After Discharge From Maternity/Newborn Nursery – Key Points Resources • Eight to 12 feedings at the should be provided New York City Department of During Postpartum/Maternal Care Visit: • Ideally, observe breastfeeding and look for signs At Any Visit: every 24 hours, or whenever the baby shows early Health and Mental Hygiene Continue to encourage and support. of how breastfeeding is going. Verify success, anticipate challenges and support signs of hunger such as increased alertness, physical • Ask about breastfeeding duration and success. prolonged breastfeeding. activity, mouthing or rooting. • Call 311 and ask for the Women’s Healthline Signs Breastfeeding is Going Well • Advocate exclusive breastfeeding to 6 months. • Remind to give the baby 400 IU of oral • In the early weeks after birth, non-demanding • Nurse-Family Partnership provides • Be prepared to refer to specific lactation specialists • Baby latches onto , not just vitamin D drops daily until at least 1 liter or quart should be awakened to feed if four hours have elapsed breastfeeding education and support for of formula or whole is given daily. and/or community resources when needed. • suckles using jaw, not just lips since the beginning of the last feeding. low income, first time . Patients must be • Refer the mother to a lactation specialist and/or enrolled before their 28th week of pregnancy. Breastfeeding • Infant makes swallowing sound For more information, call 311. During the 3 to 5 Day Pediatric Visit: support group whenever needed. Keep referral Breastfeeding techniques: information in each exam room. Assess, prescribe Vitamin D, and plan ahead. • Infant can on both • Both breasts should be offered at each feeding for as • Newborn Home Visiting Program provides • Discuss return-to-work plans and long a period as the infant remains at the breast. The breastfeeding support in the first few days-weeks of life • Be sure to initiate a conversation with the patient. Pocket Guide options. Hospital-grade personal electric pumps first breast offered should be alternated with each For more information, call 311 Suggested conversation starters include: Signs Breastfeeding is NOT Going Well are available through some WIC programs and via feeding, so that both breasts receive equal stimulation or your neighborhood office: •“How is your milk flowing?” • >7% infant weight loss from at 3-5 day insurance in select circumstances. and draining. North or Central Brooklyn: 646-253-5700 •“Is the baby latching on well?” pediatric visit South Bronx: 718-579-2878 • Fluoride supplements are not indicated in New York City. • Pacifiers should be avoided until breastfeeding is • “Do you have any concerns about your breasts • Infrequent wet/soiled (fewer than 3-4 urine East or Central Harlem: 212-360-5942 or how breastfeeding is going?” well established. diapers/24 hrs., fewer than 3-4 stools/24 hrs.) Women, Infants and Children (WIC) Mother’s are red, cracked (likely due to latch problem) Select Coding Options Growing Up Healthy Hotline: 1-800-522-5006 Medications that are Safe for Breastfeeding Mothers • Nutritional guidelines: • Water and juice are unnecessary for breastfed www.health.state.ny.us/prevention/nutrition/wic/ Anti- Anti- Diabetes Analgesics For Breastfeeding Encounters infants and may introduce contaminants or allergens. U.S. Department of Health and Human Services Hypertensives Infectives medications If there are signs breastfeeding is not going well, Feeding problem, newborn 779.31 National Breastfeeding Helpline: 1-800-994-9662 intervene as necessary, (e.g., provide telephone and Feeding problem, infant >28d 783.3 • Supplements (water, glucose water, formula, and Methyldopa Clindamycin Insulin Morphine and other fluids) should not be given to breastfeeding www.womenshealth.gov/breastfeeding (Aldomet) derivatives in-office support, refer mother to a lactation specialist Neonatal jaundice 774.6 newborns, unless medically indicated. and/or support group). In addition: Dehydration, neonatal 775.5 African-American Breastfeeding Alliance Labetalol Ampicillin- Glyburide (infant’s Acetaminophen Helpline: 1-877-532-8535 Breastfeeding – Simply the Best sulbactam glucose may be • Reinforce on-demand feeds – and no supplementation Weight loss 783.21 • All breastfed infants should receive 400 IU of oral – will increase milk supply. vitamin D drops daily beginning in the first few days (Monday – Friday, 9 am – 5 pm) (Unasyn) monitored, but Blocked milk duct 675.24 www.aabaonline.com adverse effects • Remind mother to stay hydrated whenever Breast engorgement, ductal 676.24 of life and continuing until the daily consumption of are rare) breastfeeding the baby. Nipple infection 675.04 vitamin D-fortified formula or milk is at least one liter 1-800-Laleche (1-800-525-3243) Nifedipine Fluconazole Metformin Ibuprofen • Discuss benefits of prolonged breastfeeding to at Nipple, sore 676.34 or quart per day. www.llli.org (Procardia) Gentamicin least six months and explore barriers and solutions. Supervision of lactation V24.1 • Complementary foods rich in iron should be introduced gradually beginning around six months of age. Consult product prescribing information and the LactMed Database about specific Other specified follow-up exam V67.59 if original drugs: http://toxnet.nlm.nih.gov problem resolved Always use non-commercial Source: www.aap.org/breastfeeding/files/pdf/CODING.pdf breastfeeding materials in your office. Health Mothers Can Breastfeed If They… Mothers Cannot Breastfeed If They… At the Hospital: During Prenatal Care: Breastfeeding confers unique • Have Cesarean Deliveries The following are absolute contraindications Provide leadership in breastfeeding support from delivery through discharge. Encourage expectant mothers to Initiate breastfeeding immediately, using a semi-recumbent • Are Infected with HIV Obstetrics Providers: Providers: breastfeed exclusively for six months. position on the side or sitting up. health benefits to infants and • Are Infected with HTLV (Human T-cell Lymphotropic • Upon arrival to labor and delivery: • Support early latch: • Take Medications Virus) Type I or II What you say to expectant mothers and their Most medications can be taken while breastfeeding. Consult • Verify HIV status is known at labor • Support early skin-to-skin contact and early latch mothers. Health care providers (mandate rapid test if not known). within an hour of delivery (ideally 30 minutes). families makes a real difference. If you recommend product prescribing information and the LactMed Database about • Use Illegal Drugs and staff can a critical exclusive breastfeeding, more new mothers will specific drugs: http://toxnet.nlm.nih.gov. • Are Receiving Cancer Chemotherapy Agents, Radioactive • Check maternal medications are compatible with • Vitamin K administration can safely be given breastfeed for longer periods of time. Isotopes or Thyrotoxic Agents breastfeeding by consulting product prescribing within 6 hours of life and need not delay the first • Have Had Breast Surgery information and the LactMed Database about breastfeeding opportunity. role in promoting exclusive (including breast augmentation or reduction) • Have Active Herpes Lesion on the Breast specific drugs: http://toxnet.nlm.nih.gov. Let them know: • Augmentation mammoplasty: Breastfeed frequently to maintain (shingles, chicken pox) • Optimize breastfeeding in the nursery: milk supply. • Support early latch: breastfeeding and increasing • “ is the safest and most special food for • Have Untreated Chicken Pox • Order“exclusive breastfeeding with no • Place baby in skin-to-skin contact with mother your baby. Formula just does not give you and your • Breast reduction: Monitor infant growth since milk supply could supplementation except Vitamin D” unless be insufficient. • Have an Infant Who Has Galactosemia within an hour of delivery (ideally 30 minutes) there are true contraindications. duration of breastfeeding. baby the same protection against diseases.” • Breast biopsy involving an areolar incision: Women can compensate and support attempts to breastfeed. • Prescribe vitamin D 400 IU oral drops p.o. daily. Your counseling and support • “The longer you breastfeed your baby, the better. by augmenting production in the unaffected breast, but monitor Note: In women whose infant has known or suspected • Ask pediatric team and nursing to minimize • Ask the nurse or lactation coordinator/consultant Every bit of breast milk your baby gets is important. infant growth since milk supply could be insufficient. G6PD deficiency: While this is not an absolute contraindication medical assessment and interventions for healthy to see the mother as soon as possible to support And it helps you to regain your shape and lower • Have Hepatitis A for breastfeeding, mothers should not ingest fava beans or infants until first feeding is attempted. breastfeeding. efforts should start while medications such as nitrofurantoin, primaquine phosphate or your risk for some cancers.” Initiate breastfeeding after infant receives immune serum globulin • Support continued on-demand feeds: • Describe colostrum and its benefits. and then vaccinate at one year of age. phenazopyridine hydrochloride, which are known to induce • Encourage rooming-in so on-demand feeds are the patient is pregnant, and • “It might be a little hard at first, but it gets easier. hemolysis in deficient individuals. “It doesn’t look like milk, but it will satisfy your baby easier. Inform the mother on-demand feeds will and give him/her special protection in the first few It benefits your baby for the rest of his/her life.” • Have Hepatitis B continue through the neonatal Initiate breastfeeding after infant receives hepatitis B immune improve milk flow and supply. days. It’s all he/she needs.” • “Most women can breastfeed. Your body will make globulin and first dose of the three-dose hepatitis B vaccine series. “In the first few weeks, you’ll find the more often • Support rooming-in so on-demand feeds are enough milk to give your baby all the food he/she the baby suckles at the breast, the better the flow easier. Inform the mother on-demand feeds will period and beyond. • Have Hepatitis C of milk.” needs for the first six months of life.” Hepatitis C is not a contraindication for breastfeeding, but reconsider improve flow and supply. if nipples are cracked or bleeding. • When maternal procedures are indicated, schedule “In the first few weeks, you’ll find the more often the them after breastfeeding or arrange for use of baby suckles at the breast, the better the flow of milk.” This pocket guide has been • Have Pierced Nipples hospital electric pump prior to procedure if the Remove nipple accessories before feeding to avoid the risk of mother will be off the floor for more than 2 hours. • Counsel mothers to avoid pacifiers and formula developed to support you infant choking. supplementation. • Have an Occasional Alcoholic Drink • Discharge planning: in this effort. Please help us Avoid breastfeeding for two hours after the drink. • Make certain that the 3-5 day outpatient visit is • Smoke scheduled for early breastfeeding follow-up. make breastfeeding the norm. Counsel mother about smoking cessation and to avoid infant • Provide contact information for breastfeeding exposure to secondhand smoke. support upon discharge. • Remind mothers not to take formula samples, if offered.