If the role of pediatricians is already important during childbirth and immediate postpartum (currently, more than during pregnancy, since prenatal visits to the pediatrician do not usually happen), more so if it will be during baby's first days of life.
In those first days in motherhood the contact between mother and baby has already been established, the time of delivery (where we are hardly willing to raise doubts or suggestions) has already passed and the visit of the pediatrician occurs in a more relaxed environment.
The Breastfeeding Committee of the Spanish Association of Pediatrics recommends promoting and supporting breastfeeding in the document entitled "How to promote and support breastfeeding in pediatric practice."
In the section dedicated to the first days after delivery, these are the recommendations that, if followed, would favor the successful establishment of breastfeeding:
- During the first days of life it is important to encourage the mother to offer the chest very often, between 8 and 12 times a day and whenever the baby shows signs of hunger (pacifier, yawning, search movements or hands to mouth) without waiting for him to cry desperately (excessive crying is a late sign of hunger) . The mother will be encouraged to keep her child to the breast for as long as she wishes.
- It is better to offer both breasts in each shot, allowing the infant to take from the first breast for as long as he wishes and offering the second afterwards, also as long as he wishes, but not forcing him. Mothers will be instructed to alternate the order of the breasts in the shots.
- During the first weeks of life, infants who do not ask frequently should be stimulated and awakened to offer breastfeeding at least every 4 hours.
- All breastfed infants should receive an intramuscular dose of 1 milligram of vitamin K in the first 6 hours after birth and after having made the first chest.
- In motherhood it is not advisable to offer the breast-fed newborn baby serum, water or substitute supplements except in cases of strict medical indication and in this case it is preferable to administer them with a glass, spoon, syringe or supplementary, avoiding the use of pacifiers or teats . These should not be provided to the breastfed newborn. It is important to advise against its use and explain to parents and family members the interference they may cause in the establishment of breastfeeding.
- Hospital records can be used by the pediatrician to control the amount and manner of administration of the supplements in the case of medical indication.
- Excessive crying in the breastfed infant may indicate problems with breastfeeding that need to be evaluated and corrected. It is advisable to explain to the mother and her relatives the function of non-nutritive suction to relieve the anxiety caused by the baby's crying.
- It is essential that the newborn remains 24 hours with his mother in the same room, and the necessary weight checks, physical and analytical examinations can be performed right there, in the presence of his parents.
- It is advisable to perform the evaluation of at least two chest shots every 24 hours, to early detection of grip or suction problems. The problems detected can thus be solved early by the pediatrician or other lactation experts. It is useful that the observations of the taking, the problems detected and how they have been solved or the instructions for their follow-up are adequately documented in the clinical history, as well as the number of chest shots, urination and bowel movements.
- Before hospital discharge, it is advisable for the pediatrician to verify that the infant effectively sucks from the breast and that the parents know how to wake him, recognize the signs of hunger without waiting for crying and know the technique of breastfeeding on demand.
- It is important allow and encourage access to maternity nursing mothers, belonging to local support groups and offer mothers the possibility of using this support. In the discharge report you can add the way to contact a local support group.
- Before discharge it is convenient for the pediatrician to verify that the mother knows the technique of manual milk extraction and the use of breast pumps.
- It is important that the pediatrician makes sure that commercial packages whose contents may interfere with breastfeeding are not delivered to the mother or families: pacifiers, teats, bottles of mineral water, magazines with advertising of milk houses and various coupons to receive advertising them at home. In addition, complying with the marketing code for breast milk substitutes and current Spanish law, companies that manufacture substitutes must not directly or indirectly advertise in the workplace (through brochures, calendars, posters, blocks of leaflets, pens) or deliver samples or gifts to the pediatrician or the staff that works with the mothers, nor do they accept them.
As we see, all are good practices for the first days of the baby's life and the correct establishment of breastfeeding.
Some recommendations that, although many professionals already put into practice, hopefully they are extended thanks to the preparation and involvement of many more pediatricians, such as those who write these bases, together with midwives, nurses and the rest of the medical staff that is next to the mothers In these crucial moments.
