Guest Author - Nicki Heskin
There are many reasons that hospitals follow particular routines. Some are based upon evidence-based research on safe outcomes for mothers and babies. Some are based upon convenience and efficiency for the hospital. Some are based upon public health issues that may have little to do with the needs of a particular mother or baby. Some are based upon liability concerns. Still others simply reflect the habits of the hospital staff.
Sadly, few of the routines surrounding the birth of a baby have very little to do with successfully establishing breastfeeding. Following, of course, the safety of the mother and the baby, including the safe completion of the third stage of labor (delivery of the placenta and afterbirth), my attention following the birth of a baby immediately shifts to establishing breastfeeding. In fact in the beautiful wonder that is nature, establishing breastfeeding is intimately tied to the third stage of labor, which is all the more reason to make breastfeeding a priority in the immediate period after birth.
Here I will discuss some common routines surrounding the birth of a baby. I write this not to encourage new mothers and fathers to wantonly challenge hospital policies, but to be on the alert for when a hospital routine may be effecting the establishment of breastfeeding. Sometimes new parents may be able to mitigate these challenges, other times they may need to do their best to work around a policy – either way, awareness is key.
Epidurals – Epidurals affect the establishment of breastfeeding. I have seen estimates that nearly 90% of women deliver with epidurals (or other anesthesia) today. The significant factor in epidurals is the massive fluid load delivered by IV when administering epidurals in order to protect blood pressure. As this fluid settles out in the body, including the breast, it can make latch difficult. There are latch techniques that can help – for more details, see my articles on Epidurals and Breastfeeding.
Warming, Weighing, Cord Cutting and Bathing – Hospitals routinely take babies immediately following delivery away from mothers (usually not far, just in the room) for weighing, bathing and sometimes mandatory time in a baby warmer. I believe this to be a major intrusion into the immediate bonding meant to occur between mother and baby in the moments following birth.
Cutting the cord is tied to this (pardon the pun) because with delayed cord clamping, which is becoming more and more accepted as good practice, the baby *can’t* be taken from the mother. I believe that babies are meant to be warmed on their mother’s chest, which is a convenient place to latch on and get breastfeeding! Bathing and weighing can wait until after that first feed. Some hospitals will be very open to this, and some will not budge. Parents will have to determine how much of an issue they want to make of this, but plan for Dad to be one to handle this when the actual delivery team is in place. Mom is kind of busy!
Pitocin after Delivery – Even those mothers who had a drug-free birth often receive Pitocin immediately after delivery in order to stimulate the delivery of the placenta. The idea is to reduce hemorrhage in the third stage, which is certainly a theoretical positive! However, the administration of Pitocin can cause shivering and severe cramping. When I had Pitocin after my first daughter, I was so miserable I didn’t even want to hold her for 15-20 minutes because I didn’t want to meet her when I was so unhappy, dampening my elation and delaying her first feed. By the time I got her that immediate post-birth alertness of newborns was already starting to fade, which affected the feed.
The sad and ironic part of this is that immediate breastfeeding has the same effect as Pitocin, releasing oxytocin (the natural hormone Pitocin synthetically imitates). If I had another hospital birth, I would, in the absence of any danger signs, request a delay in the administration of Pitocin to instead breastfeed and only receive the Pitocin if there were indications of a problem in the third stage. Some hospitals may be game. Others will simply not budge on this issue.
Room Changes – Once the baby is born, labor and delivery wants to get a mother off of their service and over to the post-partum unit. This happens in the hours after birth, and can interfere with mother’s seeing or following the signs that their little bundle is ready for their next feed(s). If you see the signs of “licking and looking” or rooting towards the breast, simply let the staff know that you’ll be happy to move rooms or fill out that next form, etc., after the baby has fed. If they say it will “just take a minute,” don’t believe it. Nothing in a hospital just takes a minute.
These are a few of the potential pitfalls that may interrupt the establishment of breastfeeding in the early hours of a baby’s life. They are not insurmountable. If these things have happened, they may have ultimately had no negative effect. But given the choice, I would try to mitigate these concerns with a doctor or labor and delivery team. When you take a tour of the hospital, these are great things to ask about. Often, simply being aware of breastfeeding as the next goal after delivery and being aware of the impacts of routine policy on that goal is enough to make it a non-issue.
Disclaimer: All material on the BellaOnline.com Breastfeeding website is provided for educational purposes only and does not constitute medical advice. Although every effort is made to provide accurate and up-to-date information as of the date of publication, the author is neither a medical doctor, health practitioner, nor a Board Certified Lactation Consultant (IBCLC). If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation. Information obtained from the Internet can never take the place of a personal consultation with a licensed health care provider, and neither the author nor BellaOnline.com assume any legal responsibility to update the information contained on this site or for any inaccurate or incorrect information contained on this site, and do not accept any responsibility for any decisions you may make as a result of the information contained on this site or in any referenced or linked materials written by others.
Great breastfeeding guides for a new mother: