Is Breastfeeding in Your Birth Plan?
I’ve read a lot of hospital birth plans over the years. When it comes to breastfeeding it’s often a simple line or at the end that goes something like:
“I plan to exclusively breastfeed. Please do not give my baby formula, sugar water or a pacifier.”
It seems like that should be enough to include, after all you’re expecting that staff will help with latching your baby on and offering positioning suggestions.
If the breastfeeding support provided by staff was evidence based and reduced potential harm to you and your baby then that one line would be enough.
A few years ago I would have thought this was sufficient. However as new evidence emerges (evidence that most parents aren’t aware of) it’s time we took a closer look at how breastfeeding is being initiated in hospital, how effective it really is and how much harm it potentially causes. I’ve written about the challenges of initiating breastfeeding in hospital here.
Recent research in Ireland on laid-back breastfeeding by McGuigan and Larkin (awaiting publication) found that while awareness of the position was high (over 80%) among midwives and student midwives, only 6.75% reported using a laid-back breastfeeding position frequently when helping mothers establish breastfeeding. The majority (over 80%) continue to suggest upright positions. When combined with midwives who have never heard of laid-back breastfeeding, nearly 40% have never offered this position at all. Although midwives and students reported high levels of success getting babies to latch on in a laid-back position when they do try it (almost 94% for those with specific education on LBBF and 70% for those without), the majority report that they have neither the knowledge or confidence to suggest this position to mothers. Instead they continue to rely on “traditional” positions based on bottle feeding, with the midwife remaining “hands on” and directing the latch, positions that have been promoted in midwifery education for decades.
Birth Preferences
No doubt you’ve heard of birth plans (preferences). Many women who are preparing for a natural/physiological birth will write birth preferences. This helps parents side step non-evidence based and potentially harmful routine procedures and interventions that are routinely used for hospital births. Written birth preferences can also helps moms access individualized care - not one size fits all care.
Maybe this is news to you and now you’re wondering what kinds of breastfeeding ‘interventions’ are routinely happening in that first hour after birth that you need to be aware of?
The most common breastfeeding initiation approach is ‘hands on’.
Mechanical Positioning Breastfeeding Initiation - Hands On
Many women will have staff manipulate their breasts and baby manually as the most efficient approach to get the box checked and get you moved to postpartum. This forced feeding approach is accompanied by anxiety raising complicated steps and uncomfortable positions that keep moms in a state of discomfort and confusion. Hands on mechanical positioning usually happens in an upright position - rarely laid back in gentle recline. Sometimes moms are laid flat in the bed and of course mom can’t make eye contact with baby which releases more oxytocin.
Physiologic Breastfeeding Initiation - Undisturbed Breastfeeding - Hands Off
Growing evidence confirms that a physiologic approach should be the norm for all healthy moms and babies. The current approach isn’t working. In labor we know that the less we interfere in the process while adopting a watchful wait and see approach works best for most moms. Just like in a natural/physiologic labor we respect the process while also watching for signs that additional support may be needed - we trust birth until events suggest otherwise. A physiologic breastfeeding approach is very similar to undisturbed birth. As providers we need to facilitate an oxytocin friendly environment that supports the emergence of maternal instincts and newborn reflexes and feeding behaviors. This doesn’t mean staff won’t help you, or you’ll be left to figure it all out yourself, it means that in the same way your body knew how to grow your baby on the inside - it knows how to nurture and nourish your baby on the outside - with little effort from you. It’s also reassuring to know that your mindfulness practices are increasing your confidence - not just for breastfeeding but also to advocate for you and your baby. Breastfeeding preparation is a relatively new intervention itself - your ancestors and their ancestors survived and thrived without forcing babies and breasts together.
We do this by trusting that, like other mammals - our mammalian newborns are born knowing how to locate the breast and begin nursing - infant led self-attachment is the norm for all other mammals. Compared to hands on breastfeeding instruction laid back breastfeeding is associated with significantly less nipple soreness leaving hospital and less stressed moms trying to recall the ‘15 steps’ and complicated holds. Standard breastfeeding instruction fails to recognize that mom’s brain activity isn’t capable of learning and recalling information at that time which adds to mom’s anxiety. Birth and breastfeeding are right sided brain activities - that means you have to feel your way through it and your brain just isn’t firing on all cylinders the day after you give birth especially your memory. Several studies have found that women find a hands off approach to be less objectifying and less disempowering - leading to more confidence.
Suggestions for Birth/Breastfeeding Preferences
I prefer a physiologic approach to breastfeeding initiation in a laid back position with minimal/no hands on manipulation of my baby’s body and my breasts. I understand that initiating breastfeeding in this way reduces nipple soreness and encourages maternal & newborn instinctual behavior.
Please place baby on my breast after birth for immediate skin to skin so baby self attach. Note: your baby doesn’t need to be made to crawl from your abdomen or from between your breasts - he’s likely to be exhausted too. If baby is too tired he may take longer to latch and staff will want to force baby to latch).
As soon as possible after birth and immediate postpartum care please dim the lights. All newborn routine procedures can be done with my baby on my chest to avoid any separation.
I would like to postpone weighing until after the first feed.
I understand my baby may be sleepy due to labor/medication and I may need additional support but I prefer not to rush my baby’s first nursing.
These are my suggestions but as with birth keeping a flexible attitude on the day is important.
What else would you include?
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