Birth & Breastfeeding - The Surprising Connections
The first few days after baby's birth can determine a mother's long-term breastfeeding success.1 Women often expect breastfeeding to come naturally, and then are surprised to find themselves in the midst of a steep learning curve trying to make their way through a maze of difficulties to establish breastfeeding. But what if it didn't always have to be so hard? The truth is, babies come equipped with instincts and behaviors that are meant to help breastfeeding come naturally. A healthy, full term baby born via medication-free, vaginal delivery will "crawl" to mother's breast when placed skin to skin on her chest, will use all his senses to see, smell, feel and taste his way to the nipple, and will root until he attaches at breast (see video below). This strong inner drive to breastfeed will continue over the coming days, helping baby to show feeding cues when hungry, latch deeply at the breast, and stay awake long enough to get a full feeding. Unfortunately, commonplace birth practices are putting women at a disadvantage by interfering with these inborn mechanisms, making breastfeeding feel anything but natural.
Let's explore how birth impacts breastfeeding, and 5 practical steps expecting mothers can take to help breastfeeding come naturally to her and her baby:
Let Baby Set the Delivery Date
23% of women are induced,2 sometimes because of convenience or physical/emotional discomfort as opposed to medical necessity. Breastfeeding comes easier to full term babies thanks to their mature instincts, bigger and stronger mouths, and increased ability to stay awake for a full feeding.3 The average first time mother will go 8 days past her due date if nature is allowed to take its course4 - making spontaneous labor more of a mental feat than anything as women try to resist the alluring draw of an induction. Under normal circumstances, a baby will "cue" labor when he/she is ready to be born, initiating the cascade of hormones leading to labor. Not only does induction increase risk of a baby who is less developmentally ready to breastfeed, but it also doubles a woman's risk of cesarean.5 Which brings us to the next tip...
Avoid Cesarean, or if medically-necessary request a "Gentle" Cesarean
Because of the physical trauma of cesareans - which are considered a major surgery - most women will experience a delay in their mature milk coming in compared to women with vaginal births.6 After a vaginal birth, first time moms usually notice an increase in milk production on day 3 as their milk transitions from colostrum to "mature milk." When milk production is delayed and doesn't increase until day 4 or later, baby becomes increasingly hungry - even inconsolable - often resulting in formula supplementation or baby losing excess weight (greater than 7% birthweight).7 Another reason cesareans get breastfeeding off to a more difficult start is because mother and baby are often separated at the moment of delivery instead of baby being placed skin-to-skin on mother's chest. Women can request a "gentle" cesarean, which includes having baby immediately placed on mother's chest while still in the surgical room. This keeps baby's breastfeeding instincts intact as she is able to root for the breast and initiate the first feeding within an hour. So how does a woman avoid cesarean? Its not always possible, of course, but a some cesareans can be avoided by waiting for labor to start on its own (avoid induction), following certain labor practices that help minimize interventions, and hiring a doula (see tip #4).
Choose Pain Meds Carefully
Studies have shown that pain medications used during labor affect a newborn's breastfeeding behaviors after birth.8 They may reduce baby's instincts to seek the breast and latch or they may cause baby to be sedated and sleep heavily (disrupting feeding patterns). When possible, medication-free natural delivery is most likely to get breastfeeding off to a smooth start. Breastfeeding is a dance between mother and baby, and if either partner is not participating it makes the whole process more difficult. An alert newborn with fully engaged instincts is more likely to latch well and show feedings cues. If you find that you want or need pain medications during labor, opt for a low dose epidural over narcotic IV medications as this seems to have a milder effect.
Hire a Doula and Take a Comprehensive Childbirth Class
Take a comprehensive childbirth class that teaches techniques for coping with labor pain and how to prevent interventions, since less interventions typically results in better breastfeeding outcomes. In addition to taking a childbirth class, consider hiring a doula. According to Laura Speece, CLD, CCCE, "A doula is the only birth professional who offers continuous, uninterrupted support during labor. She will come labor with you at home and stay with you all the way through the initial breastfeeding time - offering support, encouragement, comfort measures, information for you to make fully informed decisions, explanations of medical terms, reassurance of what is normal in labor, and a calm, confident presence. All of this results in significantly lowered c-section and intervention rates, shorter labors, and higher breastfeeding rates!! No matter what type of birth you are planning, everybody deserves a doula!" To find local doulas and childbirth educators, check out the Charlotte Birth Collaborative.
Stay Skin-to-Skin the First Hour
This has already been mentioned several times, but it can't be understated the importance of letting baby's breastfeeding instincts "lock in" by remaining skin to skin and breastfeeding during the first hour. Numerous studies have showed that breastfeeding initiation and long-term duration improve with skin-to-skin contact at birth.9 Even while you are delivering the placenta or getting stitches, let baby snuggle up on your bare chest. Once he shows interest in feeding, let him self latch while you are in a reclined position. If baby gets frustrated or the first hour is nearly over without him self latching, help baby attach to the breast using the approaches in these videos.
3 Feeding Patterns of Full-Term and Preterm Infants at Forty Weeks Postconceptional Age. Journal of Developmental & Behavioral Pediatrics, 2002
4 The Length of Uncomplicated Human Gestation. Obstetrics & Gynecology, 1990.
5 Elective Induction of Labor as a Risk Factor for Cesarean Delivery Among Low‐Risk Women at Term. Obstetrics & Gynecology, 2000
9 Early skin-to-skin contact for mothers and their healthy newborn infants. The Chochrane Library, 2007