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.
~
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”-
- Have
a written breastfeeding policy that is routinely communicated to all
healthcare staff.
- Train
all health care staff in the skills necessary to implement this policy.
- Inform
all pregnant women about the benefits and management of breastfeeding.
- Help
mothers initiate breastfeeding within one hour of birth.
- Show
mothers how to breastfeed and how to maintain lactation, even if they are
separated from their infants.
- Give
infants no food or drink other than breastmilk, unless medically
indicated.
- Practice
rooming in - allow mothers and infants to remain together 24 hours a day.
- Encourage
breastfeeding on demand.
- Give
no pacifiers or artificial nipples to breastfeeding infants.
- 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:
- 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.
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