<My from-the-outside, looking-in perception at the moment is that with <earlydischarge moms are unprepared for engorgement and it throws them <for aloop. There is no universal close follow-up by VNA within 2-4 <days so BFis down the tubes by the time they come into the office at <one-two weeks. And many VNA nurses don't have adequate training in breastfeeding support! I couldn't agree with you more. As a community health CNS and a lactation consultant, I work for a hospital and developed a home visit program for our delivering moms. Approx. 92% of our moms recieve a home visit, and we find lots and lots of bf problems. As the milk becomes more abundant, the shape of the nipple/breast changes, and within two days after discharge, things are totally different!! No wonder these little ones have a hard time. We see our moms 48 hours post discharge, which is the 4th post partum day. Many are tearful, and so happy to see us. When I set up the program, part of the theoretical framework was discussing how we send many newborns home from the hospital before adequate feeding patterns are established. Where else in the hospital do we send patients home who are unable to eat, or have lost close to 10% of their body weight?? As I am based in the hospital, I am often dismayed as I read my fellow LC's bashing hospital practices. There are many of us here working hard to make the hospitals more breastfeeding friendly. Our administration was extremely supportive of this type of program, and continue to be. I would challenge others in the hospital to steadily, patiently bring studies/literature to the powers that be to consider developing this type of follow-up program. Early follow-up is essential for breastfeeding success!! Linda J. Tandy, MSN, RN, IBCLC Cedar Rapids, Iowa, where it is snowy and cold, bbbrrrrrrr! *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html