We now understand that a correct and deep latch minimizes soreness. A poor and shallow latch causes nipple pain and damage.
Still, there ARE some practical ways to prepare, while you are still pregnant, to increase the likelihood of breastfeeding success.
Your choice of care provider and place of delivery can impact your birth and breastfeeding experience. These, I think, tend to work together. You may have a care provider which supports your choices for handling labor and birth, but if you deliver in a place where lots of medical intervention is standard, the course of your labor can be affected. If there is a chance your care provider might not be available for your delivery, you may be at risk for more medical intervention than you desire. The results of interventions you may experience in your labor could have negative affects on breastfeeding.
Obviously, home birth offers the most natural approach. There is no invasive, or labor altering medical equipment or medications available. Studies indicate that for a low risk mother and baby, with a qualified birth attendant present AND qualified medical care available as backup, home birth is a safe option. But, home birth is not for everyone. Personal choice or medical conditions can eliminate this option.
Birth centers are located near or are inside hospitals. They offer support for natural approaches to labor and birth. If necessary, medical assistance is just a few doors down, or a few blocks away, and is part of the same system.
Labor and Delivery units in hospitals tend toward a medicalized handling of birth. There is more pressure to stay in bed, stay tethered to the fetal heart monitor, not eat or even drink in active labor, have IV fluids, have an amniotomy (break the bag of waters) or receive Pitocin (a drug which causes contractions), have an epidural, and deliver by C-section.
Teaching hospitals, especially, seem to introduce interventions more readily. They have to provide learning opportunities for medical students and residents. Care providers deliver who there tend to be trained to more actively manage labor and birth. They often impose time limits before starting the next intervention.
Still, there are hospitals whose nurses and physicians are very open to natural delivery. They will do a great job of supporting women who want to minimize medical intervention.
Do you homework thoroughly. This choice is important enough to seek God's wisdom and guidance. Pray for direction.
I once overhead a group of residents and their attending talking during shift change report. They were discussing one woman who wanted to have a VBAC (vaginal birth after Cesarean section). One of them asked why she had a C-section with the first baby. No one knew, but the comment was made, "perhaps it was two hours from shift change." It seems that if labor is progressing too slowly for some physicians, they will push a decision to go ahead and do a C-section before a shift change. It takes a while for the new shift to gear up for surgery (of course they can always handle an emergency C-section at any time). They think it is better to do surgery when everything is organized than to risk needing to do one at shift change. Before hearing this, I had never considered "5:00" to be a risk factor for having a Cesarean! Baby may be fine, mother may be fine, but labor may be slow. However, it is 5:00 (two hours before shift change on most 12 hours shifts). Just in case labor continues to stall, do the C-section now instead of risking that the baby might not be doing so well during shift change and one might have to be done then.
But, what if the baby continued to do well, and and the mother continued to do well? What if labor would finally progress in a couple of hours if everyone just had a little more patience? Too late! Shift change! C-secton! And mom and baby are exposed to increased risks associated with an operative delivery. These risks include a decreased chance of breastfeeding success -- not to mention all the health issue which result from formula feeding.
The place of delivery, it's philosophy of care, and the philosophy, training, and experience of the care provider (OB, midwife, etc) all impact breastfeeding. A woman who has been induced a little early for fear of a 'big baby', who had a lot if IV fluids and Pitocin, and who needed an epidural over the long labor before ending up with a Cesarean because of a "failed induction" is more likely to experience problems with breastfeeding. Women who deliver without interventions or medications are less likely to have problems.
Childbirth preparation classes can affect breastfeeding success. When investigating which classes to take, inquire about the philosophy of the course. Is it consumer oriented? Will is cover the pros, cons, and possible alternatives to childbirth interventions? Does it provide objective, factual information on the effects of pain medications on labor, and baby, and breastfeeding? Does it teach a wide variety of comfort techniques to help you cope with pain? Does it cover ways to support a vaginal birth and ways to decrease the chance of needing a Cesarean delivery?
Hospital classes tend to tell you what to expect. However, they usually do not go into a lot of information on ways to support natural birth and ways to avoid a C-section. But, some do provide more complete information and have a consumer oriented philosophy, so check them out.
Contact the director or coordinator who is in charge of birth classes, and ask the above questions. Also, contact you local La Leche League group for recommendations for both care providers and for places of delivery. They tend to know the scoop and are happy to share what they know.
Take a breastfeeding class and/or attend a La Leche League meeting or other breastfeeding support group meeting. You can glean a lot of great information from these sources.
Be careful of the literature many doctors provide. A lot of it is given to them by the formula companies.
Read some good books on childbirth and on breastfeeding. For childbirth, I recommend Pregnancy Childbirth and the Newborn by Penny Simkin, et.al, and Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel. For breastfeeding, go with The Womanly Art of Breastfeeding by La Leche League (just focus on the breastfeeding material -- take or leave the other material on parenting, etc.), and The Nursing Mother's Companion by Kathleen Huggins. There are other good books on birth and breastfeeding out there. These are just the ones I like personally and have no problem recommending.
If you have inverted nipples, or other anatomical or endocrine issues which might impact breastfeeding, make an appointment during pregnancy with a certified lactation consultant (LC). She can assess your situation and make recommendations which can help breasfeeding go better.
It is helpful for all women to have support from a lactation consultant soon after the delivery and for the first days after birth. See if your place of delivery has LCs on staff and how much they are present on the unit. Especially if medical issues arise which require special approaches to feeding the baby, a lactation consultant can be an invaluable resource. She can help you avoid pitfalls which can sabotage breastfeeding.
Develop a birth plan and go over it with your care provider prior to labor and delivery. Take a copy for your labor nurse to read and discuss you desire with her. Tell her you are looking forward to her helping you meet your goals. Keep the plan to one page. If it is any longer, it won't be read or remembered. Keep the tone positive. Start with your top 5 requests, written in bullet points, and then add another 5, also in bullet points. For breastfeeding, one would be "I want to have my baby placed skin to skin on my abdomen immediately after delivery and allowed to remain there until she has finished her first breastfeeding."
Prepare to labor without pain medications, and minimize the use of pain meds. They can lead to problems with labor, lead to an operative delivery (forceps, vacuum extraction, or C-section), impact the baby's overall condition, and cause a disorganized suck. Any or all of these can cause problems with breastfeeding.
A recent study has shown that epidurals are associated with cessation of breastfeeding in about 30% of the women studied. This was the result after accounting for other factors, like education level, ethnicity etc. Some studies show no effect, but there are flaws in some of them. For example, one study compared women who had epidurals with women who were given narcotics. The study should have compared women who had epidurals with women who had no medication. Other studies indicate that epidurals do negatively affect breastfeeding.
It is very important to note, as some of the studies did, that most of the problems can be handled and corrected with time AND support of a lactation consultant. Studies show that without good information and support, breastfeeding is more likely to fail. IF YOU HAVE ANY PROBLEMS, WORK WITH THE LC! Don't try to fix them on your own if you are not certain what is going on or how to fix the it.
Anxiety and tension make labor longer and hurt more. To decrease your need for pain medications, learn and practice many comfort measures, especially positions and techniques which help you meet each contraction with relaxation. These can include, slow dancing, sitting and rocking on a birth ball, sitting on a birth ball in a shower or relaxing in a warm bath. (If you are at home, and your "water has broken", do not take a bath. Instead, shower.) Use a slow or patterned breathing technique, or even moan using low pitched sounds during a contractions.
A good class will give you a variety positions and techniques to help you cope with labor. If you still find that you need medication for pain, chances are you have progressed pretty far in labor. As a result, you will have minimized the total amount of medication taken. This can minimize any potential negative effects on labor and breastfeeding.
It may be possible, if you are wanting an epidural late in your labor, to see if the anesthesiologist can give you just enough medication to lessen the pain but keep your motor neurons "awake" so you will be more likely to push the baby out. This decreases the chance of needing an operative delivery. The effect on the baby should be also be less.
Consider hiring a doula (a professional labor support person) to care for and encourage you during labor. Studies have shown that the presence of a doula decreases the chance of operative delivery, like forceps and C-sections. If you can't have a doula, try to have at least one woman who has experienced labor, who knows comfort measures, and who has a positive attitude about labor, birth, and breastfeeding. Yes, baby's daddy (as a Christian, hopefully your husband!) can be wonderful at providing emotional support, but women helping women provides a type of nurturing support most dads can't. Plan to enjoy the support available from both, if possible.
Tell the physician, nurse, and/or midwife NOT to suction the baby's nose and/or mouth for at least one minute to see if the baby can clear it's own airway. Almost all normal newborns can. Suctioning can cause swelling of the membranes in baby's nose. Abrasions can occur in the baby's mouth, on the palate. Both can lead to latching and breastfeeding problems.
Tell the physician or midwife NOT to cut baby's cord for at least three minutes. Studies do not support early cord cutting. If the cord is cut immediately, 40% of baby's blood volume remains in the placenta and cord. At one minute, 20% remains in the placenta and cord. Delaying cord cutting allows baby to have an easier transition to air breathing without stressing his or her brain and other organs.
When baby is born, have him or her placed immediately on your body, skin to skin. (This should be discussed with your care provider before labor.) The amniotic fluid on your body helps your baby begin to reorganize and locate the nipple. Your heart beat, voice, and the amniotic fluid-like scent being emitted from your areolas (the dark skin around your nipples) also calms your baby and helps him locate your breast. The nurse can wipe baby while baby is on your tummy. It has been suggested NOT to wipe babies hands as the amniotic fluid on them helps them locate the breast and nipple.
Skip the hat. Babies kept skin to skin with their mothers don't need it. It just gets in the way of mom smelling and touching ALL of her baby.
Your baby will be colonized with the organisms (germs) from you body before picking them up from someone else -- a good thing. The nurse can wipe your baby off right there on your tummy. The less disruption your baby experiences, the more likely she can accomplish the self attachment sequence. This lets her take in a nice meal of colostrum during the first hour or two after birth. Routine newborn procedures can be delayed for a few hours.
Breastfeeding take priority because it impacts your baby's health more than weighing, measuring, and giving the Vitamin K shot right away. Even if the you have a C-section, in many cases, baby can be placed skin to skin on your chest so she can have the opportunity to breastfeed right away. Some hospitals have developed a "sterile pathway" so that mom is the first non-sterile thing a baby touches after C-section birth.
Sometimes a medical situation prevents immediate contact with the mother. Don't worry, babies are capable of figuring out how to self attach later on. But, getting your colostrum into your baby during the first one or two hours of life plays an important role in the regulating your baby's blood sugar, colonizing its G.I. tact, and decreasing the need for supplemental feeding with formula, so try. Your baby will take a long nap, beginning around the end of the second hour. The colostrum helps prevent blood sugar from becoming too low during that time.
See www.breastcrawl.org for a video clip produced by the World Health Organization. It shows what babies can do right after birth. The cultural birth practices(such as holding baby cheek to cheek with mother) are different than in American places of birth, but the breast crawl is recognized as being universal. Once again, God's design is on display.
In this video, the baby is has been wrapped and placed next to mom's face before being unwrapped and placed on her abdomen. In other videos shown in breastfeeding classes the baby is immediately placed naked on mom's tummy and not removed until baby latches and nurses. Once baby is on mom's tummy and chest, the baby's movements help her find her mother's breast, and the pumping of her legs to get her there helps massage mom's uterus. This causes it to contract so bleeding is diminished. Neat, huh? Or should I say, epic, huh?
The nice thing about infant self attachment is that all mom has to do is relax in a semi-reclined position and let baby do the work. She will naturally stroke and soothe her baby, and even
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| The Semi-Reclined Nursing Position. Baby Can Be Placed at Any Angle for C-section Moms. Picture Courtesy of La Leche League International. |
make attempts to help her find the breast. When baby is placed skin to skin on mom, her body will keep her baby nice and warm. If mom feels baby is getting cool, a light blanket over both of them usually takes care of the problem. Or, the thermostat in the room can be adjusted. Research confirms that mom is the best baby warmer ever made. Skin to skin contact can cause remarkable changes in a sick baby.
A recent article told the story of a premature baby who was dying. The mother wanted to hold her baby against her body (sometimes called "kangaroo care") so she would die in her mother's arms instead of in an isolette. As this tiny baby lay against her mother's chest, something remarkable happened. Her breathing and heart rate became stronger. Her color changed from gray to pink. The doctors and nurses were amazed. They knew this baby was dying and that there was nothing else medical science could do. Yet, this simple act of placing this baby next to her mother worked a "miracle". They doctors continued to treat the baby, and she is now a healthy little girl. They expected her to have some brain damage due to lack of oxygen, but her mother had pumped her milk for her baby. Since breast milk promotes normal brain growth, it overcame the whatever damage occurred in this case. People reading this story were amazed -- except the lactation consultants. We understood how all of this worked to save that baby's life. Once again, God's design to protect His tiny ones was on display.
In the semi-reclined, or "laid back" position as it is sometimes called, mom will not have to worry about how to hold the baby this way or that way. Trying to feed a brand newborn while mom is in an upright position can be a little difficult sometimes.
If you prefer to sit up, use the cross-cradle or football hold for that first feeding. (Cradle hold is usually NOT recommended until baby has more control of its head and can latch correctly and maintain the latch). If you find all of this fiddling to be frustrating, why not just lie back with your baby lying with its nose between your nipples? This helps her smell and see the target! Relax, be patient, and give your little one time to work through this process. Usually by one hour, they have found the prize and are enjoying their reward. Often, it is long before that. You can always try upright positions later.
There are also some important tips to help promote success in breastfeeding during the first days and weeks. I will cover these soon.
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