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Anticipating Discharge

September 2020

During the month of September, we will be studying Step 10 of the Ten Steps to Successful Breastfeeding, which states, “Coordinate discharge so that parents and their infants have timely access to ongoing support and care,” (1).

“As a part of protecting, promoting, and supporting breastfeeding, discharge from facilities providing maternity and newborn services should be planned for and coordinated so that parents and their infants have access to ongoing support and appropriate care,” (2).

10-discharge-breastfeeding

Anticipatory guidance is necessary to prepare the breastfeeding family for discharge to home, and excellent suggestions are provided by the Academy of Breastfeeding Medicine’s Clinical Protocol #2 which was updated and revised in 2014. (3). The clinical guidelines include:

  1. Healthcare providers who are trained in lactation assessment and management should perform and document an assessment of breastfeeding effectiveness at least once during the eight hours prior to discharge.
  2. The anticipation of breastfeeding problems should be assessed based on both maternal and infant risk factors.
  3. Families should be encouraged to exclusively breastfeed for the first six months by all healthcare providers.
  4. Families will benefit from appropriate, noncommercial educational materials on breastfeeding.
  5. Provide anticipatory guidance on all aspects of lactation to the family’s support system.
  6. Teach all new mothers the hand expression technique in order to alleviate engorgement, increase and maintain her milk supply, and obtain milk for infant feeding.
  7. Provide new families with contact information for counseling, advice, and health assessments in their community.
  8. Provide all new mothers with contact information for peer support.
  9. Mothers who plan to return to outside employment or schooling should be provided with additional support information.
  10. Pediatric follow-up appointments should be arranged prior to discharge within 3-5 days of age.
  11. Additional visits for breastfeeding assessment and assistance are recommended.
  12. To support exclusive breastfeeding when the mother has been discharged but the infant is not, keep the mother either as a patient or as a “mother-in-residence”.
  13. With the infant in the NICU, mothers should be encouraged to provide prolonged skin-to-skin care/kangaroo care and continue to breastfeed regularly.

Each of these clinical guidelines is expanded upon in the ABM Protocol #2 and is an excellent start to implement in the birthing facility. Stay safe and thank you for supporting, promoting, and protecting breastfeeding!

Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC

Professional Development Educator

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References:

1. WHO and UNICEF. 2018. Baby-friendly Hospital Initiative, Ten Steps to Successful Breastfeeding. Retrieved from https://www.unicef.org/nutrition/index_breastfeeding-ten-steps.html
2. World Health Organization. 2018. Implementation Guidance. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-Friendly Hospital Initiative. Retrieved from https://www.unicef.org/nutrition/index_breastfeeding-ten-steps.html
3. Evans, A., Marinelli, K.A., Taylor, J.S., and The Academy of Breastfeeding Medicine. (2014). ABM Clinical Protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: “The Going Home Protocol”, Revised 2014. Breastfeeding Medicine; 9(1): 3-9. NOTE: All ABM Protocols are free to download at https://www.bfmed.org/protocols, with at least 5 languages available.

 

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