Babies At Risk
Not all babies in the newborn nursery have equal chance of breastfeeding success. Either maternal or infant factors can contribute to impaired milk transfer, so it is important for physicians to be aware of the risks and knowledgable about proactive management strategies. The "preventative management guidelines" presented here are intended for the mother and baby who are exclusively breastfeeding. They are designed to support breastfeeding for those pairs who are at risk of breastfeeding failure.
To promote exclusive breastfeeding, as recommended by the American Academy of Pediatrics (2005 Policy Statement) and the Lucile Packard Children's Hospital (LPCH) Breastfeeding Policy (2004), lactation support focuses on three critical determinants: the establishment of a robust milk supply, effective attachment (latch-on and transfer of milk), and maternal confidence. These are the three most common issues, accounting for the largest drop off in breastfeeding, which occurs within the first several post-partum weeks. (Ertem, 2001; Taveras, 2003; Kuan 1999; Dewey, 2003)
Routine maternity care may not address the needs of patients at risk for breastfeeding failure. Proactive management guidelines are recommended for sub-groups of mother-infant pairs at highest risk for early discontinuation of breastfeeding.
Patients with unpreventable risk factors include mothers of preterm infants and/or multiples, those separated from their infants for medical reasons, and mothers with C-section deliveries, breast surgery, or a previous history of breastfeeding failure. Proactive management begins with the early identification of these at-risk mother-infant dyads and more aggressive measures to support milk production, attachment and maternal confidence than would be required by low-risk dyads.
Each shift, each mother-infant dyad will be assessed for risk factors, and a plan of care will be tailored to address their current, individual issues. Those at higher risk will receive an escalated level of consultation from a team of lactation support providers.
Here we identify nine sub-groups, which are at risk for lactation failure. For each sub-group, the first paragraph summarizes the rationale for the risk factors. Following this, suggested proactive measures are listed, which should begin on the first day. The last paragraph presents a suggested script to be used to inform the mother of the reason for these steps, while fostering a positive approach. The Appendices provides readily available instructions and tools to implement the management guidelines.
In order to create a sustainable system, our goal is to maximize the knowledge and skills of frontline maternity nurses. For a patient with risk factors, who requires the attention of a more trained individual, the primary nurse will be required to review her plan of care and attend bedside consultations.
Sub-Groups at Risk for Lactation Failure
- C-section Mothers
- Mothers with multiples
- Infants who have not latched-on or nursed effectively for 12 hours
- Mothers of NICU or PSCN infants
- Infants supplemented more than once in 24 hours
- Infants < 38 weeks or less than 6 pounds
- Infant with loss of 10% birth weight
- Mothers with breast surgery
- Mothers with a history of breastfeeding failure
- Antepartum mothers at risk of preterm delivery
For your information
This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization and copying of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.