I agree so thoroughly with Mardrey's answer that I had to take a second look at who sent it. (I thought maybe I had done it in my sleep). Basically, we could chart complexity "after the fact" but not "before" Cheryl Muller RNC IBCLC (hospital L.C.) Date: Mon, 29 Nov 2004 21:43:27 EST From: Mardrey Swenson <[log in to unmask]> Subject: levels of patient complexity Laurie asked about My boss will be giving me further details on this soon, but I thought I would ask now and if any of you have such a system, would you be able to share it with me? If anyone else has any ideas as to how to describe the 4 levels, feel free to chime in. Thanks. I don't know how your boss decided that there should be four levels, Laurie. I'm not saying that something along those lines might not be developed. But I've seen too many psychological and just plain body comfort/abilities/awkwardness issues that would make a particular mother/baby dyad hard to predict or categorize this way. And when would these levels by assessed? Six hours after birth/ Twelve hours after? 24? It sounds like your boss wants to charge some mothers more because it takes longer for her and the baby to achieve an acceptable comfortable successful level of breastfeeding?? This does not sound like support nor protection of breastfeeding. I do see that that it could help to know that some mother/baby dyads might need more support more frequently. And want to use that for staffing purposes. But at the same time I just don't see that you could proceed from Primip with no risk factors to an assigned management level. Nor for a mother of her second child with risk factors for often the baby's makeup makes all the difference. For instance, a particular mother might have soft breasts with nipples that are elastic and not flat, and a baby that is starting to open her mouth and root well so assigned to a low management level. But the mother might be taking a long time to learn how to hold the baby so that he doesn't slip away from her, or she might keep on moving and planting the baby firmly on the crook of the elbow too far away from her breast - no matter how softly and gently you show her with a doll model or describe to her what she is doing. Some mothers want to do it themselves and resist teaching initially. This type of mother may eventually figure it out on their own or learn what she specifically needs help with on her own. Or may not. Or given that same initial evaluation another baby might keep putting her hands in the way just as she is brought onto the breast, blocking her latch. Or that baby might be doing something with her tongue so that the latch looks "perfect' from the outside, but the tongue could be thrusting, or held back in the mouth. Another baby might get on the breast so well and then suddenly slide off to the side losing hold of the breast. [We figured out by observing a baby doing this that he had been pushing his tongue against this finger tips most likely in utero and after some sucks did the same thing - pushed his tongue forward and abruptly dislodged himself from the breast! It took days to change this already established habit.] (By the way it's often the staff that tells a mom the latch looks 'perfect' and then I walk in, find out there is pain, some nipple trauma and say something is going on and let's see what we can find out.) I see a mother and baby progress at their own unique rate as each day passes, learning in a way that isn't necessarily replicated by another mother and baby who initially might have the level of parity and exact type of breast/nipple and baby who opens well. Can you predict which mother is which at the start? Are we giving the moms personality tests? Myers-Briggs for instance? One mother/baby dyad who on the first day may be doing wonderfully on the second, while the next dyad with the same initial presentation may take three days to get to a similar place. Will each level of these four have subdivisions to map out the myriad of subtle differences that occur? Awkward mother not physically comfortable, but slowly learning? Awkward mom with a baby doing something funny with tongue and mother experiencing pain and frustration by the end of the first day? Or a mother might have upright firm breasts, but a long trunk, and long baby who only achieves a comfortable latch with the mother leaning back elongating her trunk and letting the baby's body angle down it rather than sitting upright when they latch. It might take a few days to figure all that out. The baby's contribution can be a tremendous factor. A mother with flat nipples might have struggled for days with her first 'slurper' baby and categorized at a different risk & managment level, but this second might latch like a pro by the end of the first day. Or with the help of the type of positioning in the "Follow Me Mum" video the mother might learn a different way of latching this baby that works well in one session or in five. I've seen too many mothers with no risk factors take longer to finally say, "I think I've got it" than many mothers with risk factors. So I wonder if this style of evaluation would be at all effective, or just one more thing the staff would have to chart without any real prediction of outcome nor designated management level. Things change so fast in the first two days. I'll be interested to see what others have to say. You got me thinking at any rate. Thanks, Mardrey Swenson *********************************************** *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html