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Hospital Policies That Promote Breastfeeding Success

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Avoidance 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.

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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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