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