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Hospital Policies That Promote Breastfeeding Success

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It'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.

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From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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