By Genevieve Colvin, IBCLC lactation consultant at BabyLiveAdvice
Many mothers start out wanting to breastfeed but are met with challenges once the baby is born. Hospital practices can and do impact whether you meet your breastfeeding goals. Being prepared to nurse your baby is important!
This “how-to-guide” will help you navigate the hospital experience and meet your breastfeeding goals!
1.Plan to Breastfeed: Research supports that when you KNOW that you are going to breastfeed your baby, you are more likely to succeed. Find your breastfeeding support team before you go to the hospital, so that you know who to call, text, email, or visit for help immediately after your baby is born. Support can come from your partner, family, friends, or local support groups like Breastfeeding USA, La Leche League or WIC. Schedule a telehealth lactation consultation with BabyLiveAdvice to address prenatal questions, in hospital concerns and after discharge when breastfeeding can be very tricky!
Why it works: The Surgeon General tells us that when mothers don’t have defined goals for breastfeeding and the going gets tough, families turn to formula fast. The first two weeks of your baby’s life can be challenging, and breastfeeding is a lot easier when you get off to a good start. It’s important to focus on exclusively breastfeeding in the beginning – even if you plan to include formula feeding down the line. If you know you want to breastfeed AND you have a plan to be supported in that decision, when the going gets tough, the tough get breastfeeding! Again, say it with me, “I Plan to Exclusively Breastfeed”.
Planning + Information + Support =Breastfeeding Goals
2. Choose Breastfeeding-Friendly: This is really a two-part step – first, choose a breastfeeding-friendly physician or midwives who are options in your insurance network. Ask around in your community for providers whose practices most promote breastfeeding success and interview those covered by your health plan specifically. You can learn a lot about how a provider prioritizes breastfeeding in their approach to care by simply asking! Also the hospital where you give birth matters – so, if possible, chose a Baby-Friendly designated hospital. These hospitals have staff who follow the Ten Steps to Successful Breastfeeding.
Why it works: Research shows that the Ten Steps to Successful Breastfeeding bring together the right services at the right time to help you breastfeed during the critical time when your hormones are working for you! That doesn’t mean that the process always works, but it works a lot better than hospitals that aren’t even thinking about supporting breastfeeding. You are the birth consumer, so let the medical staff know your intentions to breastfeed and ask for support!
3. Skin-to-Skin Baby! Your breast milk supply is grown by a baby that frequently feeds. After birth the drive to breastfeed is very strong! Ask for your baby to placed skin-to-skin immediately after birth and then leave your baby there. What happens next is one of the most magical dances! Your baby has instinctual behaviors that end with latching and nursing for the first time. This can take more than an hour to play out, so allow baby some time. Ask hospital staff to perform the post-birth assessments while baby is skin-to-skin.
Why it works: It’s hard to breastfeed your baby if it is wrapped up like a burrito in the bassinet across the room! In fact, while swaddling can be an awesome tool to help you get some much-needed rest, swaddling can suppress feeding cues and make it hard for parents to respond appropriately and timely to baby’s needs. Knowing when your baby is hungry and responding quickly to early feeding cues are much easier if you are holding the baby and resting together. Babies also stay warmer, have better blood sugar control, and breath better when skin-to-skin.
4. Skip the Bath: Ok – I know what you are thinking. Yuck. What does this have to do with breastfeeding? The reason is so cool! When your baby is born, they will be covered with a waxy, cheese-like substance. What about that weird cheesy white stuff? I’m so glad you asked. I wish I could bottle that stuff and use it as part of my nightly face anti-wrinkle protocol. It’s called Vernix Caseosa and it is amazing! It is antibacterial, anti-fungal and all sorts of yummy for soft baby skin. We don’t wash it off – RUB IT IN! So, let your nurses know, or even better, ask your labor support person to let them know before birth, that you don’t want the baby bathed until breastfeeding is going well.
Why it works: When babies are born, their senses, like eyesight and hearing, aren’t fully developed, so encouraging and pointing baby to the breast is not going to help your baby latch. BUT, their senses of smell, taste, and touch are super strong. Put the baby skin-to-skin in the “breastaurant” and watch them use their nose to guide them to the breast. They suck on their hand (which tastes like amniotic fluid because you didn’t wash it) and then they smell mom’s skin and notice that the areola smells strongly like amniotic fluid. That’s when the “breast crawl” begins. Notice your baby self-navigate over to the breast and latch on. When you bathe the baby, you wash off the smell of “home” and disrupt the baby’s ability to self-navigate and function well at the breast. As a baby is learning this new skill (to latch, suck, and swallow at the breast) it’s best not to interfere by washing the baby with strong smelling soaps. Give your babies a few days to learn how to breastfeed before adding in strong smells! Rinsing baby with warm water is all that is necessary.
5. Learn Hand Expression: It’s a lot like the breast self-exam that you are supposed to be doing every month. In the early days after birth, hand expression is more effective than an electric breast pump in bringing out the colostrum (the early, super-powerful immune boosting milk.) Plan to rest and recover with baby skin-to-skin and nursing “8 or more in 24”! (That’s at least 8 nursing and/or milk expressions within a 24-hour period.) So, here’s how – after baby has latched and nursed for about 20 minutes with some good audible swallows, using hand expression, express a little extra milk into a spoon or cup and give it to baby. Do this as you feel comfortable and until you feel your milk come in. A goal might be 5 solid hand expressions on day one. Don’t worry – you will know when your “mature” milk comes in.
Why it works: Your breasts go into overdrive to make milk about 72 hours after you deliver your baby’s placenta. Until then, you have small amounts of special milk called “colostrum” that is yellow, sticky, and exactly what your baby needs to learn how to breathe and eat outside your womb. The drops of colostrum from one good feed usually equal about a teaspoon to a tablespoon, which is perfect for a newborn since they have never done this eating business before. Nurse at the breast but follow up with some “dessert” feedings by spoon and you should see a rocking’ milk supply on day 3 and a lower risk of other newborn related complications, like jaundice.
6. Learn Baby Cues: Babies are not the most obvious communicators, so it might feel like you must play detective to learn what they want. Crying is a baby’s superpower! A crying baby drives an adult to action, quickly. Babies don’t cry because they suddenly realized they are hungry; they cry because we’ve missed all of their subtle cues for the last hour and now baby is frustrated. Babies have basically two types of communications cues: “Yes, more please” and “oops, you got it wrong”. The more you respond to your baby’s cues, the quicker you learn how to communicate with your baby.
Why it works: Parents who are tuned into their babies feel more confident about their parenting ability. The sooner you respond to a baby’s cue, the sooner you learn whether you got it right or wrong and you build strong communications skills in your baby. Parents who respond quickly to their baby’s cues have babies who cry less!
7.Kick out visitors: It’s exciting to introduce your new baby to grandparents, friends, and relatives but lots of visitors can interfere with getting to breastfeed off to a good start. People have lots of germs, even if they don’t appear to be sick! New babies are cute and cuddly, and visitors usually want to hold the baby, but new people smell weird to the baby, so baby shuts down and sleeps instead of nursing. Because baby was weirded out by these strange-smelling people, she didn’t give any feeding cues, so now she’s back at the breasturant and is starving, but being a newborn, she isn’t a strong communicator, so all she can do is wail. You may be stuck with an overstimulated and hungry baby who won’t latch, breastfeeding seems overwhelming, and at this point, many parents ask for a bottle of formula.
Why it works: Breastfeeding is a learned relationship between mom and baby. Parents must learn how to read their baby’s cues. It’s hard to do that if people are coming and going (which is already happening with all the medical personnel). So, your best bet is to tell everyone to wait until you and your baby are home. And if they must visit, keep the visits short.
8.Babymoon Time: Stay together, room together, sleep when baby sleeps. Your baby’s tummy is tiny, and he must feed frequently to bring in a full milk supply and grow big and strong over the next 12 weeks. This means you are not getting long stretches of sleep, so napping and sleeping when the baby sleeps is critical. In the hospital, your “Second Night” is sometimes more challenging that the first night. By then, if nursing hasn’t gone well during the day (see #8 above) moms often turn to formula when they have a crying baby. Babies are going to cry – probably a lot on that second day. Day one was all about recovery, rest, and responding to baby. Day two is about reinforcing the response to those baby cues. Stay calm. Remember the crying has little to do with your parenting skill, and everything to do with how uncomfortable it is to feel all the new experiences of being out in the world. Crying a lot on the second day is a typical reaction to having to deal with temperature changes, uncomfortable feelings, and developing communication skills. Can you imagine how great it would be if a little baby could simply say, “Dude, I’m hungry and wet, which I thought I made clear about 10 minutes ago – but whatever. Can you help me out here?”
Why it works: Mothers who respond early to their baby’s cries, have babies who cry less over time! You cannot spoil a new baby. Crying is not always about hunger – so try soothing measures that are calm and repetitive, like singing or massaging. Wait for about 20 minutes. Chances are baby just needed to vent! While a newborn may sleep about 16-18 hours a day at the beginning, it’s not super predictable and mostly they want to sleep in the breasturant. This is a perfect way to bring in a strong milk supply, but it starts to feel like too much to handle if you don’t have a plan to rest and recover. You are now growing your baby on the outside for the fourth trimester, so your breasts are like the placenta now – and baby will want to be latched on a lot. You may will feel like you are doing nothing but feeding the baby. Plan to camp out near baby so you can respond quickly to those feeding cues. Families that work together to get through those early weeks with lots of resting during the day are bonded. After a good nurse, ask your partner to hold the baby skin-to-skin, so you can get some time in the bed by yourself. Learn to nurse lying down so you can rest during the day!
9.Practice Makes Perfect: My background is in music and when parents ask me how to start a child on an instrument I always say, “If you want them to play piano, don’t buy them a violin.” The idea is that we get good at the instrument that we have in hands, or in this case, in our mouths! This is true for breastfeeding. If you want your baby to breastfeed, don’t give a bottle. There is plenty of time to teach a baby how to take a bottle, but there is a critical time in the first weeks of life when breastfeeding is established. If you “do both”, it’s hard to fix breastfeeding later. For moms who plan to go back to work, or who plan to “do both”, the best way to support those decisions is to focus on exclusive breastfeeding for the first 6 weeks of your baby’s life. So, no bottles and pacifiers while in the hospital until your milk supply and breastfeeding is comfortable for both mom and baby!
Why it works: Breasts have lots of cells to make milk, and they grow fast in the first week of a baby’s life. Breasts need a lot of stimulation by baby or a pump in those weeks to ensure adequate supply. Babies need to practice breastfeeding in order to sustain mom’s milk supply. Any interruption in those early weeks can cause problems down the road for mom’s production. Start out exclusively breastfeeding and get over that initial hump! If your baby has a medical need for supplementation, there are many ways to do this, like using a spoon, syringe, or cup. Ask your hospital staff for help in using an alternative feeding device, like a supplemental nursing system, so you can supplement at the breast. Get a pump if you don’t feel like your breasts are being stimulated enough or use hand expression.
10. Ask for Help: If you are having any breastfeeding difficulties, before you leave the hospital, plan for getting help after discharge. If you haven’t already learned how to position and latch your baby, now is the time to ask for some help so that you can avoid sore nipples.
Why it works: When baby is close to mom’s body and begins the latch with the “nose pointing at your nipple”, it positions the baby’s mouth so that the nipple will be placed in the roomy part of the top of baby’s mouth. When you see your baby open wide, press at your baby’s back quickly, so baby gets a deep latch. Using correct positioning and latch will help you avoid sore nipples and get good milk transfer to baby! If latch is not going well, ask for help from the nurse, a referral to an IBCLC, hand express if latch is painful and get a pump, so you don’t miss any time stimulating your breasts in those early days!
The biggest learning curve of breastfeeding is in the first week! With some planning, information and support, you can meet your breastfeeding goals. Babyliveadvice is committed to supporting your breastfeeding goals!