Monday, September 13, 2010

What You Need to Know If You're Going to Breastfeed

Sydney nursing in the hospital
I was going to have a natural birth, and I was going to breastfeed, maybe babywear, but not co-sleep. That was the plan and as I soon learned of hospital birth, your plans don't mean much. Despite having a rough start breastfeeding my son, I nursed him for two years and never supplemented once we left the hospital. He's a healthy, hyper three year-old now. I had a nine month break before I began nursing my daughter after a planned homebirth ended in another c-section. Now nearly six months later I feel compelled to share what to expect if you want to breastfeed after a hospital birth, and how to navigate a system that isn't always set up to help you succeed.

If you are planning a natural birth or homebirth, I strongly encourage you to read this. As a member of our local ICAN, LLL, and Birth Network, I hear too many women say, "I never read about c-sections or breastfeeding or induction, because it wasn't going to happen to me!" Well, one of the best ways to prevent problems during and after birth is to be educated and informed so you can recognize the warning signs and advocate for yourself. Not only can this help you avoid unnecessary interventions but if the unthinkable happens and you wind up in an emergency situation, you'll know what to expect from breastfeeding. I had three things on my side regarding breastfeeding after c-section: a supportive partner, a lot of info on breastfeeding, and someone to call for moral support. All those things helped me fight to breastfeed in a formula friendly hospital, but this is what I wish I had known.

All that said, breastfeeding is an art. To many it takes practice and patience and to others it comes more naturally, but all breastfeeding moms evolve with the particular demands of their breastfeeding relationship. After two years of breastfeeding with little issues after preliminary problems, you can imagine how surprised I was to have to be hospitalized for mastitis after my daughter's birth. Breastfeeding and breastfeeding support doesn't fit into one neat category no matter who you are! So the best defense against breastfeeding problems is to go in with a game plan, know what to expect, and who to call.

First and foremost do not expect the hospital to be as invested in breastfeeding as you are. Doctors and nurses are not required to take any classes or complete any training on breastfeeding. Most hospitals have a Lactation Consultant (LC), but in my experience, they aren't always helpful. My first hospital birth the LC popped her head through the door, said things looked fine, and left. Things weren't fine. My son had a bad latch, but she didn't know that because she was never withing 10 feet of me. The second hospital's LC was nice and helpful and I didn't need her too much, which is good because she was only available during business hours and was stretched between all the other women on the floor.

My first hospital was a formula-friendly hospital, which means they pushed supplementation early and often. They brought me a fancy diaper gift bag full of formula, tried to sell me on how healthy organic formula was, and simply would not listen to me when I said it was normal that my milk wasn't in on day 2. Imagine how they treated me on day 4 when my milk wasn't in yet. The pestering turned to threatening. I was endangering my child who needed to eat. Some moms couldn't breastfeed and that was ok. Well, geez, with help like that...

Now listen up, this is important. At the time I believed there was a correlation between my induction, c-section, and the pitocin/fluids I was given and the fact that my son peed on everyone who touched him for the first few hours of his life. He came out peeing and he didn't stop. That's not particularly normal. Nor is it normal for a baby to look swollen. I know now that the excessive amounts of intravenous fluids I was given artificially inflated his birth weight. Henci Goer confirms this in The Thinking Woman's Guide to Better Childbirth. What does this mean for breastfeeding? Inflated birth weight (aka water weight) means as baby loses the swelling, his weight goes down. The sad thing is that nurses don't get this (well, one of mine at my second birth did), so alarms start going off. Baby is losing weight! Doom. Gloom. Unfortunately, this is when they start pushing you to supplement. They may be gentle or they may threaten. Both of my children were down about 10% of their birth weight by the last day in the hospital. Both of them were content, easily woken, and healthy kids. Neither screamed for food or acted unwell. So I fought supplementation. The first hospital threatened to not let me go home if I refused to feed my baby. Apparently sitting for hours with him nursing colostrum was not feeding him. So my husband finger fed him an ounce of formula and we left. It's the only formula he ever had. By the way I had to walk out of the hospital after major surgery, take a different elevator and catch up with my husband, son, and nurse, who had left carrying my baby without waiting for me or offering a wheelchair. E! True Hollywood Story, folks. Paints a picture, doesn't it?

James shortly after birth
The second hospital was much more breastfeeding friendly but just as uneducated. When my daughter who was also born swollen after 2 days of IV fluids began to lose weight, the nurses started in on the supplementation thing. They were kinder but try as I might to explain everything was fine, they were concerned. On our final night, my husband fed her a little formula by finger to preempt any threat they wouldn't let us leave. I wish I had spoken to our hospital pediatrician, because it turns out he wasn't concerned. Her bilirubin was normal and she was content. She was latching and he assured me once my milk came in everything would be fine and to just pop by my doctor for a weight check at the end of the week.

So check with your doctor, consider if baby is seriously jaundice (most cases of jaundice are better treated with breastfeeding than supplementing) and trust your instinct. If baby is latching and happy, hold out for your milk to come in!

My milk came in on day 5 after my first induction/c-section, and day 4 with my second. I've since checked with countless other c-section moms, induced moms, and moms where there was interventions and they all gave 4-5 days as the average time frame. I also noted that the first 24 ours after my c-section with both births that my nipples did not want to easily respond to latch. The nurse after my first birth told me I had flat nipples, which isn't true, and the second time they asked if I did. I told them I did not and that this happened after my first birth as well. This surprised them, which surprised me. To me the correlation was obvious. My body was so relaxed from pain meds it wasn't responding properly. A lot of other mothers report that, despite what a doctor will tell you, pain meds and pitocin can inhibit a baby's natural rooting and sucking instinct. These are all issues that can be conquered with time and patience and since you know this now it will make it much less stressful for you to stick to your guns!

There is a bit of a window to work in if you can. After my son's birth it was hours after he was born before I was given him to nurse. I was too out of it to ask and they waited until I was out of recovering. After we left the OR with my daughter, I was encouraged to nurse immediately. Before they bathed her or put her in a warmer. A nurse helped me onto my side and we nursed within the first hour of her birth. If you have a c-section insist they let you nurse before all those unnecessary procedures. If you have a vaginal birth, try right away. The first thing your baby is going to want to do is root for your breast. It's instinctive. If you can't nurse that quickly, you can still breastfeed, but try to aim to nurse in the first hour if you can.

Hospital birth and postpartum care also foolishly subscribes to the idea that you can schedule and chart everything. They are literally obsessed with wet and poopy diapers. They will make you write it all down and cluck over it. God forbid you forget to write one down. My husband and I admittedly mostly make it up because we always forget. We never lied, we just were never sure on the time or the amount or the color. Here's what's important for a breastfeeding mom to know. It's my opinion that nurses expect babies to poop or wet more because babies on formula poop and wet more. It is completely normal for breastfed babies to have far less wet diapers in the first few days after birth while milk is still coming in. It is not a good indication of whether or not baby is eating enough until milk has come in! La Leche League explains that breastfed babies will have only 1-2 wet diapers while they are receiving thick colostrum aka the superfood. Colostrum is so important that it really upsets me that more moms feel pressured to get their milk going. Babies needs colostrum! If you are feeling pressured and begin pumping to help start up your milk, make sure you give your baby all that colostrum through a Supplemental Nutrition System.

For the first twenty-four hours a nurse will likely come in every two hours to wake you up and tell your its time to breastfeed! This is supposed to be helpful. Personally it makes me stabby. I subscribe to the feed on demand philosophy. I let my baby feed as long as he/she wants and I bedshare. None of these things really fly at the hospital. First, they freak a little if you sleep with baby even propped up on your chest. Second, in my experience, even if you tell them your just nursed and baby is now sleeping contentedly, they want to see it! This is so frustrating because baby and mom need rest, but it is one of the hiccups in breastfeeding at a hospital. So if you are looking forward to getting some rest at the hospital before you head home, I wouldn't count on it. Try to be gentle with your nurse. I sort of threatened to strangle my first night nurse after my second c-section at 4 a.m. In my defense, I was hungry and sleep-deprived and we had called an hour before to let her know we had nursed and she could skip her visit. She didn't. They are doing what they think is best and until hospitals get with the program and require breastfeeding training, you are going to deal with this. Remember, you shouldn't schedule nursing. Listen to your baby and listen to yourself. Some breastfed babies get right down to business, nurse and are done. Others linger. My first would nurse for 45 minutes every two hours (1:00-1:45, 3:00-3:45). My daughter is content after ten minutes and just nurses whenever.

Avoid pacifiers and bottles as they can cause bad latch. If the hospital insists after making you labor for two days without real food and your baby is born with low blood sugar (how could that happen?!) that they have to give him or her glucose or formula, ask for it to be fed by syringe as quickly as possibly. At my first hospital, they gave bottle without informing me and when I sent my husband to tell them to stop, I was quickly treated as a difficult patient. At my second hospital, the nurse shot the glucose into her mouth as businesslike as possible. You want your baby's first feeding experience to be special moment for you both - don't let a bottle prevent that. For my second birth I took a sign that affixed to my baby's bassinet that reminded everyone (I'm a breastfed baby! Please no pacifiers or bottles!) The nurses there loved it. Although they did say that when she was in the nursery, they had to hold her if she got upset since they couldn't give her a binky, so someone was always holding her (score!!!!) They didn't mind too much, she's a cutie. If you are considering circumcision, and I hope you will leave your son intact, they will offer you a pacifier with sugar water to calm the baby. Unfortunately this doesn't do anything to alleviate the pain, it only stifles the cries. You should try to avoid artificial nipples until your supply is established and your baby is latching easily. I would suggest using a SNS if you need to supplement at all.

You may have a fantastic nursing experience. It might be easy for you, or it could be hard. The best thing you can do is be prepared! Have a game plan. Read a really good book or two on nursing. I suggest The Breastfeeding Book by Martha Sears. Consider hiring a doula to make sure you have support during and after birth. Go to a LLL meeting and get some phone numbers to call for help if you are struggling. Share your desire to breastfeed with your spouse/partner and share this info - a supportive partner is really helpful when things get stressful. You are not alone and there are women all over the world who want you to succeed, know you can, and will help you do it.


Anonymous said... [Reply to comment]

I'm an IBCLC, and I agree with most of what you say here. As a NICU nurse, though, I can tell you that giving a baby a pacifier and sugar solution (usually 24% sucrose) is based on medical research. It is unknown whether it actually decreases the pain that babies feel or increases their tolerance to it, but it does, in fact, work very well for most babies. Please understand I am NOT advocating circumcision, merely educating about neonatal pain control in general. Unfortunately, especially in a neonatal intensive care unit, painful procedures such as blood draws, heel pokes, and IV starts must be performed at times. If it's feasible for a mother to breastfeed during things like heel pokes, it is ideal. A baby who is able to latch well can receive supreme comfort from his mother. However, usually in the interest of the amount of space available around a small person, breastfeeding isn't always possible during a procedure. At those times a pacifier and sugar solution can make a baby MUCH more comfortable during (and sometimes even sleeping through) a painful procedure.

Jenn said... [Reply to comment]

Hi anonymous, I think we can all agree that when it comes to the NICU circumstances can be different. However, I do want to point out that new research published this year out of London shows that the sugar water pacifier trick is not any more effective than a pacifier with sterile water. A pacifier is really only useful to give the baby something to cling to in this instance, and you are right, mother's breast is the ideal comfort measure during comfortable, medically necessary procedures. Here's a bit about the new research:

Megan said... [Reply to comment]

I was really lucky because my hospital provided me with a room where I slept in with my baby the whole time so he never ended up in the nursery where he could possibly get formula. It also helped that the nurses came ONLY when you pressed the call button and they were required to be lactation consultants. At my hospital, breastfeeding was pushed, and the hospital pushed it on people who were even planning on formula (there was a girl on my floor) saying that even if you only feed them breastmilk while you are in the hospital that you are doing a tremendously amazing thing for your child. A nurse helped me latch for an hour and a half when I was having difficulty at first! Though I know this isn't the typical experience, I was really grateful to be at such a progressive hospital. I was at Prentice Women's Hospital in downtown Chicago (associated with Northwestern University, only for women, literally the hospital is entirely dedicated to birthin' babies and women's issues) and I think it would be great if someone (maybe you, Jen?) wrote an article singing their praises, because they really deserve it! While we were in the hospital, they also held a 2 hour long class on breastfeeding where attendance was strictly enforced (that's how I knew about the girl on my floor who was doing formula, and she actually changed her mind and decided she would at least breastfeed during her maternity leave, imagine what a difference Prentice made in that baby's life, and probably so many others!). They also gave us a name of a nurse we could call 24 hours a day who would come out to see us if we were having problems. Great support :) Even if I'm living in a different state, I think I'll move back to IL for a while to have all of my babies there... :D

Megan said... [Reply to comment]

Do you even see them mention formula? Hahaha...

Jenn said... [Reply to comment]

Megan that sounds amazing! It is absolutely what hospitals should offer women. I may move to Chicago just to birth there!

rachel said... [Reply to comment]

This post makes me really appreciate my hospital stay. I was having trouble with bleeding immediately after the birth, and the nurse helped my little guy find my breast within 5 minutes of his arrival (and he latched like a champ - he was hungry!). I co-slept in the hospital, fed on demand, and I guess I did make up answers about when we last fed, but mostly because he was pretty much constantly latched those first few days. The kid wanted to eat...

So not all hospitals are that bad on the BF front (although I understand that that is not necessarily the norm). A baby-friendly hospital should encourage and support breastfeeding, and actually, my hospital was not even one identified as baby-friendly.

Megan said... [Reply to comment]

My hospital is part of a study on infants with low birth weight that must be admitted to the NICU. Their results regarding those babies and breastfeeding are pretty inspirational:
Sorry that I'm gushing about my hospital so much, but it was just an amazing experience, I couldn't have asked for more! They even had a place in the room for the dad to sleep so the whole family could be in their own private room the entire time, and it was such a great way to spend our first moments as a family (not to mention that our room had a whole wall that was just a window view oflakeshore drive/lake michigan, that didn't hurt either!)

Annie said... [Reply to comment]

Thank you so much for this amazing article!! I had awful night nurses with my first daughter and amazing ones with my son but they were at separate hospitals. Since it has been 3.5 years since DD's birth I really hope that when I got back to the hospital I had her in they do NOT have the awful nurses on staff.

Yes, having very few wet diapers sets off unneccesary alarms. I need to remember this now before I get all emotional and let them talk me into stuff then! Thank you so much!

And definitely find a La Leche League leader you can call anytime during your hospital stay. They are so caring and knowledgable in my experience.

mikroenjeksiyon said... [Reply to comment]

Was a beautiful page. Thanks to the designers and managers.

Anonymous said... [Reply to comment]

I don't know... I feel really bad for you. You sound extremely bitter about your birth and after-birth experience. I had a hospital birth and breastfed... and it was NOTHING like you said. The LLL ladies at the hospital were SO SO SO helpful and patient and positive. Nothing went down that *I* didn't want to go down. I mean yeah, I threw my birth plan out the window and went with the flow (so to speak) as different situations arose... but at no time was I ever forced to abandon my principles or do something for myself or my son that made me edgy or uncomfortable. Sounds like you just didn't do a good job researching your hospital options beforehand... :( Everybody should know that it's NOT always like this. Don't expect the hospital to know what decisions to make for you... make them yourself and choose your hospital accordingly!

Jenn said... [Reply to comment]

Well, anonymous, if you take a look around my blog you will note that I write on birth disappointment. I did a lot of research on birth and a lot on breastfeeding. Unfortunately, in today's society too many women are asked to compromise their principles by hospitals that don't always know what's best for them or baby.

I have every right to judge my birth and breastfeeding experience. My hope is that other women who are put in this position don't fall into a detrimental supplementation cycle because the nurses have no training in breastfeeding. Moms should know breastfed babies have different needs and not be pressured to conform to formula fed standards.

I not only made every decision regarding breastfeeding for myself. I fought for them when I was condescended to and mocked. I'm not bitter. I'm empowered enough to call out a broken system and refuse to be a part of it. I'm super glad you had a good experience. That's a rarity for most women who are made to feel inadequate.

And you are right, I could have chosen a different hospital the first time. I foolishly still believed hospitals wanted to do the best thing for mom and baby not push formula.

I'd also note that you say you had LLL people at the hospital, so either you were being helped by people who were not staff or ....

I owe honesty to people who read this. This was my experience. Even at a baby-friendly hospital the second time, I still fought against misinformation. I'm not willing to risk a mother's desire to breastfeed on the chance she will get a more informed hospital than I did (in 2 different states).

And I don't really get what you are trying to say anyway. You are a mass of contradictions - either you called the shots or you didn't. I successfully breastfed both of my kids because I was armed with this information and trusted myself.

MarfMom said... [Reply to comment]

Women don't always have a choice in where to birth, Anon. I didn't. I was a high-risk pregnancy and there was only one hospital equipped to handle me as a patient. I researched breastfeeding ahead of time and knew what I wanted but I still hit a LOT of road blocks. Some are similar to what Jen wrote about, others were very different.

I think it's ok to be upset about your birth or breastfeeding experience. I don't think it's ok to try to shame women about those feelings. If we're honest about what's happened to us, we can help other women avoid those same pitfalls.

Sarah said... [Reply to comment]

Hi Jenn,
Thank you so much for sharing your birthing/breastfeeding experience. I too had a similar experience (Australian expat giving birth in Hong Kong last year) when I had my son. It seems that I am not the only one who is disappointed with the way births, and especially breastfeeding, is managed in the hospital system.
Like you, I ended up writing a blog post about my experiences with initiating and maintaining breastfeeding in an environment that not only fails to encourage breastfeeding but blatantly pushes formula feeding. I shouldn't have been (but I was) completely stunned when, after a 50 hour labour, the first thing the nurse said was "what brand of formula do you want us to give your baby?". When I told her that I was going to breastfeed she was equally stunned. I was the ONLY mother in the whole hospital who was attempting to breastfeed and the ONLY mother who did not supplement with formula. To make this happen, my husband, my pro-breastfeeding pediatrician, and myself had to repeatedly tell the nurses not to give the baby any formula and to bring the baby to me if he needed to be 'fed' (they are big on babies being in the nursery here). I discharged myself within 36 hours of giving birth, before my milk came in, because I couldn't stand the strict 4 hourly feeding schedule, the complete lack of support (I never saw a lactation consultant, one was never offered and I am so grateful that my son had no problems with latch and I was educated and knew what to do) and the judgement from the nurses when I would come to the nursery to collect my baby to breastfeed him.
My son is now 9 months old, still breastfed (in addition to solids) and is thriving! I agree that more needs to be done in breastfeeding support and that it should be a requirement that all nurses working with new mums be educated in breastfeeding. Mums need to be supported and encouraged to breastfeed, they need to have support systems in place to help them when the going gets tough and they need to feel that breastfeeding is the norm and not the exception (you should see how stunned most people are in HK when they find out I am STILL b'feeding my son - can you imagine?).
Thanks again Jenn!

amyelizabethsmith said... [Reply to comment]

I had a homebirth, but my son would not latch. We tried and tried -- the first two days I gave him colostrum with my finger than a syringe. By Day 4, my milk had not come in, no success with a pump, and he was starving. We gave him formula (Alimentum, to prevent allergies) until Day 7 when my milk came in. I had a beautiful, unmedicated birth, but my little boy did not root, had a hard time sucking, still refuses a pacifier. After my milk came in, he never got another ounce of formula. For 4 weeks I pumped and tried putting him to the breast at every bottle feed. At 5 weeks, my son all of the sudden, with God's grace, latched on. It took 2 weeks to get over my (our) thrush b/c of all the equipment I was using (bottles, shields, syringes) and now he is 7 weeks and solely on the breast. I had a lot of help from a BCLC, but I know if I hadn't persisted, I would have been swayed by my family, friends, telling me that formula is just fine. No it's not. The bonding alone is worth millions to me -- not to mention the nutrition, cost-effectiveness, and convenience!!!! So, now, though, I am humbled and know that every mom has a different experience and does try her best -- but some things (all things) don't work out to our expectations.

Jenn said... [Reply to comment]

@Amyelizabethsmith way to go, mama! Thank you for reminding us that sometimes breastfeeding after any birth can take time and lots of patience.

@Sarh - good for you! I bet you've inspired a lot of women to reconsider formula feeding around you.

Post a Comment