Preparing for Breastfeeding Before Birth

PREPARING BEFORE BIRTH:

• Be Able to Recognize “The Booby Traps”
• Choosing a Pediatrician
• Know the Ten Steps to Successful Breastfeeding
• Breastfeeding After an Epidural
• What’s Colostrum?

Be Able to Recognize “The Booby Traps”

“75% [of new mothers] try breastfeeding at least once, yet only 13% make it to 6 months of exclusive breastfeeding [which is recommended by most organizations]. Compare that to Sweden, where 98% try and 79% are nursing at 6 months! Mothers are being urged to breastfeed but set up to fail: 60% do not reach their personal breastfeeding goals, whether that’s 2 days, 2 months, or 2 years, and it is not their fault” – Bestforbabes.org (emphasis mine)

So whose fault is it? Read “The 2011 State of Breastfeeding in the U.S.” to find out.

• Intro to Booby Traps
• Bad advice booby traps
• Cultural and institutional booby traps
• Top Ten Booby Traps that may not be so obvious

The American Association of Pediatrics acknowledges barriers to “initiation and continuation of breastfeeding” that include:

“Insufficient prenatal education about breastfeeding;

Disruptive hospital policies and practices;

Inappropriate interruption of breastfeeding;

Early hospital discharge in some populations;

Lack of timely routine follow-up care and postpartum home health visits;

Maternal employment (especially in the absence of workplace facilities and support for breastfeeding);

Lack of family and broad societal support; media portrayal of bottle feeding as normative;

Commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and some television and general magazine advertising;

Misinformation;

…Lack of guidance and encouragement from health care professionals.”

Choosing a Pediatrician

Read: “Is Your Doc Breastfeeding-Friendly or Breastfeeding Phony?”

Know the Ten Steps to Successful Breastfeeding

These are the ten steps that every birthing facility should include in its maternity/infant care-giving protocol, outlined in the WHO/UNICEF statement “Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services.” How does your hospital or birthing facility measure up? The facility will… (emphasis mine):

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Okay, so what if you got off to a pretty crappy start after labor and birth? Fear not! You can still become such a pro Nursaholic that you practically sweat breast milk, but you need to find the right support.

Read “When Breastfeeding Doesn’t Work Out – Guilty Secrets” by Lesley McBurney BA, ABA Breastfeeding Counsellor, plus “Bonding After Delayed Breastfeeding” and “Attachment Parenting Despite Medical Obstacles” from Jan Hunt’s advice column.

Breastfeeding After an Epidural

No shame in opting (or threatening to shoot people) for pain medication during birth. That shit is tough, you know? But you still need to be informed before you go into labor, even if you PLAN to eschew the spinal goo because when it comes to birth, you don’t know the ‘birth plan’ half as well as your baby does…and he’s not going to spoil that surprise!

Any drugs during labor will have an effect on your baby, on you, and on breastfeeding, and you should be fully educated about how. The epidural is NOT ‘just a numbing agent.’ This is a very sensitive time to receive a shot of drugs so the ratio of medical risk-to-benefit should be weighed with as much care as any other intervention.

Remember how your medical caregiver warned you to stay away from most drugs, medications, herbs, and even soft cheeses while pregnant? Does it make sense that a foot-long needle squirting your spine full of drugs is suddenly, magically safe at full-term? Not really. But whether or not you still want (or need) it, the knowledge of what to expect can be empowering.

You need to know how drug interventions can harm breastfeeding so if there’s an issue, you can track it back to the stupid epidural and blame the drug rather than beating up on yourself.

“One study found that 67% of women who had an epidural reported partial or full formula-feeding in the first 12 weeks compared to only 29% of women who had not. Mothers who had an epidural were also more likely to report having ‘not enough milk’” …

A baby’s exposure to drugs during labour (such as with an epidural) may dull the instincts he needs to seek his mother’s breast and breastfeed…

Epidurals often cause a drop in blood pressure. To prevent this, mothers are usually given IV fluids. The use of synthetic oxytocin also means the use of IV fluids…

Use of IV fluids may result in generalised swelling, including of the breast. If the swelling affects the areola and nipple, it is harder for a baby to attach to feed…

If a mother has IV fluids, her baby may be born with more fluid too. This might falsely inflate a baby’s birth weight. When he sheds this fluid, he might appear to lose more weight than ‘allowed.’ This might dent a mother’s confidence in breastfeeding and lead to pressure to offer supplements…

Epidurals increase the risk of instrumental delivery. This can result in pain, stitches and birth trauma for the mother, and bruising, swelling and trauma for the baby. Pain felt by the mother and/or baby can make early positioning and attachment to the breast more difficult and may affect breastfeeding outcomes…

Epidurals can cause a fever in women in labour. Because fever could also be a sign of an infection involving the uterus, the baby might be taken to the nursery for monitoring. This mother-baby separation can delay breastfeeding initiation and make breastfeeding harder to achieve.”

– Australian Breastfeeding Association

Links:

• “A Look at the Research: The Link Between Epidural Analgesia and Breastfeeding” – Sylvie Donna
• “Analgesia and Anesthesia for the Breastfeeding Mother” – The Academy of Breastfeeding Medicine
• “Effect of Labor Epidural Anesthesia on Breast-feeding of Healthy Full-Term Newborns Delivered Vaginally” – Journal of the American Board of Family Medicine
• “Epidurals and Breastfeeding” – Jan Riordan, RN, EdD, IBCLC, FAAN
• “Epidurals and Breastfeeding” – Nicola Aquino, liaison administrator LLL Canada
• “‘Epidurals don’t affect the baby,” and other myths about labor medications and breastfeeding” – Best for Babes
• “Epidurals: real risks for mother and baby” – Dr. Sarah Buckley
• “Labor epidural anesthesia, obstetric factors and breastfeeding cessation” – Dozier AM et al

What’s Colostrum?

Read more about all the amazing stuff in colostrum here and its role in milk production in this section. For now, it’s good to know that measured in drops rather than ounces (like it typically is in bottles).

You see, this is the actual capacity of a newborn’s stomach:

Don’t miss the continuation of this series. Upcoming topics include:

GETTING STARTED AFTER BIRTH

• Breast Crawl
• Delay the Baby’s First Bath
• Getting a Good Latch
• Newborn Procedures
• Positions for Breastfeeding

THE FIRST SIX WEEKS

• Is My Baby Gaining Enough Weight?
• Should My Baby Be Sleeping Through the Night?
• This SUCKS–not just literally. Will it be like this forever?!

OTHER CONSIDERATIONS

• Cesarean Section
• Premature Birth & NICU
• Sleepiness After Birth
• Universal Vitamin Supplementation