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Early Breastfeeding Problems

Follow up after discharge

Early Breastfeeding Problems

The Importance of Early Infant Follow-Up After Discharge
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.

Find lactation specialistsThe Hospital Where You Delivered
Many hospitals that serve mother-baby pairs have a lactation consultant or lactation nurse specialist on staff. The hospital also may have an electric breast pump that you can use on site to relieve severe breast engorgement. You can call the nursery any time night or day to discuss your problem with a staff nurse. Ask if you can talk with or be seen by the lactation consultant. Many hospitals offer follow-up services for new mothers and babies.

Lactation Consultants at Hospitals, Clinics, or in Private Practice
A lactation consultant (L.C.) is a relatively new member of the health care team who focuses on providing breastfeeding education to parents and on helping nursing mothers overcome breastfeeding problems. Many L.C.'s are registered nurses who have pursued additional training to work with breastfeeding mother-baby pairs. A lactation consultant can provide personal assistance with breastfeeding technique, teach you how to use a breast pump and other breastfeeding supplies, recommend ways to increase your milk supply, demonstrate alternative methods for feeding supplemen-tal milk when necessary, and offer essential support and educa-tion. Credentialing as an International Board Certified Lactation Consultant (I.B.C.L.C.) identifies individuals who have attained voluntary certification by the International Board of Lactation Consultant Examiners. To receive the I.B.C.L.C. credential, applicants must complete academic prerequisites and required practice hours assisting breastfeeding mothers, in addition to passing a comprehensive examination. The I.B.C.L.C. designation is the most widely accepted standard for lactation consultants, although some highly skilled breastfeeding specialists have not pursued this designation.

Your obstetrician, family physician, or pediatrician may work with one or more lactation consultants to whom you can be referred. You also can locate an L.C. in your community by contacting the International Lactation Consultant Association or Medela, Inc. (see Resource List, page 445). Nurses, midwives, dietitians, educators, and other individuals from a wide variety of disciplines work as lactation consultants. I recommend that you ask about the professional background and training of the person with whom you work. I cannot overemphasize the importance of good communication between your lactation consultant and your own and your baby's physicians.

La Leche League (LLL) International and Nursing Mothers Counsel
These volunteer organizations are excellent sources of information and mother-to-mother support for breastfeeding women. If these reputable groups are present in your community, they should be listed in the white pages of your phone book. Both groups provide telephone counseling, and La Leche League holds regular meetings. LLL also offers recorded information on selected breastfeeding topics and provides telephone assistance to health professionals and others, including mothers, through its Center for Breastfeeding Information. While knowledgeable counselors are present in both organizations, you should realize that these peer support groups are not a substitute for professional medical guidance.

The WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children)
Local WIC clinics provide helpful counseling for their breastfeeding clients, and many offer peer support. In addition, some WIC programs provide electric and manual breast pumps for mothers who need them. WIC clinics also can refer clients with complex breastfeeding problems to other community resources.

Lactation centers
Some breastfeeding mothers are fortunate enough to live in communities where a lactation center is available. These lactation programs often are sponsored by hospitals and may offer complimentary breastfeeding services for mothers who deliver there. In addition, they may provide outpatient consultation (for a fee) for mothers in their community who have breastfeeding difficulties. Most lactation centers also offer telephone advice, operate a pump-rental program, and sell breastfeeding supplies.