The First 48 Hours - Breastfeeding in the Hospital
The Breastfeeding Journey (and its speed bumps)
In a social media world, we have very easy access to stories of catastrophic proportion. Even word of mouth is configured to send us only the most dramatic stories - a smooth path isn’t a story that gets repeated. We hear about times things went very wrong and there was a lot of pain or sadness. Breastfeeding is intense and emotional and touches on every part of parenting and life. It’s easy for things to go wrong in one area and quickly ripple into supplementation then quitting. Often times, moms are worried or ashamed to ask for help until after its clear that something has gone very wrong. It is my hope that in sharing these common challenges, you feel more prepared for what might come up. With that information, you can face common challenges with confidence and move through them with a sense of ownership and pride.
Common Birth Interventions
Of course, you’ve probably known a friend or family member who dealt with a low milk supply and was totally surprised. Word is getting around but it is definitely not common knowledge: lots of birth interventions can change the way you experience your first few days of breastfeeding. If you don’t know about these possibilities, it can easily feel like things aren’t going well and you just weren’t meant to breastfeed. That feeling can easily spiral if no one steps in to help you with the right information. Luckily, you’re here! You’ll have the information and you’ll know where to go if you need a hand. If you've already given birth, it can help to understand your current situation, allowing you to better face any challenges that may have come up.
It is common for these interventions to stack. For example, being induced can be very painful and physically challenging. Epidurals and IV fluids can ease the process and are often used throughout the process.
Before I add information about these impacts, I have a disclaimer. This is by no means a judgement of how anyone gives birth. Interventions can be elected for comfort, health, or safety and these choices are important for a family to have their baby the way they want to. However, breastfeeding risks aren’t always brought up. I want to share this information to make it available as these decisions are being made.
Intravenous (IV) Fluids:
Why would you use them: Birth is an exhausting process and it can be difficult to keep liquids down for some moms. I had a lot of issues with dehydration and it stalled my own labor. So I opted for IV fluids to keep myself and the baby hydrated and well equipped to finish laboring. After 28 hours, he finally came and we were ready to breastfeed!
What are the breastfeeding risks?: However, my breasts were already engorged and hard simply from the extra fluids in my body. This can make it difficult for the baby to latch until these fluids have time to leave your body
What can be done?: Many techniques are available to help you work through this temporary engorgement.
Reverse Pressure Softening
Biological Nursing
Hand Expression
Labor Induction:
Why would you use them: We still aren’t sure what causes a baby to start the labor process, but we know that oxytocin has an enormous role in moving the process forward. Baby isn’t always the best judge of timing, though, and sometimes doctors will decide that labor needs to be started before the process begins naturally. This can be for any number of reasons and can even be elective! If this decision is made, a large amount of Pitocin is delivered to the patient. Pitocin is a powerful artificial version of oxytocin.
What are the breastfeeding risks?: As in birth, oxytocin plays a large role in the muscle contractions within the breast that help move milk to the nipple. When the body is exposed to large amounts of synthetic oxytocin during the induction, changes to receptivity in the body can take some time to level out. As such, it may be more difficult to get good milk flow in the first day or two.
What can be done?: In this case, it is recommended to get as much skin-to-skin as possible, increasing the amount of natural oxytocin your body is making. Feed baby 8-12 times a day on their cues, letting them stay latched as long as they need. The nipple stimulation will help you keep breastfeeding on track even with delays from Pitocin. If this isn't getting enough food to the baby, colostrum can be expressed by hand and given with a cup or spoon. The frequency of removal is the most critical point.
Epidurals:
Why would you use them?: It is no small task to labor and push a baby through a 10cm birth canal. The pain can be incredibly intimidating and it is no small matter. In the face of that, many moms opt to use a spinal block, also known as an epidural. This effectively blocks pain signals from below a certain point on the spine from reaching the brain. For most patients, it means that labor is significantly less painful, often painless.
What are the breastfeeding risks?: An epidural often relieves pain using a narcotic pain killer. This can cause lethargy in a newborn. The science is incomplete but anecdotally there seem to be delays in beginning breastfeeding from baby's sleepiness. This can cause issues with blood sugar or weight gain and generally cause anxiety for mom and professionals. Formula supplementation can easily follow.
What can be done?: Uninterrupted skin-to-skin was found most effective in the limited studies that are available. Of course, that is a fairly low-risk intervention and one that is well known to support breastfeeding in any case.
Separation:
Why would this happen?: Babies are taken to the nursery or the NICU for countless reasons. Personally, my son had aspirated meconium (terrifying at the time but as a four year old, he thinks it’s very funny) and jaundice. His jaundice was fairly intense so he was taken to the nursery for round-the-clock blue light treatment.
What are the breastfeeding risks?: Especially in the earliest hours, mom and baby should have constant access to each other to enable on-demand feeding. Ideally, this time would be skin-to-skin and uninterrupted. When baby needs care away from mom, this process is interrupted and adds a challenge to beginning breastfeeding. Baby does not get to practice latching as quickly or as often and mom doesn’t have as many opportunities to learn hunger cues. When all of these things combine, it is definitely a disadvantage to successful early breastfeeding.
What can be done?: First is something I wish I had done; ask if the baby can stay with you. Turns out there were room-in options to treat his jaundice that no one had mentioned. This isn’t always possible, though. In those instances, you can spend time sitting with your baby in the nursery. Talk to their care team about how you can maximize your contact with the baby in ways that won’t interrupt their own medical care.
Of course, if you're still in a Virginia Beach or Norfolk hospital, most are well staffed with lactation specialists to walk you through this information in real time and as it applies to your particular situation. They can often provide you with tools to express, store, or give milk. And this is by no means an exhaustive list of things that can happen during a birth, simply an overview of some of the most common ones. If you're interested in the impacts of c-sections, I'll be covering that topic separately.
I hope you find this information useful as you prepare to breastfeed your baby. Natural doesn't mean easy but you have so much support in your community, including myself. If Songbird Lactation can help with your preparation or breastfeeding, please reach out to emily@songbirdlactation.com or 757-276-3241 for an appointment.
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