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Hospital Policies That Promote Breastfeeding Success

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Hospital Policies That Promote Breastfeeding SuccessIt's no great mystery which hospital policies promote breastfeeding and which ones jeopardize its success. Fortunately, most U.S. hospitals have made great strides in becoming more "baby-friendly." The higher the breastfeeding rates where you live, the more likely the hospital where you deliver will have supportive maternity policies that foster breastfeeding success. On the other hand, hospitals with high bottle-feeding rates may be geared to a bottle-feeding norm. The following policies are known to help get breastfeeding off to the best possible start. Even if these desired practices aren't standard policy at your hospital, ask whether an exception can be made in your case. Hospital staff often make special concessions for informed, assertive patients who ask for what they want. Request that your own and your baby's doctor write hospital orders that help assure favorable breastfeeding practices.

Continuous Rooming-in
Many studies have shown that one of the best ways to promote successful breastfeeding is to keep mothers and babies together in the same room. Close proximity of her infant helps a mother learn to read her baby's cues and respond promptly to her baby's needs. Breastfeeding on demand occurs more readily when a mother and baby are together. A baby cared for in the nursery probably won't be considered to be "demanding" until she is crying out loud. An astute mother with her baby in her room can pick the infant up to nurse as soon as she starts to stir. Studies show that babies are less stressed and don't cry as much when they are cared for in their mother's room. Mothers whose babies are kept in the nursery often admit that they worry more about their infants. Rooming-in can be a great confidence-builder. The new mom who succeeds in providing most of her baby's care herself in the hospital leaves knowing she will be able to meet her baby's needs at home. Ask to keep your baby in your room at all times unless you need the staff to watch your baby while you shower, for example. If your baby is not allowed in your room at night, request that she be brought to you for all nursings at night and ask your baby's doctor to write an order to that effect.

Usually, hospitals with liberal rooming-in practices also have the most liberal visitation policies. The popular trend toward family-centered maternity care is highly commendable, and certainly a vast improvement over the arbitrary rules in place when I was having babies. It can be a wonderful thing to bring a child into your family surrounded by all your loved ones, but I must warn you about turning your room into a block party. Having all your extended family and friends can be fun for a time, but you may be left feeling like an entertainment coordinator. Limit visitors to those you really want to have present, and then keep visits short. Remember, the purpose of your hospital stay is to learn to care for and feed your baby, not make small talk with visitors.

Demand Feedings
Be prepared to nurse your baby at the first sign that she is interested in feeding. Put her to the breast as often as necessary to satisfy her. You may nurse as frequently as every hour or so, but don't let more than about three and a half hours elapse without attempting to get your baby to breastfeed. Frequent feedings are important to help your baby become proficient at latching on and sucking properly and to help bring in a milk supply that matches your baby's requirement. The best advice is "watch the baby, not the clock."

Unrestricted Duration of Feedings
In the past, it was common hospital policy to restrict the duration of feedings when a woman first started breastfeeding. Typically, a mother might be advised to nurse only three to five minutes on a side, perhaps increasing the length of feedings by a minute each day. This misguided policy was based on the mistaken belief that sore nipples could be prevented by keeping feedings short at first and building up the sucking time slowly. This common policy was flawed for several reasons. We now know that the most important cause of sore nipples is improper infant latch-on, rather than prolonged duration of feedings. Severe restrictions on the length of feedings can cause mothers to become preoccupied with watching the clock. By restricting feedings to five minutes or less, many frustrated babies were removed from the breast before the let-down reflex was triggered!

Numerous breastfeeding experts today insist that no restrictions should be placed on the length of feedings. They argue that an infant who is latched on correctly will not cause any nipple trauma regardless of how long she suckles. Certainly, a newborn should be allowed to nurse at least ten to fifteen minutes if she desires, once a nurse has verified that the baby is latched on correctly. However, I have encountered some women who nursed for prolonged periods in the first two days and developed severe nipple trauma and pain, despite having their infants positioned correctly. I think this results because some babies create excessive negative pressure when they nurse before the milk comes in abundantly. For this reason, I prefer to aim for moderation in feeding times, say perhaps twenty minutes maximum per side at each feeding during the first three days. If your nipples are becoming painful, I suggest you make sure the infant is latching correctly and then shorten feedings to about ten minutes per side. Frequent shorter feedings are preferable when nipple tenderness is developing.

Page 2Avoidance of Pacifiers
Many hospitals routinely issue a pacifier to every newborn. Health professionals who care for babies have been taught that infants have a strong sucking urge that is not necessarily satisfied by feeding alone. Physicians and nurses rely on pacifiers to soothe an upset baby so they can perform necessary assessments like listening to the heart. It never occurred to most medical professionals that a pacifier might be an impediment to getting started breastfeeding. But a recent study has shown an increased risk of early weaning among young infants who frequently use a pacifier. I can think of several explanations why early use of a pacifier could interfere with the successful initiation of breastfeeding. First, a pacifier is an artificial nipple that is longer and more rigid than the breast nipple and areola the baby needs to learn to use. For some babies, frequent exposure to an artificial nipple might interfere with learning to breastfeed. Another argument is that newborns need to suckle the breast frequently to obtain sufficient milk and to give the breasts sufficient stimulation. The whole concept of supply and demand is that the breasts produce milk in response to how much the baby nurses. Sucking on a pacifier does nothing to stimulate the mother's milk, and it is a nonnutritive activity for the baby. In the early weeks of life, most, if not all, of a baby's sucking effort should produce food for the infant and trigger milk production in the mother. Furthermore, the less experienced a mother is, the less skilled she will be in distinguishing how well her baby nursed and whether he still might be hungry. Many hungry babies will calm down and appear satisfied when given a pacifier when they really need to be breastfeeding and obtaining milk. For these reasons, I discourage new mothers from using a pacifier in the first weeks of breastfeeding. During this time, the baby should be encouraged to nurse in an unrestricted manner without interference by artificial nipples. All sucking should provide nutrition and be channeled toward stimulating the mother's milk production.

Once the baby is latching on without difficulty, is gaining weight steadily, has surpassed his birth weight, and breastfeeding has become well established, then the mother can introduce a pacifier if she chooses. By waiting four to six weeks, a mother will be much more experienced in distinguishing infant signs of hunger from comfort sucking needs. She will be less likely to overuse the pacifier once she has learned to interpret her baby's cues accurately. Ask the hospital nurses not to give your baby a pacifier, or to use one sparingly. For those of you who need a comeback response to the infamous, "He's just using you for a pacifier!," try this one: "I'd rather have my baby use my breast as a pacifier than to substitute a pacifier for my breast."

Availability of Necessary Breastfeeding Equipment and Resources
A hospital that provides maternity services ought to be able to meet the needs of its breastfeeding clients. In addition to providing accurate information and direct assistance with breastfeeding, hospitals should make necessary breastfeeding equipment available to nursing mothers. Many mothers will need a hospital-grade rental electric pump to solve a breastfeeding problem, to express milk for a premature baby, or to pump after returning to work. If your hospital doesn't have a pump-rental program of its own, ask where you can obtain a rental pump should you need one. Many hospitals stock breast shells for inverted or sore nipples, USP Modified Lanolin (medical grade) for sore nipples, small breast pumps, dual collection kits for rental-grade electric pumps, the Supplemental Nursing System, and other breastfeeding supplies. Before you leave the hospital, request the phone numbers for several sources of support and information about breastfeeding. Good resources to request include your hospital's breastfeeding specialist, local private lactation consultants, a local breastfeeding referral center, La Leche League, Nursing Mothers' Counsel, and local WIC Programs.

No Supplements for Breastfed Babies Unless Medically Necessary
Years ago, it was common hospital practice to offer a bottle of water or formula to a newborn following each breastfeeding until the mother's milk came in. This destructive policy had a very negative impact on breastfeeding success. In many cases, breastfeeding was sabotaged before a woman even left the hospital because babies received numerous bottle-feedings while they were still learning to nurse. Not only was the longer, more rigid bottle nipple easier to grasp than the soft breast, but the contents of the bottle flowed much more rapidly than the trickle of colostrum. No wonder many new babies began to prefer bottle-feeding over breastfeeding! Even when supplemented babies appeared to still nurse well, many failed to breastfeed as often as recommended since their tummies stayed full longer due to the extra fluids they were given. Since her baby didn't nurse frequently, a mother's milk supply might never become well established, thus perpetuating her use of the supplemental feeds. All too often, breastfeeding just fizzled before it ever got going.

Today, breastfeeding advocates around the world recognize that routine supplementation of newborns can place successful breastfeeding in jeopardy for all the reasons just mentioned. Ideally, your baby will be solely breastfed during your hospital stay, without receiving any additional fluids. On the other hand, I must emphasize that sometimes a valid medical reason, such as prematurity, severe jaundice, or low blood sugar, makes it necessary to temporarily give extra milk to certain newborns. In such cases, the benefits of giving the required supplement outweigh the potential risks of undermining breastfeeding. The obvious prudent thing is to tend to the baby's welfare first and work on perfecting breastfeeding once the health of the baby is assured.

Withhold Gift Packs Containing Formula
Some infant-formula companies supply hospital nurseries with free formula and gift packs for new mothers. The practice is a cost savings for the hospital and a marketing opportunity for the formula manufacturers who recognize that new mothers are likely to purchase formula brands that are most familiar to them. Both breastfeeding and formula-feeding mothers routinely receive formula-company gift packs, although the contents of the packs are different based on the mother's feeding method.

Most breastfeeding proponents believe that formula-company marketing practices have a negative effect on breastfeeding success. They are legitimately concerned that giving expectant or new breastfeeding mothers anything with a formula logo on it can imply a subtle endorsement of formula-feeding and undermine breastfeeding. Many breastfeeding advocates insist that hospitals should stop accepting formula-company giveaways, and instead should bid on and purchase their own infant formula, just as they buy other supplies. A few baby-friendly U.S. hospitals who embrace the Ten Steps to Successful Breastfeeding already have stopped accepting free formula. Many hospitals have stopped giving formula-company gift packs to nursing mothers. If you do receive any formula to take home, make sure you understand when, if ever, to use it. As a new breastfeeding mother, you need to appreciate that giving your baby formula without a valid reason could reduce your chances of succeeding at breastfeeding. There's probably no harm having formula in your house as long as you don't use it inappropriately.