The Boob Group
Birth Interventions: The Impact on Breastfeeding

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[00:00:00]

[Theme Music]

Robin Kaplan : Unless a mother is in the natural birth community, or birthing with a midwife, it is very common that she will hear that birth interventions, such as epidurals and inductions, will not have a negative effect on her labor, her baby, or her baby's ability to breastfeed. With caesarean, induction and epidural rates at an all time high, what effects might these have on your ability to meet your breastfeeding goals, and what can you do if these interventions are absolutely needed? Today, I would like to welcome Fleur Bickford to the show. Fleur, aka nurture child, is an RN and an International Board Certified Lactation Consultant, as well as an avid writer, speaker and social media maven in the field of lactation. Today, we're discussing birth interventions and their effects on breastfeeding. This is The Boob Group, episode 40.

[Theme Music/Intro]

Robin Kaplan : Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. I'm your host, Robin Kaplan. I am also an International Board Certified Lactation Consultant, and owner of the San Diego Breastfeeding Center. At The Boob Group, we are your online support group for all things related to breastfeeding. Did you know that we have a Boob Group Club? All Boob Group Club members will get access to all of our archived episodes, plus bonus interviews, transcripts and special discounts and giveaways from our partners. Plus, you can interact with all this great content through the web, or through our free Boob Group app, available in the Apple and Amazon marketplace. Today I am joined by two lovely panelists in the studio. Ladies, will you please introduce yourselves?

Shanna LeCount : Hi, I'm Shanna, I am a mom of two babies.

Robin Kaplan : How old are your kids?

Shanna LeCount : I have a six year-old and I have a 17 month-old.

Robin Kaplan : Fantastic!

Marites Hoyla : Hi, I am Marites, I have two kids, a 12 year-old and a 7 month-old, and I teach prenatal yoga and I stay home with little Aiden.

Robin Kaplan : Fantastic! Well, welcome to the show, ladies.

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[00:02:28]

Robin Kaplan : Here's a question for one of our experts.

Daniel : Hi Boob Group! My name is Daniel and I'm from Manhattan. I am currently pregnant with twins and I'm due in a few months, and I'm having a tough time finding local and online resources on breastfeeding twins. Do you think that attending a regular prenatal breastfeeding will prepare me adequately for breastfeeding my twins? Also, can you recommend ways I can connect with other moms of twins in my community? Thank you so much, I really appreciate it.

Jona Rose Feinberg : Hi there! It's Jona. Great question, Daniel. I absolutely think that a regular prenatal breastfeeding class can be helpful for a mom of twins, especially if these are your first babies. There are many factors that can make breastfeeding twins more complicated or different, but having an understanding of the basic mechanics can only help. It's a great idea to supplemental class like this with some twin specific resources. I recommend Karen Gromada's book, Mothering Multiples, as well as her website, karengromada.com, for a pregnancy, breastfeeding and parenting resources for parents of multiple. You might also find it useful to schedule a prenatal breastfeeding consultation with a local specialist, who can address any specific questions you have and help you get prepared before the babies arrive, and then keep doing that for support after the babies arrive. It's also great to connect with moms of multiples. You can join your local parents of multiples organizations for online or in person support and resources. Note that sometimes clubs are more breastfeeding educated than others, so if you don't get the support you need there, don't hesitate to look elsewhere. In some areas mothers at the local support group have experience supporting moms of multiples and can be a great option for meeting other moms. There are also support groups offered at hospitals and in breastfeeding centers, so you can contact them to see if they have a group specific for moms of multiples, or if they have resources in your area. There are also online forums for breastfeeding twins on several of the online parenting communities, which can be another great way of connecting and learning from other moms and you can do that from the comfort of your pajamas or at 4 in the morning. And of course, you can check out my website, breastfeedingtwins.org, for links to these resources and more information or support. Good luck! And enjoy your beautiful new babies!

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[00:04:51]

Robin Kaplan : So today on The Boob Group we're discussing birth interventions and their effects on breastfeeding. Our expert, Fleur Bickford, is an RN and a private practice International Board Certified Lactation Consultant, in Ottawa, Canada. You can find Fleur speaking around the globe about breastfeeding, writing blog articles for her website, nurturechild.ca, and supporting moms through Facebook and Twitter. Thanks so much for joining us, Fleur, and welcome to the show!

Fleur Bickford : Thank you very much for having me, Robin, I'm really excited to be here.

Robin Kaplan : I want to start this show by saying that some birth interventions are absolutely critical to save a baby's or mother's life. We are not going to debate that topic at all today. We are also not going to place judgement on anyone who choses to use birth interventions during their labor. Our goal for today's show is to discuss how birth interventions can affect breastfeeding, and what to do to counteract these effects should you need to use a birth intervention. And to start, here are some statistics in the United States: 33% of births are by caesarean, 42% of first time moms are induced, and 60% of moms receive an epidural, and obviously, in certain areas of the country, that's actually a lot higher, and, of course, some are a bit lower. So, Fleur, what is the cascade of interventions and why is it referred to as a cascade?

Fleur Bickford : The cascade of interventions is when seemingly small interventions lead to a whole series of other interventions. When you look at the word “cascade”, one definition that you get is a small waterfall, typical one of several that fall in stage on a steep rocky terrain. And I thought that that was actually a pretty accurate visual of what can happen with birth interventions. As an example, consider the intervention of continuous electronic fetal monitoring. It may seem like a fairly benign thing for a mom to be hooked up to the monitor, to keep track of the baby's heart rate. However, when we have a mom who is hooked up, usually she is in bed, because if we have a mom who is wondering around, often the signal isn't picked up very well, and so mom's in bed, and now you have a mom who isn't moving around and the labor slows down. At this point, Pitocin is often added to speed things up. With Pitocin, we've got contractions more intense, so even if the mom was planning on having a natural birth, we often end up with an epidural, so now we have the epidural meds in the mom's system, therefor also in baby. With Pitocin and epidural, we have an increased risk of C-section. So we see just one simple intervention – putting a fetal monitor on can lead to a whole bunch of other interventions. And the cascade can continue even after the baby is born. With a C-section for example, we also have separation of mom and baby after birth, the separation often results in a baby that's less stable than one who is skin to skin with the mom and the blood sugar may drop, then we have formula being introduced to bring it back up, or we have a baby who isn't nursing well because of medication that was given during delivery, and again, we have a baby who is being supplemented, and this is a concern, because we know from numerous studies that early supplementation with formula is associated with early weaning.

Robin Kaplan : Is Pitocin generally thought of as the first trickle in the cascade?

Fleur Bickford : It's not always the first one, but it's a big one for sure. With Pitocin, a mom has to be on continuous fetal monitoring, so as we've just discussed, the fetal monitoring by itself – and the fact that we have a mom who isn't moving around – can lead to a whole lot of other interventions. The other big thing that happens with Pitocin, and the same is true for epidurals and caesarean sections, is that we have a mom who is also getting a lot of IV fluid, and we have new research that tells us that with all of the extra fluid the mom is getting, some if it will go in the baby. And this is something we've thought for a long time, but we now have the research to prove it. And this means that the baby's birth weight is artificially inflated after birth. And then when the baby starts to pee all of the excess fluid, it can look like the baby has lost a lot more weight that he may actually have. Then we get into moms being pressured to supplement with formula, and the whole downward spiral of things that can happen when we get to that point. The researcher Noel-Weiss, who did the original research about the IV fluid and birth weight, concluded that baby should be weighted 24 hours after birth, and that 24 hour wait should be used to calculate weight loss in a baby in order to give them time to get rid of any excess fluid.

Robin Kaplan : Ladies, I'd like to open this up to you now. What was your labor like and can you tell us if you had any medical interventions during your labor? Shanna?

Shanna LeCount : My first baby, my six year-old now, I actually had HELLP syndrome.

Robin Kaplan : Can you explain what that is?

Fleur Bickford : It's just basically a general acronym that encompasses a bunch of issues that you're having as a mom, and the only way to stop thos things from happening, your body breaking down, protein that comes out in your urine, and all these different things, is to deliver the baby. So there really wasn't any option in terms of induction and waiting to see if my body could have the baby naturally, because my plate rate was dropping, and I had some issues clotting and whatnot, so it was rush to the OR. So I had my baby.

Robin Kaplan : At how many weeks?

Fleur Bickford : He was 34 weeks and a couple of days. And so there were a lot of things going on, I had my baby, he was healthy, considering he was early, he had a good weight, his scores were good, but they still whisked him right away to the NICU, and they finished my C-section operation, and I remember being wheeled in a completely separate area, they took my baby to the NICU, and I just remember sitting alone, 'cause my husband had gone with the baby, and a while had past and nurses had come in to check on me, but it kind of got to the point where I had to ask to see my baby. At that point they said sure, they wheeled me into the NICU, and even then, my first experience wasn't a breastfeeding experience, it was, “Here's your baby”, and I got to hold him, but they were even very cautious to let me do that, because the medication that they had given me hadn't completely worn off. I got to have some touches and some time with my baby, but it wasn't even until later that night, I had my baby probably around 8:30 in morning, that emergency C-section, and then in wasn't until probably in the evening, until I saw a lactation consultant, and she then told me that I have some issues going on and I need to start pumping. That was kind of the initial thought. So she left me this hospital pump and she explained to me that I'd be pumping and I wouldn't be having anything really come out, and I thought that was strange, but I went along with the process and that's what we did for a while. My son spent five days in the NICU, and I think it was probably the third or fourth day before I actually even tried to get him to lash onto my breast, and there was no lactation consultant to help me do that, it was the nursing staff. And they really weren't supportive and they had this tiny baby and it was that whole ram them over the boobs sort of scenario, which, as a new mom, was very uncomfortable with. So our breastfeeding experience just started way on the wrong foot.

Robin Kaplan : Did you have birth interventions with your second child?

Fleur Bickford : With my second child, my doctor – I was here in San Diego, I wasn't for my first birth, but my doctor had given me the option to either try either try a VBAC, or to repeat the caesarean. And I decided, because my first birth experience was kind of crazy, to go with the repeat. And that experience for me was completely different. Because I had my baby at Mary Birch, which is a really good hospital for moms in our area. So I was prepared, I got past 40 weeks, so I was like 40 weeks and 3 days, my baby was full term, completely healthy baby. She stayed with me in the OR, my husband got to hold her in the OR with me for a while, for the majority of my procedure. And then really there is only a ten minute period probably where she wasn't actually with me. And then as soon as I got out of the OR, there was no “Let's wait until you hold your baby”, they put her right to my breast, and she started nursing right away, and we've had a really successful breastfeeding experience since then. So too completely different sort of deliveries and breastfeeding experiences.

Robin Kaplan : How about you, Marites?

Marites Hoyla : I actually have a very similar story, my first son was born about 41 weeks, and I'd gone into the hospital and I was in labor, my water didn't break, so they broke my water, thinking they'll kind of encourage labor to continue, and I reached about 24 hours and then I had a fever. And so they rushed me into the OR, and during that time my son's heart rate dropped to 60, and it was just consistently at 60, so they took him out and I remember the doctor saying how much distress he was in, he had pooped all over himself, he popped blood vessels in his eye, the poor thing. And then once they took him out, they showed him to me, “Here's your baby”, and then they whisked him away, and I didn't see him for hours and hours and hours. I was just so medicated at that point that I didn't really realize how long it has been, and by the time they had got me into another room I still didn't see him. He was in a nursery, they gave him a bath, all these things that was never kind of asked of me if they can do that to my baby. By the time I got in my room and I finally saw him, they had given him to me to just, “Here's your baby”, and then off he went to the bassinet, which was close to my bed, but he was still in a wooden nursery for a while. And then the nurse came and we tried nursing, and he wasn't latching on, and so they had given me a pump as well, and I thought it was just the strangest thing, why would I all of the sudden have a pump? But I was just putting my trust in their hands thinking that they know better and they've gone through this multiple times.

Robin Kaplan : It's a shame they didn't tell you the rational behind it.

Marites Hoyla : Yeah, it was just kind of like, “Here! Here!”, “Pump milk because your baby can't latch on”. And a few days later we went home. He still had problems latching on, so I was engorged and it was so uncomfortable, and all they could tell me when I called, was to take a nice warm shower and kind of help that pressure instead of nursing your baby. And I ended up drying out and my first one was on formula. Which was a bit disappointing. With my second one, we also had an emergency C-section, and I tried to go VBAC, again, he was distressed, I guess my kids are pretty dramatic at birth, and so we waited into the OR to come out, but he was with me, next to me, the whole time. When I went into the recovery room, he was next to me, they cleaned him up next to me, and when they were done cleaning him, they put him on me and he just kind of pressed up like an upward facing dog, latched on right away, and we've had a really good nursing relationship. I'm pretty happy with the second.

Robin Kaplan : You are able to kind of redeem your first. For me, I was so naive, I went in and I was ready to have my baby that day, because I felt like I was done being pregnant, so I chose the elective induction, which turned into a very long route with Pitocin, then breaking my water, which turned into an epidural, and eventually my 18 hour labor. I was told that I just have to push one more time, and he will come out, and after pushing for about 2 and half hours I was like, “OK”. And my husband told me, “Yeah, she snipped you”, so I had an episiotomy on top of all that, without being asked, which I guess I'm thankful in some ways, because it ended up not being a caesarean, which pretty much that would have been. But the recovery was about six weeks, because of the extreme episiotomy. And the second time around, seven hour labor, I pushed three times. It was just different, but definitely, that long traumatic birth was not only dramatic for me, but also for my son as well, which kind of impacted our breastfeeding in the beginning for sure. So Fleur, according to research, which birth interventions have the greatest risks for negatively impacting breastfeeding, and why?

Fleur Bickford : It's hard to say which interventions come with the greatest risks for breastfeeding issues, due to the fact that it tends to be quite individual, and the progression of breastfeeding also depends on how things are managed afterbirth. Research on birth interventions is also very difficult due to the fact that with the whole cascade of interventions that we've been talking about, it can be really difficult to zone out what specifically is responsible for any breastfeeding issues. What we do know however is that medications given during labor have a definite impact on the baby. Recent research has found that epidural medications during labor and delivery are associated with 0.5% greater weight loss by the newborn, and increased rates of supplements in hospitals, along with fewer babies being fully breastfed on discharge from hospitals. So we certainly see effects from epidural medications that are used. Other studies have also shown intermittent breastfeeding and sucking behaviors, and again, we get into a whole cascade of interventions after the birth as well when we have a baby who is not nursing well. We also have narcotic medications that are sometimes given during labor and delivery, respiratory function for babies which often means separation of mom and baby after the birth, and they can also interfere with coordination, sucking, swallowing and breathing. Pitocin is associated with higher rates of jaundice. It also causes very strong frequent contractions, which can end up leading to feel distressed, which then leads to an emergency C-section a lot of the times. Those really strong contractions can lead to pressure on the fetal skull, which can impair the functioning of the cranial nerves. And the other thing with Pitocin is that it has an anti-dieretic effect, which means that the mother ends up retaining a lot of fluid after birth. And that can lead to swealing in mom's breasts postpartum, so we see that it's not exactly engorgement with milk that we have moms with these really swollen breasts, and that can certainly slow down the milk coming in and it can also make it a lot harder for the baby to latch on and nurse well, which then leads to sore nipples and poor milk transfer, poor weight gain and then of course we see the formula being introduced as well. Other interventions such as C-section can also have an impact in breastfeeding and we'll discuss that a little bit later.

Robin Kaplan : Do these interventions increase the risk for breastfeeding challenges short-term and long-term?

Fleur Bickford : Yes, they certainly do. Short-term, we definitely see an increase in breastfeeding difficulties, and we often have sleepy babies, or babies that just are not latching on well, or they are not transferring milk very well, and its these short-term issues that tend to lead you to longer term issues. The first couple of weeks after birth are really a critical time for establishing milk production. So if we have a mom and a baby that are struggling in the first few weeks, milk production gets off to a rough start, we have a baby who hasn't been nursing very well, and milk isn't being removed, than that can certainly have a long term impact on milk production. And if things don't go well in the first couple of weeks, sometimes it's not possible to recover fully from that, and it may not be possible to ever bring in a full supply of milk with that baby. So we definitely see immediate challenges with babies not latching well, moms getting sore, babies not transferring a lot of milk, and then those short-term issues can certainly lead to longer term issues.

Robin Kaplan : Most of these interventions we are mentioning are ones that are taking place in the hospital, are there ones that take place in birth center or home birth setting as well?

Fleur Bickford : There certainly tend to be far fewer interventions in a birth center, or home birth. However, there are times where a forceps may be used even in a birth center or home delivery, if the baby is needing some help. Sometimes, even just gentle traction on baby in delivery is a little more difficult, and a doctor or midwife has to help the baby out. All of those things can have an impact on breastfeeding, simply because babies aren't really ment to be pulled out, they're meant to be pushed out.

Robin Kaplan : How can an elective induction affect breastfeeding?

Fleur Bickford : With an elective induction, usually the biggest impact is the fact that often we have an early baby, so inductions are usually scheduled sooner rather than later, sometimes they are scheduled because there is an issue with the baby, the baby needs to be delivered a little bit early, sometimes there is fear that the baby is going to be too big, and of course, the ultrasounds results can often be off, so we do frequently end up with a baby who is a little bit pre-term, and these late pre-term babies are not really premature, but they are not full term either. Those late pre-term babies as we call them can have a lot of difficulties with breastfeeding, their coordination for sucking and breathing tends to need a little more time to develop, they tend to be quite sleepy and don't feed as well, so we see increased rates of jaundice with those babies and definitely an increased rate of breastfeeding difficulties, which again leads to greater weight loss and things like formula having to be introduced. So those babies that are just a little bit early, which is really common when we have an elective induction, can definitely cause some issues for breastfeeding.

Robin Kaplan : And is there a difference in effect in a mother who had a scheduled caesarean compared to an emergency caesarean? She has already started labor on her own, it seems that this is one of the stories that's been told in with our panelists.

Fleur Bickford : There is definitely a difference between the two, as to which one may have more impact on breastfeeding, it's really hard to say. The biggest issue with the scheduled C-section is often that they are scheduled earlier rather than later, the same with an elective induction, and then we run into all the issues associated with a late pre-term baby. There may also be a difference due to the fact that with the scheduled C-section the mother is not experiencing all the hormonal changes associated with labor, and the baby is not being exposed to the usual phases of the birthing process, and we don't really know yet what impact that may be having on mom and babies, but it does have some impact, we really just don't have a lot of research yet to know exactly what impact it does have on both mom and baby and breastfeeding. With an emergency C-section, one big issue with that tends to be the emotional impact of it. So if you we have an emergency C-section, although we have the mother usually going into labor on her own, and so we have the hormonal response of being into labor, the baby has been exposed to the natural forces during the birthing process for the most part, but with the emergency C-section we usually have a very strong emotional reaction and the emotional side of things doesn't get talked about a lot, but I think it's a very important aspect. Women spend nine months planning for birth, and picturing how things are going to be, so when things don't go as planned, that can really be quite dramatic. Women who have experienced a difficult birth have certainly an increased risk of depression, and that in turn can have an impact on breastfeeding. If birth doesn't goes as planned, it's really important for mothers to give themselves time and permission to grieve the loss of the birth as they pictured it, it really is a grieving process that has to happen. And unfortunately, a women's feeling about her birth are often unintentionally dismissed by people around her, people often tell a woman, “You should just be happy, you got a healthy baby”, and of course, we are really happy that we have a healthy baby, but at the same time, mom's feelings really matter as well. I often tell moms that it's OK to love your baby but hate the way they came into the world, it's really important to acknowledge those feelings, and working through those feelings. It's important how women go through it, if they are going to be very individual, some women like to talk about it or to write their birth stories, and some women may need to consider counseling to help them work through things.

Robin Kaplan : OK, when we come back, we'll discuss how the routine use of vacuum can affect breastfeeding as well as what to do to counteract these effects if you end up needing birth interventions. We'll be right back.

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[00:28:55]

Robin Kaplan : OK, we are back and we are speaking with Fleur Bickford, who is a private practice lactation consultant and also the owner of the website NurtureChild. So Fleur, when a woman is faced with the decision to use vacuum extraction or have a caesarean birth, most women will choose the vaginal birth over surgery. If the vacuum is necessary to remove the little one, what effects could this have on breastfeeding and what should she be looking for after the birth?

Fleur Bickford : Well, any intervention where the baby is pulled rather than the mom pushing the baby out can certainly have an impact on breastfeeding, so vacuum and also forceps or C-section – vacuum is definitely a big one when it comes to breastfeeding – with any of these interventions, this baby may be affected after birth – imagine what it would be like if somebody would stuck a giant vacuum on your head and used it to pull you out of a tight space. The baby's head is going to be affected. The other big issue is forceps and vacuum extraction can cause bruising and swelling of the head and face, and due to the pressure that's being exerted, that can cause a distortion of the cranial bones. We also see significant moldings on the baby's head with a vacuum, and although the baby cranial bones are designed to move over one another, the forces exerted by vacuum and forceps can often cause shifts in the cranial bones that are not easily self-corrected by the baby after birth. And because everything is connected, underneath the cranial bones we've got membranes and then the nerves, and it's all connected, so if the cranial bones are being shifted out of place, due to a vacuum or forceps, then all these things can cause irritations to the baby's cranial nerves, and those nerves control everything through the mouth and the jaw. So that could lead to alterations of sucking patterns, and as a result we could end up with pain from mom, and also ineffective milk transfers. So then we've got a baby who's not getting enough to eat and we see weight loss. Babies really are meant to be pushed out by mom's uterine contractions, so when a baby is delivered by C-section, forceps or vacuum, or even we have a well-meaning doctor who's trying to speed up a vaginal delivery by helping the baby out, it can cause structural issues as well within the baby spinal cord. And sometimes we can see a really strong preference of nursing on one side over the other, mom may have pain on one side, but not the other. Occasionally, I've seen babies have a complete inability to latch on one side but they would be OK on the other side. And a lot of the structural issues will work themselves eventually, the baby is either able to gradually self-correct these issues, or the baby learns to compensate the restrictions and eventually be able to nurse effectively. This is why we see a lot of moms who are struggling in the beginning of birth, have weeks of pain, and then eventually it goes away. But in the meantime, we've got mothers that are really struggling and they're having a lot of unnecessary pain and often a very frustrating breastfeeding relationship. So one thing that can certainly be done to help in that situation is making use of complementary therapy such as chiropractic care, cranial therapy, all of those things can make a big difference for breastfeeding. It really helps to address some of the structural issues that can be cause by vacuum and forceps and C-section, and it can help the mom to develop a smoother breastfeeding relationship.

Robin Kaplan : And Fleur, how significant is skin to skin after birth and the days forward to counteract the effects of birth interventions? It sounds like our panelists with the second babies had their children with them immediately, where with their first ones that didn't happen.

Fleur Bickford : I would say that it's very important, being skin to skin with mom is where baby is most stable, and any separation from mom tends to disrupt the baby sucking response, it increases stress hormones in the baby. So especially when we had that kind of intervention in the birth, skin to skin with mom is where we want the baby to be, because it helps with the recovery process after the delivery. We also know that babies that are separated from mom are colder, so even if they are on a warmer, separated babies tend to have a body temperature of 1 degree Celsius lower than babies that are kept skin to skin with mom. And babies that are skin to skin also have more stable heart rate, blood sugar, respiratory patterns, oxygen levels, all that is more stable when a baby is skin to skin with the mom. The skin to skin contact also allows the baby to be colonized with mom's bacteria, instead of the hospital bacteria, and that's important since mom has antibodies that react to her own bacteria, not necessarily to the hospital bacteria. And when we have any kind of separation between the mom and baby, that's an impact on the mom as well. By keeping the baby skin to skin, we're promoting bonding and increasing milk production, it prevents or decreases the feeling of tiredness in the moms, because of all of the hormones that are relieved. So it really does help both mom and baby to recover faster from pregnancy and labor and delivery. We also have studies that have shown that babies that are kept skin to skin in the hours after birth are more likely to latch on and breastfeed, and are more likely to breastfeed well. So skin to skin contact is important for all babies, but especially if we had interventions during delivery, it's the best place for mom and baby to recover.

Robin Kaplan : And ladies, it sounded again that you had your babies not skin to skin the first time around because they were whisked away to the NICU, and then the second time around, you had skin to skin after birth and how do you think that this was significant in establishing your breastfeeding relationship with your second born children, and maybe counteracting the fact that you had to have another caesarean? Both of you actually had a second caesarean, so how do you think that helped?

Shanna LeCount : I think that definitely there was a huge difference from the first to the second. My breastfeeding experience with my first got cut short, I did pumping exclusively, so my body, the second time, was familiar with the process, but it never really got that opportunity to skyrocket in the first birth, in the first breastfeeding experience. So with the second baby, I think just having initial connection where she was, skin to skin, and she had that sort of – not necessarily immediate, but very soon after birth – she was able to latch on and start that whole process. I think my body was like – oh, we know what to do with this! And so I think that definitely established our success in breastfeeding, and we're still breastfeeding, so completely different, definitely a better experience.

Robin Kaplan : That's great, how about you, Marites?

Marites Hoyla : I agree, it's the same thing with me. I had Aiden on the skin to skin shortly after the C-section, and it was like he knew what to do. And I remember laying there thinking, “OK, this is how it's supposed to work...”

Robin Kaplan : … This is what I learned at my breastfeeding class.

Marites Hoyla : Yeah, this is natural, it felt like I just surrendered to that time, and allowed him to do what he is meant to do, which is nurse. And I liked the smell of it too.

Robin Kaplan : It's intoxicating.

Marites Hoyla : It is. They should bottle that up.

Robin Kaplan : That's fantastic. Fleur, for a mom who ends up using birth intervention, either by her choice or when it's a necessity, are there things that she can do after the baby is born to decrease her risk for breastfeeding challenges? What would you recommend being the most critical during those first few hours and days in the hospital, and what about long-term?

Fleur Bickford : If a mother has interventions during the birth – we've already talked a little bit about skin to skin contact, and that is certainly the best place to start in terms of reducing the risk for breastfeeding challenges when there have been interventions. So keeping baby skin to skin, and by that I don't mean just a few minutes from time to time, we want the baby in a diaper only, mom ideally with nothing on from the waist up, and the baby staying there as long as possible. So we are not talking skin to skin for half an hour after birth and then that's it, we want the baby skin to skin with mom as much as possible, because that is the most stable thing for the baby. And also, by keeping the baby close, he has easy access to the breast and mom is better able to pick up on any early feeding issues. If we have a baby who is not latching or not nursing very well, which is quite common when there have been interventions in delivery, then one of the things that are really important is to start frequent hand expressions and speed feeding in the first couple of days. It really is the best way to prevent some of the issues we can run into, with things like weight loss, formula supplementation in hospital. Pumping in the first few days after birth usually is not very effective, simply because the volumes are small and through pumping, the minerals get lost in the pump. Hand expression is really important, it's something that moms can practice even during pregnancy, providing we don't have a mom who is at risk for pre-term labor. Hand expression can be practiced even before the baby arrives, so if we have a baby who is not nursing, hand expressing that food can expressed straight into a spoon, and then the spoon fed to the baby. And by doing those two things, keeping baby skin to skin and hand expressing, we end up with a baby who is being kept stable, who is getting what he needs and he is not loosing weight and we are protecting mom's milk supply. And if we can protect mom's milk production, so that we have milk coming in on time, we're not dealing with delayed milk production, that really makes things easier down the road. If we have a baby that's not nursing that well, and then we try to delay milk production or lower milk production on top of that, it makes things much harder to deal with. So two simple things, skin on skin, hand expressing breastfeed, and then, as the milk starts to increase in volume, if we still have a baby who is struggling to nurse, and at that point pumping can be introduced, but in those first three days hand expression is much more effective. The other thing that I certainly recommend is getting help sooner rather than later from an International Board Certified Lactation Consultant, if we're dealing with a baby that is not nursing very well. So seeing somebody in hospital, but also, once you get home, having trouble at home, a lot of moms are discharged even before their milk comes in, and then the milk comes in sometimes, if there are issues with engorgement or whatever the issue may be, but a lot of moms have a tendency to wait and see, there is this sort of mentality of, “breastfeeding is natural and I should be able to do this, I shouldn't need help”, but it really is a learned skill and it's better to get help sooner rather than later because the sooner breastfeeding problems are addressed, the better chance we have of being able to resolve them. So getting help right away if you're having problems can really cut down on long-term breastfeeding issues.

Robin Kaplan : Well, ladies, thank you so much for your insight and Fleur, thank you so much for insight into birth interventions and their effect on breastfeeding. And for our Boob Group Club members, our conversation will continue after the end of the show, as Fleur will share if a mom is destined to have breastfeeding challenges if she has birth interventions, and how to minimize common interventions during birth. So for more information about our Boob Group Club, please visit our website at TheBoobGroup.com.

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[00:42:46]

Robin Kaplan : Here is Laura Audelo, sharing ways to overcome society booby traps.

Lara Audelo : Hi Boob Group listeners! I'm Lara Audelo, a certified lactation educator and a market manager at www.bestforbabes.org and owner of Mama Pear Designs. Today we will talk about how you can achieve your personal breastfeeding goals without being undermined by cultural and institutional booby traps. Let's talk about the checklist that you can use to avoid booby traps in the hospital. This list will especially help the mothers who will be giving birth in a facility that has not yet earned the baby-friendly hospital recognition. Those hospitals are required to follow this protocol as standard practice. To avoid the booby traps, make it clear that you want to hold your baby skin to skin immediately after birth, whether you give birth vaginally or by caesarean section. Make it clear that you want to delay the umbilical cord clamping until after it stops pulsating. Let the hospital know that you want to initiate breastfeeding in the first hour, that you don't want to have a baby suction unless it's medically necessary, and that you would like to delay all newborn procedures until after the first feeding. Let them know that you want a room in with your baby, and not have the baby taken to the nursery unless medically necessary. Let the staff know that you do not want your baby supplemented with formula, unless medically necessary, and any supplementation must be approved by you or your partner. So lay your baby back and savor your breastfeeding and skin on skin at the same time during at least the first day. Let the staff know that you don't want your baby to be given a bottle when you're separated or not. Seek expert help for latching conditions with staff that has a bigger training in breastfeeding in order to minimize any possible issues. Specify that you want to have access to an ICLC. Limit staff and visitors to a number that allows you to focus on your baby, getting breastfeeding off to a good start. You can even bring a sign to put on your door. Also let the hospital know that you don't want to give the baby formula after you leave the hospital, and don't leave without getting referrals for breastfeeding support groups in your community. It seems that this is a lot for mothers to do, consider asking your local breastfeeding support group, breastfeeding experts and moms groups to help your hospital to begin the process of becoming a baby-friendly hospital. You and your baby deserve to have proper breastfeeding and good care. A special thank you for Tony Lieberman, ICLC, for writing The Booby Traps series for Best for Babes. Visit BestForBabes.org for more great information about how to meet your personal breastfeeding goal, and my business, MamaPearDesigns.com, for breastfeeding support. And be sure to listen to The Boob Group for fantastic conversations about breastfeeding and breastfeeding support.

Robin Kaplan : Thank you so much to our expert, panelists and all of our listeners. If you have any questions about today's show or the topics we've discussed, please call our Boob Group voice mail hot-line, at 619-866-4775, and we'll answer your question on an upcoming episode. If you have a breastfeeding topic you'd like to suggest, we'd love to hear it. Simply visit our website at TheBoobGroup.com, and send us an email to the contact mail. Coming up next week, we'll be chatting with Andrea Blanco, about the joys and challenges of breastfeeding a toddler. Thanks for listening to The Boob Group, your judgement-free breastfeeding resource.

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[Disclaimer]

This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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