Tag Archives: skin to skin

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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Before You Breastfeed: 10 Tips for New Breastfeeding Moms

2 Apr

1. Learn about and use Laid-back breastfeeding technique. This approach taps into your baby’s feeding instincts. Your baby is capable of latching and feeding well at the breast.

2. Have a list of things others can do to help you when they come to visit. If visitors must come in the early weeks have a list posted on the refrigerator of small tasks that YOU would find helpful and reduce your stress. Usually someone else holding the baby is not as helpful as someone running a load of laundry or fixing a meal or changing the sheets on your bed. Don’t be afraid to ask for help; your job is to spend time with your baby learning about her, feeding her and resting.

3. Spend as much time as possible in skin to skin. Having skin to skin time with your baby has amazing effects on the both of you. Science has proven that skin to skin contact with mom and baby stabilizes baby’s temperature and heart rate, helps mother identify early feeding cues, and helps mother bond more deeply with her baby.  Get comfy in a recliner or bed, have baby down to diaper and lay her on your chest heart to heart. You can put a blanket over her back and just relax. Baby may rouse and search for the breast or may fall comfortably to sleep with the familiar sound of your beating heart.

4. Learn about how to know your baby is feeding well. One of the biggest concerns new mothers have is whether or not their baby is getting enough from breastfeeding. Following are some signs to look for:

  • Your baby has adequate diaper output.
  • Your baby wakes to nurse on their own.
  • Your baby is alert and active when feeding.
  • You hear or see baby swallowing as they feed.
  • Your baby is gaining weight well.
  • You may also notice your breast feel softer after a feeding and/or you may notice a let down during a feeding or milk dripping from the other breast.

5. Find or recruit a support system. One of the major reasons women quit breastfeeding before they expect to is a lack of support from family and friends, and research tells us the spouse/partner plays the biggest role. If you are struggling in the early weeks, having family members and supportive friends to lean on and who will encourage you will help you reach your breastfeeding goals.

6. Find a breastfeeding support group early on. Breastfeeding support groups, like La Leche League or hospital based groups, are a valuable resource for help and support in the early weeks of breastfeeding.

7. Don’t forget to take care of yourself. Often times moms are so exhausted they forget to eat or drink frequently. Having snacks that you can grab quickly are life savers. You will feel your best if you are also making sure you are resting often and getting plenty to eat and drink.

8. Get help early on if things are not going well. Many moms are reluctant to get help or not sure where to find help with breastfeeding issues, but getting help early is so important! Many times minor issues can turn into major problems if help is not found early on. Getting qualified help is the key when facing challenges. An International Board Certified Lactation Consultant (IBCLC) is the highest accredited breastfeeding helper and has proven skills to assist in many of the common breastfeeding challenges. But not all Lactation Consultants are IBCLC’s so be sure to ask!

9. Take a prenatal breastfeeding class. Find a class that is taught by an IBCLC, and attend early in your third trimester.  Often times, classes taught in other locations besides hospitals will focus on prevention of problems and provide more practical breastfeeding information rather than teaching “this is how we do it at XYZ Hospital.”  Consider a private class to get the most customized experience.

10. Build your portable nursing nest. Whether you decide to have a special place to nurse your baby or nurse in different locations throughout the house, having a basket of self-care items within hand’s reach is invaluable.  Here’s a list of things you may want to include in your portable nursing nest:

  • Water bottle – If you forget it, you will feel like you just trekked through the Sahara…
  • Healthy snacks – High protein, high fiber, tasty snacks to keep you satisfied…
  • Cell phone – You will get very adept at texting while nursing…
  • iPod, mp3 Player – Relaxing music…increased relaxation helps those breastfeeding hormones flow better…
  • Burp cloth – For little spits and leaking milk…
  • Breast pads – Disposable or reusable…
  • Lanolin – Your choice of nipple cream, such as Earth Mama or MotherLove, all-natural ingredients…
  • Book/Magazine – Or these days, Kindle, Nook or eReader…
This is YOUR time with YOUR baby…learning together…slow down, relax and enjoy!
*photo courtesy of www.007b.com