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Breastfeeding Success Begins in the Hospital
Five Hospital Practices that Extend Your Duration of Breastfeeding
Marianne Neifert, M.D.,
Author of Great Expectations: The Essential Guide to Breastfeeding

Your hospital experience -- brief as it may be -- can have a powerful impact on your long-term breastfeeding success. Making hospital changes in maternity care practices has been shown to significantly increase breastfeeding initiation and duration rates. The Baby-Friendly Hospital Initiative (BFHI) -- launched in 1991-- is a worldwide campaign to encourage hospitals and birthing centers to adopt maternity practices supportive of breastfeeding. (See Hospitals that commit to improving their support for breastfeeding mothers by successfully implementing the BFHI's Ten Steps to Successful Breastfeeding can apply for and receive the designation as a "Baby-Friendly Hospital." While only 83 maternity facilities in the U.S. (among more than 3200 hospitals and birthing centers) have chosen to comply with all Ten Steps and be awarded "Baby-Friendly" status, a recent large study in Colorado1 has identified five of the BFHI supportive practices (dubbed the "Can Do 5!") that have a significant impact on breastfeeding duration among mothers of healthy newborns. The following "Can Do 5!" successful maternity practices can help extend your duration of breastfeeding after you are discharged from the hospital:

1. Baby is breastfed in the first hour after birth. The AAP recommends that healthy infants be placed skin-to-skin with their mothers immediately after birth and remain with their mothers until the first feeding occurs. Immediate skin-to-skin contact not only eases your baby's adaptation to the world, it allows the two of you to get to know one another, and promotes early breastfeeding. A baby who nurses well shortly after birth is more likely to continue breastfeeding effectively, and a successful early first breastfeeding experience promotes a mother's confidence. Ask to have your baby placed tummy down on your bare chest immediately after delivery, and watch how her inborn reflexes help her achieve a successful early feeding. You may want to limit your visitors during this intimate bonding time.

  1. Baby is fed only breast milk in the hospital. Many studies show that giving supplements to breastfed infants is linked with a shorter duration of breastfeeding. Supplemental milk should be offered only for a valid medical reason. When babies are supplemented with formula, they breastfeed less often, since formula takes longer to digest than breast milk. Infrequent breastfeeding may interfere with establishing an abundant milk supply. Furthermore, giving unnecessary supplements undermines a mother's confidence in her ability to produce sufficient milk. Ordinarily, frequent, round-the-clock breastfeeding will provide all the milk your baby needs.

  1. Baby stays in the same room with mother. By keeping your baby in your room throughout your hospital stay, you will learn to recognize her earliest feeding cues and be able to offer your breast whenever your baby is ready to nurse. Furthermore, studies show that babies are less stressed and do not cry as much when they are cared for in their mother's room. Rooming-in is a great confidence builder. When you provide most of your baby's care yourself in the hospital, you leave knowing that you will be able to meet your baby's needs at home. To make the most of your rooming-in experience, ask your partner to help limit your visitors at the hospital and monitor their length of stay.

  1. Baby does not use a pacifier in the hospital. Several studies have found an increased risk of early weaning when a pacifier is introduced to breastfed infants in the first weeks of life. During this sensitive time, all your baby's sucking efforts should provide her with the milk she needs and stimulate your breasts to produce a generous milk supply. Sucking on an artificial nipple can interfere with learning to nurse, and frequent use of a pacifier may limit how often your baby breastfeeds. Once breastfeeding is going well and your baby is thriving, you can introduce a pacifier if you desire. To reduce the risk of SIDS, the AAP recommends that babies use a pacifier when falling asleep. Mothers of breastfed infants can wait about a month to offer a pacifier.

  1. The hospital gives mother a phone number to call for breastfeeding help after hospital discharge. These days, most new mothers are discharged before your milk has come in and before your baby has become proficient at breastfeeding. Even when breastfeeding seems to be going well in the hospital, problems commonly arise in the early days at home. Knowing where to turn for help can allow you to overcome early breastfeeding glitches before you get discouraged. There's no need to struggle on your own. All breastfeeding questions are important, and expert help is available. Ask your hospital nurse or lactation consultant who you can call for breastfeeding help after you go home.

Each of these five hospital practices was found to have a significant positive impact on breastfeeding duration. More importantly, breastfeeding continued longest among mothers who received all five supportive hospital practices. Nearly two-thirds of mothers who reported all five breastfeeding-friendly practices (versus half of mothers who did not) were still nursing their babies at four months after hospital discharge.

Clearly, what happens in the hospital in the first day or two after birth powerfully impacts a woman's breastfeeding experience after discharge. Expectant moms can take heart in knowing that requesting five simple steps while you are in the hospital can boost your chances of long-term breastfeeding success.

Additional Hospital Practices That Promote Successful Breastfeeding

Other supportive breastfeeding practices that help lay the foundation for success include:

  • Nurse as often as your baby gives feeding cues. Many new parents expect their baby to cry when she is hungry. But crying is the last sign of readiness to feed. Instead of waiting for your baby to cry, look for earlier, more subtle clues that she wants to nurse. Babies signal their readiness to feed by rapid eye movements, arousal from sleep, increased alertness, flexing their arms and legs, squirming, wrinkling the forehead, bringing a hand to their mouth, turning their head, or moving their mouth or tongue. One of more of these signs will be evident before your baby cries out loud.

  • Nurse as Long as Your Baby Desires. In the past, new mothers often were advised to keep breastfeeding sessions brief until their milk came in. This dictum was based on the mistaken belief that sore nipples could be prevented by slowly building up an infant's sucking time. Actually, the most important cause of sore nipples is improper infant latch-on, not lengthy breastfeeding sessions. If your newborn is latched on well, she should be allowed to nurse at least 15 minutes at each breast. Strictly limiting how long your baby nurses can prevent her from getting all the milk she needs and keep you from establishing an abundant milk supply.

  • Forego Gift Packs Containing Formula. As a marketing strategy, infant-formula companies routinely supply hospital nurseries with free formula and giveaways for new mothers. However, some studies show a link between receiving a formula gift-pack and a shorter duration of breastfeeding. To avoid an implied endorsement of formula-feeding, some hospitals have stopped giving formula-company gift packs to nursing mothers. If you receive a gift pack with formula, make sure you understand when, and when not, to use it. Giving your baby formula without a valid medical reason can undermine successful breastfeeding.

1 Erin Murray, Sue Ricketts, and Jennifer Dellaport. Hospital Practices that Increase Breastfeeding Duration: Results from a Population-Based Study. BIRTH 2007; 34 (3):202-211 (September)

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

Author Bio
Marianne Neifert, M.D.,
author of Great Expectations: The Essential Guide to Breastfeeding, also known as Dr. Mom®, is a popular pediatrician, nationally recognized expert in breastfeeding management, and celebrated author of child-rearing books and magazine articles. In 1985, Dr. Neifert co-founded the Lactation Program in Denver -- one of the very first community breastfeeding centers in the nation, sponsored by the Colorado Health Foundation. She is also clinical professor of pediatrics at the University of Colorado Denver School of Medicine. A long-time leader in the field of breastfeeding medicine, Dr. Neifert is a co-founder of the Denver Mothers' Milk Bank, founding member of the American Academy of Pediatrics Section on Breastfeeding, the International Lactation Consultant Association, and the Health Advisory Council of La Leche League International. Dr Neifert has addressed audiences in forty-six states and has been a guest on countless radio shows and national television programs, including Today, Good Morning America, The Early Show, 20/20 and CNN. She has written for numerous publications, including Parenting, BabyTalk, American Baby, and ParentLife.

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