60 Tips for Healthy Birth: Part 6 – Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Keep Mother and Baby Together after Birth

1. Learn why keeping mother and baby together is healthy for you, your baby, and breastfeeding.

2. Ask your care provider about routine practices after birth. Does she encourage mom and baby to stay together?

3. During your hospital tour, ask the tour guide what nursing staff does to help mom and baby get off to the best start after birth. Do they promote skin-to-skin care? Do they delay routine newborn procedures until mom and baby have had a chance to feed?

4. Include on your birth plan that mom and baby should be kept together after birth. Share your birth plan with your care provider and the nursing staff at your place of birth.

5. Let your partner and birth support team know that you would like to keep your baby with you after birth. With the chaos that generally happens after birth, they can help facilitate your wishes.

6. Take a good childbirth class to learn how interventions can affect birth and your baby, and how they can be avoided. Many interventions can lead to separation of you and your baby.

7. When you are moved to a postpartum room after birth, keep your baby in the room with you instead of sending her to the nursery. Babies sleep best when mom is near, and you will get the best start with breastfeeding when you are close enough to see and hear their early hunger cues.

8. Take a good breastfeeding class, which will provide information on how to get breastfeeding off to a good start, including skin-to-skin care and tips for the first latch/feed with your baby.

9. If you must be separated from your baby after birth, spend time skin to skin with your baby once she is back in your arms.

10. If you have a cesarean, ask your care provider about bringing your baby skin to skin immediately after he is out. Some hospitals perform “family centered cesareans,” where mom and baby are kept skin to skin and breastfeeding is initiated in the OR. If your hospital does not permit you to hold your baby skin to skin in the OR, ask that your partner or birth support person hold baby skin to skin while you finish out your surgery and get moved to the recovery room.

Dangerous Breastmilk Sharing? Learn More About the Latest Study

Earlier this week, news sources all over the United States reported on a new study published by the journal Pediatrics, the official publication of the American Academy of Pediatrics. The study found that most human milk purchased via the internet (74% in the study) was contaminated with bacteria. This, according to the study, puts infants who consume the milk at risk. Popular news sites reported things like the following:

“The results are ‘pretty scary,’ said Dr. Kenneth Boyer, pediatrics chief at Rush University Medical Center in Chicago, who was not involved in the study. ‘Just imagine if the donor happens to be a drug user. You don’t know.’” (FoxNews.com)

“Of 101 samples purchased anonymously, nearly three-quarters of the samples contained bacteria that could make a baby sick, including three batches that tested positive for salmonella.” (U.S. News & World Report)

“Nearly 75 percent of breast milk bought through the site… was tainted with high levels of disease-causing bacteria, including germs found in human waste.” (NBC News)

So what, exactly, does this all mean? Is all shared breastmilk dangerous? What kinds of risks do bacteria in breastmilk pose? Thankfully, we can turn to helpful responses from experts in this field to better understand the study and what it means for you, if you are seeking to purchase or receive donated breastmilk. Alison Stuebe, MD, MSc, a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine, wrote a response to the study to help shed light on the its methods and potential for errors. About the sample that was obtained, she explains:

Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.

The sample obtained for the study may be skewed, but the sensational headlines don’t key in on this detail. Stuebe says:

Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination.  The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage.

And what do we make of the potentially harmful bacteria found in the milk? Suzanne Barston, a maternal health advocate, blogger, and freelance writer, shared her response on Science & Sensiblity. She says:

The other important factor to consider is that we can’t know if any babies would’ve necessarily become ill after ingesting this milk; all we can be sure of is that milk transported across the country from anonymous encounters online has a good chance of containing nasty bacteria. This was an in vitro study of a biological substance – not a study that involved actual cases of sickness caused by contaminated breastmilk.

Stuebe talks further about the difference between normal bacteria found in breastmilk and the bacteria discussed in the study. She informs readers:

A growing literature demonstrates that “fresh from the tap” breast milk contains a wide variety of bacteria, and these bacteria colonize the infant’s gut. The study reported in Pediatrics did not distinguish between species of bacteria, nor did they compare the frozen samples with freshly expressed breast milk.

When a mother cannot breastfeed, she must be able to evaluate her options between donated breastmilk and formula feeding. Amber McCann, a board certified lactation consultant and co-editor for Lactation Matters, reported recently on Science & Sensibility:

Is milk sharing risk free? Absolutely not. There are also risks to breastfeeding and formula feeding. Dr. Karleen Gribble and Dr. Bernice Hausman discuss these concerns in their paper Milk Sharing and Formula Feeding: Infant Feeding Risks in Comparative Perspective. In it, they explore the issues of contamination of milk with pathogens, chemicals, concerns with milk collection and storage hygiene. They also discuss the risks to formula use that are not present when feeding human milk.

When working with families seeking shared breastmilk (outside of a milk bank that reserves milk for babies who are in critical need) McCann encourages them to first consider anyone they know who may be willing to share milk, and then to explore local online milk sharing groups, like Human Milk 4 Human Babies and Eats on Feets, and groups that facilitate broader-range sharing and shipping, like MilkShare. When seeking milk, McCann guides families to “thoroughly research what sorts of screening they consider essential (such as blood work from pregnancy and questionnaires about lifestyle choices such as alcohol and medication use).”

The key to making the decision that’s best for you and your baby is becoming informed. Learn about all of your options and weigh the benefits and risks. Stay away from popular news outlets and carefully inserted soundbites and instead, look to trusted resources. The decision process may not be an easy one, but it is worth your time to investigate.

 
photo credit: Indrani Soemardjan via photopin cc

World Breastfeeding Week: Breastfeeding Resources Round-up

On the last day of World Breastfeeding Week, Giving Birth with Confidence celebrates by sharing some of the best resources that have been posted this past week.

Tips for Coping with Post-weaning Depression & Mood Swings at BellyBelly

Breastfeeding Images from Our Past at Mothering

50 Ways Dads can Bond with Babies at Code Name: Mama

The Breastfeeding Toddler Explains at The Leaky Boob

Liquid Assets at FitPregnancy

Working Mom Balancing Act at Pregnancy Awareness Month

Why Hospital Policies Matter: Study of California Hospitals Finds Birth Practices Impact Exclusive Breastfeeding Rates at Science & Sensibility

Nursing School at Lamaze for Parents

The Short- and Long-Term Benefits of Breastfeeding at CWS Blog

World Breastfeeding Week: Nursing in Public Tips & Tricks

In a perfect world, women would feel comfortable to breastfeed anytime, anywhere. But the reality is that some women feel more comfortable breastfeeding when they use a nursing cover or locate a more secluded area to breastfeed. Just as women have a right to breastfeed anytime, anywhere, anyhow, women also have a right to feel comfortable when they breastfeed. The following are tips and tricks other moms have found helpful when they breastfeed in public:

Practice at home in front of a mirror. When you get the hang of breastfeeding, you’ll become a pro at shifting your shirt to feed your baby. If you’re concerned about showing too much while breastfeeding around others, practice at home in front of a mirror. You’ll probably find that the amount of skin you show is very little. Don’t believe me? Check out the pictures on this mama’s blog.

Buy a good nursing shirt. A good breastfeeding shirt will make you feel like Houdini. With a bit of practice, it allows you to feed baby quickly, easily, and modestly.

Enlist support. Discuss with your partner about how you will breastfeed in public. Your partner could feel awkward at first too, and that’s ok, especially if it’s a new experience for you both.

Spend some time around other breastfeeding moms. See how they handle nursing in public. Find out what worked to make them feel most comfortable.

Feed your baby in a carrier. Wearing a Moby wrap? An Ergo? A Hotsling? With some adjustment, baby carriers can position baby to breastfeed while providing an effective cover, too.

Focus inward. If you don’t look around for the reaction of others, you won’t find any. Just like if you were out in public with your nose in a book, few people would bother you. If you’re solely focused on your baby, you won’t have time to worry about what others may think.

Find a secluded area. Ask for a corner table at a restaurant, find an empty park bench, book a window seat on a plane — if you’re concerned about peering eyes, find a spot that’s away from the main stream of traffic.

Wear a nursing cover. There are so many to choose from these days. A nursing ensures that you will be 100% covered, which some moms appreciate. However, it can become cumbersome as baby grows and is more aware of her surroundings. She may not like being covered.

Prepare your response. If you’re worried about negative feedback from strangers, prepare your response in advance. There are some very witty comebacks floating around the internet. Check out this great list.

Know your rights. While public harassment for breastfeeding is not as common as you may think, it does happen sometimes. If it happens to you, know that you have rights and know what those rights are. The site Breastfeeding Law has a list of rights, state by state, as well as rights about pumping in the workplace, federal laws surrounding breastfeeding, and up-to-date information on current legislation.

Know that most people think you’re doing an awesome thing. For the few naysayers, there are even more positive people out there who think you’re a great mom. Believe in what you’re doing, feel confident about feeding your baby, and keep on keepin’ on.

 

 

 

World Breastfeeding Week: Creating Your Village

In honor of World Breastfeeding Week, August 1-7, Giving Birth with Confidence is sharing breastfeeding resources throughout the week. 

You’ve probably heard “it takes a village” when it comes to parenting and raising children. And it’s true — surrounding yourself with supportive family, friends, and professional and online resources goes a long way in making your parenting experience a better one. But what about a “village” for breastfeeding? Breastfeeding can be (and often is) a wonderful experience. It also can be trying, challenging, and hard work. Creating access to a network of people and resources who support breastfeeding will help you in times of need, provide a sounding board for your thoughts, and celebrate with your triumphs.

To create your village for breastfeeding, take a few moments before your baby is born (or right this minute, if baby is here) and answer these questions:

  • Who can I call/where can I go if breastfeeding starts to become painful?
  • Who can I call at 3am when I have an important breastfeeding question/issue that needs to be solved right away?
  • Who can give me tips (and show me!) on how to nurse in public?
  • Who will I call when I want to brag about making it through the first month of breastfeeding?
  • Who will I call to celebrate when I’m still nursing at 15 months?
  • Who will I talk to when I feel like giving up? Who won’t judge me on my decisions?
  • Who will I call when breastfeeding is over? 
  • Who will come over to my house and sit with me for an hour or more to observe my baby feed if I’m feeling uncertain?

You may be thinking, “I don’t know that many people!” If you’re unsure of who will fill your network, here are some suggestions:

  • Friends or family members who have breastfed in the past or are breastfeeding currently
  • Your midwife or OB
  • Your doula
  • Supportive women in your local mom’s playgroup
  • Your child’s pediatrician
  • Supportive online breastfeeding forum (https://www.facebook.com/groups/kellymamas/)
  • Your local La Leche League group
  • Your hospital’s lactation consultant staff
  • Evidence-based websites, like kellymom and La Leche League
  • lactation consultant

 

 How did you create your village? What questions would you add to our list?

 

World Breastfeeding Week: When to Get Help with Breastfeeding

In honor of World Breastfeeding Week, which begins tomorrow, Giving Birth with Confidence will share breastfeeding resources throughout the week. 

Breastfeeding is natural, but it doesn’t always come without challenges. Access to reliable resources is essential for a successful breastfeeding relationship. If you experience any of the following issues during breastfeeding, seek professional support (through a local lactation consultant or local La Leche League group).

Issues with Baby

  • Inconsistent or painful latch
  • Eats for less than 5 minutes per breast
  • Routinely feeding less than 8 times in 24 hours and does not have adequate wet and dirty diapers
  • Not consistently swallowing (listen to hear a “kuh” sound to indicate swallowing)
  • Fussy after most feedings
  • Poor weight gain or significant weight loss
  • Takes artificial nipple (bottle or pacifier) but not breast
  • Prematurity, birth defects (esp. cleft lip/palate), illness, traumatic birth
  • Long separation from mother
  • Working to return to the breast after supplementing with formula
  • Jaundice
  • Multiples

Issues with Mom 

  • Low milk supply or milk didn’t come in
  • No noticeable change in breasts (not becoming full or engorged)
  • Noticeably asymmetry/lopsidedness in breasts
  • Engorgement that does not go away and difficulty feeding
  • Nipple pain — bruised, cracked, bleeding or blistered nipples
  • Inverted or flat nipples
  • Nipple tenderness after the first week
  • Tenderness, heat, or pain in one area of the breast
  • Flu-like symptoms (in mom) and/or fever

 

Beginning Breastfeeding Basics

It’s instinctual for a newborn to attach to the breast. Studies have shown that a baby placed skin-to-skin on his mother’s chest right
after birth can crawl to the breast and latch on. If you hold your baby in the traditional cradle position, he’ll be able to latch on properly when his head is level with your breast, aligned with his body, and he is facing you. You should not have to lean toward him, and he should not have to reach toward you to attach. Wait for your baby to open his mouth wide so that he attaches to the areola, not just the nipple.

Another option is the football hold, where your baby is tucked by your side. Hold him on his side, his nose to your nipple. Place your arm along his back, supporting his shoulders and neck with your fingers and thumb behind his ears. Don’t hold the back of his head; he will instinctively throw it back as he latches on. Be patient and let your baby lead you; don’t rush him or pressure yourself. Remember, he knows how to do this.

As he sucks, watch and listen for his swallowing. This is the ultimate assurance that he is getting milk. Your baby will let you know when he is finished by unlatching or falling asleep; he may not want to nurse on the other breast. If he doesn’t, it will feel full when he is ready to nurse again, so start with that side.

If you pay attention to your baby’s feeding cues, nurse him often and allow him to nurse until he is finished, you can be sure he is getting enough milk. Look for these signs:

  • You will notice the change in his sucking: bursts of sucking will be followed by a pause as he swallows. You can also see the neck muscles move as he swallows milk.
  • The color of his stool will change from the dark meconium to mustard yellow by day four if he’s getting enough milk. By day six, your baby should have at least six wet diapers and three or more bowel movements in a 24-hour period.
  • Your baby should be gaining weight, although it may take 2 to 3 weeks for him to regain his birth weight.

Some babies take a few days or even weeks to breastfeed effortlessly. If yours is not nursing frequently, you are unable to identify swallowing or he is not producing enough wet diapers and bowel movements, contact your health-care provider or lactation consultant immediately. Also, keep in mind that it’s common to experience some discomfort during the first few minutes of breastfeeding. However, your nipples shouldn’t hurt throughout the entire feeding. If they do, it’s likely that your baby isn’t latching on properly. If your baby is latched correctly and you’re still experiencing pain after a few minutes, you should seek help. Most breastfeeding problems have simple solutions, but it’s important to get help sooner rather than later. Many pediatricians and hospitals have lactation consultants on staff – and may conduct regular breastfeeding classes. Your local department of health may also have a referral service. You may also contact your local La Leche League group.

 

For more parenting resources, visit the “New Parents” section of the Lamaze website.

Do I Need to Take a Hospital Tour?

This is a question many first time parents ask. There are different options depending on where you are giving birth — virtual, group or private tour. The hospital tour is an optimal time to find out how your desired birth fits into the hospitals policies and procedures.

Lamaze has created a webcast that offers insight on how taking a hospital tour can impact your labor and birth experience, the best questions to ask during a hospital tour, and tips for getting the most out of your hospital tour. Webcast presenter Allison Walsh is a Lamaze Certified Childbirth Educator and Manager of Parent Education and Lactation Services at Beth Israel Hospital in New York City.

During the webcast, you will discover:

  • The importance of taking a hospital tour before the big moment arrives
  • Tips on preventing the “mad scramble” to the hospital
  • Key issues to explore when on your tour
  • Tips to learn about hospital and provider policy on labor support, mobility, nutrition, comfort measures, breastfeeding and many more

 

For an additional hospital tour resource, check out the Lamaze tip sheet: Tips on Getting the Most from Your Hospital Tour.

 

About Allison Walsh, IBCLC, LCCE

Allison is a Lamaze Certified Childbirth Educator, Board Certified Lactation Consultant, mother of three and the Manager of Parent Education and Lactation Services at Beth Israel Hospital in New York City. As a childbirth educator, hospital administrator and delegate to the United States Breastfeeding Committee, she has been advocating for safe and healthy birth initiatives in hospitals and care centers for most of her career. Allison’s focus is implementing evidence-based maternity and surgical practices, and reaching international, national and state breastfeeding goals.

What Women Are Saying About Birth and How it Can Help You

Listening to Mothers III Report Debuts with Feedback on Birth and Maternity Care from 2,500 Women Around the U.S.

 

Last week, Childbirth Connection released the third in a series of reports (the first and second were released in 2002 and 2006) entitled Listening to Mothers. The Listening to Mothers III report is devoted to understanding the experiences and perspectives of childbearing women as a means to improving maternity care policy, practice, education, and research. Results from the first two reports have been widely used to do exactly those things.

The other intention behind the report’s findings is to increase awareness among childbearing women of the issues in our maternity care system and motivate them to seek safe and effective care. Some people like to say, “What you don’t know, can’t hurt you,” but in the case of knowing about your maternity care, what you don’t know can impact the safety and health of you and your baby. When you know all of the choices available to you, you are empowered to make the best decisions for your family.

Below is a summary of some of the key findings (excerpted from the Childbirth Connection website). I encourage you to click through and read the full report. Earmark items that you want to learn more about. Highlight things that you want to mention to your care provider. Circle things to include in your own birth plan.

The use of prenatal ultrasound has increased, including a steep increase in use for an indication that is not supported by evidence. Between the second and third surveys, the proportion of women who had two or fewer ultrasounds decreased from 41% to 30%, while the proportion who had five or more ultrasounds increased from 23% to 34%. In the most recent survey, 68% of women reported that their caregiver used ultrasound near the end of pregnancy to estimate fetal weight, compared with 51% in Listening to Mothers II. Routine fetal weight estimation is not supported by evidence or clinical guidelines.

>>Learn more about common interventions used during birth.

Many women report experiencing pressure from a care provider to have a cesarean, labor induction, or an epidural. The percentage of women who experienced pressure to have a cesarean rose from 9% to 13% between the second and third surveys, while pressure to accept an epidural increased from 7% to 15% and pressure to induce labor increased from 11% to 15%. The proportion of women who attempted to self-induce labor increased from 22% to 29% during the same period, which may be related to pressure to accept medical induction and desire to avoid such intervention. (In Listening to Mothers II, one-third of women who attempted self-induction did so to avoid a medical induction.)

>>Learn about the importance of letting labor begin on its own.

Women’s interest in and access to VBAC is shifting. The data on vaginal birth after cesarean (VBAC) suggest a small increase between the second and third surveys in the proportion of women with a prior cesarean who were interested in the option of a VBAC, from 45% to 48%. The proportion of women with a prior cesarean who reported a lack of access to VBAC grew to 56% in the current survey from 42% a decade earlier. For those who did not have the option of a VBAC, the proportion reporting that their care provider or their hospital was unwilling declined appreciably between the last two surveys, however, the proportion of mothers denied access to a VBAC for a medical reason unrelated to their prior pregnancy more than doubled (20% to 45%) across the past two surveys.

>>Learn more about VBAC options.

Hospital support for exclusive breastfeeding is improving, although women’s intentions to and experiences with exclusive breastfeeding appear to be declining. Among women intending to exclusively breastfeed, there has been a marked decrease in the percentage of women who received free formula samples or offers at hospital discharge (from 80% to 66% to 49%) and whose babies received formula or water supplementation during the hospital stay (from 47% to 38% to 29%). Across the two most recent surveys there was an increase in newborns being primarily in their mothers’ arms in the first hour after birth, a practice that facilitates breastfeeding, from 34% to 47%. However, the percentage of women nearing the end of pregnancy who hoped to breastfeed decreased over the three surveys, from 67% to 61% to 54%, as did the proportion exclusively breastfeeding at one week (falling from 58% to 51% to 50%.)

>>Learn more about the importance of keeping baby with you after birth and establishing breastfeeding.

Learn About Latch & Breastfeeding with YouTube

Photo from La Leche League International.

When beginning to breastfeed, and throughout your breastfeeding career, achieving a proper latch is the key to ensuring a comfortable experience for you (no cracked or bleeding nipples) and a satisfying experience for your baby (milk in his tummy!). Know this: Breastfeeding should not hurt! If it does, you must re-examine your baby’s latch. A poor latch leads to hurt, sore, and “traumatized” nipples, which leads to frustration, pain, and disappointment. If you find that you’re experiencing pain from breastfeeding, seek help as soon as possible. The sooner you can fix a bad latch, the less likely it is you will endure more severe nipple pain. If possible, seek help from a lactation consultant in your area. Some will consult over the phone, which can help, but for latch problems, it’s best if a lactation consultant see you and your baby feeding in action. Often, hospital maternity wards will have lactation consultants on staff. Call the hospital to ask if you can stop by for a consultation. Otherwise, search for a private lactation consultant in your area.

If a lactation consultant is not available or if you’ve already seen someone and want more information, YouTube is an excellent resource. YouTube contains several videos that demonstrate — with a live baby & mom — a good latch. Search YouTube with phrases like “good breastfeeding latch,” “how to get a good latch,” and “good latch bad latch.” Watch a few different videos to see how babies are positioned at different angles, and how a good latch looks looks on moms with different breast size and appearance, and with babies of different ages.

 Have you used YouTube for breastfeeding help? Tell us about it in the comments!