by Donna Walls, RN, ICCE, IBCLC
Most prenatal classes tend to focus on “information” about breastfeeding like how it works or lists of all the things that can go wrong. So, whether we are teaching formal classes, having informal conversations in support groups or just talking to friends and family there are just a few points to cover to help new mothers be successful in the first days of breastfeeding. First, make sure skin to skin is a priority for the first hours after birth. When newborns are skin to skin they stay warmer, cry less and can self-attach for the first feeding (skin to skin is beneficial for breast and formula fed newborns!). Second, keep moms and babies together. New maternal hormones are flooding the mother, hormones that encourage protection and nurturing of the newborn. Keeping mothers together with her newborn allows her to learn her infant’s cues when they are hungry, need to be held or maybe need some calming and comfort. Mistakenly, hospitals believe housing newborns in the nursery will allow the mother to rest. Research demonstrates that mothers actually get more and a better quality of sleep when their infants are close and continue to nurse through the night. For those nursing mothers research shows it is important to breastfeed frequently in the first hours and days to establish and build milk supply. Third, feed when the baby is ready- not on an arbitrary schedule. Newborns often feed on an irregular schedule, responding to hunger or thirst. The goal in the first days is to feed a minimum of 8 times, preferably 10-12 times. Myths persist that newborns are sleepy in the first 24-28 hours and are not interested in feeding when just the opposite is true. Keeping the newborn close, preferably skin to skin, encourages frequent feeding when the baby smells the milk and stimulates their appetite. When the infant is close the mother she can learn their cues, small body movements, rooting or hand to mouth activity. Fourth, assure a correct, effective and comfortable latch. For a comfortable, effective latch the infant needs to latch with a wide-open mouth, far back on the breast. Human infants do not “nipple feed” (which is why moms DO NOT need the “perfect” nipple to feed her baby!} but rather form a teat with the nipple and breast tissue. Mothers should feel a tugging, pulling sensation that only happens when the nipple is farther back in the top half of the infant mouth. If breastfeeding hurts mothers should be encouraged to ask for help, especially in the hospital or birth center before going home. We need to present breastfeeding education and information in a simple, “easy to do” format. Most pregnant women have not had the opportunity to see mothers breastfeeding, to learn by watching. Breastfeeding is often presented as foreign, hard to do and uncomfortable. So, in order to make breastfeeding the norm, we need to talk to women about their concerns and offer evidence-based, practical information to build their confidence and help them be successful in breastfeeding their newborn.
References and Resources
https://www.BFMed.org CDC.gov/breastfeeding The Surgeon General’s Call to Action to Support Breastfeeding American Academy of Pediatrics AAP Policy on Breastfeeding and Human Milk USBreastfeeding.org CDC Guide to Breastfeeding Interventions: Maternity Care Practices www.babyfriendlyusa.org Bartick, M, et al (2017) Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal & Child Nutrition, Vol 13, Issue 1, DOI: 10.1111/mcn.12366 Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52 Cell Press. “How a beneficial gut microbe adapted to breast milk.” ScienceDaily. ScienceDaily, 6 April 2017. <www.sciencedaily.com/releases/2017/04/170406121515.html>. Cadwell, K and Turner-Maffei, C. The Pocket Guide for Lactation Management. 2017. Jones and Bartlett. Burlington, MA. Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. 2016 Oct. Primary Care Interventions to Support Breastfeeding: Updated Systematic Review for the U.S. Preventive Services Task Force