Cause and Effect: Birth -> Breastfeeding

Being both a birth doula and a supporter of breastfeeding moms puts me in an interesting position to observe the (sometimes dramatic) effects of the birth experience on breastfeeding.

This is a tricky and potentially delicate topic for someone who educates prospective parents about breastfeeding. Parents come from diverse backgrounds and belief systems. My aim never is to criticize any woman for the choices she makes about childbirth or child rearing. At the same time, if a woman professes to be really committed to breastfeeding, I think we as educators have an obligation to point out aspects of the birth experience that have the potential to make the experience more difficult than it needs to be.

Separation of mom and baby

We have come a long way from the days when (healthy) babies were immediately whisked off to the nursery and sometimes not reunited with their mothers for hours. In all the Bay Area hospitals where I have attended births, “rooming in” is the standard–no sending the newborn to the nursery unless there is a health issue.

But “no separation” can be defined in different ways. Even keeping the baby in the room does not guarantee that it will be skin-to-skin with its mother for the first couple of hours. Hospital staff have their routines and unless parents insist that nonessential routines (e.g., bathing) be delayed and essential ones (e.g., checking baby’s heart and lungs) be done while the baby is on the mom, the staff will do what they’re most comfortable doing. Ten or 15 minutes at the warmer a few feet from mom may not seem like “separation” or like much of a big deal. But in the first hour, that’s 10 or 15 fewer minutes of alert/awake time that the baby has to feel and smell its mother, laying the groundwork for the first latch. I’ve also seen happily nursing babies interrupted because, again, the hospital staff needs to check the baby or needs to move the mom to a postpartum room.

The tricky part with this is that many babies will appear to do just fine even if their initial skin-to-skin time has been shortened or their first feeding has been interrupted. No big latch problems, no milk supply issues (two of the areas moms struggle most with). The problem is that we can never know what might have been. How much better could the experience have been if no separation had occurred?

Medication in labor

This area requires me to tread with even more caution. It’s not my call whether a mother should or should not receive pain relief during labor. But I do think she should make the decision with a full awareness of both benefits and possible risks.

The problem is that if you ask an anesthesiologist about the risks of, say, epidural anesthesia, he or she will focus on the risks to the mother, which admittedly are small. There usually is not a full disclosure of effects on the labor, the baby, and the breastfeeding experience. For example, one study found that the babies of women who receive epidural anesthesia in labor are more likely to receive a bottle supplement while hospitalized (Effect of Labor Epidural Anesthesia on Breast-Feeding of Healthy Full-Term Newborns Delivered Vaginally.) Or consider the possible effect of a known side effect of epidural anesthesia, maternal fever.  Some mothers with epidurals–especially those that last for many hours–experience rising body temperature. This can result in a routine “sepsis workup” to rule out infection in the baby. Result: separation of mom and baby and possible interruption of breastfeeding.

Long or difficult birth

Lest you think that all negative impacts on breastfeeding result from being in a hospital environment, know that some simply result from the way the birth unfolds. A long labor, depending on the circumstances, can be exhausting for the mom. It can be exhausting for her uterus, too, which may not contract as it vigorously as necessary after the baby is born, possibly leading to other (necessary) interventions. Often there is little a mom can do about the length of labor beyond doing her best to ensure that the baby is in a good position.

And here things get tricky. In some cases, a mom who receives an epidural after many hours of labor that allows her to rest before the baby was born has a better initial breastfeeding experience than the unmedicated mom who is so physically drained after the baby is born that she may not even feel capable of/interested in holding the baby right away.

Needless to say, this area, like all aspects of birth and early infant care, is a complicated one with few clear-cut answers.  But adhering to a few general principles–minimizing separation of mom and baby, minimizing pharmaceutical pain relief, and supporting moms well so they are able to bond with the baby immediately after the birth.

Lactation consultant Diane Wiessinger has some great information about this on her web site, especially her essay “It’s the Birth, Silly!” There’s more to say and I’ll no doubt revisit this topic in the future!



Watch your baby, not your iPhone timer

There are two schools of thought about how to prepare for breastfeeding (and, I suspect, to parenting as well). One is the read-everything, prepare-to-the-nth-degree approach. These folks read all they can get their hands on, take a bunch of classes, and ask their friends for advice in advance. The other school of thought is best summed up by “How hard can it really be? After all, if it didn’t work, the human race wouldn’t be here!”

So which approach is more successful?

You’ll be happy–or unhappy–to hear that moms in either group may have problems breastfeeding. I hear statements like:

  • It’s so much more difficult than I thought.
  • I thought it was a natural thing, why am I having so much trouble?
  • Why is my baby doing x or y; the book said…?

The reason both the well-read and the faith-in-nature types may have problems initially can be summed up in a single word: expectations.

Those who have read and studied everything in advance believe they know what to expect. When their baby deviates from the norm, they are perplexed and frustrated. Often, the numbers that stick with parents from classes and books are the averages. Of course, no baby is average! Yet parents then don’t know what to expect, especially in the first few weeks when they’re just figuring their babies out.

Those who haven’t educated themselves may not have any idea how often a newborn feeds. They may not understand that newborns (in the first week or two) may not wake themselves for feeding. So the parents blissfully let their “really good sleepers” snooze away for 5-6 hours, which means they won’t get adequate feedings and mom’s milk supply won’t develop. Lack of food makes these babies even sleepier and jaundice may be a problem (which itself causes sleepiness).

One of the most misleading pieces of misleading information is the advice to “feed your baby every 2-3 hours.”  I have tried to modify this advice; I usually say “feed your baby 8 to 12 times every 24 hours.” Looking at it this way makes it easier for parents to deal with cluster feedings, but even this description can lead parents astray.

What we often fail to point out is that the every 2-3 hours guideline is a bare minimum, the amount of feedings you need to ensure that your baby is not starving and you’re not sabotaging your milk supply in the early weeks. The truth is that babies may feed more frequently–sometimes MUCH more frequently. A baby may eat every hour for 8 hours, or non-stop for 3 hours. This is not necessarily a sign that something is wrong!

The best advice is to “watch the baby, not the clock.” If your baby is hungry, feed him or her. Yes, this does mean educating yourself. You need to be familiar with baby’s hunger cues and be able to respond before the baby resorts to full-blown wailing. And you need to understand the size of your newborn’s stomach and the fact that they digest breast milk quickly.

Beyond some familiarity with the basic biology of breastfeeding, devote your time and energy to becoming an expert on your baby, not reading what the experts have to say about the “average” baby. After all, your baby didn’t read any books, and he or she knows exactly what to do.