Breastfeeding is the undisputed optimal feeding method for infants. In recognition of this fact, Healthy People 2020 calls for an increase in the number of mothers who have ever breastfed to 81.9%. However, the Centers for Disease Control and Prevention reported this rate for 2011 as only 74.6%. To accomplish the Healthy People 2020 goal, mothers need excellent breastfeeding support during the first few days of their infants’ lives. The American Academy of Pediatrics 2005 Policy Statement recommended observation of feedings twice per day during the newborn's hospital stay.
Studies have shown an association between optimal feeds during initial hospital stay and longer duration of breastfeeding. The new mother/baby dyad often has difficulty in the first few days of life in establishing breastfeeding. Continuation of poor feeds can lead to a multitude of other breastfeeding problems that can ultimately lead to early breastfeeding cessation. Observation and subsequent intervention can lead to better breastfeeding at discharge.
In a typical case, a first time mother told her nurse that breastfeeding was going well. Two days after discharge, the mother returned for an outpatient lactation consult complaining of sore nipples and decreased output from the infant. Upon observation, the lactation consultant noticed that the infant had a shallow latch, was not transferring milk well, and was causing nipple damage. The lactation consultant corrected the positioning and latch, resulting in immediate relief of pain. The lactation consultant was able to hear frequent swallows and the infant seemed satisfied afterwards. Subsequently, the infant began having abundant wet and dirty diapers and gained weight. If a feeding had been observed during admission, these problems could have been resolved sooner. Many mothers in this same situation would have stopped breastfeeding. This mother can now successfully breastfeed exclusively for 6 months and continue breastfeeding for at least a year.
Mothers generally stay in the hospital from 48 hours to 96 hours postdelivery. During this short time period, nurses often rely on mother's self-report of breastfeeding sessions. Initially, the mother may not be able to effectively determine whether the feed is nutritive. Nurse observation of breastfeeding during the hospital stay is imperative to ensure a successful start. While lactation consultants are experts, it is the postpartum nurses who are key to around the clock observation and evaluation of breastfeeding. Observation should include latch, positioning, and adequate transfer of milk.