Being pregnant and becoming a new mother is an exciting time that is often filled with questions and decisions you will need to make. The American Academy of Pediatrics (AAP) recommends only breast milk for baby’s first 6 months with complementary foods introduced after six months and continued breastfeeding for 2 years or beyond as long as mutually desired by mother and child. What can you do to be as prepared as possible for birth and meeting your lactation goals? Below are a few tips to consider.
Attend a Prenatal Birth and Lactation Education Class
Having a better understanding of the normal physiology of labor, birth and breastfeeding will help you define and reach your goals. Prenatal childbirth classes will review various birth options and possible medical interventions that may be presented to you as you labor or birth your baby. Prenatal lactation classes will prepare you for your first latch, how to know your baby is getting enough milk (e.g., number of wet diapers per day), and how to maintain a strong milk supply and milk flow. Understanding how the birth process and the choices you make during labor and birth affect breastfeeding success can help guide your decisions. Empowering yourself with both birth and breastfeeding information and how they are connected will assist you in making informed decisions so you can advocate for your wishes.
Develop a Birth Plan
A birth plan is a written document outlining your goals and choices during labor, delivery, and early postpartum. This plan lets your healthcare team know your wishes and can be particularly helpful for hospital or birth center staff, who may have never met you prior to the day of birth, to understand how to best partner in your care. It is best if your plan is easy to read. Depending on when you arrive at your birthplace, staff may be in a rush and you don’t want them to overlook important points. Bullet-pointed outline format kept to a page is often preferable to a longer document written in paragraphs.
When thinking about a birth plan, focus on the elements where you will need your healthcare team’s support. A desire for specific music playing from your playlist, for example, is usually fully under your control and, therefore, maybe not important to include in your plan. Think about areas where nurses, doulas, and your OB or midwife could assist you. Sometimes, when labor gets intense and you don’t wish to or can’t hold a conversation, having your preferences outlined in a birth plan helps to ensure your desires will be understood by the staff supporting you.
Your birth plan may include requests and preferences such as:
- Lowering of lights and sounds to create a calm environment
- Access to the shower or birth tub
- Pain medication available to you as soon as you arrive, offered later, or not at all
- Help to facilitate you being as mobile as possible during labor (usually helps speed up labor)
- Access to a squatting bar or birth stool
- Requests for delayed cord clamping
- Immediate skin-to-skin contact with your baby
Despite the best preparatory classes and most well-thought-out birth plan, birth often comes with some surprises that are not planned. Remaining open and flexible and partnering with a provider you trust will also be important factors in your overall satisfaction of your birth experience.
Effects of Childbirth Interventions on Breastfeeding
There are a number of interventions or procedures that may occur in the hospital or birth center setting either due to the facility’s policies or because you or your provider requests them. With these interventions, there might be effects on breastfeeding outcomes. It is important to talk with your healthcare provider about why these interventions may be needed and if there are alternatives if you would prefer another option.
Below is a list of some of the childbirth interventions that may occur before and during labor that could affect the breastfeeding process.
- IV fluids: IV fluids may be started either as a matter of the facility’s policy to start them with all laboring mothers or in case there is a need to provide certain medications during birth. The increase in fluids from the IV could lead to an increase in breast tissue/engorgement and cause your baby’s birth weight to appear inflated after birth. In turn, the baby may then appear to have rapid weight loss during the first few days after birth when it is actually just the excess fluid leaving the baby's body. A provider only focusing on the baby and not understanding what occurred during your labor may not understand the reason for the baby’s weight loss and suggest milk supplementation. As an alternative, you can ask your healthcare provider to only provide fluids if they are needed for a medical reason.
- Induction: A decision may be made by you and the provider to start labor earlier than the baby's due date. Medications will be needed to start the labor process before your body and baby are ready for the process to begin. The drugs used may lead to your baby having a weaker suck reflux as well as being sleepy causing a disruption in your regulation of oxytocin, the hormone that helps with breast milk release. Skin-to-skin immediately after birth can assist with the generation of lactation hormones to get your milk production on track.
- Assisted Vaginal Birth: If your baby is not able to get through the birth canal and labor is not progressing, your healthcare provider may need to use equipment to assist the baby out while you push. Assisted vaginal births may lead to bruising on the baby’s head and a delay in the baby’s suck reflex. Bodyworkers such as chiropractors, craniosacral providers and osteopaths can help support babies to heal from these types of birth injuries.
- Cesarean Birth (C-section): C-sections can lead to separation from the baby due to hospital policies. In recent years, hospitals are including an option for family-centered or gentle c-sections where the baby is not separated and skin-to-skin often happens on the operating table. Using the reverse crawl position where the baby latches to the breast while keeping his or her legs up on mom’s shoulder allows breastfeeding to happen right on the operating table without disrupting the operation.
- Pain Medications: You may decide to use pain medications during the labor and delivery process. Medications may cause your baby to be sleepy at the breast, and may lead to decreased sucking reflex and rooting (involuntary muscle response to stimulation of the baby’s mouth to help your baby find the nipple to feed) and an inefficient latch. Opt for epidurals without fentanyl so your baby doesn’t experience the effects of the opioid.
How Can I Get Breastfeeding Off to a Good Start?
Despite what happened in your labor and delivery, here are a few breastfeeding tips to have a good start in the early days postpartum. You may want to mention these ideas in your birth plan as well.
- After birth, delay the first bath until the first 24 hours or until you go home so you have uninterrupted time with the baby.
It is only recommended to suction your baby if medically needed, not on a routine basis. Your healthcare team can use a towel to wipe baby’s lips and baby’s nose to clear excess secretions if needed. Express your wish for gentle or minimal suction in your birth plan.
- After birth, your baby needs to often have measurements like length and head circumference completed. These procedures can all be done by the healthcare team while your baby lies on your chest. Much can be done while the baby is breastfeeding. Breastfeeding helps the baby while any blood draws are done.
- Your first milk is called colostrum, and it contains many protective antibodies and other health promoting components. Making sure your breastfed baby frequently receives colostrum in the first couple of days is important for his or her health and to establish a strong breast milk supply.
- Purchase your breast pump before you give birth and take it to your hospital or birth center when delivering. You can even get your breast pump for free through insurance. Check your eligibility here! The lactation consultants on-call can show you how to put it together so you are not spending time on a manual when you are home and need to take care of your baby.
- After birth, have your baby stay in your room with you and sleep near you while in the hospital. Ask your support partner, family and friends to assist you with any needs you and your baby have during this time.
- It is recommended not to use any artificial nipples or pacifiers unless medically necessary. Talk with your healthcare provider or pediatrician about why they are needed if they are recommended for your baby, so you understand and can request other options that would be more supportive of breastfeeding.
- After birth, it might be beneficial to try different positions (e.g., side lying breastfeeding position or using a nursing pillow) during your breastfeeding session that help you feel comfortable, especially after the birthing process.
If you have any concerns or questions regarding breastfeeding after you deliver, you can request to speak to the on-call, hospital-based lactation consultant before you are discharged to assure you have your questions answered. Breastfeeding mothers can also book a virtual one-on-one appointment with an Aeroflow lactation consultant from their hospital bed!
Where Can I Find Support?
- Join a support network of new moms, parents, and parents-to-be. Aeroflow’s free postpartum support group meets every Monday at 3:00 pm ET on Zoom.
- Work with a doula. Today doulas offer both in-person and virtual care. Doulas give you a more personalized experience preparing for birth and breastfeeding. Virtual doula care is free through insurance at Aeroflow. Usually you see your doula a few times prenatally; she is there for you during labor and birth and for a while after birth. A doula also generally checks in with you a couple times after birth to help support your home transition and first week with the baby.
- Get to know your healthcare provider’s approach to childbirth, reasons for this approach, and for information to help determine if a procedure is commonly performed by the provider. If you write a birth plan, it is important to make sure your wishes align with your provider’s philosophy and practices.
- Write a birth plan with one of our Aeroflow specialists. Write to firstname.lastname@example.org to set up a birth and breastfeeding plan session covered by your insurance.
- Choose a birth place that is best for you – hospital, birth center, or home. Having a birth location that is supportive of your values and plans can be a game changer in achieving your goals. Women change providers and practices up through the 9th month of pregnancy. If what you are doing doesn’t feel comfortable, get on the internet, make calls, ask friends, and interview other providers. Confidence in those that care for you is essential to your experience of a positive birth, even if actual events surrounding your birth don’t go as planned.
- Identify the support people in your life. Try to put support in place before your big day. Perhaps your partner or your sibling or best friend is the obvious choice as your main connection. Looking for temporary paid help for the postpartum period can be a game changer to keep your anxiety about household chores at a minimum. In addition to housekeepers, postpartum-focused care is possible. Baby nurses tend to focus on the baby - feeding, laundry, rocking - while postpartum doulas really work for the family to help transition to life with a newborn. They are there to help guide you to take over as a parent. Generally, postpartum doulas have some background in breastfeeding and may be more supportive of breastfeeding overall. Including your support team in your prenatal breastfeeding education can be a wonderful way to make sure everyone is on the same page.
How to Find a Birth Class that Understands the Lactation Connection?
At Aeroflow, we offer a two part series, “Birth and Breastfeeding Part 1 and 2””, where we go into more details regarding the information in this article and discuss with you labor and delivery interventions that may affect breastfeeding and how to be successful in meeting your lactation goals. To schedule an Aeroflow birth and breastfeeding class, click here.
- Holmes, A, McLeod, A, Bunik, M. (2013). Academy of Breastfeeding Medicine Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine, 8(6): 469-473.
- Hoyt-Austin, A, Kair, L, Larson, I, Stehel, E, the Academy of Breastfeeding Medicine. (2022). Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, revised 2022. Breastfeeding Medicine, 17(3): 197-206.
- Martin, E, Vickers, B, Landau, R, Reece-Stremtan, S, the Academy of Breastfeeding Medicine. (2018). Breastfeeding Medicine, 13(3): 1-8.
- Meek, J, Noble, L, Section on Breastfeeding. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1): e2002057988.
- The American College of Obstetricians and Gynecologists. Sample Birth Plan Template. Accessed at: https://www.acog.org/womens-health/health-tools/sample-birth-plan#:~:text=A%20birth%20plan%20is%20a,well%20before%20your%20due%20date