ecent
media attention to life-threatening conditions of selected newborns
has caused some parents distress and concern about the safety
of breastfeeding. "Is my baby dehydrated?" they ask.
Yet at the same time, while health care budgets are being down-sized
and health care providers are looking for the most cost-effective
way to provide maternity services, questions are being raised
about policies of sending mothers and babies home within hours
of birth.
The assumption that breastfeeding is "risky" is obviously misplaced. What is "risky" is the lack of consistent and clear information provided to new mothers to know that their baby is feeding well. And also the lack of easily accessible resources to help with any concerns or problems. Thus, length of hospital stay is not the determining factor but rather the level of effective assistance from both the hospital and the community.
With reduced staffing levels and postpartum stays of six to forty-eight hours in many Canadian hospitals, staff need to streamline information and determine what can be dealt with in hospital and what needs attention after discharge. Skilled breastfeeding assistance in hospital needs to be provided to every mother with the basics of position, latch, frequency, duration and signs of adequacy discussed. A breastfeeding assessment should be done by the primary nurse prior to discharge. When problems are identified, discharge should be delayed or a clear feeding plan and prompt community follow-up arranged.
Currently, in Canada there is not a single hospital that has been designated "Baby-Friendly", an international designation recognizing hospitals that promote, protect and support breastfeeding. Therefore, many hospitals continue practices that contribute to a poor start for the breastfeeding relationship and negatively affect breastfeeding outcomes. This situation is aggravated when there is inadequate early community assistance to breastfeeding mothers, a situation common to many Canadian communities.
In some communities, excellent services are provided with public health liaison nurses contacting families in hospital prior to discharge and sending a referral notice to the health unit. Mothers on the discharge program are also contacted and visited when needed within 24 hours after discharge. In other communities early discharge is not accompanied by any change in the community follow-up. Few resources are available post-partum, poor communications exist between hospital and community services and the limited resources available, allocate little towards breastfeeding help.
Is breastfeeding and early discharge a problem? No. The problem is the lack of information provided to families and the lack of effective support for breastfeeding women. The media emphasis should be on how Canadian communities can provide cost effective support for breastfeeding families and how all levels of government regional health boards, provincial and federal can provide this. Communities will benefit, not only from long term cost savings but more importantly, healthier children. Supporting women to achieve their breastfeeding goals should be on everyone's agenda.
Thanks to Frances Jones RN BScN IBCLC and Marina Green RN BScN IBCLC.