Episode 207

I have had the opportunity to witness first hand how birth impacts early breastfeeding. Observing mothers in hospitals, birthing centers and at homebirths has been quite eye opening to me. I have attended these births as a friend, as a birth doula and as a lactation consultant. I have witnessed first hand, many of the situations that Mary talks about in her book. Today, I would like to highlight one very important area that I feel we are still lacking in and that doesn’t get enough attention.

I am referring to the Baby Friendly Designation that hospitals earn. New parents rely heavily on the place where they give birth, to be able to assist with early newborn breastfeeding. After all, if you have never breastfed before, you will likely need help and will likely have many questions when your baby is born. It is very easy and takes very little time to open a bottle and demonstrate to parents good bottle feeding techniques. It takes knowledge and skill to help new mothers in the early days of breastfeeding. It is common for new moms to have many questions in the early days of breastfeeding –

• How do I know my baby has a good latch?
• How do I know when my baby is full?
• Do I offer one side or both sides?
• For how long?
• How do I know when my baby is hungry? or gassy? or overstimulated?
• I have no milk?
• When does my milk come in?
• What do I do if my baby won’t latch?
• If my baby is peeing every day, does this mean they are getting enough?

For years, it was well known that many facilities employed staff that had a varying degree of education in breastfeeding. Some staff who worked with new mothers had little to no education. Some used their own experience with breastfeeding and shared this with new mothers.

This created inconsistent information to parents. Their complaints were that one person told them to hold there baby a certain way and the next person who came in told them something totally different. Some moms were berated for offering both sides and were told they were going to overfeed their baby. Some were told if they kept their babies on one side for more than “x” amount of minutes, their baby was just using them as a pacifier. This is confusing to parents and quite frustrating. This lack of standardized care caused Parents leave the hospital in a state of confusion.

It was common for me to work closely with a mom during my day shift at the hospital and come in the next morning to see this same mom. I would see several bottles of formula, all with different amounts left in them and I would ask them how breastfeeding is going?

Common responses: I couldn’t wake her up to feed and it had been 3 hours. I was told that she needed to eat and because I couldn’t wake her up to breastfeed, I was told I need to give her a bottle of formula. They were concerned about her: blood sugars or she would get jaundiced. And the consequenses to that would mean there baby would need to go the nursery and might not be able to get discharged when the parents were. Or they were told that the last weight check showed too much loss. They were told there milk wasn’t it and their baby was losing too much weight. This was all way too common.

The Baby Friendly Hospital Initiative was created to address this problem as well as increase the breastfeeding initiation and duration rates. In order to receive this designation, hospitals need to follow a curriculum, action plans, training, competency verification, along with an on-site survey that facilities need to go through to successfully complete this process in order to be granted a license to use the Baby-Friendly certification.

It was recognized long ago that hospitals and birthing centers could say they were baby friendly, without really having to show that their staff was trained in basic newborn breastfeeding practices. Now they have to go through this certification process and be able to prove they have met the requirements.

One of the requirements to becoming Baby Friendly is to adhere to the Ten Steps to Successful Breastfeeding.

The Ten Steps to Successful Breastfeeding was developed by a team of global experts and consist of evidence-based practices that have been show to increase breastfeeding initiation and duration. Baby Friendly hospitals and birthing facilities must adhere to the Ten steps to receive and retain a Baby Friendly designation.

Here are the 10 steps:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast milk unless medically indicated.
7. Practice roomin in – allow mothers and infants to remain together 24 hours a day
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

I would love to say that this has solved all the problems associated with poor breastfeeding management or lack of standardized care.

This would all seem so simple, right? And yet, it is not!
There is hospital administration turn over, nursing staff turnover.
Some hospitals and birth centers have an IBCLC on staff. Some do not.
When I worked at a large city hospital, parents were told there was an IBCLC on staff 7 days a week.
Oh yes there was. That was the truth.
The important piece that was missing is that during times of budget cuts, we were only there for 2-3 hours a day making it impossible for us to see 15 moms a day.

Probably the biggest issue is that in some facilities, once the certification was received, there was no one ensuring that the policies were adhered to. Think about your own workplace and policies that are put into place. Whether they are policies that help your workplace run smoother or help the employees be more productive or for safety reasons, you would like to proudly say that these policies were all being adhered to, however, for various reasons, there is probably a few that are being ignored, done somewhat halfway and others followed to the “T”. Perhaps it depends on who is on call that day? Whether the boss is in or not? Is it a busy time of year and some things go by the way side.

I am going to let you in on a little secret, some facilities where you are going to give birth at, are just like that. Others follow Baby Friendly to the letter, 365 days a year, 24 hours a day 7 days a week.

As you have listened to moms that I have interviewed, you may recall that a fair amount of moms have said something along the lines of: and this hospital was suppose to be Baby Friendly, and yet they pushed bottles of formula on my baby. Or my baby went to the NICU and noone offer to set me up with a pump or explain to me how to use it. I hear from moms all the time who tell me their baby went for a hearing test or to the nursery for a few hours so mom could sleep and they came back with a pacifier in their mouth. Probably the biggest complaint I continue to hear is:

It was so confusing because our day nurse told us something about breastfeeding and our night nurse contradicted her. The next day my pediatrician scolded me for letting my baby fall asleep on my chest, but the lactation consultant the day before encouraged me to keep my baby skin to skin. New parents are sleep deprived, have a lot going on emotionally and physically after the birth. They are often in and out of the hospital in 1-2 days and are a bundle of nerves when coming home with a baby for the first time.

I would like to suggest to my listeners that are planning on giving birth at a hospital, to attend a local breastfeeding group that there hospital offers. If you cannot find one, search for a La Leche League meeting close to you. This is a group of volunteers who meet once a month to offer support to other breastfeeding moms.

If you are giving birth at a birthing center, do the same thing. Attend a breastfeeding group at the birthing center. If they don’t offer one, ask your midwife or doctor for a referral where you can go in the community to connect with other breastfeeding moms.

Planning a homebirth, ask your midwife for the number of a few other moms who recently gave birth or for a local breastfeeding support group that they either give, or refer moms to.

Whether hospital, home or birthing center, I would like to give you some homework. Connect with 5 other moms that have given birth in the last month or two, who have used your facility or provider. Ask them what breastfeeding was like for them. Ask them what kind of support they received the first 2 weeks of breastfeeding. Were all there questions answered? By the time they were discharged or by the time they left the birthing center or by the time their midwife left their home, do they feel that the questions they had about breastfeeding were answered? Did they feel they had easy access to information once they were home on their own. Were they given a referral list to IBCLCs in their community.

I know I sound like a pain in the tush sometimes, with suggesting you get all your ducks in a row. To so many parents they think breastfeeding will just happen, the baby is born, they latch well and no issues whatsoever. I am here to tell you that this happens all the time. I am also here to tell you that for every baby that breastfeeds well from the beginning, there is the next baby and mom that struggles.

I want you to do your homework assignment because I desperately want you to be prepared in case you are that mom and baby pair that are struggling, I do not want you to fall through the cracks. I want you to do your due diligence and find out if the place you are giving birth at, the provider that you are using, takes breastfeeding support seriously and is prepared to provide expert help in the even you have some challenges. All breastfeeding mothers should be seen by an expert who is checking the babies latch, offering suggestions when necessary, educated you on normal newborn breastfeeding behavior.

Whether you pay for your birth out of pocket or insurance covers it, the average vaginal birth with no complications can cost anywhere between 3-6 thousand dollars depending on where you live. My attitude is that if you were purchasing something for a few thousand dollars, the least you should expect is someone available to answer basic questions correctly and be there for you if you have any bigger issues.