Tag Archives: Home Visit

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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No Perfect Houses Allowed: Preparing For Your Lactation Consultation

9 Apr

*Don’t clean! As lactation consultants,  our focus is on mom and baby.  We won’t be looking at the piles of laundry or dishes in the sink.  Leave the tidying up for the in-laws and even then wait at least a month…..

*Dress For Comfort Not Style.  PJs are totally ok!  Just wear a top with easy access so you won’t have to worry about it getting in the way of your breastfeeding efforts.

*Tuck Your Pets Away.  Or ask us before the visit if we mind the pets being out.  Sometimes dogs and cats are so friendly they want to be in middle of the consult.  Although Rover and Mr. Whiskers are cute, they can be a distraction for momma, and we want you to feel relaxed throughout the consult and not concerned about the pets sniffing out the new visitors and their strange bags. 🙂

*Expect to Breastfeed.  But don’t hold off a feeding if your baby is hungry before we arrive.  They are usually always willing to eat again.  It’s helpful if you can text us when you expect the baby to feed next, and we may be able to adjust our schedule around the feeding!

*Pick a location.  Decide where you will be most comfortable breastfeeding…couch, recliner, bed…and have pillows, burp cloth, receiving blanket and a bottle of water within reach.

*Write Down Your Questions.  Don’t try to remember them…your new mom brain won’t let you.  Take a couple of minutes the day of the consult to make a list of questions and concerns you may have.  We won’t leave until we know that you have had all of your questions addressed. 

*Plan payment.  Feel free to ask ahead of time the specifics about fees and payment methods so it’s not a source of worry and surprise for you at the conclusion of the visit.  You or preferably your partner may also want to contact your insurance company to see if any of our services are reimbursable to you or can be applied to a flex spending account.

*Get Your Pump Out.  If you are using a pump at the time of the consult, have it available for us to look at so we can make sure the fit is good for you and provide you tips for getting the most out of your pumping sessions.

*Talk With Your Support Person.  And ask them if they might be available to listen in on the consult and watch techniques.  Having another set of eyes and ears present ensures that when we leave you will feel confident in their ability to give you gentle reminders of the techniques and tips you learned during the consult

*Get Baby in Skin to Skin.  Plan to have your baby dressed in just a clean diaper and spend a few minutes with her on your chest, heart to heart, before our arrival. Babies who are held in skin to skin just prior to feeding go through a specific set of feeding behaviors which generally enables them to latch and breastfeed more efficiently.

*Relax.  And give yourself a pat on the back for seeking help.  While we can’t always provide an immediate fix (sometimes those magic lactation wands just don’t work), our goal is to leave you with a plan, feeling empowered and more confident to take charge of your breastfeeding journey.