Establishing The Fourth Trimester: Success In The Hospital

We were called upon recently to see a new mama who had just delivered her perfectly healthy, beautiful baby boy at the hospital. We will call her "Jane". Jane had a history of breastfeeding difficulties with her older children and she wanted to set the stage for an optimal breastfeeding experience with this baby. The hospital lactation staff had brought a pump to her room, but because of their heavy caseload, she felt that she could get more personalized support for nursing her baby by calling in private help. She had lots of family in town staying in their home for the much anticipated arrival of this baby, so believing that she would benefit from less interruption and distraction, Jane wanted us to come to her bedside before leaving the hospital.

Jane had an unmedicated, normal vaginal birth at a local hospital. She had sought out all of the pieces of the puzzle for an optimal birth and postpartum experience, she had researched and chosen a Baby Friendly hospital based on their written breastfeeding policies and normal birth outcomes. She hired a supportive birth doula. She delegated the care of older children to her support team and requested additional lactation help.

And then during our visit with her that morning, where her goal was to work on latch pain and positioning difficulties, her effort to nurse her baby was interrupted 8 times over the course of about 2 hours. The baby was even removed from the room without Jane's direct consent for 30 minutes. 

Those immediate hours and days after having a baby should be sacred- but it didn't feel that way. 

In that moment, our mothering instincts went into overdrive. We wanted to create a safe space for the mama and baby who desperately needed the time to get to know each other. A baby’s desire and physiology to nurse are driven instinctively. And those instincts are triggered by the touch of mama’s skin, the warmth of her body when she holds him close to hers, when he smells her colostrum, and by hearing the familiar sound of her beating heart. It is so important in those immediate moments, hours and days after birth, to keep mother and baby close and connected. 

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Some hospitals are finally catching on to the benefits of "the magical hour" and family-focused recovery (which has been connected to better breastfeeding outcomes) by even implementing a protocol or adopting similar policy to the Baby Friendly Hospital Initiative: “Ten Steps To Successful Breastfeeding”-

1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming in - allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

Even in the best of circumstances, the best birth possible, and in the most “breastfeeding-friendly” of hospitals the fast-paced setting and number of different staff members with different roles can make it difficult for the facility to fully adhere to their own policies! For example, even when nursing on cue is encouraged, if there are rules that say the mother and baby must each have their vital signs checked every x number of hours, then the vital signs will be checked and breastfeeding will be put off “for a few minutes”. The issue starts to become problematic when every cue is being put off because there is another test, another check of the hospital bracelet, another hospital photographer, another person popping in to bring a tray, take a tray away, and so on until hours have passed and the swaddled baby has fallen asleep without a chance to just be at his mother’s breast undisturbed. So, how can you protect your Fourth Trimester experience while you are in the busy hospital environment? As you gather your birth team and postpartum support, start a discussion about the importance of breastfeeding and the Fourth Trimester to you. Allow your postpartum support people to be gatekeepers and advocates keeping this time sacred for you and your newborn.

Set limits and expectations with the hospital staff by:

photo credit skintoskinbenefits.com

• Explaining to every nurse and lab tech whose shift rotates through your hospital room that you want your newborn to stay bed-side. Staff should never assume you are comfortable with them taking the baby away for bathing or tests.
• Placing a note on your door whenever you are breastfeeding your baby to come back later. Tests can be delayed. Newborns that are undisturbed and skin to skin with their mothers are calmer, cry less, regulate their body temperature more efficiently, and of course have an easier time breastfeeding.
• Letting everyone know that your priority is to nurse and get to know your baby. Your care team should support this. You can kindly ask for a new nurse assignment if you are not feeling supported.
• Reminding your care team that everything should be done in your presence. Remember, you are always entitled to ask “why”, and should be encouraged to do so. Even the simplest request to postpone or decline your newborn’s bath can have an enormously positive impact on breastfeeding.