If you don’t feel ready to go home when your doctor thinks you are, explain your concerns and request more time. If your baby isn’t nursing well, ask if you can stay even an additional twelve hours to give you several more breastfeeding sessions where assistance is available. If that isn’t possible, see if you can arrange for an appointment the following day with either a lactation specialist on staff at the hospital or a private lactation consultant in the community. Whenever you seek breastfeeding help from someone other than your baby’s doctor, it goes without saying that the doctor must be kept informed of all such encounters and feeding recommendations. Your baby’s doctor should be the one to coordinate all aspects of your baby’s health care. Babies At-Risk for Inadequate Breastfeeding Doctors, nurses, and parents alike usually assume that because breastfeeding is “natural,” it will proceed naturally. They expect that any problems experienced in the hospital will magically clear up once the family gets home and the mother’s milk comes in abundantly. For most women, things do go better with each subsequent feeding and each passing day. But for a few mother-baby pairs, early small problems become serious chronic matters that threaten the success of breastfeeding and the baby’s well-being. After years of evaluating breastfeeding problems, I believe I can predict with some accuracy which mother-baby pairs are at increased risk for inadequate breastfeeding. These couples deserve closer follow-up and monitoring to help them be successful. Anything that could affect the mother’s milk production or her baby’s ability to latch on to her breast and suckle well can have a negative impact on breastfeeding. Some typical examples are listed below.
Lactation Risk Factors in the Mother Previous breastfed baby who didn’t gain weight well Flat or inverted nipples Variation from normal in breast appearance (such as marked asymmetry) Previous breast surgery that may have cut some milk ducts Previous breast abscess Extremely sore nipples Minimal prenatal breast enlargement Failure of milk to come in abundantly after delivery Severe postpartum breast engorgement Medical problems, such as hemorrhage, high blood pressure, or infection
