Shorter length of stay for postpartum mothers and their newborns necessitates careful community follow-up after hospital discharge. The vast amount of information given during the initial postpartum period can be overwhelming. New parents often need considerable support to understand the nuances of newborn care including newborn feeding. Primary health care and community services need to ensure there is a seamless continuum of care to support, empower, and educate new mothers and their families to prevent unnecessary hospital readmission and other negative health outcomes. The Healthy & Home postpartum community nursing program provides clinical communication and supports to bridge the gap between acute hospital and community follow-up care through home visits, a primary health care clinic, a breastfeeding center, a breastfeeding café, a postpartum anxiety and depression support group, bereavement support, and involvement in a Baby-Friendly Initiative™ coalition. Nurses working in the program have the acute care skills and resources to complete required health care assessments and screening tests. They are also international board-certified lactation consultants able to provide expert breastfeeding and lactation care. This paper describes how the Healthy & Home program has evolved over the past 25 years and offers suggestions to other organizations wanting to develop a postpartum program to meet the physical and mental health needs of postpartum families to promote maternal and infant wellbeing.

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Background: Physicians require breastfeeding education appropriate to their roles. The aim of this survey was to determine physician learning needs and to inform development of breastfeeding education for physicians. Methods: A cross sectional survey was distributed to family physicians, pediatricians and obstetricians in a tertiary institution. Importance of knowledge to practice and confidence to manage was assessed for 18 learning topics proposed by a multi-specialty physician working group. Descriptive statistics, ANOVA and tests for equality of variances were calculated. Mean values of importance to practice and confidence to manage for each topic suggested learning priorities. Results: The study group included 75 physicians. The most important topics were “informed choice when supporting newborn feeding,” “analgesics, antidepressants and other medications while breastfeeding” and “community resources for breastfeeding support.”  Confidence to manage was lowest for “latch assessment,” “what mom can do during pregnancy to promote milk production,” and “risk factors for delayed lactogenesis.” Preferred learning formats were 15-minute online modules and grand rounds. Conclusions: Physicians acknowledged the importance of all topics but report lowest confidence to manage latch assessment, prenatal interventions to support lactogenesis and management of delayed lactogenesis.  Participants placed relatively low importance on learning about latch assessment despite the central nature of this skill in supporting early breastfeeding.

Recent literature suggests that when breastfeeding goes well, it may protect mothers from the deleterious effects of postpartum depression. Using a phenomenological approach, the objective of this research was to provide insight into the lived experience of breastfeeding in mothers with postpartum depression. Two major themes emerged from the participants’ perceptions of breastfeeding with postpartum depression: (a) Breastfeeding in the Dark: Despite difficulties associated with establishing and maintaining the breastfeeding relationship, breastfeeding through depression meant bonding with baby and maintaining a semblance of control; (b) Breastfeeding Under Wraps: Mothers perceived a lack of support to breastfeed their babies and delayed seeking support for their symptoms of depression out of fear of being stigmatized. This study underscores the need for heightened awareness regarding perinatal and postnatal screening for depression. The early identification of women at risk for postpartum depression will offer healthcare professionals the capacity to engage women and their families in a participatory manner to work through natural challenges associated with establishing and maintaining the breastfeeding relationship.

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