Breastfeeding Support Starts at Home

A few months after I was hired by the Ob/Gyn department of a local hospital, I received a letter indicating that I had been assigned to work on a committee. Apparently, it was a requirement to maintain my privileges that was buried in the fine print of the application. My assigned committee was focusing on how to support breastfeeding on the postpartum ward. I resented being on this committee as I would have rather been in the clinic seeing patients and I didn't understand why there was such a great need to be "breastfeeding friendly." I found that the proposed breastfeeding initiatives (remove formula samples from the take home bags, only offer formula to the mother and baby if recommended by the pediatrician), seemed to stigmatize the woman who couldn't breastfeed, or one who was struggling. "What about breast cancer survivors? Women who are HIV positive?" I really enjoyed raising the counter point as I couldn't stand the nurse who led this committee. I also noted that conversations among the committee members seemed to be more directed on how we could advertise how our hospital was more supportive of breastfeeding than hospitals in the area. There seemed to be little discussion on how we could benefit an actual postpartum mother.

I found that the nurses on the postpartum ward during my stay were very helpful to get breastfeeding started, without being too in your face about it. They observed Kate's latch, gave me some position tips and when she didn't seem to be getting enough calories, they recommended using the supplemental nursing system to administer formula and they suggested trying to pump my colostrum. They sent us home with some samples of formula, which was most appreciated as we just needed it a few times and were able to avoid buying a whole can. It was just what we needed to get started, but I feel what most strongly influences breastfeeding success is the support received at home.

Prior to becoming pregnant, I had heard about the father's role for supporting breastfeeding and I probably rolled my eyes. In particular, I recall having one patient who at night months was really ready to be done with breastfeeding, but her husband was adamant that he wanted her to breastfeed for a year. The tone of his voice was chilling. I had to ask the patient for a fake urine specimen so I could get her out of the room discretely and ask questions about possible intimate partner abuse. It just felt that if he could be so coercive about breastfeeding, he may be controlling her in other ways. I don't know if it was something he read in his Manual for New Dad's book, as Husband would regularly ask me, "Do you need anything? Can I bring you anything?" while I was nursing. At first I resented it a bit, I felt like an invalid; that I couldn't take care of myself. Then I realised that if I didn't respond, he'd probably stop asking. So I learned that it was okay to ask for a glass of water, or a cup of tea. Mostly I came to appreciate that while checking in on my needs, he was participating in the nursing process.

Until I became proficient at getting Kate to latch and watching her cues, I really didn't feel comfortable breastfeeding in front of anyone else. I still won't say that I'm entirely comfortable breastfeeding in front of my father, but we've both moved on. I didn't feel comfortable at all breastfeeding in front of my in-laws, but I didn't want to have to leave the room every time she needed to feed. I would sit in the corner of the room and use my modesty cover. "Would you like a (burp) cloth?" my mother in law would ask about every five minutes. "No, thank you" was my answer every time, but that really translated to 'No, just please leave me the fuck alone!' Sometimes recognising when she needs privacy is also an important component of support.

Interestingly, while I won't go as far as to say that she was unsupportive, the one person who gave me a hard time about my breastfeeding, was my mother. It started when she first criticised how often I was feeding, and suggested that I should be taking Kate for a walk or rocking her when she cries, rather than nursing. While we were driving from Connecticut to Pennsylvania to visit my aunt, I needed to hand pump during a rest stop just for relief (there was no way I could feed Kate milk that was pumped in a rest station bathroom, but I made Husband pour the milk out, as I couldn't bear to do so). When I walked out of the bathroom stall, my mother was waiting with her arms folded across her chest. "Can we go now?" she demanded in a huff. Clearly, my need to pump for the purpose of comfort was an inconvenience to her.

We went stopping with Kate while my mother was visiting us for Christmas and I suggested stopping at Star.bucks for a coffee and so I could nurse Kate. "Oh, do they have a room?" my mother asked. I laughed to myself. Surely she didn't think that California was so liberal that each Starbucks was equipped with a breastfeeding room. Later that day, we met up with my Dad and Husband for lunch. While we were waiting to be seated, I announced that I was going to change Kate and I grabbed the diaper bag and headed to the rest room. When I returned, my mother asked "Did you feed her?" I couldn't believe that she would think it would be acceptable to feed my daughter in the bathroom, but more so ...how? She had been in the bathroom of that restaurant before. It's two tiny stalls and a sink. I used the modesty cover while I fed Kate at the table. I sort of had the volition to flash my mother just to try to piss her off. Yet her most aggravating action came while we were visiting my friend Amy and her husband Sheldon. Amy had a baby two weeks after Kate and we were both comfortable feeding in front of each other and our families. I started to nurse Kate while Sheldon was on the other side of their large open concept living and dining room. My mother grabbed a muslin blanket from Kate's infant seat and walked over to me and draped it over Kate without saying a word. She didn't need to; her message was clear. I needed be covered as if I were an inappropriately dressed teenager. I felt stripped of autonomy. It's my body, my breasts, my modest, my comfort level. I decide if I want to cover. I responded to her passive aggressive actions with one of my own. I took the blanket off and dropped it on the floor.

So, I admit that much of my intention for this post was to have a good rant about my mother, but it feels interesting to note that although I've become so much more enlightened about breastfeeding through my own experience, some of my prior perspective is validated. I feel the role of the hospital staff was to help us start breastfeeding though teaching and trouble shooting, but the support received when you leave the hospital is far more important for continuation. I enclosed my list of tips to help with breastfeeding.

1. Work with the nurses in the hospital to make sure your baby gets a good latch. Kick visitors out until you feel comfortable flashing your boobs.
2. Do what ever position feels best. My nurses kept advocating the football hold, as it's supposed to be easier for C/s mammas; but we both hated it, so I asked the nurses to stop setting it up for us.
3. If you need to give formula, ask about SNS (Supplemental Nutrition System also called Supplemental Milk System). You get baby to latch on the nipple and then slip a small flexible catheter into baby's moth and deliver formula through a syringe. It's great as you both get to work on nursing and she gets the nutrition she needs. (Medela sells a SNS kit)
4. Plan to bring your Boppy/My Breast Friend to the hospital. Not all will provide and it's best to get familiar with yours
5. Don't panic (right away) about whether baby is getting enough to eat with each feed (after milk is established and the eight is going back up). Babies are smart and will take what they need. Some times it will be a big feed, other times it's just a snack. Listen for your baby to make gulping sounds and watch their hands, if the hands are relaxed, it indicates satisfaction. Count the wet diapers (urine is a better indicator than poop) We used the app MammaBaby, which allows you to track diapers, feeding times (and which breast) and sleep.
6. Go to a Lactation support group in the early days, even if things are going well. You'll gain confidence that you're doing the right things and will pick up some tips and may offer help to someone else.
7. Make sure your nursing bra fits properly. If it's too tight, it can constrict milk supply.
8. Also make sure your pumping flanges are fit to your nipples
9. The term 'nipple confusion' is a bit of a misnomer. It has less to do with the distinction between a human versus a rubber nipple and more do to with the amount of effort required by the baby. Milk flows from the bottle much quicker and easier for a baby, where as baby has to work harder to remove milk from the breast. However, if you are planning to have baby use a bottle, the best time to introduce a bottle is between 3-4 weeks. Be sure to use low flow nipples and continue to offer at least one bottle every 1-2 days.
10. Get a hand pump. It's great to keep in your diaper bag and you can pump without worrying about noise or where to plug in. Plus when baby nurses on one side, you can quickly pump on the other.
11. Hands free pumping bra. Must have hook and latch closure. The zippers break too easily and don't adjust for your changing chest size.
12. Drink Mother's Milk tea 3-5 cups while waiting for milk to come in and then 1-2 cups a day. I also do daily beer (avoid feeding 1 hour post consumption) weekly pint of ice cream and lots of oatmeal cookies.
13. As baby sleeps longer at night, consider getting up to pump. My feeling is 'tap the gold mine while you can'. I've built up quite a frozen stash, plus lots of manipulative points with my husband "I got up to pump all those nights the least you can do is X" or "I can afford to buy [something] because I saved us the expense of formula." Oh yeah, that one will get used a lot...
14. When you go back to work, order more sets of phalanges and pump parts. It avoids needing to wash the same set between pumping sessions (and the awkwardness of washing your pump parts in the breakroom of your office).
15. Playing Tetris the the best way to pass time while pumping.