3 secrets to support breastfeeding.

I attended a really interesting workshop with the Infant Feeding Academy this week. Learning about 3 ‘secrets’ to successfully establish breastfeeding. In due course, I would love to train as an Infant Feeding Coach, but I am still learning the ropes as a Birth and Postnatal Doula so need to focus on that for now – patience Bea, all in good time!

The UK has one of the lowest breastfeeding rates in the world. Research shows that 81% of mothers initiate breastfeeding at birth, but many stop in the first few weeks with only 17% still exclusively breastfeeding at 3 months, and 1% at 6 months. 63% of women who stop breastfeeding report that they would have liked to have breastfed for longer and state lack of support from hospital staff, midwives and family (17%), problems with latch (17%), milk supply (15%) and pain/ discomfort (10%) as their reasons for stopping.

As a result of our chronically underfunded and under resourced maternity system, infant feeding training within the NHS is insufficient. 44% of local authorities have cut breastfeeding servies as a result of recent budget cuts and there is simply not enough training provided to midwives and maternity support workers, and not enough lactation consultants to go around. This means that sadly a lot of people are left unsupported and unaware of how or where to access quality support.

For now I will be adopting these three ‘secrets’ into my practice as a birth and postnatal doula, whilst signposting my clients to more qualified providers of support when required. Get in touch if you have been thinking about hiring a doula, and would like to discuss how I could support you in your journey.

1.     Learn to hand express antenatally

This is beneficial for two main reasons 1) you learn how to do it 2) you can collect colostrum

Having a ‘bank’ of colostrum is good because:

a.      It’s a back up if first feed is difficult and/ or baby is struggling or slow to latch

b.      It can be used if baby is in NICU, has hypoglycaemia (low blood sugars) or has been separated from Mum

c.      Gestational diabetes or high BMI may delay the milk coming in – so expressed colostrum syringes can be used in the meantime

d.     It helps pass the meconium (baby’s first poo) and clear the gut

e.      Can be used instead of resorting to formula

If you have learnt how to handle the breast antenatally you will be better placed to do this if/ when you need to post birth. Expressing can:

a.      Stimulate the breast and trigger milk to come in, and to make more milk

b.      Maintain a milk supply whilst other issues (such as a tongue tie) are investigated and/ or addressed

c.      Can help to overcome previous trauma from previous breastfeeding experience or abuse

A sufficient milk supply is triggered by frequent and early feeding and emptying of the breast. If the baby isn’t latching directly Mum needs to hand express to establish and maintain a good milk supply. 99% of the time feeding issues can be fixed if Mum has a good milk supply.

2.     Prioritise the ‘golden hour’

The ‘golden hour’ – which in reality can be between 45 and 90 minutes – is the time in which baby should be left in uninterrupted skin-to-skin with Mum, immediately after birth and until they feed.

During this time, baby should be left to initiate ‘crawl’ and look for milk. Providing baby is term, healthy and unmedicated (pethadin or epidural); they should be on mum’s tummy, the lights should be dim and there should be no interruptions from medics (or birth partner).

During this time, baby will go through 9 instinctive stages in order to initiate breastfeeding.

1.     The birth ‘cry’ – the first inflation of the lungs, not necessarily a cry

2.     Onto the chest and there is a period of relaxation

3.     A period of awakening – baby is very alert and wide eyed

4.     Period of activity when they start to shuffle, move around and locate the breast

5.     Rest

6.     Crawling reflex – they kick their feet against the abdomen (this also helps to contract the uterus and reduce blood loss) to propel the baby towards the nipple

7.     They then start to familiarise themselves with the breast with their hands and mouth, they lick and salivate until they find the nipple

8.     Suckle

9.     Fall asleep

These stages are often interrupted after or during the period of activity (stage 4) as there is a) pressure on the midwives to ‘process’ the baby (weigh, vitamin k, baby checks) so they can move onto the next family or to finish their shift and b) sometimes by the parents who want to know what the baby weighs, start updating family or allow the birth partner to hold baby

Baby is they returned to the mother’s chest, but this takes us back to stage 2 – if left alone they often then make their way through to stage 7 – but then it’s often time to get the mother up, have the perineum checked (and stitched if required), have a shower etc so baby is put onto dad’s chest skin-to-skin where they get disorientated and go to sleep, after which point they have a nappy put on and get dressed and the opportunity for their first feed is gone.

3.     Write a feeding plan

Like a birth plan, this enables you to understand your options and work out your preferences.

Similar to a birth plan, the process of writing a feeding plan is the important part as it initiates conversations, research and thoughts to support your breastfeeding journey - such as learning the importance of hand expressing or the golden hour.

Quite often your feeding plan will outline small changes to ‘the norm’ that are actually no more work for the midwives, but can greatly increase your chances of a successful and positive breastfeeding journey.

You could include on your feeding plan:

·       Details on whether you have expressed colostrum and where this is being stored (make sure it is labelled if you are birthing in a hospital or midwife led unit)

·       Preference for vitamin K to be given whilst skin-to-skin

·       Preference for baby checks to be done whilst skin-to-skin

·       Preference to be transferred to the postnatal ward/ room whilst skin-to-skin, which can be on a bed or in a wheelchair

·       Request to be left alone with your baby skin-to-skin immediately after birth for up to 1.5hrs – if you have birthed in a pool this could involve draining the water and perhaps placing a beanbag in the empty pool to make you comfortable

·       Preference for baby to be weighed ‘prone’ – facing down – to maintain their foetal, curled up positioning and not stimulate the moro reflex which stimulates adrenalin – especially if weighing needs to take place before baby has fed

Doula Bea x