The majority of families plan on breastfeeding. In the United States alone, 81.1% initiate breastfeeding in the hospital. Unfortunately, little is being done to help families reach their goals if breastfeeding issues arise or if mothers have to be separated from their infants. In fact, most medical professionals will recommend formula feeding in these situations. Not only does this practice undermine a person’s autonomy, but also places the baby and mother at increased risk of illnesses and diseases later in life.
Since we know that breastfeeding is a huge public health issue and that most prenatal women plan on breastfeeding, everyone in the perinatal field should have some basic knowledge to insure the breastfeeding relationship is respected and protected. The World Health Organization reminds the world that if babies are breastfed within one hour of birth, and exclusively for six months (continuing on until age 2) one million lives would be saved. These statistics coupled with the intentions of the parents are enough for all birth professionals to take notice.
Breastfeeding rates drop significantly after discharge from the hospital. There are several reasons this can happen and, more importantly, several ways it can be avoided. The best way to insure breastfeeding success is to insure breastfeeding initiation. When a baby is born, many people believe that feeding is the number one priority. I think this concept may be related to the mother’s experience. She has often been deprived of food the entire labor and once the event is over, she is famished. We have to remember, while in labor, Baby still has a direct line to nourishment, and once baby is born, he still has a fairly “full” stomach. Baby has amniotic fluid, mucous, and anything else absorbed via the placenta taking space in the stomach. The baby is not famished, or “on empty,” but rather a little shocked and adjusting to life outside the womb. One of the best ways to calm a baby and prepare for feeding is to hold the baby skin-to-skin. Allowing the baby to explore his new surroundings and crawl to the breast is a beautiful, biological journey. This is quite the contrast from the days when moms were “helped” by sandwiching the breast, eliciting a wide gape and shoving the baby on, all while instilling fear in the mom by addressing the issue of her “large baby” and the need to feed immediately.
Childbirth and lactation educators can prepare families by reminding them of all the biologically normal events that will happen at birth and what to expect when it comes to baby’s feeding. Prenatal education can save a breastfeeding relationship by offering anticipatory guidance. Educators can also remind families that babies should start out with small amounts of fluid, which comes in the perfect quantity through colostrum. These newborns have never used their digestive systems; they are also leaning the suck, swallow, breathe pattern. A fast-flowing bottle filled with two ounces of supplements can be overwhelming. In the case of feeding a newborn, more is not better.
For doulas who have the honor of attending the birth, they can offer additional tools for the parent who is unable to latch the baby. Sometimes medications or birth trauma can interfere with baby-led latches and mom needs additional support and information. I always recommend trying the laid-back breastfeeding approach. This position has Mom reclined and baby laying on her body. Mom should be shown how to hand express a few drops of colostrum to entice the baby. Often, baby will respond and begin to nurse. In the event that a lactation consultant is not available to help with a difficult latch, and too much time has passed between feeds, there are viable solutions to feed the baby that do not require introducing a bottle or resorting to formula. Moms could be taught to hand express a few drops of colostrum into a spoon and spoon feed her infant. One video that shows several ways to hand express can be located at this link. This feeding method can successfully transfer the nutrients and relieve the fear that the baby is not being fed. Newborns only need about a teaspoon of colostrum at a time. This milk is so nutrient dense and high in fat—it is the perfect food to introduce to the immature gut of the newborn. After the baby has a feeding or two from the spoon, the entire family can get some much needed recovery sleep and then address the feeding issue again in a few hours. This practice will thwart the spiral into supplementation and cessation of breastfeeding. Anyone looking for a good visual of spoon feeding is encouraged to follow this link to Global Health Media.
If the baby is discharged and still experiencing some breastfeeding difficulties, it is important to offer referrals to an IBCLC, but a postpartum doula is an essential team member that can ensure breastfeeding success. Not only can a postpartum doula offer emotional support, one can also share valuable information and education. Parents should be taught the important hunger cues and signs of milk transfer. Early postpartum, moms should place the baby at the breast or “respond” to every feeding cue. Feeding cues include smacking lips, protruding tongue, placing fist in mouth, turning head, stirring, stretching, grunting and crying (crying is a LATE sign of hunger). If the baby has many opportunities to practice feeding, the process may be learned quickly. Once the baby is home and feeding regularly, he should have one wet diaper for each day of life, for the first week and then around 8-10 diapers daily. Other signs of milk transfer include moms indicating their breasts feel softer and lighter after a feed. The baby should show wiggling ears and mom should feel baby drawing the nipple in his mouth, and after a few sucks, she should hear a swallow. Baby should be more relaxed and be content after the feed. Mom could also have baby’s weight checked. Baby should return to birth weight by 10-14 days postpartum.
If baby continues to have difficulty feeding at the breast during the early postpartum period, parents can successfully provide breastmilk through cup feeding. This method of feeding is a great way to allow baby to control the flow and avoid bottle feeding (which could lead to the artificial nipple gaining preference and affecting the latch back to the breast). This is a great skill for parents to learn, and can be viewed here.
With so many ways to protect the breastfeeding relationship and support a parent’s desire to provide breastmilk for their baby, we should see the gap close between the percentage of people wanting to breastfeed and the number who actually succeed. If all perinatal professionals are equipped with the knowledge and skills to support families we will see the pendulum of infant feeding swing back to where it once was. I hope 2019 finds all of us making a difference in the lives’ of the families we serve by helping them reach their goals. There are wonderful ways to gain more lactation knowledge and I highly recommend a Certified Lactation Educator Training be added to your New Year’s Resolutions. Your confidence and skill level will enable you to provide the care needed by the families you serve. Contact firstname.lastname@example.org to find a course near you or inquire on how you can host a training.
Christy Jo Hendricks
CAPPA Faculty, IBCLC, RLC, CLE, CCCE, CD
Christy Jo brings over 20 years of teaching experience to the classroom. She is an Internationally Board-Certified Lactation Consultant (IBCLC) and Certified Birth Doula. She has a passion for facilitating and protecting the mother/baby bond. Her contribution to this field has been recognized by the United States Presidential Volunteer Award and the Phyllis Klaus Founder’s Award for Promoting the Mother/Baby Bond. Christy Jo’s life-long goal has been to help others reach theirs. Her informative, yet entertaining teaching style makes learning enjoyable and retention easy. Christy Jo is the creator and instructor of the Grow Our Own Lactation Consultant/IBCLC Prep Course which has been used to train hundreds of women to follow their dreams of becoming Lactation Consultants. Her extensive lactation knowledge and reputation have made her courses desirable by Public Health Departments, midwives, doulas, WIC organizations and individuals entering the perinatal field. Christy Jo currently teaches lactation, attends births, facilitates lactation clinics for low-income clients and advocates for women in Southern California, where she lives with her husband and three children. More…