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Sunday, June 25, 2017

Preparing for breastfeeding: choosing where to deliver

Where you choose to deliver your baby may have a tremendous impact on preparing for breastfeeding and reaching your personal  breastfeeding goals, says pediatrician and lactation consultant Laurie Jones, MD, IBCLC.

Laurie Jones, MD, and Tanya Belcheff, CNM, examine day-old Judel Alia

That’s because a key predictor of long-term success for breastfeeding rests on what happens between a mother and her newborn in those precious hours after birth.

Doctors, nurses, hospital policies, and family member interaction- even well-meaning visitors—can “make or break” the early breastfeeding relationship. “Babies and mothers are programmed with instincts to breastfeed, says Jones, who practices at St. Joseph’s Hospital and Medical Center, “but modern hospitals and health care providers mostly get in the way or interrupt those instincts.”

Jones, a member of the Arizona Chapter of the American Academy of Pediatricians says the Arizona Baby Steps program, launched by the Arizona Department of Health Services (AZDHS), has worked wonders at hospitals across the state to train nurses, doctors, and administrators in the best ways to support breastfeeding mothers after delivery.

The program promotes the implementation of five evidence-based maternity care practices that help a new mom to meet her breastfeeding goals.

Funded in part by the Centers for Disease Control and Prevention (CDC), the voluntary program was offered to hospitals in Arizona by the AZDHS, and implemented beginning in early summer, 2010.

The most important thing a mother can do to get breastfeeding off to a good start, says Jones, is to have unrestricted and uninterrupted time “skin-to-skin” in the first days following birth.

That first hour immediately after birth, says certified nurse-midwife Tanya Belcheff, MSN, CNM, should be considered the “golden hour.”  Belcheff, who also practices at St. Joseph’s, says it’s a time to cuddle, to bond- and can even predict the duration of the breastfeeding relationship.

“Studies show that the number of minutes you can have your baby skin-to-skin immediately after delivery, says Belcheff, “directly correlates with the number of months that you are successful at breastfeeding.”

It’s a new-old concept, she adds,  which helps regulate a newborn’s temperature, glucose levels, and breathing rate.

Also known as “metabolic stabilization,” Jones says that a baby will warm faster on a mother’s chest –or a father’s chest, or a partner’s chest, for that matter — rather than the traditional warmer used in hospitals. No matter what the feeding method is — breast or formula – this early contact is best for a new baby.

If moms come in asking for skin-to-skin contact during labor, and the nurses understand the importance, they are more likely to get it, says Belcheff, so it is important for labor/delivery professionals to educate their patients during pre-natal care.

Dr. Jones with Dr. Plimpton, who delivered Judel

Dr. Steven Plimpton, MD, an OB-GYN in private practice in Phoenix, says that that skin-to-skin contact is often offered as routine by labor and delivery nurses who understand and appreciate the benefits. “The mom will do it right away, assuming that it is the best thing for the baby.” This early contact helps bring in the breast milk, too.

A first bottle during the very early hours, says Plimpton, can interfere with the process. “The baby sucks it down like it’s the best thing in the word, and then the mom thinks she’s inadequate because the baby doesn’t suck on her like that, or cries when she tries to put her to the breast. The more you promote it right at the beginning, I think the more successful it’s likely to be.”

AAP new updated policy clearly says that all procedures should be delayed until after the first feeding, says Jones. But expanding that policy beyond the pediatric literature takes time.

Getting everyone on board – obstetricians, midwives, family practice doctors, nurses –who helps participate in the birthing experience — is the best way to get baby off to a good start.

That’s why policies like Arizona Baby Steps are needed, so that nothing is left to chance. As long as the baby has a healthy Apgar score, which can be taken while the baby is on mom’s chest, says Jones, other routine procedures, like weighing and giving medicines – can wait.

Expectant moms should make a birth plan, says Belcheff, and discuss their wishes with their care provider. Jones says that a mother can reach her breastfeeding goals with a strong belief that she can do it and by making choices that support her goal. “Don’t overthink things in the first few days — human mothers have been doing this with no other option for 267 million years. And you can, too!”

 Jones offers the following tips on what expectant moms should know in order to get breastfeeding off to a good start:

  • Choose a hospital that has inpatient lactation consultants (designated as IBCLC) seven days a week and trains nurses and other providers in basic breastfeeding support.
  • There are still many hospitals that keep babies in a separate unit to get routine phototherapy or routine antibiotics which is very disruptive and always detrimental to the early establishment of a mother’s milk supply.
  •  Discuss a birth plan with your birth provider that includes immediate skin-to-skin after delivery and keeping mother and baby together at all times during the hospital stay with minimal interruptions.
  •  Let the nurses and doctors know that you do not want any formula, bottles, or pacifiers given to your baby.
  • Ask friends and family to visit during a limited window of time so that you have as much uninterrupted time with your baby as possible to be free to learn your baby’s hunger cues and needs.
  • Avoid any hormonal contraception until breastfeeding is well-established at the earliest around 6 weeks post-partum.

 

Arizona Department of Health Services

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Vicki Louk Balint

Multimedia journalist Vicki Louk Balint covers medical issues for RAISING ARIZONA KIDS magazine.

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