Speaking Out Perfect Storm or Perfect Time for a Bold Change ? Jane

Insufficient milk production and suboptimal breastmilk intake account for the lion’s share of reasons mothers give for stopping breastfeeding, and the resulting health, financial, and emotional impact of these problems is incalculable. Sufficient milk production heavily depends on management in the first 3 postpartum days, as the early, frequent, and effective removal of colostrum influences subsequent milk production (the strongest determinant of duration and exclusivity). Suboptimal breastmilk intake is a greater risk for the expanding population of infants born less than full term (< 39 weeks) who may have fewer reserves, greater caloric needs, and less effective breastfeeding skills. Delays in time-sensitive prevention result from: B A problem-oriented versus preventative support system that jumps in only when weight drops, bilirubin level rises, or mothers insist B A dwindling number of skilled, accountable, and available bedside nurses to provide timely assistance, coupled with over-reliance on the fragmented, episodic expertise of lactation consultants B Undifferentiated lactation management between the low-risk term mother–infant dyad and the at-risk dyad. This results in excessive focus and unrealistic expectations around attachment (latch and milk transfer) in relatively immature newborns.