Pregnant? Prepare Now for Breastfeeding!

Our new scientific understanding of the microbiome and breastfeedingepigenetics is helping us to understand how babies who are fed human milk, and those who are fed formula, are inhabited by different microbes. Our comprehension of why babies who aren’t breastfed are more likely to have health issues is deepening. One reason is there is a difference in the way their genes are activated. I think it’s fascinating! Stream the documentary Microbirth for a better understanding of how we create our baby’s gut health during pregnancy, birth and breastfeeding.

Breastfeeding is what makes humans mammals, and in some ways is the most natural of acts. If you’ve ever seen a mom breastfeed her baby while she keeps up with her toddler at the playground, you know that. But breastfeeding is also learned. And for most of us, because we haven’t spent our lives surrounded by nursing moms, that learning curve can be steep in the first few weeks. It usually takes three to four weeks before the first time mom can talk on the phone, eat dinner, and nurse at the same time. Setting aside the first few weeks to learn to nurse and to recover from labor and birth makes sense. See my post on doulas and other tips for making postpartum easier.

“I believe, like with any journey, the preparation phase is the most important aspect of breastfeeding.” Christy Jo Hendricks, an International Board Certified Lactation Consultant (IBCLC) from Birthing and Breastfeeding told me. “When a mom receives evidence-based information prenatally, she is equipped with knowledge and power. Most moms make their feeding choice prenatally, so diving into the discussion early is very advantageous. Those who educate themselves rarely fall for scare tactics, and are prepared for stages of lactation. Moms should have confidence in their bodies and understand the basic anatomy and physiology of lactation.”

Learning about breastfeeding while you’re pregnant will make it easier to do when your baby comes. Take a breastfeeding class and read the Womanly Art of Breastfeeding. Understanding breastfeeding position and latch before you start will help you from developing sore nipples postpartum. Include your partner in your educational process. When the other parent is on board with breastfeeding, and understands how it works, mothers breastfeed longer and are less likely to supplement.

I asked Lucia Jenkins, RN, IBCLC, the Executive Director of Baby Café USA, what advice she offers pregnant women. She told me the “first thing to do is find a Baby Café, La Leche League group, or other breastfeeding support groups where you can watch women breastfeed. Being able to observe a newborn latch is particularly important. A photo or video pale in comparison to seeing it in front of you.” Christy Jo says agrees. “Moms can find their support group before they deliver so if any issues arise, they have a built in sounding board that will offer advice and support.”

“Remember babies breastfeed, moms don’t.” Lucia reminded me. “A baby on his or her side will be disorganized, but if he or she is on top of the mom in a laid back position, you’ll be amazed at how capable he or she is.”

“The best thing for pregnant moms to do to prepare for breastfeeding is to learn about the importance of skin to skin and laid back breastfeeding,“ Laurel Wilson, IBCLC, the owner of MotherJourney told me. “Skin to skin is not just for the first hour after birth. It is a way of being with your baby in those early days and weeks that helps you extend that connection you felt during pregnancy. It keeps baby close for breastfeeding, keeps them calm and nurtured, and regulates his or her temperature, breathing and heart rate. It is the key to the best experience possible after the baby is born.” Lucia agrees, saying “Skin to skin is not an event, it’s a place for your baby to transition over the first few weeks. Plan on doing lots of baby wearing with your baby just in a diaper.”

Lucia Jenkins, IBCLC, the executive director of Baby Cafe USA, shared these suggestions with me. “Learn to hand express some colostrum. Around the eight month moms start to be able to do this. Try to find a hospital that is Baby Friendly. Make sure you do immediate skin to skin for at least an hour. The baby’s bath and weight check can wait. They aren’t important. What’s most important is that baby has mama. Your baby’s vernix is extremely protective.”

Plan to keep your baby with you postpartum. Known as rooming in, babies who sleep in their mothers’ rooms are happier and cry less. Studies show that moms who room in get similar amounts of sleep to moms whose babies sleep in the nursery. Learning to read your baby’s early hunger cues and nursing him or her frequently initially helps to get breastfeeding off to a good start. Understand the risks of your baby having even one bottle of formula in the hospital.

The choices you make for your labor and birth can affect your breastfeeding experience in the beginning. Common pain medications, pitocin, vacuum delivery, and cesarean birth can all increase the learning curve in the beginning. Even something as simple as an IV in labor, can result in over hydration for you and your baby. A mom who is over-hydrated will have swollen breast tissue which makes it more challenging for her baby to latch. A baby who is born over-hydrated will initially have excess fluid, which increases his or her birth weight. This can cause the baby to lose more weight (greater than 10%) of his or her birth weight, which can result in formula supplementation. Using the twenty-four hour weight, rather than the birth weight, is more accurate in this situation. Labor interventions are sometimes necessary, and moms can go on to successfully breastfeed afterwards, but breastfeeding should be seen along a continuum that includes pregnancy and birth. If you know you will be giving birth by cesarean, discuss with your doctor prenatally breastfeeding and holding your baby skin to skin in the operating room.

When interviewing pediatricians, ask how they will support you during breastfeeding. Pediatricians don’t learn much about breastfeeding in medical school, so expect that they will refer you to an International Board Certified Lactation Consultant (IBCLC) if problems arise. IBCLC is the gold standard when it comes to lactation support. They are usually available for consultation in the hospital during the postpartum period. You can also find an IBCLC who will visit you at home.

Check with your HR department to make sure you will get pumping breaks and a place to pump that is not a bathroom when you return to work. Federal law protects these rights. If you are in the military you can get support through Breastfeeding in Combat Boots.

A common concern that many moms have is breastfeeding while taking medications. Most meds are compatible with breastfeeding, or there is a similar one that is. Discuss the safety of the medication with your pediatrician, not the prescribing doctor. Call the Infant Risk Hotline for specific information about the safety of your medication.

Some of my fondest memories of my daughters’ early years are of breastfeeding. But I also remember the steep learning curve in the beginning, and some very long early nights when I wondered why people kept talking about how fast those first years go by. Now I see that while the days (and nights!) can be long, the years are short. Preparing for breastfeeding during pregnancy will make those first days easier.

Julie Brill, CCCE, CLD is a childbirth educator, labor doula, and breastfeeding counselor. She also trains labor doulas and childbirth educators throughout New England. The homeschooling mother of two teenage girls, Julie is also the author of the doula anthology Round the Circle: Doulas Share Their Exeriences. She offers private childbirth classes in the Boston area.