Suctioning

“Routine” Suctioning

When I was at the pushing stage in labor with my first child, I was totally unprepared for the nurse to look over at me and say, “I know your birth plan says you would like your child handed to you immediately following birth for uninterrupted skin-to-skin time but there is a little meconium and hospital policy states that we must first do an endotracheal intubation and oral suctioning.  It won’t take long, and then she will be brought to you.”  To say I was heartbroken would be an understatement but when you are 10 cm dilated and having a baby is not the time to negotiate.

I was elated to have just had a totally natural birth and decided not to dwell on this “minor” situation.  It seemed very brief, although looking back at the time on pictures, I realize it had to have taken several minutes (in which they weighed her as well) before she was given to me.  Once she was in my arms we did cuddle and nurse and have nearly 1 1/2 hours of skin-to-skin time. It was absolutely incredible. And I fell in love.  But, I always had in the back of my mind that this intubation was unnecessary and I wanted to make sure I was better prepared if there was a next time.

Research supports what my heart felt.  In otherwise healthy, full-term babies no benefits are shown for pharyngeal, esophageal, or gastric suctioning, although there are many negatives.  First, studies have shown a statistically significant lower heart rate for 20 minutes in babies who are suctioned.1 A Cochrane review concluded that routine endotracheal intubation and suctioning of term babies due to the presence of meconium is not a best practice and should be abandoned.  More importantly, there can be long-term consequences when this procedure is performed in terms of intestinal disorders and delay in baby’s prefeeding behaviors.2  We also know that immediate and uninterrupted skin-to-skin contact between mom and baby immediately following birth has a significant impact on successful breastfeeding as well as many other benefits including regulating baby’s temperature, stabilizing baby’s heart rate, lowering stress levels for mom and baby, reducing crying, stabilizing blood glucose levels, promotes bonding, increases mom’s levels of oxytocin and milk volume.  Whew.  With all of these important benefits, anything that takes a baby away from immediate skin-to-skin contact for the first 2 hours of life should be significant and medically necessary.

When my fourth baby came along this exact same situation presented itself while I was in labor pushing.  This time, however, I was better equipped.  I had talked with the midwives about this scenario and they agreed that the best practice would be to give my baby to me for immediate skin-to-skin following the birth and not suction him first.  Two hours later, while Jack and I were still enjoying our precious skin-to-skin time together the midwives checked his temperature (one early indicator if there were a problem) and he was just fine.  This was a much less invasive method and achieved the same goal – a healthy, happy, breastfeeding baby!


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Why Natural Childbirth Matters

0202911666_10100156572893941_1838070281_nBirth is not just a painful hoop a woman must go through to meet her baby; rather it is a critical stepping stone that has major implications for breastfeeding and bonding over a lifetime.  In fact, if we look at all other mammals (and remember, humans are mammals!), when birth gets messed up so does bonding, breastfeeding, sometimes even life itself.  It has been said that if we want to fix breastfeeding, we must first fix birth. 1 Natural childbirth matters in a profound way.

When I was a child my friend’s cat had a litter of kittens.  I thought they were the cutest little kittens I’d ever seen and ran to pick one up.  But I wasn’t allowed too…because everyone knew that if I touched a baby kitten and took it from her mother the mother might reject it and the baby could die.  Now, of course humans have brains with great reasoning skills and we don’t typically reject our babies when the doctors take them off to be weighed and have other “normal newborn procedures” done to them.  But the point is still the same. . . our births in the western world have become so medicalized, so far from natural, we don’t even recognize birth interventions as a valid reason for breastfeeding complications.

Other mammal mothers labor in a quiet, dark, relaxing place, upright, with as much food/drink as they like – without bright lights, stressful surroundings, medications, and time constraints.  They immediately lick, touch, or nurse their young after birth.  And when their babies are taken away, or when birth interventions are done, there is a high rate of rejection, breastfeeding problems, and even death.  Among mammals, a sign of good mothering is being fiercely protective. 2

Contrast this scene to a common birth in the west:  in a hospital, lying down, monitors on, with drugs, an unfamiliar setting, bright lights, stress of time constraints and medical staff doing “routine” checks and coming and going, dutifully “obeying” the system.  Deliveries many times involve forceps or vacuum extractions, episiotomies, or even C-sections.  Babies are promptly cleaned (we must get that icky goo off, we believe!), weighed, given an injection, oral suctioned, and the list goes on.  The baby is then dressed, swaddled, and, finally, given to his mother.  Delayed skin-to-skin, no opportunity for mom and baby to bond with the initial smells before cleaning, no chance to soak in such an amazing experience and bask in the wonderful hormones of love, attachment, and bonding during those critical minutes/hours after birth offer.  A typical hospital birth today is about as opposite to a natural birth as possible.

It’s incredibly rare for a normal mammal not to nurse.  Why is it so common for human babies?  Well, birth really does matter!  And birthing practices definitely have an impact on breastfeeding success.


Skin-to-Skin

Skin to Skin Contact

Jack is Born at Heath Hospital

Skin-to-skin contact, when possible, is important for getting breastfeeding off to a good start.

Skin-to-skin contact (SSC) following birth is incredibly important for all babies, including preterm babies.  It is easy to do – a mother simply holds her baby with his stomach down (prone position) against the front-side of her chest between her breasts, neither with clothes between them.  A blanket can be placed on the outside of the baby while he is wearing a diaper and/or a hat.  Ideally, SSC should begin immediately following birth and last through the first breastfeed – or for the first 1 ½ – 2 hours following birth. The results are amazing!

A new baby has just come from the safest place he’s known – inside his mother’s womb.  There, he has been cared for completely having every need met immediately.  He was protected, hearing gentle noises buffered by the womb; his heart rate and oxygen saturation levels were optimal; he was held, warm, fed, and loved on demand.  After birth, this same baby has entered a whole new world and the safety of being skin-to-skin against his mother’s body helps him in this transition.

Today the over-medicalization of the birthing process many times leads to the separation of mother and baby following birth.  Lights are bright, sounds are loud and unfamiliar, scales are cold, and the person he knows best, his mother, is not always nearby.  Research shows this separation of mother and baby is highly stressful and can lead to what is known as “protest despair” in baby.  When babies are separated following birth, babies exhibit a ten-fold increase in stress hormone levels.1  This stress should not be underestimated either!  The baby will protest by crying. His heart rate, blood pressure, and breathing will increase.  After protesting, he will despair, moving to a state of dissociation.  Left in this state of distress, away from his mother, can have lasting emotional effects. And maternal levels of oxytocin (which is often referred to as the love hormone and significantly impacts bonding) peak following birth. When mom and baby can’t be together, precious bonding time is lost in their relationship.

SSC is a safe and simple alternative to separation following birth.  In fact, babies’ body temperatures are better regulated in SSC than in an incubator; heart rates are more stabilized; cortisol and blood glucose levels are more normalized; and there are greater chances for breastfeeding success . . . not to mention the precious time of cuddling and bonding together.   For mothers, SSC not only helps to regulate her body temperature, but heightens oxytocin levels and milk volume, promotes bonding , and increases confidence in her mothering ability.2 Babies who are placed in SSC following birth are much more likely to spontaneously breastfeed than those who are not.

SSC was first used in Colombia, South America in the 1980s for babies in the NICU when there wasn’t space available in conventional incubators.  Compared to babies cared for in environments with greater technology, the babies receiving skin-to-skin contact each day fared much better.3  Research on SSC and twins has found that each breast uniquely regulates its temperature depending on what each baby needs.  If one baby was too cool, the breast temperature on that side would increase; if the other baby was too hot, that breast would decrease in temperature.4  SSC after birth has also been shown to significantly increase the survival rate of babies who are born with very low birth weights.5

In addition to its many positive benefits immediately following birth, SSC continues to have a positive impact on breastfeeding in the early weeks and months with your new baby.  SSC continues to promote bonding between mother and baby, helps baby to latch, increases a mother’s milk supply, and can even help a baby who is refusing the breast to begin to nurse.  The benefits of SSC are increased, the longer and/or more frequently a baby is held this way.

The first hours after birth are critical to bonding with your new baby and can never be returned.  All necessary interventions in a healthy newborn can be done while baby is skin-to-skin with his mother.  Bathing, weighing, etc. can all wait until later.  Postpone all non-essential things and relax and enjoy this precious time with your new little blessing.


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Sample Birth Plan

Labor:

  • Drugs – I desire a drug-free birth.  Please do not offer pain medication or Pitocin.
  • Vaginal Exams – Minimal
  • Monitoring baby – Intermittent only
  • Movement – I would like complete freedom of movement during labor.
  • Stripping of Membranes – Please do not strip my membranes.
  • Breaking of Water – Please allow my bag of waters to break naturally.

 During the pushing stage:

  • Positions – I would like the freedom to push in any position that is comfortable for me.
  • Perineum – I would like to try for an intact perineum with massage, support, hot compresses, controlled and guided pushing, and positions to promote perineal stretching.
  • Episiotomy – I would prefer to tear naturally and not have an episiotomy.
  • Forceps/Vacuum extraction – I do not want these used unless my baby’s life is threatened.
  • C-section – A last resort and only to be considered if my life or baby’s life is threatened.
  • Time – As long as baby is tolerating labor well, I would like to labor at my own pace without time constraints or labor augmentation.

 After Birth:

  • Baby – To be laid directly on mother’s chest after birth and allowed to breastfeed in skin-to-skin contact.  Any observations or measurements should be done while baby is on my chest.  Please allow baby to be laid on mom even through delivery of placenta and any repair work.  I would like to be present for all newborn procedures.
  • Cord – Please allow cord to stop pulsating before it is clamped.  Please do not milk the cord to speed the process.  Please do not clamp the cord early.  If possible, I would like to leave cord attached until placenta is delivered.
  • Placenta – Please allow the placenta to be expelled on its own, with no pulling or tugging.  I do not want to be given Pitocin unless fundal massage to control bleeding is not effective.
  • Temperature – I would like to hold baby skin-to-skin during the first hours to help regulate baby’s body temperature.

 Baby Care:

  • Rooming In – To begin immediately.  All necessary examinations should be performed w/us present.
  • Breastfeeding – The baby will be breastfed exclusively.  Please do not give baby a pacifier, bottled water, glucose water, formula, etc.
  • NO lab work is to be drawn, no injections or medications of any kind are to be given without our prior consent.

Alternate Plans:

  • Should a C-section be necessary, I would like my husband to hold baby in skin-to-skin contact immediately following birth until I am able to hold baby.
  • Should baby need special care after delivery, my husband or I would like to be present in the NICU or elsewhere.

Click here to download a .pdf of this sample birth plan.


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Making Your Birth Plan

iStock_000014079658XSmallPlanning and preparing for the type of birth you want to have are important steps in achieving your birth goals.  Having a birth plan is an important part of this process.  Making your birth plan and having it written down so that you can talk about and share it with your doctor, midwife, doula, and nurses at delivery can help ensure you are able to clearly communicate your wishes and desires so that during labor your expectations are clearly understood.  Below are some important do’s and don’ts when writing a birth plan:

  • Limit to one page
  • Only include things that are not standard practice – you don’t want it to be too long
  • Clearly communicate your birth expectations and desires
  • Include what you want to happen in a “Plan B” scenario…IF this happens, THEN x, y, and z are my wishes…
  • Bold or highlight key points you want to stand out
  • Share your birth plan with your doctor(s)/midwife BEFORE your birth
  • Make sure doula has a copy (if you have a doula)
  • Take with you to hospital/birth center and share with nurses when you arrive (consider having a small basket ready that includes some fresh fruit, chocolate, etc. along with your birth plan as a kind gesture to the nurses who will be in your labor and delivery room)

Click here to see a sample birth plan.


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Birthing Practices that Help Breastfeeding

Having the freedom to move during labor is important for natural birth.

Having the freedom to move during labor is important for natural birth.

A typical hospital birth in the western world is overmedicalized – to the point where there’s almost a belief a woman’s body cannot perform this most natural of things without assistance.  We know in the rest of the mammalian kingdom that if birth is interfered with there is a great likelihood of the baby dying (usually by rejection of the mother and not suckling).  Could this actually be happening right before our own eyes with human babies and modern medicine?  Of course most mothers don’t “reject” their babies, but interventions affects a baby’s ability to latch and suckle effectively; rob mothers and babies of the critical minutes and hours immediately following birth where hormones are at their peak and establishment of a lifelong bond is beginning (could this time be even more important for teen moms, unplanned pregnancies, etc.?); and negatively impact a mother’s milk supply.

There are many simple things that can be done to improve birthing practices and allow new moms and babies every opportunity possible to succeed at breastfeeding.  The following list includes important points to consider in preparing for your birth:

  1. Plan for a natural birth.  Read books, decide what you want to have happen, write out a birth plan, and discuss it with your doctor or midwife.
  2. Select a doctor & hospital that is supportive.  The current c-section rate in America today is 1 in 3!  That’s saying that 1/3 of all women’s bodies are incapable to do what they were created to do without medical intervention.  Instead, it is much more likely to be the other way around – when you get involved in a natural process problems occur which lead to more problems and interventions…a slippery slope for sure. Doctors with low c-section rates, midwives, and birthing locations with Baby-Friendly Hospital Initiative status are all better options.
  3. Plan for baby to be given to mom immediately following delivery – postponing all newborn procedures on a healthy baby until after the first few hours following birth (or allow procedures to be done while in skin-to-skin with mother).
  4. Don’t wash the baby – babies use their sense of smell to find the nipple and moms are drawn to their babies with hormones of love and bonding through smell and touch.  There is no need to scrub a newborn down before cuddling and spending precious hours in skin-to-skin care.  In fact, consider waiting a couple days before giving your baby her first bath.
  5. Dim the lights – bright lights are harsh on a new baby’s eyes.  If you have to have bright lights on, shield baby’s eyes.
  6. Allow skin-to-skin time to continue through first breastfeed- and then as much as possible in the first few days following birth.  Skin-to-skin is the single most important thing to help breastfeeding success.
  7. Delay cord clamping – this is oxygen rich blood that your baby needs.  Wait until the cord has finished pulsating – or, even better, wait to cut the cord until the placenta has been delivered.
  8. Have a Plan B in place – though you plan and prepare for a natural birth, sometimes things don’t go as planned.  For example, if you need an emergency c-section, who could hold your baby in immediate skin-to-skin following birth until mother is able?  Does your hospital have a policy of oral suctioning if your baby passes meconium in labor? Could you sign paperwork in advance to prepare for this scenario or others that might occur so you can still have your birth wishes fulfilled?
  9. Less is more – Less intervention means a more natural birth.  This is the goal.  A woman’s body knows what to do if she is not stressed, under time constraints, in a strange or harsh place, etc.  Sure, there are times when medical intervention is necessary.  But birth is natural, normal.  Plan, prepare, and expect a natural birth.
  10. Relax and don’t stress – plan and prepare and do all that is in your power to have a natural birth.  Then relax and enjoy the thought of the day you will get to meet your new little blessing!  Birth is not something to fear; rather it’s an exciting time where your body is doing what it needs to in order to birth a new life.  Trust your body; remember you’ve done all you can to prepare; relax and enjoy the experience of birth.

Krista Gray, IBCLC

Prenatal Breastfeeding Classes

Whether you’re preparing to breastfeed or need support with your current situation, Krista Gray, IBCLC – Nursing Nurture Lactation – is here to help.  I am a certified lactation consultant and offer in-home lactation consultations as well as prenatal breastfeeding classes to assist you in meeting your breastfeeding goals.   I see clients throughout the Upstate of South Carolina and North East Georgia as well as via Skype and FaceTime worldwide.

Prenatal Breastfeeding Classes

Private Prenatal Breastfeeding Class – $85 for a 1 1/2 hour private class.  We will discuss the basics of breastfeeding from what you can do to be prepared, the early days, common problems and solutions, how to express and store milk, maximizing your milk supply, and what to expect as your baby grows.*

Prenatal Consultation – Addressing specific concerns – $50.  Do you have a specific concern about breastfeeding? I’d be happy to meet with you over coffee and discuss your concern so that you can be better prepared for your new baby’s arrival.

Prenatal Group Class – $35 per couple.  Minimum of 3 couples, maximum of 6.  Do you know other couples that would like to take a prenatal breastfeeding course with you?  This class includes information and encouragement for a successful breastfeeding experience, including how birth affects breastfeeding, getting breastfeeding off to a good start, positioning your baby at the breast, common problems and solutions, how to express and store milk, maximizing your milk supply, and other helpful support.

*in home rate applies to homes within 15 miles of 29655 zip code.  Beyond that area, there will be a fuel surcharge and hourly travel fee, which will be quoted at time appointment is made.

*Payment can be made with cash, check, and PayPal.

*Payment is expected at the time services are rendered.  Nursing Nurture does not file insurance on your behalf, but will provide you with an itemized Super Bill for your health insurance provider.

Learn more about Krista Gray, IBCLC or contact Krista to schedule a breastfeeding class.


Megan Church Blog 2 Featured

The Fussy Feeder: My Breastfeeding Journey Continued

Megan Church HeadshotMeagan Church is a writer, children’s book author and the brainpower behind Unexpectant.com, which explores the realities of birth, babies and beyond. She lives in the Midwest with her high school sweetheart, three children, two cats and one dog. Her passions include running, black coffee, and simple, yet intentional living. Connect with her on Twitter @unexpectant or Facebook/unexpectant.

Before the birth of my third child, I had a certain amount of fears that my luck had run out. My first two births had gone well and both babies were excellent nursers. As I prepared for baby number three, I worried that something would go wrong. Would this one end in a c-section? Would I be able to handle natural birth again? What if we encountered nursing problems?

I’m happy to report that despite my concerns, the birth went smoothly. I had a beautiful and quick water birth. Adelyn let out a small cry and then immediately began to fall asleep on my chest. She awoke a few minutes later to breastfeed for the first time. I let out a sigh of relief. Everything seemed to be going smoothly.

While still in the hospital, our doctor mentioned that Adelyn had a slight tongue tie. He said he didn’t think it was a concern because she was nursing fine and she could extend her tongue beyond her lower lip. Soon enough we headed home and all was well. Until she was six weeks old.

When Adelyn hit the six-week mark, something suddenly changed with her feeding. My good, content nurser began to fuss at the breast. I remember the day it first happened. My mom had come to visit. Adelyn was hungry, so I sat down on the couch to breastfeed her. I put a cover over me for privacy, but the baby didn’t seem to like it. She struggled to latch or hold the latch and began to fuss. I decided to move to the privacy of my bedroom where I could take off the cover and better focus on her. I eventually got her to feed and assumed it was a one-time event. Unfortunately it was not.

The next few months were wrought with fussy feeding sessions. It got to the point where I couldn’t sit down with her until letdown occurred. Instead, I would walk, bounce, sing and/or shush her. She’d suckle briefly, unlatch and cry. I’d coax her back on, just to have the cycle repeat itself. Once my milk began to flow, she would nurse just fine and I could sit down. I tried to view these sessions as an extra calorie burn, but I was getting frustrated and began to dread feeding her.

My first two babies fed often and whenever the breast was offered. If we were heading out to dinner or church, I could offer the breast to “top them off.” They always accepted. Adelyn did not. She would only feed when she wanted to and she began spacing her feedings out at an early age. There were days when I was concerned by the fact that my two-month-old (for example) hadn’t fed in six hours. And then when she did seem hungry, it took quite an ordeal to get her to nurse. The quick letdown that I had with my first two suddenly became slow and difficult. There were sessions when I would pump to get my milk flowing and then put her to the breast. But, there were also times when even the pump couldn’t stimulate letdown.

I was becoming exasperated and frustrated. I talked to our doctor and he suggested that I not feed her so often. His assumption was that I was attempting to feed her when she wasn’t in fact hungry. I decided to back off and watch her more closely for hunger cues, but the feedings were still fussy. The good news was that she was gaining weight and growing fine. So, even though she was fussing, she was getting the nutrition she needed.

One day, I finally decided to go to a lactation clinic. I never wanted to deal with the hassle of packing up the baby to head out the door, especially in the winter and when I had two other kids at home. But, one day I finally did it. By the time I arrived, Adelyn was beyond hungry. Unfortunately there was only one consultant there and a line of women in front of me. So, I took my baby to the corner and attempted to nurse her. By the time letdown happened, I was sweating profusely and embarrassed because my screaming child had distracted every other baby from their peaceful feedings.

Finally a consultant came over to me. I explained what our nursing sessions entailed. But, since Adelyn had already eaten, the consultant couldn’t see it in action. Finally she looked at me and said, “Well, some babies are just fussier than others. The good news is that they say fussy babies sometimes grow to be very intelligent.” At that point, I didn’t care if she became the next Einstein. I just wanted to sit down, while nursing my baby. Was that too much to ask?

We continued to struggle for the next few months. I tried different holds and positions, watching her cues more closely, and even relaxation and deep breathing to encourage a speedier letdown. I had gotten into the habit of scrolling through social media on my iPod, while I nursed her. I wondered if I was too distracted by the device, so I put it away and tried concentrating on Adelyn. But, then I would be concentrating too much and I’d start getting upset along with the baby when my letdown didn’t happen right away.

We continued to struggle for a few months, but, just as with my first two, I had a goal in mind: I would nurse Adelyn for her first year. I knew that even though it was frustrating, in the bigger picture, this was a short moment in time. This stage would pass soon enough and I would never be able to return to it again, especially because she is the last baby we plan to have.

Around six or seven months, her feeding did begin to improve. We both continued to hang in there and work our way through it. We still delayed solids with her just as we had done with our first two. She started with finger foods around eight months of age. I was afraid to start her too soon, have her catch on too well and then refuse the breast. Thankfully that didn’t happen.

Unfortunately breastfeeding her never became the beautiful, peaceful experience that I see in so many pictures or that I had with my first two. But, we did make it to our goal. Adelyn weaned around 16 months of age.

Looking back, I wish I would’ve gotten more support from another lactation consultant. Though we muscled through the experience, I wonder if it could’ve been more peaceful had I gotten different support and advice. To this day I wonder if that tongue tie did affect things. Was she not latching properly enough to coax letdown efficiently? Maybe it had more to do with personality. She is definitely a spirited child who lets her opinion be known (for example, she never allowed us to spoon feed her, but finger foods that she could feed herself were acceptable). Couple her personality with the possibility that stress was causing my letdown to slow and maybe it was just a bad combination.

I don’t know what the answer is and maybe I never will, but I do know that even though it wasn’t easy and even though I still struggle when I remember just how exasperated I was at times, I’m glad I kept my eye on the goal. It has been a few months since she weaned and I am so thankful that I nursed her beyond our goal. It may have been a struggle, but I know that it was for a good reason: no other food could nourish and grow her like my breast milk did.


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Emergency C-Section in Egypt

Premature twin in incubator

The twins spent their first few days in an incubator in the NICU in Egypt.

To say I was excited when I found out I was pregnant would be an understatement.  I had dreamed of being a twin when I grew up and always thought I would love to raise twins. Still, I’m not sure anyone can be totally prepared to hear they are having twins! This excitement quickly turned to fear though when I realized I would have to birth twins.

I really wanted to avoid a C-section and I planned and prepared all throughout my pregnancy.  We were living in Egypt and my doctor strongly encouraged me to have a planned C-Section.  When my boys were breech and not changing positions we made plans to return to the states where my doctor was still keen to let me try to birth them vaginally.

breastfeeding premature baby

First time to attempt breastfeeding my twins – 26 hours after birth.

Fast forward to January 24th. . . I was 32 weeks, 3 days pregnant without problem. I felt great, well, except for feeling like a blue whale, but don’t all pregnant women feel large at the end?!  I was packing and preparing for our return to the states just four days later.  That morning I woke up around 8:00 a.m. and felt mildly uncomfortable in my still half-asleep state. I tossed and turned a little and remember saying, “I think I’m having a contraction.” My lower abdomen was tightening, but I figured it was just Braxton-Hicks . . .

After getting up and taking a shower, these mild contractions suddenly turned into intense labor with contractions coming almost on top of each other.   We called my doctor (who had been quite relieved when he learned we were going back to the states) and we headed to the hospital in Egypt instead.

syringe feeding colostrum

Since they were losing weight at the breast I syringe-fed my colostrum to the boys.

We arrived at 9:45 a.m. and I was already dilated to 8 cm. Since they were breech the hospital doctor wanted to prep me for a c/s but I refused. I was taken upstairs to labor and delivery and I could feel the contractions change and I had the urge to push – I knew I was now fully dilated. But, I didn’t feel a peace to work with the contractions and push those babies out without my doctor there. (I look back now and have to laugh at this scene because here I am on a bed in the hallway because the medical staff at the hospital didn’t know what to do with this foreigner who was refusing a c/s – and they didn’t know how to help me birth breech twins! We were all just waiting for my doctor to arrive.)

My doctor did arrive and said on the way he’d been thinking about it and he had decided he would give me the opportunity to birth them naturally. I was so thankful. He went and washed up and I went to the delivery room. However, when my doctor checked me his entire demeanor changed and I could sense the intense worry in his eyes. He said he had talked with the neonatologist and both really recommended a c/s.  I just didn’t have a peace to do this naturally without his support – especially since just a few minutes earlier he was okay with me trying for a natural delivery.

Syringe feeding colostrum when my newborn preemie was unable to latch on.

Syringe feeding colostrum when my newborn preemie was unable to latch on.

At this point I didn’t even have an IV so they put me under with general anesthesia.  They put the mask on my face and I was out.  They were born within a couple minutes – which makes me thankful that James and Luke still didn’t get exposed to much anesthesia.

James was born first (3 lb, 15 oz.), and then Luke (3 lb, 13 oz). They received a surfactant lung treatment since there had not been time to give steroids to me to boost their lungs before their birth. They also had extra oxygen to breath for the first 24 hours (their heads were under an oxygen bubble) and the next day they were breathing fine on their own.

We were in the hospital for six days before bringing our twins home.  (I realize that they would have probably stayed much longer had we been in the states as they were just 3 ½ pounds when we brought them home!)  You can read about my journey breastfeeding these little guys here.

Premature baby's hand

My boys were both under 4 pounds (1.8 kg) at birth.

Though this birth was nothing like I’d planned or hoped, I am very thankful they were born healthy and safe.  It is okay, and important, to grieve a birth that doesn’t go as planned.  I took comfort in knowing that I had done everything I could to prepare for a natural delivery – even to the point of buying plane tickets to another country!  I wonder sometimes what would’ve happened if I’d just pushed them out.  I do wish it hadn’t ended in a C-section but, more importantly, I am thankful they are safe and healthy.  And even though there were many “strikes” against us making breastfeeding difficult (preemies, twins, emergency C-section, not breastfeeding for the first time until 26 hours after delivery, no skin-to-skin after birth, and more) we made it.  Determination can overcome these barriers and more!


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The First Week

You’ve planned and prepared for you new little blessing and the time has finally come – your baby is here!  What should you expect during the first week after birth?

Following Delivery

6959630279_bd936a1d85_bWhether your labor and delivery was completely natural, an emergency cesarean section, or something in between, it is important to hold your baby in skin-to-skin contact immediately (or as close thereto as possible) following birth.  Delay all non-essential checks of baby that cannot be done while baby is in skin-to-skin with mother until after the first breastfeed. (With a cesarean delivery the mother will need help holding baby.)

Babies instinctively know what to do.  When labor is unmedicated, babies can be placed on their mother’s stomachs and will actually crawl up, find the breast, and spontaneously breastfeed on their own.  It is called “the breast crawl” and it quite powerful to watch!  However, even if you choose to lay your baby directly on your stomach and breast and help him attach, the important thing is bonding together, skin-to-skin, without interruption until after the first breastfeed.

The first 24 hours

During the first 24 hours, hold your baby in skin-to-skin contact as often as possible.  This helps to establish a mother’s milk supply and encourage a baby to nurse on demand.  You cannot spoil your baby and you cannot nurse your baby too often.  Nurse on demand – at least 10-12 times in a 24 hour period.  Rooming-in with your baby while in the hospital will help facilitate frequent nursing.

If your baby is sleepy (which is especially common if there were any pain medications during labor or baby is preterm) then it is important to wake your baby to feed him.  There should not be longer than one 4-hour stretch of sleep in 24 hours; otherwise your baby should nurse at least every 2-3 hours.

Breastfeeding should never hurt, even in the beginning, so if you are experiencing pain seek out help.  If you are in a hospital setting, ask to see the lactation consultant.  If you are in a birthing center or at home, talk with your midwife about what could be causing the pain.  The majority of the time the pain is caused because of an issue with positioning and attachment.  The earlier you are able to sort the problem the less likelihood your nipples will be damaged or your baby will learn a poor latch.

During the first 24 hours, your baby should have at least one dirty diaper and one or more wet diapers.  A newborn baby’s stomach is very small.  Thick, rich, colostrum is all he needs for the first few days until a mother’s milk comes in.

The First Week

Practices begun in the first 24 hours should continue during the first week.  Keep your baby nearby while he is sleeping so you are aware of when he wakes and his early feeding cues.  Spend as much time in skin-to-skin contact as possible.  Consider co-sleeping in the same room or even bed sharing.

After birth, a baby shouldn’t lose more than 7% of his birth weight.  However, a more accurate weight assessment is 24 hours following birth rather than immediately afterwards. 1

What if I experience engorgement?

Sometime between days 2-5 a mother’s milk will come in.  Nursing often will help her from becoming engorged.  Other ways to help with engorgement in the early days include draining one side fully then offering the other side.  At the next feed, begin by offering the side that was offered last in the previous feed.  Breast compressions during nursing are also helpful.  If a mother’s breasts are still very full and painful she can hand express to stop the pain.  Most importantly, do not give supplements!  Engorgement and oversupply can quickly change to a low milk supply for your baby once supplements are introduced.

How do I know if my baby is getting enough milk?

This always seems to be a concern for breastfeeding moms – though it should not cause worry.  There are several ways to ensure your baby is receiving enough milk.

  1. What goes in must come out.  Make sure you baby has enough wet and dirty diapers.
  2. Weight gain.  Though it is normal to lose 7% (sometimes up to 10% of birth weight) a baby should have gained his birth weight back by 2 weeks old.  (The only exception may be if there was a breastfeeding issue that has been corrected and weight gain is now occurring, but may take a little beyond 2 weeks because it was not identified initially.)  Once a baby reaches his birth weight, it is typical to gain 30-40 grams per day.  Over time you will be able to chart your baby’s growth.  Make sure to use the World Health Organization Growth Charts because they are the only ones based on breastfeeding as the norm. (These should be used for both breast and bottle-fed babies.)  Your child should follow his growth curve.  If he was born in the 2nd percentile, for example, this is all he needs to follow.  This is his normal.  There are big babies and there are small babies. . . all that is important is that your baby follows his percentile.
  3. Observation of breastfeeds.  Is he content following nursing. . . at least for a few minutes?  Do you notice an active suck-swallow cycle?  These are important signs your baby is feeding well.

If you have any concerns, seek qualified lactation support immediately!  A minor problem could have a detrimental impact to long-term breastfeeding if left alone.