Sharon Knorr said:
<<Readmissions are so costly. One would think that not only physicians
but also medical insurers would see that lack of follow-up care is
penny-wise, but pound foolish.>>

The pressure to avoid readmission can be a double-edged sword in the
treatment of breastfeeding dyads. The way the readmissions issue plays
out with a nurse practitioner that I know of was that she encourages
formula supplementation for breastfed babies, because "it looks bad when
one of 'my' babies is readmitted for jaundice."

Many of the desirable (and normal) outcomes of exclusive breastfeeding
are subtle, and they show up over the long term, while the undesirable
outcome of having to readmit a newborn for phototherapy is all too
conspicuous, like an elephant in the living room. Supplementation
appears to be an easy "fix" for breastfeeding that is getting off to a
slow start. The underlying problem could be ineffective breastfeeding by
the baby or delayed lactogenesis in the mother, two situations that
require good follow-up to be sure they resolve within a day or two of
discharge. Supplementation is a short-term "fix" that interferes with
our discovering the real problem, which could be as serious as a septic
baby, a neurologically injured baby, a baby with a cardiac defect, a
mother with retained placenta.

Wouldn't it be great if the health care system all agreed to make a
breastfeeding assessment a standard part of the newborn exam, a
requirement both for admission to the hospital and for discharge from
the hospital? Hospitals would have to use a valid and reliable method
for assessing and documenting breastfeeds. The report of breastfeeding
behavior, whether observed by nurses, LCs, or physicians, would suddenly
be regarded as important, because it would drive the decision about when
to send the baby home, a decision that has economic and legal
implications for the hospital, the insurer, and the caregivers.

The important thing here is that a breastfeeding baby should be assessed
for BREASTFEEDING. A baby sucking a doctor's finger or swallowing
formula.or even swallowing human milk.from a bottle nipple are not good
enough measures of breastfeeding competence!

The body that accredits hospitals in the USA is JCAHO. Probably someone
on this list is working with JCAHO on breastfeeding issues, or has a
link to someone else who is doing that. When JCAHO speaks, hospitals
listen!

Chris Mulford, RN, IBCLC
LLL Leader Reserve
working for WIC in South Jersey (Eastern USA)
Co-coordinator, Women & Work Task Force, WABA

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