COUNSELING THE BREASTFEEDING MOTHER

Counseling the Breastfeeding Mother
In the time before managed care and "drive-through" deliveries, the vast majority of newborns remained in the hospital for several days after birth and were typically examined by their physician when they were aged 2 weeks. In theory, this longer hospitalization allowed ample time to ensure that the baby was receiving adequate nutrition and had demonstrated the ability to appropriately latch on and suckle at the breast once the mother's milk became available. In addition, the longer stays gave the staff more opportunities to reassure the mother, answer her questions, and provide her with support and encouragement.

However, rates of breastfeeding in the United States declined during the periods of prolonged postpartum recuperation, with the lowest rates occurring in the 1950s. Reports of breastfeeding infants who were failing to thrive decreased, but at the same time fewer infants were being breastfed. Women who continued to breastfeed received supportive breastfeeding care from a variety of sources, including their social network. With the recent reemergence of breast milk as the ideal source of infant nutrition, more women are choosing to breastfeed.

Women were once supported by others with personal knowledge about breastfeeding; however, this has been replaced with generations of women and men who are experts about formula feeding. Lack of community knowledge about breastfeeding and shorter hospital stays have led to more breastfeeding failures. Because women and their infants are now being discharged earlier, it is essential that the tradition of the first follow-up at age 2 weeks be replaced with earlier more carefully planned assessments of the breastfeeding mother-infant dyad. Such early follow-up makes lactation success more likely and leads to a healthier infant.

Careful follow-up depends on the health care provider's knowledge of the mechanics of breastfeeding, the evaluation of successful lactation, and the interventions required if difficulties develop.

This article reviews the mechanics of breastfeeding, correct breastfeeding techniques, and sufficient versus insufficient milk supplies. A discussion of early follow-up of the breastfeeding mother-infant dyad and the warning signs of difficulties in that dyad are also included. Emphasis is placed on assessing the breastfeeding neonate and determining when neonatal jaundice is pathologic. Finally, common breastfeeding problems are discussed, with emphasis on their early recognition and management.