Well Baby Well Mother Article #3
March 8, 2001
Getting Started Breastfeeding in the Hospital
By Patricia Gima, IBCLC
Board-certified Lactation Consultant
With more and more research on the health benefits of human milk for human infants, women in the U.S. are making the decision to follow their births with breastfeeding. Many are finding success and enjoyment in the experience. There are few pediatricians left who don't encourage a woman's breastfeeding of her baby.
However we all know of someone who strongly wanted to breastfeed but, because of complications, was not successful. That woman feels that she has failed herself and her baby. But she hasn't failed at all. Someone has failed her – failed to give her educated assistance for getting started and for continuing breastfeeding for as long as she wishes.
As a Lactation Consultant in private practice I hear from these women during the first weeks after the birth of their baby when they are struggling to correct what went wrong from the beginning. Most breastfeeding problems are created while the mother and baby are still in the hospital and are due to mismanagement early on. Most of the hospital practices that interfere with breastfeeding were put in place when most mothers were formula feeding and not everyone has learned that some of those practices do not carry over well to breastfeeding mothers and babies.
I want to offer some preventive suggestions based on 30 years of experience working with mothers who wanted to breastfeed their babies. These are suggestions for getting off to a good start. They do not guarantee that your baby will have no problems learning to feed, but they will help you to recognize the problem and to get the help you need to assist your baby in learning. Some issues that I will cover are:
. Feed early and often
. Low volume in the beginning
. Sore nipples
. No bottles and no pacifiers
. Mother or Dad with baby at all times
. Skin to skin Rooming in round the clock
. Mother needs sleep
. Limit visitors First night home from the hospital
One of the first concepts I want to stress is that your baby wants to feed at your breast. Babies don't come here desiring silicone. Your body and your milk smell familiar, like the amniotic fluid that he has been living in. You have what he wants and you have the "equipment" to deliver it. If you don't give up on him he will learn to feed at your breast. You are not doing anything wrong. You don’t have defective breasts or nipples no matter their shape and size.
Feed early and often
Request that your baby come to your breast as soon as the umbilical cord is cut before the eye drops and bath. This is a most important time in the life of your baby. You feel and smell safe to him after whatever birth experience he has had. Some babies will suckle immediately, others will gaze at you for a while, others will just put their mouths on your nipple for a while before feeding. Whatever he chooses to do is perfect. This time assures him that you are there for him. He recognizes your voice as well as your smell and taste. If he latches on allow him to feed for as long as he wants. Take your time; don't allow anyone to rush you. This is the only time that your baby will be born.
Low volume in the beginning
And you do have milk for your baby from the beginning. It is a very rare woman who has no milk for the baby she just delivered. That early milk is called colostrum. It is the best diet that your baby will every have. It is high in calories, vitamins, minerals, antibodies, immunities, antibacterial properties, and protein. Your colostrum has everything that your baby needs after birth. There is a low amount because your baby's stomach is about the size of a walnut and large amounts of milk would not be good for him at this time, as his digestive tract is beginning to start working. Colostrum is quite concentrated and is perfect nutrition. There is no desire to hasten your mature milk’s "coming in." Colostrum will be there until the mature milk is needed.
If, for any reason, your newborn is unable to feed at your breast your can express colostrums by hand and give it to him in a spoon or eyedropper. It is "liquid gold." Some women can pump an appreciable amount of colostrums but many can’t because of the low volume in the beginning. But however you can get your milk, give it to your baby. Don't let anyone tell you that since "your milk is not in" they must give your baby another food.
Hand expression is not difficult. You place your hand on the breast with fingers on the bottom and thumb on top, placed just behind the areola (dark area). You don't slide your hand on your breast, but keep the hand in that place, compressing until you see some milk appearing on the nipple. Stay at that place, continuing to compress until you get milk to drip onto your spoon. When that area is drained, rotate your hand around the breast to reach other areas. Each mother’s milk "sinuses" are located at a slightly different distance from the nipple, but, with practice, you will find where yours are and you will be able to express your milk. If you get
You can pump also but don’t be discouraged by a small amount. If it is too little to pour out, use your finger to gather it up on your finger and put it into your baby’s mouth. If you are someone who can pump a lot of colostrums, give it to your baby with a spoon or dropper, not a bottle. I will explain later why you don't want to use a bottle.
Your baby will want to feed frequently because he is supposed to do so. Remember his small stomach capacity and his need for as much of this high quality food as he can get. Place no restrictions on your baby’s frequency of feeding or his time at the breast.
Sore nipples
Feeding for a long time at the breast does not cause sore nipples. Improper latch causes sore nipples. If your baby is at the breast and your nipples are hurting he needs assistance in getting your nipple farther back into his mouth. When he is latched on well, your nipple will be stretched back to his soft palate and there will be no pain. If your nipple is halfway back and is pressed up against the hard palate, the compression will hurt. One way to help him is after he is sucking is to gently pull down on his chin as it goes down with a suck. This can help him draw the nipple farther back. Don't pull his chin down in order to open his mouth before his latch-on.
No bottles or pacifiers
If a baby has had nothing in his mouth except your breast he will more likely latch on well. Your breast and nipple shape and size are just right because they are what he knows. He will suckle until your nipple is drawn into his mouth properly and he will then be able to get the milk that he wants. However if he has had firm teats (nipples) put into his mouth bottles and pacifiers or even fingers he will expect something firm to touch his "suck spot" (back into his mouth) before he will suckle. He will come to your breast, open his mouth and wait. You can order that no bottles or pacifiers be given to your baby in the hospital. Your pediatrician orders will carry even more weight with the staff. It will be a great gift to you baby if you can assure that he doesn’t have any of the firm teats.
Sometimes when a baby cannot latch on to your breast after he has had a bottle or pacifier, you will be told that it is because your nipples are too flat or too big or too small. It is a rare mother whose nipples look like a bottle teat and even babies of those mothers have a problem latching on after the firm teats because human nipples are not going to be firm like silicone.
Mother or Dad with baby at all times
It is an added insurance if either Mother or Dad is with baby at all times while in the hospital. Anytime your baby is away from you, someone may give him a bottle or pacifier without knowing of your or your pediatrician's orders to the contrary. There are a lot of tests that are performed and some are painful. Pacifiers are often given to the baby at these times. If Dad is there he can hold the baby and let him suck on his finger for comfort as well as for quieting with such things as hearing tests. Finger suckling can also cause latch problems, but less frequently than non-skin items. The first bath can be painful to baby and will more likely be done gently if a parent is present.
Skin to skin
Your baby will feed better if he is close to you most of the time. Babies learn through their mouths and their skin. If your baby is wrapped up tightly in a blanket and is lying for long periods in a plastic bed, he will have more of a transition to you and your breast. Holding your baby against your chest with as much of his and your skin touching will help, more than you can imagine, with your baby’s breastfeeding.
Rooming in round the clock
Often mothers will tell me that their babies were feeding well, then they went to the nursery for the night, and next morning the babies couldn't latch on at all. Several things may cause this forgetting for your baby. One is the detachment of separation from you. Another is that it is tempting for the staff to give your baby a pacifier so that you can sleep longer. Another is that, if the separation is long, your baby may be extremely hungry and will find it harder to learn. If your baby is with you all of the time, you will be tuned into his feeding cues and he will feed more often, keeping his skills in tact. Even is the staff assures you that they will bring your baby to you if he wakes, these nighttime separations are a frequent cause of poor breastfeeding after a good start.
Mother needs sleep
You do need to sleep. But when you have a new baby you need to get sleep throughout the day and night, not limited to nighttime. Hospital routines make it difficult for anyone (new mother or not) to get adequate sleep. Some steps that you can take to assure you of sleep is to ask the nurses to put a do not disturb sign on your door for a while. Don’t combine this with a removal of your baby, as he can nap beside you or on your chest. If you don’t choose to have him nap with you, pull the isolette near to your bed and go off to sleep. You will then be able to hear him if he wakes. Be sure to turn off the phone and ask staff to block all visitors during this time. If you get several naps like this in the daytime you will feel like caring for your baby in your room at night. Remember that in a couple of days you will be home and you can nap in your own bed whenever you wish.
Limit visitors
Do plan to limit visitors while you are in the hospital. If you are lucky enough to have family near you who are thrilled that you have a new baby and who can't wait to welcome him into the world, you will have to be strong in limiting visitors. With no-limit visitation in hospitals today, you have to work it out yourself. What seems to work for most parents is to designate visiting hours and let everyone know what they are and why you are setting them. None of these loving people want to interfere with you and your baby’s healthy beginning, but they either didn’t breastfeed or they don’t remember how much focus it takes to get things going well.
You can let Dad call family members and say that you are receiving visitors between 1:00 and 3:00 each day that you are in the hospital – or whatever hours you choose. He can let them know that you are tired and need to get a lot of rest before coming home to full responsibility for the new baby. Friends can be told that you will call them when you are ready to have visitors. They are eager and will come bearing gifts, but I have seen breastfeeding fail because of too many visitors who wanted to stay too long. People know that the birth of this baby is wonderful and they want to be near the source of the wonderment, but it doesn’t serve you and your baby well to allow unrestricted visitors during this crucial learning, resting period. Your baby will be just as cute in a few days.
If you have a steady stream of visitors throughout the day, added to the usual hospital routines, your whole day can go by without your having enough sleep, and then nighttime will be a challenge to you and your baby. You will be tempted to have the staff care for him while you sleep and your baby is likely to encounter needless problems with feeding.
After you are at home, you will still need to restrict visitors and the same time limitation will make your recovery and continued learning go much more smoothly. Even after your baby is feeding very well, a tiring day can make feeding a challenge at night when you are overly tired. Remember that you have given birth and you need peace and quiet for a while for your recovery. And your baby still needs to be in your arms a lot of the times. Long visiting with many people holding the baby can cause him to lose his stride in the early days. If this does happen, go away, lie in bed with baby on your chest or take a nap with him beside you and he will reconnect and resume feeding.
First night home from the hospital
Your baby adjusted to the sounds, lights and smells of the hospital and the first night in your home will feel strange to him. Most babies will feel insecure in their new environment. Your baby will need to be held most of this first night until he learns that this is Home. He needs to touch someone or he doesn’t feel safe. He may want to feed often because your breast is where he feels most safe. His frequent feeding is not caused by your not having enough milk for him. He just likes to be there. Talk to him, hold him, assure him and very soon he will be able to sleep with a sense of safety. Tucking him in bed beside you between feedings is a sure way to help him know that all is well.
Be very protective of these first few weeks of your baby’s life. You can't go back and do them over. With help, your baby can resolve any problems that were created by un-knowing people, but it all flows best if you remember that your newborn needs food, warmth, and the closeness of his mother’s arms. These all happen at your breast when you take steps to assure that your baby has all of the advantages possible to get off to a good start with breastfeeding.
Have a good birth and enjoy your new little one.
Patricia Gima