Hi all,

Linda Kutner and I are working on developing risk factor assessment for
breastfeeding; information we can gather in the hospital that might portend
problems with bf later on.  We are just in the beginning stages of developing
it and working with it with our moms to see if we can get a documented sense
of who is at risk and needs especially close followup after discharge.  There
are more factors than I care to think about that puts a mom at risk; some
more significant than others, and some we may not even know about.  I'm
grateful for all input from those of you that may have others we need to know
about.  Keep in mind that risk factors are just that - it doesn't mean there
WILL be a problem, just that there is greater potential of a problem
existing.  Many of us have those factors in our heads when we are taking a
history, but it is something I think the nursing staff needs to be aware of
so they can notify the appropriate health care provider that there may be
some difficulty later on.

So, we're looking at a lot of things such as Pit induction, CNS depressants
in labor, long running epidurals (esp. the kind with more than one bolus),
preterm, breast anatomy, infant anatomy - the list goes on.

By the way, I'm now including episiotomy in my "complication" factors. (Esp.
the ones complicated by a 3rd or 4th degree laceration) MOST of the time, it
isn't necessary, and causes the mother undue discomfort which she is trying
to ignore while she is attempting to get her baby settled at the breast.  We
avoided episiotomies in the birthing center as much as possible, and the only
4th degree we had (1 in 1000) was associated with the epis.  A lot of the
moms didn't even have a minor laceration, or only had "skid marks" and they
weren't miserably uncomfortable like many of the moms I see who birth in the
usual way with epis & the rest of it.

Enough soap box for one day.

If you have anything that you think might fit in my list of red flags & risk
factors, please let me know....  Take care one and all!

Jan