Lactation Derailment Can Begin in the Hospital: 10 Tips for Avoiding a Trainwreck

29 May

I must preface this blog by explaining that

fourteen years ago I became a mother/baby nurse, and ten years ago I became the resident childbirth educator and “breastfeeding counselor” on staff at a local hospital.  We did not have an IBCLC on staff, so I was IT until we hired another educator.  My training as a nurse, some time as a member of La Leche League and my own personal breastfeeding experience was all I had in my arsenal.  Though I wasn’t “official,”  I worked the position of a lactation consultant.  And it wasn’t easy…so many moms…so little time…so many interventions.  That being said, please read the following with the understanding that I have been “on the other side,” doing my best as a nurse to help fresh babies latch…bending over beds as an educator positioning babies and sandwiching breasts for moms who were too sleepy on pain medication post-cesarean to do it themselves.

A week ago, I had the privilege of visiting a new family in the hospital to provide assistance with breastfeeding.  She has given me permission to share my observations.

When I arrived, I had dad undress baby down to diaper and in skin to skin with mom.  The baby was only 36 hours old and very sleepy after a long labor and difficult delivery.  Mom, Dad and I chatted for a moment then got to the business of latch.  The baby would not wake up.

A nurse came in to give mom pain medication.

Though I was not surprised at the baby’s behavior, he appeared jaundiced, and I knew it was important to get colostrum into him.  So, we proceeded to hand express and collect colostrum to spoon/syringe feed him.

Then the baby photographer came in to show the picture previews.

Mom asked her to come back later.  (Reminder:  Mom is sitting in hospital bed with her breasts exposed.) We continued hand expression and then fed the colostrum back to the baby.  He began to exhibit some hunger cues, so we put him back to the breast.

The OB came in to check on mom.

Once again, latch attempt without success.  More hand expression.

Knock, knock? Have you had a chance to look at your pictures? Baby photographer again. (Are you kidding me?)

More teaching, more skin to skin….fed baby more colostrum.

A different nurse came to check on mom.

Another latch attempt…

The first nurse came back to tell mom the baby’s procedure had been delayed.

We wrapped up latch attempts (and the baby) as we knew the nursery nurse would be coming to get the baby soon.  He was happily sleeping in Grandma’s arms as we discussed a care plan.

Persistent photographer, back again, insisting on showing the pictures.

I wrote out mom’s care plan.

Nursery nurse came to retrieve baby.

I ensured mom had my number for questions, planned to follow up with a home visit, and I made my exit.  Did you count the number of interruptions?  How long do you think I was there?

Eight interruptions in one hour and fifteen minutes. 

I left there concerned about derailment and feared I would encounter a trainwreck at her home visit.  Fortunately, when I arrived, breastfeeding was going well and she needed very little assistance from me at the follow up.

Now, I realize everyone that came in just saw me as a visitor.  They weren’t aware of who I was or why I was there.  However, my presence aside, feeding her newborn was mom’s priority, but what was the priority for the people that kept interrupting?  Definitely not feeding a 36 hour old, sleepy newborn who appeared jaundiced.

How can a mom even think about getting breastfeeding established when she is being bombarded by staff from all sides?  It’s sensory overload.  As a private practice lactation consultant, I see the outcome of this all the time….the trainwrecks…the result of the cascade of interventions.

What steps can you take to avoid the trainwreck?

  1. Take a prenatal breastfeeding class so that you know what’s normal for the early days of breastfeeding.
  2. Hire a Doula to minimize birth interventions which can lead to troubles breastfeeding.
  3. Find a breastfeeding friendly pediatrician who will support your breastfeeding goals.
  4. Research local resources for breastfeeding help that are available to you once you get home such as La Leche League or private practice lactation consultant that is an IBCLC (International Board Certified Lactation Consultant).
  5. Prepare your partner to be the gatekeeper after delivery to minimize interruptions in your breastfeeding. You may also want your partner to accompany your newborn to the nursery to keep watch and ensure your feeding preference is respected.
  6. Hand express your colostrum and feed back to the baby. Doing this up to 6 times a day can increase and speed copious milk production.
  7. Reinforce your desire to breastfeed without any supplementation to every nurse that you have contact with.
  8. Room-in with you baby to keep your baby close and to learn his hunger cues.
  9. Better yet, keep your baby “on” you to facilitate skin to skin contact which has been shown to stabilize temperature,
    heart rate and oxygenation. You are your baby’s best habitat!
  10. Ask to see the lactation consultant…and keep asking….getting help early is so important!
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28 Responses to “Lactation Derailment Can Begin in the Hospital: 10 Tips for Avoiding a Trainwreck”

  1. Liz Brooks JD IBCLC FILCA May 29, 2012 at 9:15 am #

    Hear hear!

  2. Vanessa Rowell May 29, 2012 at 10:25 am #

    im sure this had something to do with why breastfeeding was not succesfull as it could have been with my son….i didnt get to bf him until he was almost two days old!!!! hospjtals are so irritating!!!

  3. bellissimom May 29, 2012 at 10:17 pm #

    I remember how frustrating it was to be in the hospital and have constant, around the clock interruptions. Working with the lactation consultants was really great when we could find a peaceful moment to actually focus and work, which was not often. One thing I did was request as much time as possible with the LCs every opportunity someone would listen to my request. This resulted in us getting to work them every day at least once if not twice.

  4. ccicack May 30, 2012 at 8:22 am #

    First, I am sorry you weren’t treated like the exceptional professional that you are. Second, this look into a mother’s first several hours with baby are very telling as to what the priorities of the hospital staff are, certainly not to feed the baby mother’s milk. I am happy to hear that breastfeeding ended up making a comeback and that mom and baby were able to settle in the comforts of their own home.

  5. Caroline May 30, 2012 at 8:38 pm #

    When my daughter was born last May, my number one request was to have time to bond with her and nurse her. Turns out she had some other plans…after being head down for a morning ultrasound, she came out breech via c-section 8 hours later, never having warned us that she was even flipping through the day. She didn’t make her first breathes, and spent the first 4 hours in special care…I didn’t get my time…2 days later, she had a seizure…We spent the next 4 days in the hospital before she was transferred to a more capable NICU setting in Philadelphia at CHOP. Over those 4 days, I felt like the busiest person alive, in the hospital, and I’d just had major surgery! In the moments I spent between sitting bedside, there was ALWAYS somebody in my room for one reason or another…all I wanted was to go home, to babymoon with my newborn, and learn how to nurse her…After all, I’d nursed my son for 16 and a half months! Thankfully, I had a wonderful amazing LC at CHOP who helped me…she cordoned my area off, she taught me how to rouse a baby sleepy from seizure medications…she analyzed my milk, my nipple size, and my daughters latch…she gave me time, and made me feel comfortable…and here we are, 13 months later, still nursing strong…after a rough 35 day start in the NICU!

    • bayareabreastfeeding May 30, 2012 at 9:48 pm #

      Caroline, way to go! So happy you and your baby are doing well and that you received good breastfeeding support as you worked your way through the challenges of the NICU.

  6. Debra Woods May 30, 2012 at 8:45 pm #

    Great article. Can you tell me what is the last few words for point 5? It is missing the text. Thanks. I’d like to pass this along to my birth clients but it’s incomplete on that point.

  7. Liz D May 30, 2012 at 8:54 pm #

    This sounds exactly like my experience – my son came home slightly jaundiced due to the constant interruptions and lack of focus on encouraging me (or allowing me to since I was terribly uncomfortable with having my breast out when there seemed to always be a knock at the door) to keep feeding him in those early days. It downward spiraled from there when we went home. Despite a weeks worth of heel sticks, an ER visit, a weekend clinic visit and repeated office and home visits we muddled through but certainly it was a rough start and I can see why many mothers would find it too frustrating to continue. I think hospitals need more focus on what mothers need to support breastfeeding, and maybe a little less of the continuous checking in. Three pediatricians came to check my son the first morning he was born and repeatedly told me he was tongue-tied but the jaundice that creeped up over our stay was barely mentioned to me by the nurse in passing. Great article!

  8. StorkStories May 30, 2012 at 8:58 pm #

    Well said! My favorite is #9 but all are very very important!! I would like to add my personal tip to all moms since I see this happen every day– Please keep your baby with you after birth until first feeding established.. Just Say No to staff who want to take your baby. I’m telling you– that can work. You are the mother afterall!

  9. Nisha T. May 30, 2012 at 9:09 pm #

    I think this is a totally unfair assessment of breastfeeding in hospitals. I had tons of support when I gave birth, including the expertise of a wonderful LC. My daughter wasn’t breathing when she was born and so we didn’t get the opportunity for immediate skin-to-skin or feeding, but after she was better, every single person in that hospital made every effort to help us breastfeed because they knew that’s what I wanted. We had troubles, but that was not due to hospital staff, but we figured it out and now it’s been six months and we are still going strong with no plans to stop in the near future. I get a little tired of hearing things about how breastfeeding is hindered by hospital births when a) I didn’t a have a choice in using a hospital due to a borderline previa and b) because I had great support without a midwife or doula.

    • bayareabreastfeeding May 30, 2012 at 9:35 pm #

      Nisha, thanks for reading and commenting. I am thrilled you had a great experience in the hospital. And many moms have great support, that is why I titled it CAN begin not DO begin. Also, I did not ever imply that all births should take place at home. My intent was to make an extreme point that priorities are often misaligned and to provide tips to help moms get off to the best possible start in conditions that may not be conducive to breastfeeding. I see so many moms that don’t get the right support. I could also say that lactation derailment can begin at home, too, without the right support and follow up…no matter the setting, good support early on is a must.

  10. Helene May 30, 2012 at 9:28 pm #

    Post-delivery interruptions were a major factor in my decision to have my second and third children at home. Even though I managed to get released from the hospital in slightly less than two days, those 45 hours were among the most frustrating and annoying hours I have ever experienced. Constant interruptions for utter nonsense, and nurses literally SNATCHING my baby out of my arms for unnecessary tests or simply their idiotic schedule. Recovering from surgical birth while FIGHTING non-stop with nurses for the right to hold and breastfeed my own child was ridiculous. I am still saddened that my eldest child’s first hours earthside were spent in such a belligerent and hostile environment, even more so after having peaceful, calm beginnings with my younger two children.

    • bayareabreastfeeding May 30, 2012 at 9:53 pm #

      I, too, am sad when moms don’t have positive experiences and encourage them to find something positive in the midst to cling to. Thanks for sharing!

  11. ishen May 30, 2012 at 11:21 pm #

    I had a horrible time trying to get a lactation consultant at Alta Bates because my baby was born Ina weekend. Luckily I was determined and my baby did ok but the staff was sure eager to take him away from me for this and that!

    • bayareabreastfeeding May 31, 2012 at 6:20 am #

      It is so unfortunate that many hospitals do not provide lactation help on weekends or holidays. Good job for sticking with it!

  12. Carol May 31, 2012 at 1:07 am #

    I would love to become a lactation consultant any advice? I’m still nursing my 3.year old and am all about sharing what I know and helping .

    • bayareabreastfeeding May 31, 2012 at 6:17 am #

      Hi, Carol,
      Visit http://www.iblce.org for more info on becoming a lactation consultant. Do you have a local La Leche League group you can get plugged into? That is a great jumping off place. – Misti

  13. Amy in Oz May 31, 2012 at 2:47 am #

    A very good article! Though different to my hospital experience. I can remember the paediatrician knocking, then waiting to be called in before entering my room, while I was breastfeeding. He apologised and said he could come back later, but by the time we finished the verbal part of his checking up, baby was finished and ready for a hands on assessment.

    But on the negative side of things, we saw so few midwives both during labour (which ended in c-section) and postnatally that I felt a bit abandoned. We were having latch issues, so the midwife told me to ring my bell when baby needed a feed, and she’d come to help. I rang my bell, then waited, and waited, and waited! 45 mins later she came in and asked what I needed, but by that stage I had taken my poor hysterical baby and fed her, despite the terrible latch and nipple injuries. We never did get sufficient breastfeeding help in our 5 days in hospital. It took me, in tears, coming back to the hospital and refusing to move from the nursery until someone helped me feed my baby (they showed me a different hold, which helped immensely). Women *should not* be expected to be proactive in getting breastfeeding happening, when they have so many other things to learn and hormones swirling around after the birth of their baby!

    (The final nail in that hospital’s coffin, IMO, was when my best friend was admitted with influenza A, but they had run out of beds on the medical ward, so they put her in the post natal ward to be looked after by a nurse/midwife who also was looking after mums and babies. I will NEVER go to that hospital, where profits are more important than patient welfare!!!)

    • bayareabreastfeeding May 31, 2012 at 6:24 am #

      Amy,
      Thank you for sharing. It is extremely hard for brand new moms to process everything around them! We need to do a better job of providing a calm, low-key environment for them to begin their new journey as moms! – Misti

  14. murderboxx May 31, 2012 at 4:22 am #

    Same thing happened to me, luckily my husband was there to run interference. I asked the LC to keep going, I had waited for her too long. This was at a great baby hospital.

    • bayareabreastfeeding May 31, 2012 at 6:22 am #

      So many moms and babies, too few lactation consultants. It is virtually impossible for them to spend quality time with all the mommas! It seems to be all about the bottom line…

  15. Deidre Davis May 31, 2012 at 5:33 am #

    I was lucky to deliver at Vanderbilt in Nashville, TN. They were very considerate of my birth plan (all natural, no interventions for me or baby) and I asked every lactation consultant to come in each time there was a shift change. I wanted to soak in as much information as I could. We could have gone home after the first night, but decided to stay one more since my son had only had one really good feeding to make sure he was better established. We still struggled through the first weeks (he had a small pallet and nursed almost constantly–or so it seemed), but I am so glad we did it! He nursed for 17 months and self weaned. I missed it when it ended, and can’t wait to nurse my baby girl (who is currently due, but not in a hurry to get here, apparently–her brother was 9 days past his due date as well)!

    • Deidre Davis May 31, 2012 at 5:34 am #

      Oh, and I also researched, researched, researched beforehand. ;)

    • bayareabreastfeeding May 31, 2012 at 6:19 am #

      Deidre,
      So glad you had a great experience! That would definitely be another tip…research before choosing the hospital where you will deliver. There are some that are truly breastfeeding friendly! – Misti

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