Newborn breastfeeding in the hospital. Photo courtesy of Daquella Manera

Sutter Davis Hospital in Davis, California

Stephanie Cassidy emailed me the following:

I just wanted to say that my experience at Sutter Davis Hospital in Davis, CA was great! They are pro breast feeding and fully support it. The nurses are encouraging and lactation consultants are available to support and educate you. The thing I liked was that if you chose not to breastfeed, use a pacifier, or supplement you have to sign a waiver. So no one is going to give your baby something you do not want them to have. They encourage breastfeeding on their website: “Breastfeeding allows you and your baby to emotionally bond in a special way that cannot be matched, because breastfeeding meets both the nutritional and nurturing needs.”

I love the use of a waiver! It emphasizes the importance of the decision not to breastfeed.

A Not-So-Good Experience

Kelly wrote to share her less-than-ideal interaction with a hospital lactation consultant:

I had my third daughter one year ago yesterday and I am still breastfeeding. I have now breastfed for a total of 5 1/2 years. I LOVED the hospital she was born at. The only bad experience I had was with the lactation consultant. When I got pregnant with my newest addition I was still nursing my almost 2 1/2 year old. I was slowly weaning her off but once I found out I was pregnant I went ahead and called it quits. I never really dried up completely. When I gave birth to my newest little one I had an emergency C-section (yuck) and I wasn’t able to nurse her until about 5 hours after she was born. They had to keep her in the nursery and as soon as I could feel my legs they let me go down to feed her, she latched on perfectly. I got her in the room that night and was able to feed her with no problem. The next afternoon I was already engorged. The lactation consultant came in and I was very open to her being there. I explained to her that this was my third daughter and I breastfed my oldest for two years and my second for 29 months and that my milk never dried up while I was pregnant. My husband hadn’t brought my pump up yet and that I was so engorged that I wanted the pump for a little relief from the pain, so that I wouldn’t get mastitis and so Chloe could eat more comfortably. She basically told me there was no way that my milk was already in and that I shouldn’t pump the milk out. So I then squirted the milk out across the room. I felt like she thought that I no idea what I was talking about. She basically shrugged off everything I said. At least that’s what I felt. Then she told me how I was holding the baby wrong. I was thinking in my head, You know she is making this very stressful. If I hadn’t been so comfortable with breastfeeding she would possibly be making me not to want to do it at all. Breastfeeding is overwhelming enough to have someone like that making you feel like an idiot. Someone else finally brought the pump to me and I did what I need to with no help from her and everything is still fine today. On a positive note, I was surprised to see the diaper bag for breastfeeding mothers. With my other two daughters there where only the formula bags. It’s nice to see that hospitals are more involved in helping mothers breastfeed. That they even have lactation consultants is wonderful I just happened to get someone that thought she knew everything. All I can say to that is everything isn’t written in black and white, there are other circumstances to what she thought was correct, mine was one of those. I’m not saying that every mother will need to pump like I did. I am now going to school to become a nurse and I will then do what is needed to become a lactation consultant.

Kelly, I laughed out loud at the image of you squirting your breast milk across the room to make a point for that lactation consultant! Good for you! Best wishes for your career training — I can tell that your experience will make you a compassionate and helpful LC!

Other Carnival Participants (Stay tuned as links are posted as they come in!)

The Milk Mama: Newborns, Nursing, and Hospital(ity)
Momma’s Angel: My Hospital Experience in Norway
Hobo Mama: Breastfeeding Support: A Tale of Two Hospitals
Whozat: The Nipple Intervention
The Motherwear Breastfeeding Blog: Had a Good or Bad Experience in the Hospital? Tell Them!
BreastfeedingMums: Top Tips for Breastfeeding Success
The Beautiful Letdown: Breastfeeding in the Hospital

Post from: Breastfeeding 1-2-3

Interesting to read all your experiences and to see what a common problem this is…I’m in a tough situation so your advice would be helpful.

I’ve co-slept with my son since he was 3 months old, and it has worked great for us. He wakes up to nurse, then falls right back asleep. Neither of us wake up fully, so I’ve been able to have great sleep from from about 12 mos until now (24 mos.)

But over the last 2 weeks his sleep has been terrible. He won’t go to bed until 10:30 (used to sleep easily at 8:30) and wakes up 3 times a night nursing voraciously (like, 30-40 minutes!). I’m pregnant (2 mos) and get so irritated with this! I take him off the breast but then he cries and cries. My husband then comes and tries to comfort him but he won’t go to him at all during the night, and gets really agitated.

I’m so worn out and am thinking of night weaning, but hate the thought of having him cry for long periods of time. Partly cuz I don’t want to cause him upset, but also cuz it is horrible to listen to during the night.

Any suggestions?

Rosemary, congratulations on your pregnancy! Breastfeeding while pregnant can be a challenge emotionally and physically. My guess is that your milk supply has started to diminish a bit (which is normal during pregnancy) and/or your milk has started to taste a little salty (also a normal change). Some nurslings (like my first daughter) continue on nursing as if nothing had changed, but others are affected by the changes.

Photo by Jessicafm

I highly recommend that you check out a copy of the book Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond by Hilary Flower. It describes the experience of breastfeeding while pregnant and the various emotions it triggers in both mother and nursling. You are not alone! Two other books that might be helpful are Mothering Your Nursing Toddler and How Weaning Happens.

As for more immediate, practical advice, try offering your son a bedtime snack and some extra fluids (my suggestions would be water, milk or a cow’s milk alternative like almond milk). Does he drink from a cup, a sippy cup, or a cup and straw? Offer him his alternative drink in that cup. Have the same cup — this time filled with water only — available for drinking during the night. You can still nurse him for as long as you are willing, then offer the cup. I found that it helped to give my nursling some warning, either by offering to nurse for the length of the ABC song, or by counting down at the end of a nursing session (10-9-8-7-6-5-4-3-2-1-done!). Be sure to talk to him about the plan ahead of time, during the day and not just as you’re going to bed. “Mommy is extra tired and would like to get a good night’s sleep. We will nurse while I sing the ABC song, and then you can have your special cup! If you wake up in the night, your cup will be right there and I can sing you back to sleep.” Keep repeating your plan, whatever it might be, throughout the day and then remind him at night. “Remember how we talked about nursing to the ABC song?” He might still be upset, and you might have to keep working on a plan that suits you both. If he is verbal enough, you might even try asking him to help come up with a solution. “Mama’s mum-mums aren’t making as much milk, are they? What would you like to drink instead? Would you like your sippy cup or this special straw?” You never know, your son might surprise you! Different children have different temperaments, and you know what will work best with your son.

Does anyone else have advice for Rosemary? If you breastfed while pregnant, what was your experience like?

Post from: Breastfeeding 1-2-3

Post-It Image by Agata Urbaniak

Today I share a guest submission from a woman who does not have a blog but who felt strongly about sharing her breastfeeding wisdom in hindsight. At the end of her comment you can find the links to all the other carnival participants. First, Crystal offers the following insight:

What I wish I had known…to trust myself and my body to do what nature intended…which I am currently doing with breastfeeding my 7 week old twin boys!!!

I am currently a 27 year old mother of 3 beautiful boys. My first born son was breastfed for 18 months and weaned himself at that time. He breastfed with no problems and is as healthy as can be at the age of 4.5. Now I just recently had twin boys at 38 weeks gestation born on August 26th 2009 who are also breastfeeding on-demand. I had mixed feelings about my body making enough milk and having enough support for me to continue breastfeeding….etc. Many people said I wouldn’t be able to do it and even my boys’ pediatrician said I needed to supplement with formula because they were not gaining enough weight.

My twin boys are very healthy and are gaining weight through breastfeeding only. I am not and will not supplement with formula. My midwives said I am making enough milk for both my boys and that they are breastfeeding beautifully. Also they said that my body knows what it needs to do as long as I am eating and drinking enough. I am an experienced mother and I am experienced at breastfeeding. I must trust myself and my body to do what nature intended it to do:

To breastfeed my babies!!!!

I am happy to say that despite having my up and down days with breastfeeding two babies as it is difficult; I am never going to regret or give up on my decision to breastfeed my boys as they are worth it and much more.

Thank you to all the wonderful breastfeeding mothers who gave me advice, support, and encouragement in breastfeeding my singleton and then again in breastfeeding multiples. I believe in myself and in my body to continue breastfeeding my twin boys!!!

Congratulations Crystal and thanks for your submission!

Other Carnival Participants

Sarah Fancy Pancakes: Wish I’d Heard More Good Things
The Milk Mama: When breastfeeding begins badly, and what I should have done about it
Hobo Mama: What I wish I’d known when I started breastfeeding
My World Edenwild: What I Wish I’d Known Then: A Poem
Happy Bambino: I wish I had known then that it wasn’t up to me alone
Three Girl Pile-Up: 4 things I wish I’d known about breastfeeding
Birth Activist: What I Wish I Would Have Known About Breastfeeding
Breastfeeding Moms Unite!: You Don’t Have to Grin and Bear It
Momma’s Angel: What I Wish I’d Known Then: My List For Next Time
The Starr Family Blogg: I Wish I Would Have Known
Whozat: If I’d Known Then
Massachusetts Friends of Midwives: What I wish I’d known back then about breastfeeding
Fighting Frumpy: When Breastfeeding Feels Wrong
Breastfeeding Mums: 15 Breastfeeding Facts I Wish I’d Known as a First Time Breastfeeding Mum
Cave Mother: Nursing Wisdom
Blacktating: Breastfeeding Is Life-Changing
MumUnplugged: Six Things I Wish I’d Known

Post from: Breastfeeding 1-2-3

Laugh and Learn about Childbirth

Sheri Bayles has taught over 4,000 couples in the New York area and worked over 20 years as an Ob/Gyn nurse. The “Laugh and Learn about Childbirth” class is a 2-DVD set for a total of 4 hours and 15 minutes. Of all the DVDs, I enjoyed these the most. When I was pregnant with my first child, my husband and I took a Lamaze class offered through the local hospital. Frankly we would have been far more comfortable and invested a lot less of our time watching this DVD class at home! Sheri talks about “normal birth” and what happens when a “cascade of interventions” begins (such as in my first labor when I decided to get an epidural, needed IV fluids, had to have a catheter, and nearly had to be given pitocin when the epidural slowed down my labor).

One of the most powerful things presented in this class is how to talk to the doctor and nurses about managing your own labor. Want to breathe through the pushing stage but the doctor and nurses are telling you to hold your breath and push to a count of 10? Confidently say that you would like to try breathing and pushing for a while and see what progress you make, and if that is not going well you will switch.

The DVDs came out in 2007 and contained a lot of information from studies up to that point. The only change I would have liked to have seen was with the information presented and paper insert given about cord blood banking and a particular company. While I think it’s important for parents to learn about cord blood banking and make an informed decision, that felt more like an advertisement than information. It doesn’t diminish my recommendation of Laugh and Learn About Childbirth though and I highly recommend it.

Laugh and Learn about Newborn Baby Care

This short newborn baby care class covers everything the hospital nurse tried to teach me in 10 minutes before I was discharged from the hospital. I wish I had had this DVD to watch in the comfort of my home before I gave birth!

The class would be particularly helpful for husbands or partners to watch so that they can become comfortable caring for the baby as well. The lessons cover giving a sponge bath, diaper changes and dressing a newborn, swaddling, tub baths, diapers and dressing for a 3-month-old, and baby supplies. I recommend Laugh and Learn About Newborn Baby Care highly as well.

Laugh and Learn about Breastfeeding

As a breastfeeding blogger you know I watched Laugh and Learn About Breastfeeding first! As I said, Sheri is an International Board Certified Lactation Consultant. She nursed her twin boys for nine months, which is an admirable accomplishment! The nine lessons offered are generally helpful and present some good information. There are just a few things I want to note. Sheri recommends breastfeeding for 10-15 minutes on one side, then breaking the latch, burping the baby and switching to the other side. For many mothers and babies that might work fine, but I see an awful lot of women at breastfeeding support meetings who have low supply because they followed advice to limit feedings to that short of a duration. Ideally babies should nurse on one side until they are done, and they are “done” when they either fall asleep at the breast or pop themselves off. Sheri also mentioned starting a bottle at two weeks, and ideally I think that should wait until four weeks. She talks about pumping a bottle for the partner to give in the evening so the mother can sleep: the mother last nurses at 8 or so, goes to bed, the partner feeds the baby at 11 or so, and then the mother gets up at 2 to feed the baby again. That could give the mother 5-6 consecutive hours of sleep, which I agree would be heavenly. However, nighttime is some of the most important time for nursing sessions to build up and maintain the mother’s milk supply. Some mothers who do have a good supply might experience engorgement, which is not only painful but can also spiral over time into lower supply as the body signals itself to stop producing as much milk because the breasts are uncomfortably full. Again, some mothers have success with the “relief bottle” but others need to be careful with that.

I have to mention one other thing, simply because I found it so funny! Sheri demonstrates different breastfeeding positions (and by the way I love the footage of the mothers breastfeeding their newborns in those positions!) In the DVD there is a written banner across the screen with the title of each hold. After the “Cross-Cradle” and “Football” holds, some sports-loving man must have been a little confused, because the banner read “Sideline” position (as in the sideline of a “football” field?) instead of “Side-lying” position. It does not affect the quality of the information presented, but it gave me a giggle!

Conclusion

I enjoyed these DVDs and will be passing them on to my sister who is due with her first baby later this month. If you have watched any of these DVDs, please leave a comment and let us know your opinion as well. If not, stop by on Monday and enter the contest to win your own set of “Laugh and Learn” DVDs!

Post from: Breastfeeding 1-2-3

Today she talks about how breastfeeding success begins in the hospital:

Five Hospital Practices that Extend Your Duration of Breastfeeding

Photo by Vedrana Bosnjak

Your hospital experience — brief as it may be — can have a powerful impact on your long-term breastfeeding success. Making hospital changes in maternity care practices has been shown to significantly increase breastfeeding initiation and duration rates. The Baby-Friendly Hospital Initiative (BFHI) — launched in 1991– is a worldwide campaign to encourage hospitals and birthing centers to adopt maternity practices supportive of breastfeeding. (See www.babyfriendlyusa.org.) Hospitals that commit to improving their support for breastfeeding mothers by successfully implementing the BFHI’s Ten Steps to Successful Breastfeeding can apply for and receive the designation as a “Baby-Friendly Hospital.” While only 83 maternity facilities in the U.S. (among more than 3200 hospitals and birthing centers) have chosen to comply with all Ten Steps and be awarded “Baby-Friendly” status, a recent large study in Colorado1 has identified five of the BFHI supportive practices (dubbed the “Can Do 5!”) that have a significant impact on breastfeeding duration among mothers of healthy newborns. The following “Can Do 5!” successful maternity practices can help extend your duration of breastfeeding after you are discharged from the hospital:

1. Baby is breastfed in the first hour after birth. The AAP recommends that healthy infants be placed skin-to-skin with their mothers immediately after birth and remain with their mothers until the first feeding occurs. Immediate skin-to-skin contact not only eases your baby’s adaptation to the world, it allows the two of you to get to know one another, and promotes early breastfeeding. A baby who nurses well shortly after birth is more likely to continue breastfeeding effectively, and a successful early first breastfeeding experience promotes a mother’s confidence. Ask to have your baby placed tummy down on your bare chest immediately after delivery, and watch how her inborn reflexes help her achieve a successful early feeding. You may want to limit your visitors during this intimate bonding time.

2. Baby is fed only breast milk in the hospital. Many studies show that giving supplements to breastfed infants is linked with a shorter duration of breastfeeding. Supplemental milk should be offered only for a valid medical reason. When babies are supplemented with formula, they breastfeed less often, since formula takes longer to digest than breast milk. Infrequent breastfeeding may interfere with establishing an abundant milk supply. Furthermore, giving unnecessary supplements undermines a mother’s confidence in her ability to produce sufficient milk. Ordinarily, frequent, round-the-clock breastfeeding will provide all the milk your baby needs.

3. Baby stays in the same room with mother. By keeping your baby in your room throughout your hospital stay, you will learn to recognize her earliest feeding cues and be able to offer your breast whenever your baby is ready to nurse. Furthermore, studies show that babies are less stressed and do not cry as much when they are cared for in their mother’s room. Rooming-in is a great confidence builder. When you provide most of your baby’s care yourself in the hospital, you leave knowing that you will be able to meet your baby’s needs at home. To make the most of your rooming-in experience, ask your partner to help limit your visitors at the hospital and monitor their length of stay.

4. Baby does not use a pacifier in the hospital. Several studies have found an increased risk of early weaning when a pacifier is introduced to breastfed infants in the first weeks of life. During this sensitive time, all your baby’s sucking efforts should provide her with the milk she needs and stimulate your breasts to produce a generous milk supply. Sucking on an artificial nipple can interfere with learning to nurse, and frequent use of a pacifier may limit how often your baby breastfeeds. Once breastfeeding is going well and your baby is thriving, you can introduce a pacifier if you desire. To reduce the risk of SIDS, the AAP recommends that babies use a pacifier when falling asleep. Mothers of breastfed infants can wait about a month to offer a pacifier.

5. The hospital gives mother a phone number to call for breastfeeding help after hospital discharge. These days, most new mothers are discharged before your milk has come in and before your baby has become proficient at breastfeeding. Even when breastfeeding seems to be going well in the hospital, problems commonly arise in the early days at home. Knowing where to turn for help can allow you to overcome early breastfeeding glitches before you get discouraged. There’s no need to struggle on your own. All breastfeeding questions are important, and expert help is available. Ask your hospital nurse or lactation consultant who you can call for breastfeeding help after you go home.

Each of these five hospital practices was found to have a significant positive impact on breastfeeding duration. More importantly, breastfeeding continued longest among mothers who received all five supportive hospital practices. Nearly two-thirds of mothers who reported all five breastfeeding-friendly practices (versus half of mothers who did not) were still nursing their babies at four months after hospital discharge.

Clearly, what happens in the hospital in the first day or two after birth powerfully impacts a woman’s breastfeeding experience after discharge. Expectant moms can take heart in knowing that requesting five simple steps while you are in the hospital can boost your chances of long-term breastfeeding success.

Additional Hospital Practices That Promote Successful Breastfeeding

Other supportive breastfeeding practices that help lay the foundation for success include:

* Nurse as Often as Your Baby Gives Feeding Cues. Many new parents expect their baby to cry when she is hungry. But crying is the last sign of readiness to feed. Instead of waiting for your baby to cry, look for earlier, more subtle clues that she wants to nurse. Babies signal their readiness to feed by rapid eye movements, arousal from sleep, increased alertness, flexing their arms and legs, squirming, wrinkling the forehead, bringing a hand to their mouth, turning their head, or moving their mouth or tongue. One of more of these signs will be evident before your baby cries out loud.

* Nurse as Long as Your Baby Desires. In the past, new mothers often were advised to keep breastfeeding sessions brief until their milk came in. This dictum was based on the mistaken belief that sore nipples could be prevented by slowly building up an infant’s sucking time. Actually, the most important cause of sore nipples is improper infant latch-on, not lengthy breastfeeding sessions. If your newborn is latched on well, she should be allowed to nurse at least 15 minutes at each breast. Strictly limiting how long your baby nurses can prevent her from getting all the milk she needs and keep you from establishing an abundant milk supply.

* Forego Gift Packs Containing F*ormula. As a marketing strategy, infant-f*ormula companies routinely supply hospital nurseries with free f*ormula and giveaways for new mothers. However, some studies show a link between receiving a f*ormula gift-pack and a shorter duration of breastfeeding. To avoid an implied endorsement of f*ormula-feeding, some hospitals have stopped giving f*ormula-company gift packs to nursing mothers. If you receive a gift pack with f*ormula, make sure you understand when, and when not, to use it. Giving your baby f*ormula without a valid medical reason can undermine successful breastfeeding.

1 Erin Murray, Sue Ricketts, and Jennifer Dellaport. Hospital Practices that Increase Breastfeeding Duration: Results from a Population-Based Study. BIRTH 2007; 34 (3):202-211 (September)

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

For more information please visit http://www.dr-mom.com/

Post from: Breastfeeding 1-2-3

It’s refreshing to see evidence- and practice-based breastfeeding recommendations from a doctor. While most physicians receive very little education in breastfeeding, Dr. Neifert has many years of experience practicing breastfeeding medicine as a pediatrician, co-founder of one of the very first breastfeeding centers in the United States, and co-founder of the Denver Mothers’ Milk Bank (among a long list of credentials, not the least of which is having breastfed her own five children!)

The book strikes the perfect balance between informative and accessible, enthusiastic and non-judgmental. It gives women the tools and encouragement to get breastfeeding off to a good start and to continue breastfeeding through any challenges or changes in the breastfeeding relationship. It covers common breastfeeding problems, working and pumping, special circumstances such as medical issues or multiples, toddler nursing, breastfeeding during pregnancy and tandem nursing. I liked the tone of the book and agreed with the vast majority of the breastfeeding and parenting advice presented in it. The only issue on which we part ways is bed-sharing/night-time parenting (I’m a huge fan of co-sleeping to maximize sleep for mother and baby and to help maintain a good milk supply for the mother especially if she plans to return to work), but I was still pleased to see Dr. Neifert offer some guidelines for safe co-sleeping.

I very highly recommend Great Expectations: The Essential Guide to Breastfeeding. What about you? Have you read the book? Please leave a comment with your own book review!

Post from: Breastfeeding 1-2-3

Just a Few Weeks Early
Breastfeeding Challenges in Late-Preterm Infants

Marianne Neifert, M.D.

Until recently, babies born a few weeks early — between 34 and 36 weeks gestation — were referred to as near term infants. However, the designation, near term, implies that an infant is almost term or almost fully mature, and the misnomer has often caused health professionals and parents to underestimate the medical risks in this large, vulnerable population of infants. Recently, the American Academy of Pediatrics has recommended that infants born at 34, 35, or 36 weeks gestation be referred to as late-preterm infants to emphasize that these babies are physiologically immature and have special health care needs compared to full term infants (born between 37 to 41 weeks). In addition, the mothers of late-preterm infants are more likely to have medical complications themselves, such as gestational diabetes, high blood pressure, or C-section delivery.

The Rising Incidence of Late-Preterm Births

The proportion of all U.S. births that are late preterm has increased over the past 15 years. Late-preterm infants now comprise over 9% of all births, and account for more than 70% of all preterm births (<37 weeks gestation), representing nearly 400,000 babies each year. Although the reason for the increase in late-preterm deliveries is not well understood, one explanation is the increased use of fertility treatments, which has lead to a rise in pregnancies with twins and higher multiples. Half of all twins and 90% of all triplets are born preterm. Other possible contributors to the rise in late-preterm births include the rise in cesarean section births (now 30% of all deliveries), the need to deliver some infants early due to medical complications, and more pregnancies occurring among women at an older age. In addition, performing elective labor inductions or elective cesarean sections for no clear medical or obstetrical reason sometimes leads to the unintentional delivery of a late-preterm infant. Both expectant mothers and obstetricians need to know the importance of avoiding late-preterm delivery unless it is medically necessary.

Medical Complications among Late-Preterm Infants

Because many late-preterm babies are the size of infants born at full term, health care professionals may not always give these at-risk infants the special treatment and careful screening they deserve. Instead, hospital personnel and parents tend to treat these apparently healthy infants as if they were developmentally mature. Late-preterm infants have been called imposter babies because many of these “slightly early” newborns masquerade as full-term infants, appearing to need no special care after birth and being discharged as early as term babies. Yet, babies born even a few weeks early have an increased risk of medical complications after birth and may require a longer hospital stay than full-term infants. Late-preterm infants are more likely to develop low blood sugar, severe jaundice, breathing difficulties, and infections; to have difficulty maintaining their body temperature; and to experience feeding problems and excessive weight loss after birth. Late-preterm infants also are more likely to be re-admitted to the hospital in the early weeks of life for medical complications, including newborn jaundice, breastfeeding difficulties, dehydration, and possible infections.

The brain and nervous system are among the last systems to mature during fetal development, and some studies show that late-preterm infants have a higher risk of developmental and behavioral problems compared to full-term babies. Late-preterm infants also have a higher rate of birth defects and an increased risk of sudden infant death syndrome. For all these reasons, late-preterm infants require close monitoring, evaluation, and follow-up after birth.

Breastfeeding Challenges among Late-Preterm Infants

The initiation of successful breastfeeding can be especially challenging for smaller, developmentally immature, late-preterm infants. These babies often have trouble latching on to the breast correctly and may be unable to breastfeed effectively at first because of their lower muscle tone and tendency to tire easily. Inadequate breastfeeding increases a newborn’s risk for severe jaundice and excessive weight loss.

Providing your baby with skin-to-skin contact immediately after birth and as often as possible while you are rooming-in will help promote infant feeding behaviors and successful breastfeeding. Your hospital lactation consultant can offer valuable assistance with your breastfeeding technique during your hospital stay. Sometimes, using an ultra-thin, soft silicone nipple shield can help your late-preterm baby latch on and stay attached to your breast. Ask to be referred for extra help with breastfeeding after discharge, since it often takes several weeks for a late-preterm infant to be able to breastfeed effectively.

Late-preterm infants seldom are able to drain their mother’s breasts well at first. Ineffective breastfeeding not only increases a baby’s risk of medical complications, a mother’s milk supply can rapidly decrease if her baby removes little milk. If you deliver a late-preterm infant, you can help assure that you bring in and maintain an abundant milk supply by using an effective electric breast pump to express the extra milk your infant leaves behind after breastfeeding. Removing the milk remaining after your baby nurses is known as “insurance pumping” or “prevention pumping” because it helps keep your milk supply generous until your infant is big enough and mature enough to drain your breasts well on her own. Having an abundant milk supply also helps your immature, smaller, less-vigorous baby obtain more milk when she attempts to breastfeed because she can “drink from a fire hydrant” instead of having to work hard to get enough milk. Furthermore, the extra milk you remove with the pump makes the ideal supplement if your baby temporarily requires supplemental feedings. Your surplus pumped milk can be stored for later use (in the refrigerator for 3-5 days; in a separate door freezer for at least 3 months; in a deep freezer for at least 6 months).

After you go home from the hospital, arrange to have your baby followed closely and weighed often to monitor her progress with breastfeeding. Her first pediatric visit should occur 24-48 hours after discharge. A lactation consultant or your baby’s doctor periodically can weigh your baby (identically clothed) before and after breastfeeding to measure how much milk she drinks and monitor her progress with breastfeeding. As your baby matures and gains weight rapidly and becomes able to breastfeed effectively, you gradually can decrease your pumping regimen. Your extra investment of time and effort to safeguard breastfeeding in the early weeks after your baby’s birth will pay off in a thriving infant and a plentiful milk supply that will set the stage for a long-term successful breastfeeding experience.

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding, also known as Dr. Mom®, is a popular pediatrician, nationally recognized expert in breastfeeding management, and celebrated author of child-rearing books and magazine articles. In 1985, Dr. Neifert co-founded the Lactation Program in Denver — one of the very first community breastfeeding centers in the nation, sponsored by the Colorado Health Foundation. She is also clinical professor of pediatrics at the University of Colorado Denver School of Medicine. A long-time leader in the field of breastfeeding medicine, Dr. Neifert is a co-founder of the Denver Mothers’ Milk Bank, founding member of the American Academy of Pediatrics Section on Breastfeeding, the International Lactation Consultant Association, and the Health Advisory Council of La Leche League International. Dr Neifert has addressed audiences in forty-six states and has been a guest on countless radio shows and national television programs, including Today, Good Morning America, The Early Show, 20/20 and CNN. She has written for numerous publications, including Parenting, BabyTalk, American Baby, and ParentLife.

For more information please visit http://www.dr-mom.com/

Post from: Breastfeeding 1-2-3

Photo by Anselm

One way would be to point to the scientific studies that back up the safety of home birth. I was so happy to see news of a study showing that home births are safer than hospital births for low risk pregnancies. Yes! Shout it from the rooftops! Do more studies! Spread the word!

Have you seen the movie? What are your thoughts? Have you heard word about when the book the sequel will be released?

P.S. My husband read this post and wants to say the following: “People who are planning a hospital birth can benefit from watching the movie too because it points out common mistakes that hospitals make such as pushing epidurals and other pain medications and unnecessary interventions such as pitocin. The movie can help women and their partners manage the care in the hospital and avoid common pitfalls in hospital births that taint the experience.” (I love that man — he reads my blog AND agrees with me!)

Post from: Breastfeeding 1-2-3

My first two children were born at hospitals and it seemed like the children’s birth certificates magically showed up for me to sign sometime before we left the hospital. When Nicole was born at home, I had to go through a bunch of legwork to get her birth certificate. On the morning of Nicole’s birth, the midwife carefully explained to me what I would need to do: make an appointment with the county and take this letter and this form and a copy of a utility bill to establish residency. Click my heels three times and repeat, “There’s no place like home (for a birth).” (Just kidding). I nodded my head, yes, I will remember all of this stuff, but really I was lost in a haze of post-birth natural high, consumed by baby love, and I had no room for details in my brain. So about six weeks later when I went to the county, not only did I first go to the Office of Vital Records instead of the Health Department, I then dragged my three-year-old and newborn a few blocks more to the Health Department without an appointment, and I didn’t take a copy of the utility bill. Now I can look back and laugh, but at the time I was not amused about having made mistakes that meant yet more half-hour car rides with a 6-week-old who didn’t like the car seat.

When I think back to all the paperwork I had to fill out to get the birth certificate, I cannot recall having to answer any questions about breastfeeding. So I was surprised to read “Breastfeeding Status on U.S. Birth Certificates: Where Do We Go from Here?” Pediatrics, Vol. 122 No. 6 December 2008, pp. e1159-e1163. It explains that 79 percent of U.S. states collect breastfeeding data for birth certificates, or expect to do so within two years. According to this interesting United States map, California is not yet collecting breastfeeding data on birth certificates (so no, my memory isn’t quite that bad!) Researchers contacted the vital statistics registrars in each of the 50 states, as well as New York City, Washington, DC, and Puerto Rico. Nearly 57 percent of the registrars were already reporting breastfeeding status on state birth certificates, although the questions used to collect the information were not standardized. Most states use the Standard Certificate of Live Birth (SCLB) questionnaire (PDF), which asks, “Is the infant being breastfed at discharge?” Six states, New York City, and Washington, DC, developed their own questions. The study authors concluded:

Within the next 2 years, nearly 80% of US states are expected to be collecting breastfeeding data on their birth certificate. This represents a significant contribution to our national breastfeeding surveillance efforts, because data should be collected for every newborn in every participating state, thereby avoiding the potential for sampling bias. Because birth certificates also collect data on several relevant variables that are known to affect breastfeeding outcomes, the inclusion of a breastfeeding question on birth certificates has a strong potential to improve breastfeeding surveillance in the United States. Consistent with the Healthy People 2010 guidelines, we strongly encourage all states and US territories to collect exclusive breastfeeding data on their birth certificates and to monitor this outcome closely. Standardization of the breastfeeding question that is used on state birth certificates should be a priority so that breastfeeding outcomes can be compared across states. The revision of this question should involve a process that includes feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and training of professionals who collect these data.

Were you asked about breastfeeding when you applied for your child’s birth certificate? Do you think the information provided at that time is valuable? I agree that the pertinent question is whether or not the baby is being exclusively breastfed. It would be helpful to see which states are breastfeeding-friendly and which hospitals need to improve exclusive breastfeeding rates and reduce any unnecessary introduction of sugar water or formula.

Post from: Breastfeeding 1-2-3

The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.

“The Cost-Effectiveness of Home Birth.” J Nurse Midwifery. 1999 Jan-Feb;44(1):30-5. Gee, what a novel concept — care that costs less but has a better outcome!

I did an informal survey of sources online to determine that the average hospital birth costs around $8,000 in the United States, depending on exactly where the mother lives. That does not include the additional costs of an epidural or cesarean section, nor does it include the prenatal care from a physician, which costs anywhere from $1,500 to $3,000. For the sake of discussion, let’s say the total cost of prenatal care and physician-assisted hospital birth is approximately $10,000. Compare that to my prenatal care and home birth with a midwife, which cost a total of $4,300. That’s $5,700 — nearly 60% — less! And I was far happier with my home birth experience than my two hospital birth experiences.

Guess how much of that $4,300 my insurance company covered? $2,947.08. Compare that to what the insurance company theoretically would have paid for physician-assisted hospital birth: $8,000! By that token, the insurance company should have been paying ME to have a home birth. My choice of home birth saved the company over $5,000. And the irony is, I had to fight to get the company to cover a home birth at all. Because there were in-network midwives who could attend births at a hospital, the insurance company initially denied my request for a homebirth. I had to have my midwife write a letter to the company stating that I had a “medical need” for a homebirth (basically we argued that I had had such bad hospital experiences — with a fourth-degree tear and a failed epidural — that for my mental health I needed a home birth!) Luckily, the company agreed to pay, although I had to pay 25% co-insurance, rather than 20% co-insurance for an in-network provider. In the end, I wound up paying about $450 less out of pocket for a homebirth, and had a safe and satisfying birth.

Post from: Breastfeeding 1-2-3