I attended an interesting birth recently as a doula. The hospital worked very hard to be family-friendly and to allow mom informed consent/refusal and I was thankful for that. About 30 minutes after birth, they wanted to take the baby, weigh him, measure, etc. Baby hadn't begun breastfeeding yet, and I told them that the parents wanted to use AAP's current guidelines on that and keep the baby with them. "What?" "You know. The American Academy of Pediatrics' *current* guidelines... The one that says the baby shouldn't be removed from mom until the end of first feeding or for two hours, whichever comes last." The head nurse and the OB had the same response: 3 quick blinks with an otherwise blank expression. They looked at each other as though to say, "Do you know what the current guidelines say?" Then, the OB said firmly that it was *usual* for most hospitals to weigh the baby at this point and that they usually did that at that time, too. "We *need* a birth weight!" I responded, "I know it's usually done that way in hospitals, however, the parents wish to follow the *current* (stressing that word again) AAP guidelines in this." The OB said something I didn't catch and left the room. He returned about 5 minutes later and said, "Leave the baby with mom."

I think this information may not be widely known. The guidelines actually say, "Breastfeeding should begin as soon as possible after birth, usually within the first hour.80 – 82 Ex- cept under special circumstances, the newborn infant should remain with the mother throughout the recovery period.80,83,84 Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized. " And, later: "Pediatricians are encouraged to work actively toward eliminating hospital practices that discourage breastfeeding (eg, infant formula discharge packs and separation of mother and infant)." You can find this at http://aappolicy.aappublications.org/cgi/reprint/pediatrics;100/6/1035.pdf .

This dovetails with "Evidence-Based Guidelines for Breastfeeding Management during the First Fourteen Days," published by International Lactation Consultant Association. Management strategy #1 includes "Provide continuous skin-to-skin contact for at least the first 2 hours after birth or until after the first breastfeeding [and] Delay unnecessary procedures for at least the first 2 hours after birth or until after the first breastfeeding."

Holding hospitals accountable to evidence-based procedures is helpful for moms and babies and early breastfeeding success.

Debby S http://homepage.mac.com/dss7midwife/Personal1.html