Lactation Approach

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In this article. Dr. Alexis Lieberman, Fairmount pediatrician, and Diane Lawley, lactation counselor, describe their innovative collaboration in promoting breastfeeding. Thank you Dr. Lieberman and Diane!

AL:  I do housecalls for the newborn visit, in the Fairmount area. A year ago, a typical scenario would go like this: I would arrive at the appointment, and both parents would look stressed and concerned. The baby would be crying. The baby would have lost weight since going home from the hospital, and the baby’s mouth would look pinched and dry. The mother would describe being unable to get the baby to latch on.  The lactation consultant in the hospital helped her to nurse, and it was fine at the hospital, but once they got home, it wasn’t working anymore.  They really didn’t want to give formula but they just didn’t know what to do! I would already be reaching for my phone to call Diane, as they spoke. My phone calls sounded like this: “Diane, can you come NOW?”

In the past year and a half, Diane and I have developed a new way of approaching first-time, breastfeeding moms. Now, when I meet the expectant parents before they deliver, I suggest calling Diane from the hospital, and arranging for her to come to their home the day they get home, or, at the latest, the next day. Now, when I get to the newborn’s home, the parents are usually smiling, and the baby is often asleep. Sometimes, the baby has already started to gain weight. It’s made a huge difference!

DL:  New parents will call me either while in the hospital or once they get home. I then have the opportunity to assess and advise before they get home. Some of these Moms will call me before they have their baby and I have the opportunity to discuss how to get the best start to breastfeeding in the hospital. I find that these families usually do even better.

A typical visit usually lasts 2 hours, with a history, assessment of a breastfeeding session, including pre and post feeding weights and developing a plan based on this information. Parents usually have lots of questions and I also give them some handouts to reinforce the information we discuss. Later that day or the next morning I follow up with an email reviewing our visit and plan, and cc it to Alexis. Parents are encouraged to call or email anytime with any questions/concerns and to discuss their progress at least within the next day or so. And if I don’t hear from them I will initiate the contact.

I find the preventive contact and visit to be so much better for the family because they are more relaxed and confident than new parents whose starting point is the negative “your baby is losing weight”.  The inevitable hospital policies and conflicting information from well meaning caregivers can be detrimental to optimal breastfeeding and overwhelming for new parents.

AL: The vast majority of my patients are breast-fed, at least in the first months of life, and many for much longer. I think that most of the moms would have breastfed without the preventive lactation visit, since they are, for the most part, very committed to it. The preventive lactation visit makes the beginning a little easier, though. Most moms tell me it was worth it, and are glad they arranged it.

DL: Although breastfeeding is initiated more often these days, it does not always go as smoothly or last as long as we breastfeeding advocates would like to see. I think this has more to do with children not growing up seeing and learning breastfeeding from an early age in our society.   Hospitals that are not Mother and Baby Friendly are not able to provide new Mothers with the support and encouragement they need to feel confident in their ability to breastfeed. I am privileged to be able to help fill that gap and help make breastfeeding the beautiful, nourishing experience it was meant to be!

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