Background: Breastfeeding is the undisputed optimal feeding for babies. Healthy People 2020 has recognized this and called for an increase in the number of mothers who have ever breastfed to 81.9%. The Center for Disease Control listed this breastfeeding rate for 2011 as only 74.6%. To accomplish this goal, mothers need excellent breastfeeding support during the first few days of baby’s life. The American Academy of Pediatrics 2005 Policy Statement recommends observation of feedings twice per day during the newborn’s hospital stay.

Case: Studies have shown an association between optimal feeds during initial hospital stay and longer duration of breastfeeeding. The mother/baby dyad often has difficulty in the first few days of life getting breastfeeding well established. Continuation of poor feeds can lead to a multitude of other breastfeeding problems which can ultimately lead to early breastfeeding cessation. Thorough observation and subsequent intervention can lead to better breastfeeding at discharge.

In a typical case, a first time mom told her nurse breastfeeding was going well.  Two days after discharge the mom returned for an outpatient lactation consult complaining of sore nipples and decreased output in baby. Upon observation, the lactation consultant (LC) noticed that baby had a shallow latch, was not transferring milk well, and was causing nipple damage. The LC corrected mom’s positioning and latch, causing immediate relief of pain. The LC was able to hear frequent swallows and the baby seemed satisfied afterwards. Subsequently, the baby began having abundant wet and dirty diapers and gaining weight. If a feeding had been observed during admission, these problems could have been resolved sooner. Many moms in this same situation would have stopped breastfeeding. This mom can now successfully go on to achieve the American Academy of Pediatric recommendations of 6 months exclusively breastfeeding and then for at least a year.

Conclusion: Mothers generally stay in the hospital from 48-96 hours post delivery. During this short time period, nurses often rely on mother’s self report of breastfeeding sessions. Initially, the mother may not be able to effectively determine whether the feed is nutritive. Nursing observation of breastfeeding during the hospital stay is imperative to ensure a successful start. While lactation consultants are experts at this skill, it is the postpartum nurses who are key to around the clock observation and evaluation of breastfeeding. Observation should include latch, positioning and techniques to verify adequate transfer of milk.

Keywords: breastfeeding observation, breastfeeding assessment, latch