Anemia of Prematurity - Portal Neonatal

Counseling the Breastfeeding Mother
Last Updated: August 7, 2004
Synonyms and related keywords: breast-feeding, breast feeding, human lactation, nursing mother,
neonatal jaundice, pathologic jaundice, physiologic jaundice, breastfeeding jaundice, breast milk
jaundice, bottle-feeding, bottle feeding, formula-feeding, formula feeding, colostrum, artificial nipple,
suckling, sucking, human imprinting, galactagogues, breastfeeding problems, milk supply
AUTHOR INFORMATION Section 1 of 11
Author: Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of Neonatology,
Medical University of South Carolina
Coauthor(s): Eric M Graham, MD, Staff Physician, Department of Pediatrics, Medical University of
South Carolina; William W Hope, MD, Staff Physician, Department of Surgery, Greenville Memorial
Hospital
Carol L Wagner, MD, is a member of the following medical societies: American Academy of Pediatrics,
and Society for Pediatric Research
Editor(s): George Cassady, MD, Clinical Professor, Department of Pediatrics, Stanford University
School of Medicine; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care
Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of Pediatrics,
Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical Center; Paul D
Petry, DO, FACOP, Assistant Professor, Department of Pediatrics, Division of Maternal Child Health,
Northeast Regional Medical Center; and Neil N Finer, MD, Director, Division of Neonatology,
Professor, Department of Pediatrics, University of California at San Diego
OVERVIEW Section 2 of 11
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.