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Ep. 4: Lactating Friendly Birth

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You know, a lot of people will say, read about that and they’re like, Oh, yay! The breast crawl! We’re going to do it. And then, you know, they kind of get five or 10 minutes and they’re like, my baby failed. No, your baby did not fail.

This is Maureen Feral and Heather O’Neal. We’re midwives and lactation consultants here to talk to you about all things lactation, and boobs, body positivity, mental health, all the Milky topics. So join us for another episode.

Today we’re going to talk a little bit about things that are under your control during your prenatal and birth experience that can have a really big, positive impact on your breastfeeding experience.

I think a lot of people tend to focus, myself included, on just getting through the birth. Anticipating pain and how to manage that. And a lot of people I would say are really focused on what’s going to happen to their vagina. Yeah. I mean, and understandably, of course, but there are some things you can do really, even at the very beginning of your pregnancy that can just set you up for success with breastfeeding.

Yeah. So today we’re going to tell you how to have a breastfeeding friendly birth. Yeah. And I, and I’m going to start by saying too, like, this is not all on you as a parent, you know, a lot of what happens during your birth is out of your control and it is about your birthplace and your provider. You know, and of course there are emergencies that happen that nobody can predict, but so much of it can be influenced by that.

So I want to spend a little bit of time talking about choosing a birthplace and choosing a provider that will both, you know, combined to help you have the kind of breastfeeding journey that you want to have. Oh, absolutely. And I think that most people just say, you know, whatever happens happens, and they just go with the provider that is available.

And a lot of times you don’t have a choice, you know, maybe you don’t know who’s going to be on, but it’s a good thing to ask in your prenatal visits, how they manage breastfeeding in the beginning and how much training their nursing staff has on breastfeeding and if they actually have lactation consultants available at that birthplace.

Absolutely. And I want to talk a little bit about like the kinds of birthplaces, Heather, do you wanna throw one out there to start with? Let’s start with hospitals and just get it out of the way. Yeah. That’s like the obvious one in the U.S. Anyway. Yeah. So hospital birth. Unfortunately, I’m going to start with the bad news.

The bad news is a lot of hospitals are not set up to support people to breastfeed. And I think a lot of times, because you don’t get reimbursed enough for birth, which it could be a whole podcast on itself. So it’s really more about volume. They want to get you in and out, and usually you’re gone and discharged by the time your milk even fully comes in.

And so you’re left at home with these gigantic boobs and a baby that doesn’t know what to do with them. And you’re like, what the heck? So it’s kind of a “day late, dollar short” sometimes when it comes to hospital care. But a lot of them do have lactation consultants.

Yeah. And I’d say like some of the big questions you can ask, if you have a choice in your hospital, right? I know a lot of people live rurally and there’s just one hospital. And so we’ll talk about a little bit how you can control that experience later, but if you’ve got a choice, some things you can look for. There is something called a baby friendly hospital designation and for the people with that designation, that means that they have to meet a set of requirements that are supposed to create a more breastfeeding friendly environment for parents and their babies. And I’m going to say it, you know, it doesn’t always work and it doesn’t always create an equal, you know, opportunity facility, but it’s definitely something to look for.

Like have that on your checklist. If you have a baby friendly hospital available to you, check them out first, see what you think. Yeah. I mean, at the very least, the breastfeeding friendly status isn’t perfect, but it, at least it shows that that hospital is making breastfeeding a priority. It’s on their radar.

Somebody there is thinking about it. Right. Something else to ask about is, first, ask if they have any staff who is just dedicated to lactation support, not just say nurses who are also trained in lactation, but like, do they have lactation consultants or counselors who only do that? And then how often are they available?

Cause that’s the key. A lot of hospitals say, Oh, Heather, we have lactation staff. They’re great. And then it’s Sunday night and you need help. And they’re like, sorry, they don’t come until Tuesday morning. Yeah, what the fuck? Yeah, that just, yeah, we could probably go into all of that, but basically we just wanted to put that on your radar for hospitals and we’re not anti-hospital.

We just like to be realistic when we’re telling people what to look for. And then of course, there’s birth centers. If you’re lucky enough to live in a radius that has one. And honestly, if you are privileged enough to have the kind of healthy pregnancy that allows you to like qualify for a birth there because a lot of birth centers will only take low risk pregnancies.

So I do understand that not everyone’s in that situation where they can consider a birth center or even a home birth. But those are two other options. And, and for most places they tend to be a little bit more breastfeeding friendly. They tend to be staffed by midwives and you know, midwives do have a stronger lactation education than a lot of OBS that I know.

Right. Yeah. It’s definitely a more holistic experience I think. And I don’t think that there’s any OB GYN out there that would argue with me on that. It’s just midwives are known for our education piece that we provide and we just tend to follow people a lot closer and a lot longer and develop a closer personal relationship with our patients.

So, and I would say, wouldn’t you say also, that most birth centers do have a designated lactation person that will come to your home? Sometimes. Yeah, I’ve, I’ve definitely known birth centers to have that and others that don’t. So that’s a good thing to ask, like for any of your places of birth or your providers, ask, what does their postpartum visit schedule look like?

And do you have to come into their office for that? Or do they see you? So say if you’re trying to choose between home birth midwives, Right. That’s a really good question to ask. Like how often do you come in the postpartum and at what point do you expect to see me back in your office?

Because you know, really the best way that we can provide lactation support is being in our client’s homes, in person, several times during that first week, or being available to come out if needed. Yeah. I mean, as a certified nurse midwife who has worked in a clinic setting and done postpartum in clinic, I can honestly tell you it is a nightmare to try to handle a lactation problem in the clinic.

Because first of all, the mom has been waiting or the parent has been waiting in the waiting room for an unprecedented amount of time trying to not feed her baby so she can sit in a cold clinic environment and try to recreate the problem that she was having at home. Right. And it’s very difficult and there’s just rarely enough time in a full clinic schedule to be able to really get into the nitty gritty of what’s going on. And I felt rushed and I hated it. And that’s part of what got me on this journey.

So, you know, if you have the option to do a home visit with a lactation consultant or midwife or both, I would highly recommend that. Because they can come to you and you’re able to feed and recreate the exact experience that you were having. And I just think it’s a lot more effective. Yeah. And if you are not in a position where those things are available to you, or, you know, if you’re birthing in a hospital, but you still want some of that postpartum experience, you can absolutely interview midwives and private lactation consultants and see if they do home visits for people they did not attend the birth for.

See if they do home visits and it’s covered under your insurance. I mean, half those conversations, the worst thing that’s going to happen is they’re going to say, no, I can’t help you. And you move on. And let me just give you a little tidily bit there because I’ve done private lactation consults, and I’ve billed insurance for it.

But, if you have a person that is available to you, but only takes cash, don’t be afraid to go for it because after billing insurance, the patient responsibility amount that you’re probably going to owe is just about the same as it would be for cash anyways. So really don’t be, don’t shy away from a hundred dollar lactation visit because you’re going to get so much out of that.

And you’d probably end up owing that anyway, unless you have like Federal Blue Cross Blue Shield, which is bomb, but not everybody has that. Heather, have you ever met anybody that has that cause I haven’t? Two people! Two people. And when I got that check in the mail, I was like, what in the heck? Why can’t everyone have this? Well folks, right.

We probably should stop talking about insurance cause that maybe, maybe that will be, what do you think, Heather? Will that be another episode? I think I’m getting hives and we should definitely move on. Okay. So you have thought about birth, a  birthplaces and providers, and asked all these great questions, like what next? Now you’ve either made a choice or realized you don’t have a choice, which sucks.

And I’m sorry to say, that’s the reality for a lot of people, but what next? Right. So if you can, during your pregnancy, we also recommend that you interview your pediatrician or several pediatricians, or talk to the one that you already have. And just like, see what they think about breastfeeding. Big one is to ask what growth charts they use.

So Heather, can you tell me the difference between the two main growth charts pediatricians use? Well, one of them is strictly breastfeeding, right? From the WHO. Right. Which is slightly different. The curve is slightly different than the other growth chart, which combines breastfeeders and formula feeders.

And that’s from the CDC. Right. And, you know, when you’re trying to compare a breastfed baby to a strictly formula fed baby, it’s just not going to be the same. You can’t expect that curve to make sense in that particular way. It doesn’t mean your baby is in trouble, but what happens is, if you’re breastfeeding exclusively and you’re put against the breastfeeding formula feeding chart that’s combined, your breastfeed fed baby can actually look like they’re falling off the chart when really they’re about to come back. You just need to give them a minute. Their curve is just slightly different than a formula fed baby.

Yeah. And, and some, some good questions to ask your pediatrician, like, you know, ask them like, what happens if my baby gets thrush? Can you also write me a prescription? You know, because you might find out that actually, you would prefer a family practice doc who can see both of you in a combined visit. Right. Right. Because I mean, you know, back me up here, Heather, like we really see a breastfeeding parent and a baby as a dyad, as a combination.

Yeah, we do. And then also there’s specific kind of like turf wars going on. If you’re seeing an OB GYN and your postpartum six weeks is technically up and you have an issue, they’re going to probably push you off onto a primary care doctor or they’ll tell you to go see your women’s health doctor or a nurse practitioner.

And, you know, that’s no longer in their wheelhouse. Right. And then you don’t have consistency of care. So family practice can provide everything soup to nuts. And we like family practice. Yeah. I like family nurse practitioners as well. And, you know, maybe this is just my opinion, but I really do think that that area of medicine tends to provide a more holistic picture and, and look at things as a family and not just, you know, this is a baby separate from its parent who breastfeeds it.

Right. I would say that midwives and family practice tend to have one of the better relationships. You think we’re a little biased, Heather? Well, it’s our podcast. So we can say what we want. Anyway, so talk to whomever you’re going to rely on for medical care for your baby before that baby’s born. And ask the big questions. Do you know how to assess a proper latch? Do you know how to assess a tongue or lip tie? Do you have resources to recommend to me if those things are a problem? Can you fix that if that’s a problem?

And who do I call if it’s two o’clock in the morning? What’s available to me when it’s an emergency/ non-emergency? And also a lot of pediatric offices have open houses like once a month where you can go on at like 7:00 PM on a Thursday and meet all the pediatricians at once. And that’s a little bit more of a low stress environment where you can kind of get to know them and ask the questions without sounding like you’re giving them the Spanish inquisition.

Tell me about your breastfeeding training. Don’t screw this up for me. I don’t know. I definitely sound like that anyway. True. Yeah. Okay. So Heather, let’s say we’ve chosen our birthplace. It’s a hospital. You know, we’ve chosen, we’re dealing with the staff they have. We’ve chosen our pediatrician, whatever.

And now we’re planning for that hospital birth. What are we going to do to make sure that that is a breastfeeding friendly experience? Well, the first thing that I like to make sure my team knows is that we limit the amount of IV fluid that we put into a person, and this is across the board. So it doesn’t matter if you come in in spontaneous labor or if you’re there for an induction or a C-section, but you need to make sure that you’re only giving the amount of fluid that that person needs.

And one specific example is, when you go in for an induction, it can take up to three days. And a lot of people don’t know that. And they’ll just go ahead and hook you up to IV fluid and you’re not allowed to eat. So they kind of just run that fluid at a low rate for days and days. And they just kind of, you know, the nursing shifts change and people don’t tend to keep track on labor and delivery of how much volume is going into somebody.

And then like the worst case scenario of course, is that you have a three-day induction and you push for a long time and then you end up with a C-section where they automatically put a whole extra liter of fluid into you just to stabilize your blood pressure. And before, you know it, you’re like positive 5,000 CCS of fluid and your body is not going to enjoy that.

So Heather, tell me what happens if my body were to just have five extra liters of fluid in it. And I was trying to breastfeed. It has to go somewhere and your breasts tend to get really swollen. And the fluid makes it so swollen that your baby can’t get the colostrum out and then everything kind of starts to get backed up.

And then the more you don’t remove that milk, the more swollen you get, and it’s a slippery slope. And before you know it, you could bounce a quarter off of those hard titties and there is no possible way you can latch that baby on there with their tiny mouth. And your breasts are like shiny and it hurts and that’s called primary engorgement.

And the best way to prevent that is to remove the milk a little bit at a time, and to prevent that amount of IV fluid going in your body. Only necessary IV fluid. So that’s my absolute number one tip. What’s yours? Yeah. Okay. So my number one tip is to advocate for immediate skin to skin contact with your baby.

And what that looks like is baby comes out of you. Out of your vagina, out of your belly and right onto your chest. So yes, you can do this with a C-section, but no matter how you’re going to have that baby, it has to be a conversation you have beforehand with your provider. And with a lot of provisors, this has to be something that you or your partner or your doula just continually advocate for the entire birth.

And the breastfeeding friendly, like baby friendly hospitals, that’s one of their major tenants is skin to skin because all of the research across the board says that really makes a huge difference in mom and baby’s recovery and the success of breastfeeding, right by immediate skin to skin. I don’t mean that that nurse takes the baby, cuts the cord and says, hold on, let me clean it up for a second.

That would be a no big, Nope. That baby comes right to you all goopy covered in blood and mucus and who knows what else? And that’s just fine. Because even that two minute delay can cause problems. And having baby separated from you can cause their temperature to drop, their blood sugar to drop, I mean, they, what they do during that skin to skin time is all of their vital signs regulate based on all of yours.

True and all that goopy stuff on there, it’s there for a reason. All that white stuff that the baby is born with, and we’ll always joke and say, can I have a little wine with all that cheese? The nursing joke. But it will actually stick to your skin and pull your microbiome off of you and then it’ll get absorbed into the baby’s skin.

And so you are the very first person to colonize your baby with the bacteria that it’s going to be experiencing in its environment, which is so important for infection prevention and also digestion. We could go on and on. And skin to skin also goes hand in hand with delayed cord clamping. Oh, I love delayed cord clamping.

And by the way, the American College of Obstetrics and Gynecology, as well as the American College of Nurse Midwives have position statements that say yes to delayed cord clamping. Even with a preemie, especially with a preemie. And even, especially with C-sections. And that’s one of those times that I think that they kind of skip it.

Yes. And I don’t really, I don’t see a way that these two issues can be separated. They’re the same process to me. You know, delaying that cord clamping and immediate skin to skin. And yes, after that cord is limp and white, then it can be cut. But baby does not have to be taken off of you for that.

Even if they can’t cut it close to the, you know, to the umbilicus, cut it long and leave a clamp on there and fix it later. It doesn’t matter, baby doesn’t care. But what is going to matter to that baby is if they’re removed from you because they have this physiologically normal process of acclimating to life outside of the uterus.

And it takes a long time. It takes an hour or maybe two for them to stabilize their vitals. And then also realize like, Whoa, what the fuck? I’m not in a uterus. I’m not living in water. Now I have to eat and breathe and all of its plumbing’s getting rearranged. It’s crazy. Right. And that is okay for that process to be slow.

There’s no need to rush that with a normal birth, a normal baby. And you know, a lot of people will say, read about that and they’re like, Oh, yay! The breast crawl! We’re going to do it. And then, you know, they kind of get five or 10 minutes and they’re like, my baby failed. No, your baby did not fail.

I’ve seen this take five minutes. I’ve seen it take two hours. And those are both normal. Yeah. And also the best way I explain this is when the baby is inside of you and right up against the placenta and the cord is still attached. You, the blood is consistently circulating between the baby, placenta, baby, placenta.

So after the baby’s born, that placenta is still circulating blood. And so if you immediately clamp it, one third of the baby’s blood is still tied up in the placenta. So if you don’t clamp it, the baby is actually going to get an additional 80 to 120 milliliters of blood, which is like one third of the baby’s blood volume.

So we have seen the evidence that says that kids that are two years old, who had delayed cord clamping actually are much less anemic than the kids that had immediate cord clamping. So, I mean, this is like a long-term thing where it’s not just, you know, helping the baby immediately postpartum, but it’s helping your two year old to not be anemic and setting them up for success in that way.

And also if your baby does happen to go to the NICU, because they are a preemie, but they delayed that cord clamping. That baby is much less likely to have a blood transfusion because inevitably they’re going to draw blood on a NICU baby. But when you only have a small volume of blood and they’re taking a little bit of blood, a little bit more, a little bit more, eventually they’ve taken so much that the baby’s like, shit, I can’t do this anymore, and needs a blood transfusion.

So if that baby already has an additional 80 mil, you’re already a leg up. Yeah. And, and really, you know, a lot of you may not kind of know the, the physiological process that happens where a baby’s circulation changes from their placenta, being the organ, that oxygenates their blood to their lungs, being that organ.

But, you know, their entire circulatory system has to change. And when we clamp that cord early, we forced that change really fast. You know, we’re being like, kind of like telling these shunts that need to go into place to like snap close. You’re done. When really what happens is the change in pressure from that umbilical cord being in water to it being in air, like that triggers this process that can take five minutes, it can take 30 minutes of that cord slowly collapsing as the baby’s still slowly getting some blood from that placenta.

And when it’s done getting that blood, that cord collapses, blood does not go back the other way. If somebody tells you that, they are wrong, full stop. And you know, that’s a normal process and we should let that happen because it’s a big shock to baby’s system to have to do that faster.

You know, one of the major reasons that’s thrown out there to not do it is that it can give your baby jaundice. And there is a big difference between,  jaundice is also called Polycythaemia, so it’s basically like you have too many breaking down red blood cells. But there’s a big difference between Polycythaemia and symptomatic Polycythaemia, right.

Right. And, and, you know, you might hear this called physiological versus pathological jaundice. And you know what? Jaundice can be normal. Yeah. Tell us all about that. Well, quickly. Yeah, the, the reality is low-level jaundice that happens after the first 24 hours can be normal, can be asymptomatic. And it’s something that we do, we can monitor at home and it resolves on its own.

Right. And jaundice that happens quickly and with high levels, that’s the kind of jaundice that needs to be treated. And what studies show is that delayed cord clamping might increase the incidents of physiologically normal jaundice, but not jaundice that needs to be treated with lights. Right? If, if your baby is jaundice and needs to be treated with lights, you cannot beat yourself up because you did delayed cord clamping.

It’s most likely because of a blood incompatibility or a premature baby whose liver just isn’t ready to process stuff. Something else is going on. You didn’t do that. Right. Not your fault, Heather. Thank you. I did have one of those 36 week babies who was, all the things were wrong. Like he was breech and then he was low sugar and then he was jaundice and then he wouldn’t eat and it was like just losing weight.

It was a nightmare. So I totally empathize with any of you out there that have experienced that. Yep. All right, my dear. Why don’t you hit us with the last whopper there? Well, the last whopper is really just something that you can advocate for and most hospitals do this already, but not all. We are almost there, but not quite there yet.

And that’s delaying the bath, the newborn bath, for 24 hours. It used to be protocol that after four good temperatures, the baby could be bathed and get all that disgusting goop off. And they’d be like, wait, wait, let me clean that baby up for you. Let me clean it up for you. You’re welcome. What the heck? I know.

And it’s really not that gross. And some babies that are term are born like they’ve just taken a bath. Like, don’t think your baby’s going to definitely be covered in blood. So what I always say is if your baby is completely covered in blood, it’s okay. And the hair can be washed. So if your baby is born with a beautiful fro and it’s covered with birth guts, you can wash the hair, just don’t wash the whole body.

It can cause temperature, instability. It also strips the baby of that initial microbiome and that vernix, the cheesy stuff on there, is a moisturizer. So it’s going to prevent your baby’s skin from getting super dry. And it’s just not something that is an emergency. Like, have you ever heard of an emergency bath other than if the mom has Hep C? No.

No. That’s yeah. And, and if you do have hepatitis C, that’s a conversation you need to have prenatally with your provider and you know, it’s okay to say, Hey, like I know I have this disease status. What are the things that are going to be different for me during my birth and postpartum? Yeah. And you might want to bring up the bath because you might be traumatized by the fact that your baby comes out and they immediately, I’ve seen this where they just dump a whole thing of chlorohexidine water on the baby while they’re on your chest.

So it’s like, no, no, no, this is a win cause we’re doing skin to skin, but also doing an immediate bath. And it’s like how effective is that? And, Oh, right, right. And there might be choices that you can make depending on your hospital and what their bathing facilities are like.

And, and, you know, there might really not be, but it’s definitely a better thing to know prenatally and to understand like, okay. Say I can’t choose that, but like, you know, what else can I do to make sure that I still have this good experience? And you know, I’ve seen in say the case where we have an emergency in the immediate postpartum where that immediate skin to skin is delayed for some reason and that’s okay. That happens.

And you can start over with your baby. And your partner, if you have one, can do skin to skin in your place, because they are the closest second to the microbiome, because you live together, you’re sharing the same bacteria and that is still going to help baby regulate their temperature and help to culture them, what am I trying to say?

Culture them with a good microbiome. That what you mean? No, I don’t think that’s the right word, but you know what I mean? Yeah. Anyway, you know, any skin to skin you do at any time with your baby is going to be a good thing and it’s going to help you build that relationship. So if something happens and you don’t see your baby for six hours postpartum and say there was an emergency with baby and your partner couldn’t even hold them, don’t think, you know, my life is over, my breastfeeding journey is over and this sucks.

You can say, okay, well that was really shitty. And we’re going to start from where we are and see what we can do about it. Yeah. Just solve the immediate problem at hand and then get back to doing the thing. And that’s pretty much what we do whenever we’re working with clients.

We solve the problem that you’re having right now and then we make a plan for moving forward. Yeah. So, and just quick story, just a couple of years ago, I was travel nursing and I was at this super posh hospital that was like state-of-the-art. And it was still their protocol to bath the baby after four hours and then immediately lotion them from head to toe with Johnson and Johnson’s lotion, which had a smell.

And like when you’re using soap or lotion that has a smell, guess what the baby can’t smell? Your areolas and the milk. Like the baby cannot. Imagine. Wait, and here’s a, did you know listeners moment?

Oh, did you know those little bumps on your areola, and that’s the part of your nipple that’s flat, right? That circle around your nipple. Those little bumps are called Montgomery glands and they secrete something that smells like amniotic fluid. Yeah. So your baby recognizes that smell and wants to crawl to it.

Yeah, nature is amazing. So fucking cool. If you’d like more information on today’s topic or you want to check out the sources we used, you can find them in the show notes. Don’t forget to subscribe so you don’t miss a thing.


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