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I’m coming off a shift this weekend where every one of my postpartum rounds said this:
“The lactation consultant told me there might be a tongue tie… So we’re pumping and latching every 2-3 hours… And we’re using the nipple shield… And in the mean time, I’m trying to hand express.”
“My husband is going to do all the night feeds.”
Okay, not every postpartum mama told me this – but the number of mamas that told me there might be a tongue tie was not consistent with the incidence of tongue ties. You get the idea.
I want to offer what I give as breastfeeding advice in the clinic or hospital.
Know that it’s just advice, I’m not an IBCLC, but it’s also steeped in 15 years of experience and nursing my own 4 babes successfully (and working part to full time) over almost 6 years. There are exceptions for every mama and baby, but these are the generalities that I have stuck to for years and years.
Do more to prepare for breastfeeding than just ordering your pump.
Fortunately, breast pumps are now provided by most insurance companies.
Unfortunately, that’s all some women are doing to prepare for breastfeeding.
I hear “I have my pump in my bag….but I didn’t take any classes.”
You have to have some basic education and expectations about what breastfeeding is going to look like in the hospital and at home. Everyone should take some basic classes on breastfeeding. If you have a seasoned breastfeeding friend, ask them what to expect and to help you prepare. A lot of breastfeeding is learning with your baby, but the education provides a foundation to start from.
Here’s a list of breastfeeding classes that you can take for FREE straight from the 32 Week Visit of The Too Good to Be True Pregnancy Guides:
- Breastfeeding Housecalls
- Stanford’s Newborn Nursery
- Lactation Education Resources for Parents
- Milk & Love (course/free workbook!)
- First Latch
- Three Bird Nest
Set some expectations *before* the baby is born.
I spend a lot more time asking about what mamas and families have done to prepare for breastfeeding than I used to. What classes have you taken? Do you know about First Droplets and kellymom.com? How about skin to skin benefits? Are you returning to work…and when?
These conversations start in the clinic and can continue through admission, labor and birth.
For some of my longer inductions, we talk about starting some hand expression during induction to help with milk supply right in the hospital (and to stimulate some oxytocin receptors).
Mamas and providers, start asking these questions anytime after 24 weeks of pregnancy.
Voice any plans for feeding at night, plans to return to work, plans for pumping, plans for long term nursing, etc…everyone’s journey looks different and has different goals 🙂
This is what you’ll hear me recommend whether I’m counseling in the clinic or hospital to a mama desiring to breastfeed:
- When you are in the hospital, only breastfeed your baby (i.e. really work to not supplement with formula unless you’ve tried all the interventions). Latching to the breast is always preferred, but some babies are feisty and we have to do some hand expression, syringe feeding, cup feeding, spoon feeding. If hand expression isn’t working, then move to pumping. And do not forget about positioning – sometimes cross cradle just doesn’t work but side lying and football positions do. Try to avoid nipple shields unless recommended by a lactation consultant – they are okay for short term use and should not be used forever and ever.
- After discharge, I recommend latching to the breast for the first 2 weeks (at least) without any pumping or haakaa or hand expression. You and your baby have to get really good at breastfeeding and the only way to do that is to do it together, nursing 8-10 times a day, or more, and smoothing out all the littles bumps that you find in your journey.
- After 2 weeks, I offer this about pumping: Pumping or haakaa use once a day, between 2-8am, is all I recommend unless you have been advised to do more by a professional lactation consultant. All of our new evidence says that over-pumping and over-use of the haakaa/ladybugs is the reason mastitis and breast inflammation occurs.
- You generally do not need to put a bunch of extra milk in the freezer and you’re going to stay at home with the baby, it’s always going to be easier for you to latch the baby. And if you and your baby are going to be together for six months straight, then you might not even need your pump!
(Remember, this is general advice but for the majority of women, this is all you need to do!)
Set expectations *after* the baby is born.
Back to the night feeding comment: “My husband is going to do the night feeds.” I hear this a lot in the hospital: “My husband is going to do the night feeding so I can sleep.”
Okay, it’s a plan – and I like plans. But if you’re not getting up to pump every 3 hours and your baby is feeding from a bottle every 2-3 hours, your milk supply is going to go down.
Here are two truths:
One of the best ways to maintain your breastmilk supply long term is to nurse at night time.
It is always going to be more work to get up and pump instead of breastfeed the baby.
A better solution if you want help with night feeding is to work with your partner to get some naps during the daytime or when your partner returns home from work in the evening so you are able to get up at night.
And here’s my favorite fact that so few mamas know: Breastfeeding mamas fall directly in REM sleep – the gooooood, deep, I don’t know where I am I slept so good sleep. Even though you are getting less sleep overall, you are getting more good REM sleep at night than someone who is sleeping through night. Crazy right?
If you’re looking for your husband to help at night, ask him to fill up your water bottle and replenish your snack on your night stand, help you to get a hot shower each day, and to assume some of the meal making responsibilities in the first few months. All of those will help your self care so you are fueled and ready to care for baby at night!
Make a plan for successful breastfeeding when returning to work.
Women are a mainstay in the US workforce. Breastfeeding is also becoming a mainstay in the workforce for women – thank goodness, about time, hallelujah.
But a lot of women struggle with returning to work because no one helps them figure out how to do it successfully.
Here are my tips:
- Before birth, talk to your supervisor about your plan to breastfeed and what that looks like at work for you. Work out the bumps in advance so you have a plan. Read the laws that affect your job, company, city or state specifically – bring any education to your supervisor that you think would be helpful.
- After birth, all you need in the freezer is a day and half’s amount of milk to feed the baby – not 100 ounces mamas. Probably about 20 ounces or so depending what your baby takes in a bottle. See the above bit about pumping – a little each day adds up to a lot!
- Plan to introduce a bottle a few weeks before going back to work. Don’t wait until the day before work to try this out.
- A few days before returning work, take a half or full day away from the baby to pump and make sure you have all the things you need. Ensure you have a pump cover, coolers, storage bags…This is also a good trial run for whoever is caring for your baby.
- Make a sign for your office door or desk area that says “I’m pumping…”.
- Expect that the first week back to work will be a little hard and very tiresome. You are going to be mentally and physically tired – plan to take it easy when you get home at night and go to bed early.
- If pumping at work isn’t supported by your job, try pumping on the way to work in the car, when you get a meal/snack/break, and on the way home. Most mamas need to pump every 3 hours or so while they are away from their baby.
- Ask for help along the way – for everything. Pumping te
- Take it one month at a time. Breastmilk is recommended for the first 6 months of life. Aim for 6 months and when you get there, take it one month at a time!
Expect the slowdown.
The last tip I have is that breastfeeding causes you to slow down. Breastfeeding mandates sitting down, snuggling and feeding your baby, for hours on end, for the first few months to years that your baby continues to nurse. It’s the absolute opposite of everything our society expects of us. Embrace the slowdown mamas. Enjoy the snuggles and coos and amazing act of breastfeeding – it comes and goes faster than you can imagine.
I believe that we don’t talk enough about the intricacies of breastfeeding during pregnancy visits. And if we miss talking about it in the clinic, then we should be talking about it during admission and labor. Because by the time we get to postpartum, we barely have time to get through the basics!
Here’s my solution for that at this time.
We have dry erase boards at in each room at my hospital. For any breastfeeding mama, I write “First Droplets, kellymom.com and The Milk Minute podcast” on everyone’s board as their breastfeeding homework while they are in the hospital and for resources when they get home. I think half the battle is knowing where to go when you have questions and not everyone has insurance coverage for a lactation consultant or the money to pay for the consult.
Last bit, since the formula shortage that happened I have seen more breastfeeding across all populations than I’ve ever seen – and I am loving it. But I am also seeing more breastfeeding supplies, accessories and options than ever before and I think a lot of mamas are just completely overwhelmed.
Start conversations early…ask all the questions. Go disrupt that care.
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