Mothers who give birth today are being discharged much earlier than in past decades. Going home in twenty-four hours or less after a vaginal birth has become commonplace. Opponents have criticized the popular trend toward shorter and shorter hospital confinements, now being referred to as "drive-through deliveries." Controversy abounds about the safety of early discharge for mothers and infants, and recent national legislation now requires insurance companies to extend coverage for normal deliveries to forty-eight hours.
Much of the media attention given to this issue has focused on breastfeeding complications that resulted from too-early discharge and too-late follow-up. Several tragic cases of life-threatening infant dehydration that resulted from unrecognized inadequate breastfeeding were spotlighted in the news. These cases are unlikely to occur when close follow-up after discharge is provided. Telephone counseling can provide additional postdischarge support, but it is not an adequate substitute for a visit in person, where the infant is weighed and examined.
In the recent past, most newborns remained in the hospital several days and weren't seen after discharge until two weeks of age. Now that babies are being discharged earlier, the American Academy of Pediatrics recommends that infants who go home before forty-eight hours of age should be seen within the following forty-eight hours. This type of close follow-up should eliminate unfortunate cases of excessive weight loss in breastfed babies.
However long your baby stays in the hospital, I urge you to have your infant seen within a few days of discharge for a weight check and physical examination. Delaying follow-up until 10 days or 2 weeks while you guess about how your breastfeeding is going is just too risky. Breastfeeding problems need to be identified and remedied as early as possible. Many options exist for the early follow-up assessment, including a home health visit, an appointment at the clinic or office where your baby will receive her regular care, a hospital follow-up program, or a consultation with a lactation specialist.
Getting Help for Early Breastfeeding Problems
Many new parents mistakenly believe that sheer willpower and determination can overcome any difficulties they encounter in the early weeks of breastfeeding. Instead of seeking professional help as soon as problems become evident, these highly motivated individuals may be convinced that dogged perseverance eventually pays off. Certainly, their never-give-up attitude is admirable considering that many new parents quickly become discouraged and discontinue breastfeeding. But contrary to popular belief, early breastfeeding problems don't automatically correct themselves as a result of perseverance and wishing very hard for it. On the other hand, even the best advice can't guarantee breastfeeding success unless the parents are willing to continue their efforts. What's needed is a suitable balance of expert help and strong motivation.
If breastfeeding doesn't seem to be going well, don't delay taking action. Your problem may not self-correct despite endurance and trying harder. Instead, your difficulties are likely to become compounded by low milk or an underweight problem in your baby. Infant latch-on troubles or sucking problems, severe nipple pain, unrelieved breast engorgement, excessive infant fussiness, inadequate infant weight gain, or apparent infant hunger all require immediate attention. The earlier you obtain help for a breastfeeding difficulty, the more likely it can be overcome. The old adage "An ounce of prevention is worth a pound of cure" most certainly holds true for breastfeeding. Getting help promptly gives you the best chance of successfully breastfeeding for as long as you desire. You can request help from one or more of the following sources.
Your Baby's Physician
He or she may have experience managing early breastfeeding problems. If not, ask for a referral to a private or hospital-based lactation consultant or other breastfeeding counselor for specialized advice about your situation. Most importantly, your baby's physician needs to weigh your infant and make sure that no underlying medical problem is present that might be contributing to your baby's breastfeeding difficulties. If you seek advice from other health workers or from breastfeeding support groups, it is essential that your baby's physician remain the primary coordinator of your infant's overall care. Good communication among the various individuals who counsel you is paramount to your baby's welfare.