Booby Traps - Breastfeeding in a Busy Hospital
Part 1
Many breastfeeding preparation classes give parents an intensive express whistle-stop tour of everything breastfeeding and cover a list of topics the length of your arm leaving parents overwhelmed. You’re so focused on just getting through labor that breastfeeding prep only feels like an after thought. You’ll find Part 2 of this blog here.
(Grab your FREE breastfeeding resources HERE).
Depending on where you’re based part of that class will be spent focused on pumps and pumping - especially for US moms. But trying to give parents so much information (but at a very superficial level of learning) makes it hard to absorb the most important aspects that you’ll need in the first days with your newborn. For most moms it’s unlikely that you’ll be pumping in those first few days, so focusing on flange size etc isn’t meaningful education for you that you can use to support your breastfeeding journey during those first 2 weeks. Combine this information overload with the reality of breastfeeding support in a busy hospital you can see why less is definitely more when it comes to surviving those first 2 weeks of postpartum. Read my earlier blog about a typical labor experience in a US hospital
Hospitals are not the optimal place to learn how to breastfeed. Here’s why.
Baby is Here!
It’s over. All of the worry and stress about labor and birth is now in the past. No matter how your baby arrived you’re likely experiencing every emotion you can imagine - relief, joy, panic, uncertainty, exhaustion and probably some pain. Before you are transferred to postpartum your nurse/midwife has to document that baby has nursed or has been given colostrum you brought with you. While in labor you might have been lucky enough to have had 1:1 care from staff but this is rarely the case, there was always someone in the room or not far to support you and your partner however postpartum staffing is often far from optimal levels.
Evidence Based Breastfeeding
You may be expecting evidence based breastfeeding support but unfortunately most midwives and nurses are still teaching old school latch and positioning techniques and not a physiologic breastfeeding approach. The old school approach of forcing baby to the breast causes nipple pain to develop - and what’s one of the top reasons why women stop breastfeeding before they planned? Nipple pain. This approach may have been necessary years ago when both women and babies were heavily sedated (twilight sleep) but those days are long gone.
Knowing that you’re not getting optimal breastfeeding instruction means you and your partner will need to advocate for evidence based care. I’d suggest including specific points in your birth plan so you and your baby get off to the best start possible and avoid (or at a minimum reduce) pain. I’ve written about the importance of a breastfeeding plan here.
Postpartum in Hospital
Postpartum is often referred to as the ‘Cinderella’ of maternity services (it’s not seen as worthwhile for Government investment). As a first time mom you will have a LOT of questions and at the same time will be feeling vulnerable, uncoordinated, uncomfortable and a little clueless. You have no idea what’s normal and what’s not so you reluctantly ring the bell by your bed and hope that someone who’s not too busy can come and help. Postpartum staff are usually taking care of several moms and babies so being a squeaky wheel can make a difference in how confident you feel leaving hospital. I can’t tell you how often I’ve come to visit my clients after labor and they have been given a pump to ‘get the milk in’…this can be harmful in the early days unless your baby has been separated from you in the NICU.
In the book, What to Expect the First Year, authors Arlene Eisenberg, Sandee Hathaway, and Heidi Murkoff describe this transition as “the reverse Cinderella—the pregnant princess has become the postpartum peasant” with a “wave of the obstetrician’s wand.” The hospital has quite a busy postpartum plan for you and your baby that can involve hearing/cardiac assessments, weighing, blood spot collection, bath demo and plenty of paperwork. Throw in unexpected visitors, answering messages from family, going through all of the discharge information, it’s far from being a time of rest, recovery and bonding. Staff will be in and out even through the night doing their checks so don’t expect to get much sleep (plus you’re still on that birth high).
A new mom is usually discharged from the hospital twenty-four to forty-eight hours after a vaginal birth, or two to four days after a cesarean birth. Given the frenzied activity of postpartum this is not the time to be trying to learn and retain new information. In my midwifery training I was surprised (and yes a little naive) to find out that not all midwives cared about breastfeeding to the same level as I did. I remember hearing audible sighs of frustration from certain staff when they were assigned a breastfeeding mom as they knew their workload has just significantly increased and no additional help was coming. As a student midwife I had the luxury of having the time to spend with breastfeeding moms answering questions and offering reassurance and suggestions but that’s not the case on a normal busy day in postpartum. Staff who really want to give that nurturing breastfeeding support are often pulled in 20 different directions. Breastfeeding support gets pushed further down the priority list and families pay the price.
Dedicated Expert Support - IBCLC
Not all hospitals have full time IBCLCs - they may work restricted hours and in some cases not at all over weekends (see what I mean about lack of investment). Even if you have access to an IBCLC not all experts are created equal - one IBCLC told a client that she needed to drink milk to make more milk…
In a nutshell, the hospital isn’t the optimal place to start learning about breastfeeding. Breastfeeding isn’t at the top of your hospital’s priorities and low/disinterested staffing can limit how much meaningful support you’ll receive. (This is one of the reasons outdated information continues to be taught).
The more you know ahead of time of how to navigate those few days in hospital will help you advocate confidently for the best care for you and your baby - written birth preferences for starting breastfeeding will help.
As you wait to meet your baby talk to other first time moms about their experiences of breastfeeding support in a busy hospital.
(It goes without saying that of course there are moms who hit the jackpot and meet the most amazing staff but this is not the usual experience - did you have a positive breastfeeding experience in hospital)?
Go grab my free resources for you as you get ready to meet your baby!
