Tag Archives: Labor and delivery

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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More Than Meets the Eye: How Doulas Help Moms Breastfeed

12 May

May is International Doula Month…

Source Unknown

As lactation consultants, we are thrilled to work along side our local Houston area doulas.  It is well-supported by research that labor and birth interventions can interfere with the natural course of breastfeeding, and it is also well-supported by research that the incidence of birth complications is reduced by having a doula present at your birth.  However, a doula is more than just “present” at your birth, patting your hand through contractions.  She

  • is passionate about coming along side you during one of the most important and special times in your life,
  • meets with you throughout your pregnancy and builds a relationship with you and your partner to establish trust,
  • provides ongoing education on the labor, birth and postpartum process,
  • assists you in creating a birth plan,
  • actively networks, seeking out the best resources for you,
  • advocates for you at a time when you are most vulnerable,
  • supports you during your labor and birth,
  • acts as a gatekeeper for mom, partner and baby after the birth, and much more…

Doulas are in a unique position to recognize early on any potential breastfeeding challenges.  They understand the importance getting help early.  In our experience, moms with doula support are extremely committed to pursuing breastfeeding even through tough issues.   Cole Deelah, a South-Houston doula, childbirth educator, and midwife apprentice, describes perhaps why we have found this to be true:

“A doula can oftentimes be the mother’s first exposure to breastfeeding education. I encourage the moms that I work with to attend a La Leche League meeting, refer them to area breastfeeding workshops and classes, and offer breastfeeding books from my library, including The Womanly Art of Breastfeeding, Breastfeeding With Comfort and Joy, and others. A doula also has a lot of time during the prenatal period to educate moms on different helpful positions, what a successful latch and nursing looks like/feels like, local resources, products that might help in the journey, and what is normal/not normal when breastfeeding. And finally, in those first few moments after birth, a doula can help protect the new parenting space, help with initial latch-on, and minimize outside distractions and interference from others. In the first few days after birth, a doula is completely accessible to the new family and can oftentimes be whom the family calls when something doesn’t seem right with the breastfeeding relationship. The doula then has the opportunity to offer additional resources, like a lactation consultant, so as to ensure to the best of abilities, a successful breastfeeding relationship!” (Read more about Cole on her blog, Wonderfully Made Bellies and Babies.)

Three other doulas join Cole in the Houston Doula Cooperative, Nicole Yunker, Lourdes Resendez, and Kimberly Foster.  Read about their co-op here.

Also serving the greater Houston are are the TLC Doulas.  This group is made up of Kathleen Wilson, Dorin Jordan, Amanda Moore, Jessica Gonzales and Rowan TwoSisters.

Now hear from a mom about how her doula helped her breastfeed:

“Hi! I’m LaKendra a proud supporter of breastfeeding, midwives, doulas and all those great non intervention assets surrounding pregnancy and birth. I’m sharing my experience with you regarding Lourdes Resendez who is not just a doula but someone who has really become a special person to me and my 8 month old daughter! Growing up, I knew absolutely no one who breastfed and my family did not support me saying negative things like I’m starving my baby, I’m not producing enough milk, I need to let somebody else feed her, my milk doesn’t have everything she needs like formula, only”white” people do that, I could go on and on about the ignorance and negativity that surrounded me but you get my drift. Kennadi latched on great right after birth and Lourdes took us in for about 3 weeks as I established a great milk supply with her support, I had me a few cups of mothers milk tea on a daily basis which actually was sort of tasty to me, but she gave me that extra boost I needed to get going and staying confident in my decision!! And because of that great start, she’s still exclusively breastfed! Which as a working mom I take to heart because you really have to be dedicated pumping on lunches and breaks, but it’s been a great journey and I don’t plan on stopping anytime soon!”

…How are you celebrating your doula?

Meet the BABE IBCLCs…Misti Ryan

22 Nov

For as long as I can remember (early childhood), I have been fascinated with mommas and babies.  My earliest memory of this fascination is when I was about 4 years old after I must have seen a mom breastfeed…I tucked myself in a little corner of our living room with a blanket and my baby doll and proceeded to nurse my doll!

These early experiences fostered a desire to help mommas and babies in my adult years as I attended nursing school and specialized in obstetrics after I graduated.  My career was my passion.  Once I had my foot in the door, though, I plunged head long into my primary goal in life: getting married and having a family of my own!

My wonderful husband and I were married in 1999…baby number one was born the summer of 2001.  My sweet little daughter was born at home with the assistance of my now life long friend and midwife, Jackie Griggs.  She nursed right away.  I was in mommy heaven!  Then, day #3 hit…the challenges!  Nothing was going to keep me from nursing my baby, so I persisted through, and by 6 weeks we were nursing comfortably, and it was pure bliss!

As a labor and delivery nurse, I knew that after my own personal breastfeeding experience I was in a unique position to help moms avoid the problems I had in the beginning of my breastfeeding journey.  I took the childbirth educator position when it became available and added a breastfeeding class to the repertoire soon after.  My job evolved, and I gradually began counseling inpatient breastfeeding moms as an educator.  I made it my personal mission to educate myself on all things breastfeeding and the dream of becoming a lactation consultant was born.

La Leche League played a big role in my breastfeeding success as well as my dream.  I became a leader shortly after the birth of my 2nd daughter in 2004 and have been co-leading the Pasadena group since then.

My family grew rapidly, a son in 2003, another daughter in 2004, third daughter in 2006, and a surprise daughter in 2009…all natural births and all breastfed.  Needless to say, I stayed busy, and each year that passed I patiently postponed making the commitment to apply for the IBCLC exam.  Then, in the fall of 2010 I met Leah Jolly while working on our La Leche League groups’ treasuries.  The rest is history, and here I sit…my dream realized.

I believe mommas are strong.  I believe babies are smart.   I believe birth is a dance.   I believe breastfeeding is natural.  And I am so excited to be a part.  Let the adventure begin!