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!


Ethnic Hispanic Mother breastfeeding her son

Breastfeeding Positions

How should I breastfeed my baby?

There is no right or wrong way to nurse your little one.  Any position that is comfortable for you and your baby is just fine.  And while it is important to ensure your baby is positioned and latched well in the beginning, after a few months your growing baby and then active toddler just might choose some positions you never would have considered!  The following breastfeeding positions will give you ideas of ways many moms have comfortably and effectively nursed their babies.

Positioning Techniques

Many moms find it helpful to have plenty of pillows to prop up around them so they don’t have to support the weight of their baby while nursing.  Other moms find having pillows and feeling like they can only nurse in their “nursing station” to be cumbersome.  These moms prefer to not use pillows or other support.  Either way is perfectly fine!

What is most important is to make sure your baby is supported throughout his head/neck/shoulder region, his head and neck are in alignment, and he has equal muscle movement on both sides of his body.  This means you will want his body gently pressed against yours – his tummy on your body – and your hand securely holding his head between his shoulder blades.  Make sure your hand does not hold his head though as this is very uncomfortable and keeps a baby from latching well.  (Imagine if you had to keep your chin down on your chest while you chewed and swallowed your food!)  His head should be free so that he can bring it back if his nose becomes blocked.  Your baby should have firm contact against his mother (skin-to-skin is ideal!).

Latching Techniques

In addition to ensuring good positioning in the early days, it is equally important to ensure a proper latch.  A mother can support her breast with her hand if necessary.  Make sure to keep your fingers behind the areola and position fingers in a C-hold so that you can easily help your baby latch on and take enough breast into his mouth.  A baby’s nose should be level with the mother’s nipple.  Your baby should have his head tilted back and lead his mouth to the breast with his lower jaw.  His mouth should be opened wide, tongue down and extended over the bottom gum, with nipple pointing up toward roof of baby’s mouth.  His chin should be pressed against breast with bottom of jaw/lip taking in more areola than the top.  Your baby forms a teat with the nipple and breast tissue, which should be tucked well into baby’s mouth.  His mouth should be open very wide with both top and bottom lips relaxed on the breast and flanged outward.  There should not be any pain!  Make sure to allow your baby to nurse as long as he wants – don’t set a time limit.

Cradle Hold

Cradle Hold

Cradle Hold

This is one of the most popular nursing positions.  A baby lies on the forearm of the side she is going to nurse, and her body extends across the front of her mother.  Her head may be cradled in the bend of the elbow or down lower on the mother’s forearm depending on the size of the baby.  The baby’s chest is against her mother’s chest without space in between; baby’s chest should not be facing up toward the ceiling.  Her legs/feet may be tucked in around the mother’s waist to feel more secure.  It is important that baby is held at breast-level rather than the breast being lowered down to reach baby (which can alter the latch, put pressure on the breast, and keep milk from draining adequately in some areas leading to plugged ducts and mastitis).

Cross-Cradle Hold

DSC_1270

Cross-Cradle Hold

Similar to the cradle hold, but the baby is supported in the arm opposite of the side she is nursing on.  If nursing on the left side, baby would be held by the right arm.  In this example, a mother could support her breast with her left hand and help ensure an optimal latch.  This position is often used with preterm infants.

Football/Clutch Hold

Football Hold

Football Hold

In this position, a baby lies at breast level on the arm of the side she is going to nurse.  Her head is by her mother’s hand and her body wraps around the side and back of her mother.  This hold is especially helpful for a mother who needs to be able to better see her baby’s latch – with large breasts or with a painful latch – as well as after a c-section so baby doesn’t put weight on the incision.  Many mothers of twins also nurse their babies in this position.

Laid-Back Nursing/Biological Nurturing/Reclining

Laid-Back Nursing

Laid-Back Breastfeeding

It has a variety of names but in this position, rather than sitting straight up, the mother is comfortably reclining.  She could simply slide down in a straight back chair, sit in a reclining chair, or lie on a bed propped up with a couple pillows.  A baby can then be positioned across the mother’s body allowing gravity to securely position baby’s body against hers as well as allowing gravity to help with the latch.  This position allows a baby’s natural breastfeeding instincts to kick in.  It is particularly helpful for a tired mom to get rest while nursing or when your baby struggles to open wide to latch such as in cases of tongue tie.

Nursing Lying Down (Side-lying)

Side-Lying Breastfeeding

Side-Lying Breastfeeding

Nursing lying down is an essential tool for breastfeeding and sleep.  Since babies need to nurse at night but mothers also need sleep it is a wonderful way to meet both needs.  In this position, mother and baby lie next to one another on a safe surface.  Baby is securely pressed against mother’s body, and a mother protects her baby with her legs curled around the bottom of her baby and arm over the top.  It can be challenging to first learn this position, but with practice most mothers find it very relaxing to know they can nurse while also getting rest.

Upright Nursing (Baby Sitting)

Upright Breastfeeding

Upright Breastfeeding

Some babies prefer to be in a seated, upright position when nursing.  This type of position is especially useful when a mother has a forceful milk ejection, baby has breathing or swallowing issues, cleft palate, etc.  This position helps reduce choking from a fast flow of milk.  It is still important to adequately support a baby in this position allowing her body to feel a secure touch across her body as well as ensuring her head is well supported by holding one hand in between the shoulder blades at the base of the neck.


What To Do When Baby Won’t Latch

Cindy and Jana

Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.  You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana.  You can also connect with Cindy and Jana on TwitterFacebook and Pinterest.

Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit  for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn.  A month later, we received a phone message from Noella: “You aren’t going to believe it.  Nathan is now breastfeeding! I just decided to try it one day and it worked!”

Why babies may not latch at birth

Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:

  • Baby may be recovering from a difficult birth.
  • Baby may have a tongue tie.
  • Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
  • The shape of mom’s nipples may make it difficult to grasp the breast.
  • Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.

If baby will not latch in the first 24 hours after birth:

  • Keep your baby skin to skin as much as possible.
  • “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
  • Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
  • Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
  • Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.

If baby continues to not latch after 24 hours:

  • Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
  • Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
  • In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
  • Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
  • You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
  • Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
  • Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
  • Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
  • A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
  • Search out a mother-to-mother support group such a La Leche League.

In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.


Adoptive Breastfeeding

Breastfeeding My Adopted Baby

Mary Straits HeadshotKaren Lytle is the mom of four kids so far, three biological and one handsome adoptive son.  She has had the amazing privilege of breastfeeding all four of them, including her adopted son. Karen’s story is as unique as each mother’s breastfeeding journey, but she shares it hoping that some of it helps to inspire other adoptive moms as to the wonders of intimacy that can be a part of nursing adoptive children.

When our oldest was 15 months old, we brought home two beautiful, identical twin girls. Life was busy, but good. I was learning the joys and challenges of nursing multiples. When the girls were 6 weeks old the Lord told us it was time to start a process of adoption. We had always known we would adopt, but he told us the time was now.

We explored foster care, international, but in the end for this time, God was leading us to adopt a newborn – one who fit the qualifications of “more difficult to place.” We were matched when the girls were 14 months old, and Isaac’s birth mother was 37 weeks pregnant. I was still nursing the girls twice a day at this point, and I started weaning them the day after we met Isaac’s birth mother. As I weaned them, I began to pump every 1 1/2-2 hours including a nightly pump to get ready for the demands of breastfeeding my adopted baby.

Adoptive Breastfeeding

I had always struggled with low milk supply issues, so I think like every adoptive mother who tries this, I went through all of those concerns of whether or not I would be able to produce enough milk. But I was determined to teach him to breastfeed. So, I began to research, and I put myself on a nursing mother’s diet. I drank barley water and ate a variety of foods and spices (such as anise) that helped to nourish my milk. I also took fenugreek and blessed thistle supplements.

We brought him home when he was two days old. And I still remember that night. I told my husband that I wanted to have that first night where it was just Isaac and me so that I could be totally relaxed and work just with him on his feeding while he was sleepy and just get him used to my heartbeat. I stripped him down to his diaper, and laid him on me skin to skin. Every time he stirred, I would offer him my breast, and within a few offers, he had latched on just suckling instead of nursing. But, by the end of that first night, he had nursed twice. We slept together skin to skin, or I should say dozed together, like this for about a week. And he rarely wore any clothes during those first days together. I wrapped him up next to my skin and held him almost the entire time.

Adoptive babies need to acquaint themselves with their adoptive mother’s heartbeat, scent, and touch. With a biological newborn there are changes outside of the body, but there is an instant connection with sounds and sensations when their biological mother holds them.

With an adoptive infant, those connections need to begin to form with that new adoptive mother’s heart rhythms and touch. While there is no physical memory at this point, a child still has something called cellular memory. So, imagine this as a time where you are helping them through a grieving process that they don’t even know they have.

Also while helpful for every infant, light infant massage can be especially helpful for an adoptive infant’s transition into your family. It has also been proven to heal and correct any sensory pathways that might have received slight damage due to stress in utero or stress during delivery.  For an adoptive infant there is the added stress of separation from their biological mother.

Big brother with adopted baby.

Big brother with adopted baby.

Now, truthfully, nursing wasn’t a perfect process. While he was nursing like a champ, I have always struggled with low milk supply, so we did supplement some. And the most difficult time nursing him actually came when he was about 3 months old. I had emergency surgery and was in the hospital for four days, and while I pumped, I couldn’t nurse him. Fortunately, my sister had just had a baby, and so while I couldn’t nurse him she was able to.  But, by the time I got out, my milk supply had dropped even lower.

I met with a lactation consultant two days after I came home, and for the next 2 weeks, I used an at-breast-tube-feeding device when I nursed him. I think the amount of pain I was in and my stress that I might not be able to keep nursing him was affecting my supply. But, we made it through that, and I was able to nurse him until he was a year old.

I hope this inspires other adoptive mothers. This is a precious time with your child; relax and do everything you can to make it happen. You will not regret it. Nursing builds intimacy and trust between a mother and child.

Adoptive BreastfeedingWhile it is their best nourishment for their body, it is also building their emotional well being, and promoting their brain development beyond just nutrition as well. And when you are nursing your precious infant, especially your adoptive infant, remember to use it as a time to look deep into their eyes.

There is a reason the eyes are called the windows of the soul, and science has proven that those moments of eye contact between a mother and child in those early years provides a foundation of trust and connection that supports them for years to come. And for an adoptive infant, these times are being built at placement rather than before, so by doing this you can recoup some of that
lost time.


How to Encourage an Adopted Child to Breastfeed

Many parents who adopt do not get their child as a newborn.  Once a baby is several months old, especially if he has never breastfed before, latching to the breast for nourishment may not be something he initially accepts.  However, a child of any age, even if he has never nursed at the breast in his life, may later latch to the breast and nurse.  The following are 10 strategies to encourage an adopted child to breastfeed:

  1. Skin-to-skin
    Lots of skin-to-skin time together!  Skin-to-skin is wonderful for bonding as well as a mother’s hormones that help her breast milk supply.  It’s not just for newborns either.  If you are adopting an older child it may take time to build trust to be able to spend time skin-to-skin. Sometimes carrying them this way in a sling or wrap can help.
  2. Express milk on nipple
    Stimulating a milk let-down or even dribbling supplemental milk on the nipple can encourage a baby to latch and suckle.  If a mother has not yet built a milk supply, feeding with an at-breast tube feeding device can encourage a baby to suckle and associate mealtime with breastfeeding.
  3. Offer breast when calm
    When your baby is very hungry or upset is not the time to try to teach her how to latch onto the breast.  Work on breastfeeding when your baby is calm, perhaps sleepy even, when she is more willing to try to suckle at the breast.  Also, nurse when it is calm and the lights are dim.  Lots of noise and activity can be a distraction.
  4. Start slowly
    When your adopted infant does latch, don’t force her to stay on the breast for a full feed.  Of course, allow her to nurse as long as she wants but if she only nurses a few minutes and then is ready for a bottle or other activity, praise her for nursing for the time she did!  This is a huge milestone.  You can build up the amount of time on the breast over the coming days/weeks.
  5.  Remove all artificial nipples
    Infants enjoy sucking on something.  Nipples aren’t just good for breastfeeding; they are also the original pacifier.  If your child is reluctant to latch on the breast, make sure you are not giving her a pacifier to satisfy her need to suck and preferably not a bottle either.  Give any supplements in a cup, syringe, or by finger feeding.  Continue to offer the breast and help her see there is milk there (by dribbling some on the nipple); praise her if she does attempt to suckle.  If you do continue to feed her with a bottle, pace the feed so that the bottle can more closely mimic breastfeeding.
  6. Make the breast a happy place
    Never force your child to nurse; this is completely counterproductive.  Spend lots of time skin-to-skin and have your breasts readily available, but never make your child breastfeed.  Offer them often and praise any interest your baby has.  Make sure she is developing happy thoughts while at your breasts.
  7. Try bait and switch technique
    Hold your baby across your chest with your breast available while giving a bottle (or whatever feeding method you are using – cup, spoon, finger feeding, etc.).  After she has had some milk through the bottle, gently try to switch her to nursing at your breast (the bottle and her mouth should have been touching your breast already).  If you don’t have a strong milk supply currently, make sure to have the at-breast tube feeding device set up so it can be a simple transition from bottle feeding to suckling on the breast.
  8. Ensure good positioning and attachment
    You do not want to have to re-teach your baby how to nurse effectively once you’ve crossed the hurdle of helping your baby latch.  Ensure she is positioned well, supported across your body, and that she has a wide, deep latch on your breast.  A shallow latch can not only cause nipple damage but also fail to stimulate a strong milk supply.
  9. Breastfeed at night and for comfort
    Prolactin, a hormone necessary for lactation, is higher at night and breastfeeding at night helps to increase your milk supply.  It could be an opportunity for your baby to nurse without additional supplementation.  It is also a time she may be more calm and willing to latch onto the breast.  Bed sharing or co-sleeping can help you both get rest while allowing your baby the chance to nurse frequently. In fact, nurse your baby anytime she is willing.Even if you are using an at-breast tube feeding device but don’t have it ready and she shows interest, let her attempt to latch and suckle.  Breastfeeding is about more than the nutrition; it is also a relationship.  All breastfed babies have times of “non-nutritive sucking” where they are nursing for comfort more than hunger.  These times will help to further increase your supply and her trust in you, her mother.
  10. Try nursing in different positions/places
    If your baby is uninterested in nursing one way, try another.  She may prefer nursing on one side (perhaps the side she is used to taking a bottle on).  She may prefer nursing lying down, standing up, or walking around.  Some babies prefer to nurse while in a sling.  Try lots of different things, never forcing them, but offering to see what your baby will prefer.

Megan Church Blog 2 Featured

How I Succeeded: My Breastfeeding Journey

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.

As I discussed in a previous post, I was prepared for cracked nipples and poor latching. But I wasn’t prepared for the mental fortitude that was necessary to reach my breastfeeding goal.

Even though breastfeeding my first two children was more mentally exhausting and demanding of my time than I could’ve predicted, the mechanics of it went smoothly. From the start, both were great nursers with a naturally good latch. I never experienced soreness or difficulties with them. I credit that to a few factors:

Megan Church

Pre-birth education

Knowing I was absolutely clueless about how to breastfeed a baby, I signed up for a class at my local hospital. I took the class, while I was pregnant. This helped me understand what to look for in a proper latch, positioning and more. Sure, it was odd practicing with dolls, but when it came time for the real thing, I at least had some idea of what to do.

Immediate skin-to-skin contact

After my babies were born, they were immediately placed on my chest for skin-to-skin contact. We enjoyed an hour or two together, just getting to know one another without a lot of intrusive examinations getting in the way of the most precious bonding moments. This allowed both babies to root and follow their natural instincts for nourishment and comfort right after birth. I still remember how amazed I was after all three of my babies began to nurse on their own within the first hour of their lives. That wouldn’t have been possible without that skin-to-skin time.

Lactation consultants

Before having a baby, I was a pretty modest person. I wasn’t sure how I would respond to people seeing all sides of my body. But, in the throes of labor, discretion sort of goes out the window. And, I found that to be true, while nursing as well. Our hospital had great lactation consultants on staff who answered any and all questions. They would come watch me breastfeed to make sure the latch was good and that baby was feeding well. As a newbie with no expertise in breastfeeding, this feedback was a beautiful thing.

Supportive husband

I am blessed to have a supportive husband who also believes in the benefits of breastfeeding. After doing our research during pregnancy, we knew we wanted to not only give our babies the most natural entries into the world as possible, but we also wanted them to be nourished by the most natural food possible. He was always a great supporter and, while he might not have gotten to spend time bonding with the babies during feeding sessions, he bonded in many other ways instead (such as middle-of-the-night diaper changes, rocking to sleep, baby wearing and more). He respected the importance of breastfeeding and he’s an encourager for other moms to breastfeed as well.

Examples of others

By the time I had my first child, I had watched both of my sisters-in-law nurse their babies. While I wasn’t eyeing their latch and getting an up-close-and-personal view, their example still showed me that it was possible and that, while struggles might occur, patience and dedication can get you through.

The will to not give up

Natural birth taught me that I’m a lot stronger than I realized. Before giving birth, I did my homework. I knew the benefits of breastfeeding and I knew I did not want to give my babies formula. So even during those moments of exhaustion and times when I struggled with always having to be the one to feed the babies (my first two rejected any sort of bottle), I still knew that I didn’t want to give up. I knew it was a season of life and that weaning would eventually occur some day. I knew that my top goal was to get them through their first year without formula. And, we made it. With each of my three babies, we made it that first year…and even a few months beyond.


Maximizing Your Milk Supply for Multiples

The human body is absolutely amazing it is completely possible for a mother to make enough breast milk to exclusively nurse twins, triplets, or more.  Having excellent lactation support in the early days is critical to help maximizing your milk supply for multiples.  The following are 10 strategies to help get breastfeeding your twins or higher order multiples (HOMs) off to a good start.

  1. Plan for a variety of birth scenarios
    Have a birth plan and talk with your doctor about the importance of having as natural a birth as possible.  But, also be prepared for a situation where you may end up delivering by caesarean section.  Realize that the majority of multiples come early.  Having a plan in place for whatever birth scenario will help you to initiate breastfeeding as soon as possible after.  Make sure your doctor, midwife, and birthing facility are supportive of your birth and breastfeeding goals. And talk with a lactation consultant in advance so you have a plan in place in case your babies are born prematurely and you must express your milk in the beginning while your babies are in the NICU.
  2. Initiate skin-to-skin immediately following birth 
    Skin-to-skin contact is wonderful for both mothers and babies.  It helps regulate body temperature and blood glucose levels in babies and allows a new mother’s hormones to flourish for her baby and milk supply.  In fact, did you know that each breast will specifically regulate its temperature based on each individual babies’ needs? Skin-to-skin is possible with two babies at a time, as well as after a c-section (when a mother has help supporting her babies).
  3. Allow first breastfeed to take place while babies are skin-to-skin
    Ideally, skin-to-skin contact should continue through the first breastfeed and first two hours following birth.  This is a critical time of bonding for a mother and her babies, and it can never be returned.  Delay all non-essential procedures until after this time (or have them done while babies are on mother).
  4. Room-in with your babies
    As long as your babies are not in the NICU, keep them in your room.  (And if they are in the NICU, find out if you can room-in with them and/or practice 24-hour kangaroo mother care.)  This will allow you to follow your babies’ feeding cues and nurse when they are hungry.  It gives a new mother confidence to care for her babies and helps to establish a strong milk supply.
  5. Nurse on demand around the clock
    Newborns eat all the time – at least 10-12 times every 24 hours.  It is normal to eat much more than this…even to seem to eat “all the time.”  So you can do the math – twins could mean feeding your babies 20 or more times each day!  It is important to watch your babies’ wet and dirty diapers to ensure they are taking in enough milk. It is important that they have a wide, deep latch and you are not in pain while nursing. And it is important that they seem to come off the breast satisfied – even if this “satisfaction” only lasts a short time.  Other than this, new babies spend their time and eating and sleeping.  A twin or HOMs mom will feel like all she does in the beginning is feed babies. It is okay to feed your babies separately or at the same time – whatever works best for you!  Most twin moms find that it is easiest to start off nursing them individually and then, once each baby is nursing well, nurse them together. Knowing which breast to offer and different positions for nursing twins can make all these feeding options seem less intimidating.
  6. Don’t hesitate to pump
    The first few weeks following birth is a critical time period to establish your milk supply and make sure your body gets the message that it needs to make enough milk for 2, 3, or even more babies.  If your babies are not nursing effectively at the breast, do not hesitate to pump after a feed to ensure your body makes enough milk.  An empty breast makes more milk.  If one baby nurses effectively and the other doesn’t, you will still want to pump to ensure you have an adequate supply for both babies.  (And, you can always “top-off” your baby who is not nursing effectively with your expressed milk.)
  7. Know your magic numbers
    Your goal is to ensure your body makes 750 mL of milk for each baby, within 10 days following birth. If you are expressing to build your supply it will be easier to see the amounts in the bottle. If you are breastfeeding, it is best to watch your babies’ diaper output and feeding cues.  But, if your babies are small and not nursing well, it is prudent to express following a feed.  Don’t worry so much about the amounts adding up to 750 mL/day per child since you babies are drinking your milk from the breast too (and the benefits of feeding at the breast far outweigh pumping all your milk just to see how much is in that bottle).  But, you can keep a log and see if the amounts you are expressing are going up or down – and if they are going down it is probably because your babies are taking in more at the breast . . . which is exactly what you want to happen!
  8. If your babies are in the NICU establish your supply well
    Begin pumping within the first six hours following birth with a double-electric breast pump.  Continue pumping at least eight times every 24 hours to establish your milk supply.  Also, if your babies are in the NICU, make sure to talk to the hospital lactation consultant to develop a plan to build your milk supply and then transition your babies to your breast.
  9. Have a lactation consultant that will support you
    Find out who is in your area while you are still pregnant.  Even better, have a prenatal consultation to get to know her, and develop a lactation plan for establishing a strong milk supply for your situation.  Then, after your babies are born, you will already know who to call if you have any questions or concerns.
  10. Get involved with a mother-to-mother support group
    Though qualified lactation support is essential to successfully breastfeed twins and HOMs, it is equally important to have the encouragement and support of other mothers who have been there.  Some areas even have breastfeeding support groups for mothers of multiples!

DCG Mastitis

Preventing Mastitis

Mastitis is an inflammation of the breast.  A third of breastfeeding women experience mastitis at some point, with the vast majority occurring by three months postpartum. 1 However, mastitis can occur at any point during lactation, and there are many things a mother can do to help prevent it occurring.

Below are ten important things all breastfeeding mothers should do for good lactation management; all of which will help to prevent mastitis too.

  1. Educate yourself about breastfeeding while you are pregnant: babies should be fed on cue and not on a prescribed schedule; newborns eat all the time and should have frequent, unrestricted access to breastfeeding; every mother’s breast storage capacity is different so it is best to feed on baby’s cues, etc.
  2. Find a qualified lactation consultant in your area before you have problems and don’t hesitate to contact her if you have any concerns/questions …or even for one-on-one time with an expert to make sure you are doing everything right! (Many insurance plans are beginning to cover services for an IBCLC; even if yours doesn’t, getting qualified support so you can breastfeed is much more cost effective than buying formula and higher healthcare costs.)
  3. Practice 24-hour rooming in and lots of skin-to-skin time with your baby – all of which helps mom respond to baby’s early feeding cues, reduces skipped feeds, and aids in frequent nursing and breast drainage.
  4. Avoid pacifiers, bottles, and artificial teats. Babies have a desire to suckle and if this need is met elsewhere, such as with pacifiers, it can lead to missed feeds, full breasts, plugged ducts, and mastitis.
  5. Understand and recognize early warning signs of mastitis and proactively treat them if they occur.  When you notice full breasts or milk stasis, be extra diligent in nursing your baby frequently to ensure milk stasis turns into milk removal and not a plugged duct.
  6. Use breast massage if you have a plugged duct to enhance milk flow and remove the clogged milk.
  7. Express milk and/or use breast massage if baby is not feeding effectively for whatever reason.  You may have a premature baby or an older baby who has a cold and doesn’t want to nurse much for a few days. No matter the reason, make sure to express milk if baby’s lack of effective milk removal is temporary.
  8. Take note of changes in a baby’s feeding rhythms. If baby begins to sleep longer stretches at night, mother may need to express a little milk for comfort as her body begins to adjust. Perhaps your baby is beginning to eat a lot of solids and isn’t nursing as often during the day; take care to ensure your breasts don’t become so uncomfortably full it could turn into mastitis.
  9. Use common sense approaches for good health so your body is better able to adjust pathogens it does come in contact with: accept all offers of help; get adequate rest (perhaps you consider bed sharing for example); eat a healthy diet; wash your hands; and take care that bras, purse straps, and/or slings are not pressing into your breasts, which can lead to milk stasis and mastitis.
  10. Be especially diligent if previous history. If you have had mastitis before, including while nursing previous children, or if you have had breast surgery it is critical that you are extremely diligent to prevent milk stasis and plugged ducts from occurring. Ensure your baby has excellent positioning and attachment at the breast. Listen to your body and don’t hesitate to seek lactation support!

Birthing-Practices-Thumb

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 into 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 his 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 most important single 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.

JU18

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.  My husband and 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 our 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 be 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.