Too many new mothers are discharged to go home before they feel confident about breastfeeding or other aspects of their own or their baby's care. Unfortunately, the recent trend toward shorter and shorter maternity stays largely has been driven by financial considerations rather than the health and well-being of the baby and family. In an attempt to curb the problem of "drive-through deliveries," national legislation has been passed requiring insurance companies to extend coverage for normal deliveries to forty-eight hours. But even a two-day hospital stay doesn't guarantee that babies will be nursing proficiently by the time they go home. Early follow-up remains a crucial step in assuring breastfeeding success by identifying mother-baby pairs who need extra help shortly after going home. In late 1995, the American Academy of Pediatrics published a policy statement containing minimum criteria to be met before a newborn should be discharged. The statement strongly emphasized that all infants discharged before forty-eight hours of age should be examined by an experienced health care provider within the next forty-eight hours. In addition to the standard medical assessments performed at the follow-up visit, the encounter should include an observation of breastfeeding to assure the infant latches on and suckles properly.
While all these recommendations make the system sound fail-safe, the fact remains that most mothers go home before breastfeeding is really going smoothly. Early follow-up within two days is absolutely essential to assure that your baby is nursing effectively, especially once your milk comes in abundantly. Many pediatricians now see newborn babies in their offices a couple of days after hospital discharge, while other mother-baby pairs receive a follow-up home visit by a nurse. Still others return to a hospital-based follow-up program. While a telephone call from a nurse to check on your breastfeeding progress makes a nice addition to one of these visits, it is not an adequate substitute for being seen in person.
If you don't feel ready to go home when your doctor thinks you are, explain your concerns and request more time. If your baby isn't nursing well, ask if you can stay even an additional twelve hours to give you several more breastfeeding sessions where assistance is available. If that isn't possible, see if you can arrange for an appointment the following day with either a lactation specialist on staff at the hospital or a private lactation consultant in the community. Whenever you seek breastfeeding help from someone other than your baby's doctor, it goes without saying that the doctor must be kept informed of all such encounters and feeding recommendations. Your baby's doctor should be the one to coordinate all aspects of your baby's health care.
Babies At-Risk for Inadequate Breastfeeding
Doctors, nurses, and parents alike usually assume that because breastfeeding is "natural," it will proceed naturally. They expect that any problems experienced in the hospital will magically clear up once the family gets home and the mother's milk comes in abundantly. For most women, things do go better with each subsequent feeding and each passing day. But for a few mother-baby pairs, early small problems become serious chronic matters that threaten the success of breastfeeding and the baby's well-being.
After years of evaluating breastfeeding problems, I believe I can predict with some accuracy which mother-baby pairs are at increased risk for inadequate breastfeeding. These couples deserve closer follow-up and monitoring to help them be successful. Anything that could affect the mother's milk production or her baby's ability to latch on to her breast and suckle well can have a negative impact on breastfeeding. Some typical examples are listed below.
- Lactation Risk Factors in the Mother
- Previous breastfed baby who didn't gain weight well
- Flat or inverted nipples
- Variation from normal in breast appearance (such as marked asymmetry)
- Previous breast surgery that may have cut some milk ducts
- Previous breast abscess
- Extremely sore nipples
- Minimal prenatal breast enlargement
- Failure of milk to come in abundantly after delivery
- Severe postpartum breast engorgement
- Medical problems, such as hemorrhage, high blood pressure, or infection