Birth and Breastfeeding - La Leche League International

Your birth can affect how you begin your breastfeeding journeyPreparing yourself for birth and breastfeeding during pregnancy Where: Your birth placeWho: Your birth caregiversHow: Your birth planOnce your baby is born Your birth can affect how you begin your breastfeeding journey Starting breastfeeding is easier when you have a birth where you are supported and medications and interventions are minimized. How can medications and interventions during labor affect getting breastfeeding to a good start? Here are a few reasons: Pain medications during labor often make babies sleepy and cause their latch and suck to be less organized.1 2 3 4 5 Epidural anesthesia can cause your blood pressure to drop. This is why if you have an epidural, they will give you large amounts of IV fluids to keep your blood pressure at normal levels.6 Intravenous (IV) fluids given during labor can temporarily increase babies’ weight at birth. This can cause concern that your baby is not feeding adequately, when in fact, part of that loss is the extra fluids from your IV.7 8 9 Swelling from IV fluids can also cause swelling or edema in your body. When this occurs, your breasts may swell, especially around the nipple, making it hard for your baby to latch.10 Cesarean delivery can delay milk production and create concern about babies’ intake in the early days.11 12 13 Being educated about birthing and active involvement in labor can help you feel capable. This, in turn, can give you more confidence to overcome difficulties or challenges in your parenting. Having a trusted support person with you can help you avoid procedures that may make the start of your breastfeeding start more challenging. In some places, a  doula, who is a person trained in practical and emotional birth support, can help to advocate for you during labor and delivery.  Research indicates that having a doula in addition to a partner, friend, or relative is very helpful during labor and birth.14 Preparing yourself for birth and breastfeeding during pregnancy Learning what childbirth is all about gives you confidence to participate fully. Knowing more about managing your labor and about possible interventions can help you participate more fully during labor. If interventions are needed, you will have a better idea of how to deal with their possible effects. You may feel more capable of discussing and asking for what you need during your labor and birth. If unexpected challenges do arise during birth, you can still get off to a good start with breastfeeding. You and your support person can help prepare during pregnancy by learning about birth options, ways to relax and cope with labor, and how to breastfeed once your baby is born. Methods of childbirth preparation such as hypnotherapy, breathing exercises, acupressure and relaxation techniques Reading about birth and breastfeeding, particularly The Art of Breastfeeding Watching videos showing active birth and labor techniques Building your support network of LLL Leaders and parents in your local LLL Group or virtual LLL Group Find local LLL Leaders and Groups here: get-support LLL meetings, both in person or virtual give you opportunities to ask others how they prepared for their births: What helped them the most in their labor and birth? What type of childbirth classes did they take? Who did they have to support them? How did they get started breastfeeding? What nursing positions did they find most helpful? Did they wear their baby? If so, did they like slings, wraps, or carriers best? In a community hospital or high-risk hospital You may be able to tour hospitals and birth centers to learn about their birth and breastfeeding policies. Some things you will want to know are: What are their routine labor and birth procedures? What are their policies about fetal monitoring? Can you walk around during labor while being monitored? Or will they do intermittent monitoring? What are common interventions during labor and birth in this facility? What is their cesarean birth rate? Is there 24-hour rooming in with your baby? Are there lactation consultants available to help you with breastfeeding? What is their rate of mothers who begin breastfeeding? What percentage is breastfeeding at discharge? Where would you be transferred if you need a higher level of care? If you have a premature birth or sick baby, what kind of Neonatal Intensive Care Unit (NICU) does the facility have? Where would your baby be transferred if necessary? Ask about parent participation in NICU care such as rooming in or sleep rooms, skin to skin (Kangaroo care), expressing or pumping and lactation consultant availability, how soon you can start breastfeeding. If you have a cesarean birth, can you have your baby skin to skin while they close your incision? If not, can your support person do skin to skin until you are able in the recovery period? If you have your birth in a UNICEF accredited Baby-Friendly Hospital (BFHI), you are likely to find that staff is committed to helping you succeed with breastfeeding. BFHI hospitals meet the World Health Organization (WHO) global strategies for supporting breastfeeding and the Ten Steps to Successful Breastfeeding. For more information about BFHI hospitals: https://www.who.int/activities/promoting-baby-friendly-hospitals To find a Baby-Friendly Hospital near you: https://bfhinetwork.com/bfhi-around-the-world/ If you are planning a home birth, ask what back up plans your caregivers have for emergencies: Do they have a backup obstetrician who will accept you for care? What hospital are they affiliated with? It is important to learn about differences in caregivers for birth and how their background may impact your birth experience. There are several types of caregivers you may be able to choose from: Family practice or general practice doctors You may want to ask caregivers Do they offer childbirth classes or refer you to classes? If your pregnancy goes past your due date, what are their routines regarding induction? For induction, what methods do they use? Are they comfortable with your using natural methods to encourage contractions? If you want to give birth without medications that may impact the baby,  are they comfortable with an unmedicated birth? If medications are needed, what medications do they use, and when and why do they typically give them? Do they support immediate skin-to-skin care after birth, even when there are birth complications? If a midwife, what are their arrangements for back-up with doctors and hospitals? If an obstetrician or family practitioner, do they work with midwives and doulas? If a family practitioner, do they participate in births and care for the family after the birth? It can be helpful to make a birth plan long before your due date. A birth plan can be as simple as a sheet of paper with your wishes and ideas. There are also lots of downloadable options you can use. Letting the team that will be there at the birth know about your birth plan and discussing it with them will set you up for a good start. Reasons why you might want to avoid certain interventions can be discussed in your birth plan and with your caregivers. A birth plan should be written from the point of view of what kind of care you would like if all is well with you and the baby. Caregivers can feel mistrusted when a birth plan tries to “tie their hands,” as far as procedures go.  For example, it is preferable to write, “I would prefer not to have IV fluids unless medically necessary” than “I will not have any IVs.” Some aspects you might find important may include: Specifying your support person(s) Will you have freedom to walk and move around during labor? Will fetal monitoring be continuous or intermittent? Respect for cultural or religious beliefs? Will there be routine vaginal exams, or can we decide together when one is needed? Your preferences, for use, if any, of medications that may impact the baby The first hour after delivery. Will you and baby be together continuously? Which routine procedures are necessary, and which can be delayed or not done? Your support person can advocate for your wishes during labor and birth. Make sure you and your birth caregivers have a clear understanding of the role your support person will play. Once your baby is born, you enter a whole new world. You are a parent now! Immediately after birth, health care providers will be carrying out multiple checks on the wellbeing of both you and your little one. The first hour after birth is often referred to as the ‘Golden Hour.’ Many routine procedures such as Vitamin K injections, antibiotic eye ointment, and others can be delayed and your baby’s health can be assessed while on your chest or in your arms. Baths should be delayed for the first twenty-four hours after birth, per the World Health Organization (WHO) Postnatal Care Guidelines for Mothers and Newborns.  WHO recommendations on maternal and newborn care for a positive postnatal experience Skin-to-skin contact is recommended by the World Health Organization (WHO) for at least the first hour and a half after birth. More skin-to-skin time should be encouraged.15 Visitors are discouraged at this time so your special time with your baby will not be interrupted. It might be helpful to let those close to you know this ahead of time. Skin-to-skin helps to prevent postpartum hemorrhage. It increases the early start to breastfeeding. In one study, 63% of all babies accomplished their first breastfeeding within 30-59 minutes of skin-to-skin. Nearly 90% of all babies had their first breastfeeding when allowed skin-to-skin for 90 minutes.16 17 18 19 Even skin-to-skin done by fathers when a mother was unable to do so resulted in babies showing feeding behaviors earlier than those who had no skin-to-skin contact with either parent.20 21 Skin-to-skin stabilizes your baby’s breathing and heart rate, helps their blood sugar to remain stable, prevents stress due to being separated, and maintains their temperature better than mechanical warmers/incubators or swaddling.22 23 During the time your baby is skin to skin with you, they may feel your nipple on their face and bob their head up and down to latch. Supporting their bottom can help your baby to keep latched and feel secure. Your support person can remain your advocate to make sure that: You and your baby are not separated unnecessarily Your baby will have only your milk and your baby will not receive supplements without a medical reason Any testing, bathing or other procedures that can be done in your room, will be done in your room Remind you of tips learned in prenatal classes Be supportive of you and boost your spirits Hold the baby skin to skin when you nap or shower Learn how to change diapers and bathe the baby Offer the breast whenever your baby awakes, mouths their hand or turns their head from side to side. These are known as early feeding cues. Crying is a very late feeding cue that results in having to calm the baby in order for them to latch. Their tiny tummy needs lots of feedings. Ask for help and a lactation consult if you are having difficulties getting your baby latched on. The first days or weeks at home with a new baby can be hard. Having support available for meals, errands, and housekeeping can be a lifesaver. Let friends and family know what tasks you need help with when they ask. Knowledge about birth and breastfeeding will serve you well during and after your birthing experience. Don’t forget you can reach out to La Leche League. You may find virtual meetings especially helpful in the early days after birth. And remember, breastfeeding can be successful even with a slow start. The 2024 version of The Art of Breastfeeding states: “How a baby is born has a big impact on how easy, or difficult, it can be to get breastfeeding started. Babies whose births were more complicated or difficult tend to take a bit longer to get going with breastfeeding—but they do get there.” 24 ¹ Oommen, H., Tveit, T.O., Eskedal, L.T., Myr, R., Swanson, D.M. & Vistad, I. (2021). The association between intrapartum opioid fentanyl and early breastfeeding:  A prospective observational study. Acta Obstetricia et Gynecologica Scandinavica (AOGS), 100(12), 2294-2302. https://doi.org/10.1111/aogs.14268 ² Ghiringhelli, J.P., & Lacassie, H. (2021). Lactancia materna y anestesia [Anesthesia and breastfeeding]. Colombian Journal of Anesthesiology, 50, e.1031. https://doi.org/10.5554/22562087.e1031 ³ Takahashi, Y., Uvnäs-Moberg, K., Nissen, E., Lidfors, L., Ransjö-Arvidson, A.-B., & Jonas, W. (2021). Epidural analgesia with or without oxytocin, but not oxytocin alone, administered during birth disturbs infant pre-feeding and sucking behaviors and maternal oxytocin levels in connection with a breastfeed two days later. Frontiers in Neuroscience, 15, Article 673184. https://doi.org/10.3389/fnins.2021.673184 ⁴ French, C.A., Cong, X., & Chung, K.S. (2016). Labor epidural analgesia and breastfeeding: A systematic review. Journal of Human Lactation, 32(3), 507-520. https://doi.org/10.1177/0890334415623779 ⁵ Tomita, A., Tahara-Sasagawa, E., Yonezawa, K., Usuai, Y., & Haruna, M. (2024). Factors associated with feeding behavior in the early neonatal period focusing on early skin-to-skin contact and epidural analgesia: A prospective observational study at a single hospital in Japan. Global Pediatrics, 9, 100216. https://doi.org/10.1016/j.gpeds.2024.100216 ⁶ Guiding, A., Vanasche, K., Cacace, A., Cacace, M., Fumagalli, S., & Locatelli, A. (2023). Side effects from epidural analgesia in laboring women and risk of cesarean delivery. American Journal of Obstetrics & Gynecology Global Reports, 4, 100297. https://doi.org/10.3389/fnins.2021.673184 ⁷ Lowen, D.J., Mikhail, M., Jovic, E., Sheridan, N., Tacey, M., Bisits, A., & Hodgson, R. (2024). A double-blinded randomized controlled study of fluid restriction versus liberal fluid during induction of labour: A pilot study. Australian and New Zealand Journal of Obstetrics & Gynæcology, 2024. 1-9. https://doi.org/10.1111.ajo.13841 ⁸ Giudicelli, M., Hassler, M., Blanc, J., Zakarian, C., & Tosello, B. (2022). Influence of intrapartum maternal fluids on weight loss in breastfed newborns. The Journal of Maternal-Fetal & Neonatal Medicine, 35(4), 692-698. https://doi.org/10/1080/14767058.2020.1731453 ⁹ Eltonsy, S., Blind, A., Sonia, B., DeRoche, S., Mulaja, A., Hynes, W., Barrieau, A., & Belanger, M. (2017) Intrapartum intravenous fluids for cæsarean delivery and newborn weight loss: A retrospective cohort study. BMJ Pædiatrics Open, 1(1) Article e000070. https://doi.org/10.1136/bmjpo-2017-000070 ¹⁰ Mitchell, K.B., Johnson, H.m., Rodríguez, J.m., English, A., Scherzinger, C., Widmer, K., Berens, P., Miller, B., & The Academy of Breastfeeding Medicine. (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The mastitis spectrum revised 2022. Breastfeeding Medicine, 17(5), 360-376. https://doi.org/1089/bfm.2022.29207.kbm ¹¹ Hernández-Aguilar, M.T., Bartick, M., Schneck, P., Harrel, C., & The Academy of Breastfeeding Medicine. (2018). 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