What to Expect in the First Week of Breastfeeding

By, Priya Khullar RD, IBCLC

The first week of breastfeeding for a mother and baby is often a learning experience. This period is when the mother and baby are becoming more familiar with each other, but it is also crucial to the production of copious milk supply. There are several tips that a pregnant woman should be informed of prenatally, and they should be reiterated immediately following birth in order to ensure breastfeeding success.
All prospective/breastfeeding mothers should be informed of the following tips for the first week post-delivery:

·       Breastfeed your baby as soon as possible after birth.

·       Putting baby skin to skin helps babies breastfeed and gain weight faster.

·       Your first milk, colostrum, is thick and yellowish. Even a very small amount has everything your baby needs!

·       New born babies have small stomachs and need to breastfeed often: about 8-12 times in 24 hours.

·       You should see baby swallow after several sucks.

·       Your nipples will be slightly tender.

·       You may experience uterine cramps in the first week when you breastfeed; this is actually a good thing. This means that the hormone, oxytocin, is being released which aids in milk production. 

·       Your breasts will feel fuller around days 2-5 and then feel less full around day 7.

·       Breastfeeding takes practice! Stay confident in your body’s ability to provide the best food for your baby.

·       The best way to tell if your baby is “getting enough” is by recording their wet/dirty diapers. The following chart, provided by the California WIC Program, is very helpful:

 

 Reviewed and edited by Sara Steelman 6/8/2015

Skin to Skin Care in the Hospital

By, Lindsay Sims, BSN, RN-C 

At one hour old, life outside the womb is a special time when a baby meets his or her parents for the first time, and a family is formed. The manner in which a new baby is welcomed into the world during the first hours after birth may have both short-term and long-term consequences. There is good evidence that newborns who are placed skin-to-skin (s2s) with their mothers immediately after birth make the transition from fetal to newborn life at greater strides than not being placed on their mother’s bare chest.  One of the main benefits seen fairly quickly after s2s is initiated is the process of breastfeeding. Babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when s2s with their mothers. When the newborn is placed s2s with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Evidenced based practice shows that a baby placed s2s immediately after birth will succeed with breastfeeding at a higher rate and for a longer period of time compared to those who go to the radiant warmer after birth. In 2012, researchers pooled the results from 34 randomized, controlled trials in a meta-analysis (Moore, Anderson et al. 2012). The researchers found that babies who were randomly assigned to receive early s2s (initial or before 2 hours of age) were 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who received routine hospital care. This is a "sacred" time that should be honored, cherished and protected whenever possible.

S2s is a trend that more and more U.S. hospitals are embracing. Hospital protocols can be modified to support uninterrupted s2s contact immediately after birth for both vaginal and cesarean births. In the sections below we will cover how the baby and mother benefit from s2s, what the patient should request, and the barriers seen by the nursing/medical staff in regards to s2s.  

Skin-to skin is recommended by the American Academy of Pediatrics (AAP), the U.S. Department of Health and Human Services (HHS), the World Health Organization (WHO) and many other health organizations. One of the AAP's recommendations is that “nurses will encourage moms and dads alike to continue skin-to-skin contact throughout their hospital stay.” The Baby Friendly Hospital Initiative states that all mothers must have the opportunity for s2s contact for at least one hour or until after the first breastfeed, whichever is sooner.

As nurses/medical staff we are faced with many hurdles during this intimate/important time of s2s and breastfeeding. Some of the s2s challenges faced in hospital include the need for immediate documentation (weight/length for MD, delivery record; assessing mom & baby); family disturbances; staffing/time constraints; unstable baby; C/S baby; patient's level of pain, being tired or cold; and patient/family being uneducated on s2s and breastfeeding. An important fact to keep in mind is that the rate of Cesarean births has increased significantly in the U.S., and currently averages around 32% - or 1.4 million American babies born by Cesarean per year. The low rates of skin-to-skin care provided to this population means that there are a significant number of mothers and babies who are not receiving skin-to-skin care.

Nurses, physicians, childbirth educators, and lactation consultants have unique opportunities to develop relationships with mothers prior to birth providing education on wellness and health promotion including s2s and breastfeeding. We must take advantage of this role! With this role in hand we can customize our plan of care and interventions to allow this one hour of uninterrupted s2s, with a little adjustments of charting and caring for the patient(s).

Patients should be educated on the importance and benefits of practicing skin to skin care with their newborn baby.  They should tell the nurses/medical staff they want immediate s2s and Golden Hour when they arrive to the hospital and throughout their stay. They are in control of their stay and the staff should do everything in their power to make sure they grant their wishes towards s2s and breastfeeding.

Benefits of s2s care in the newborn:

1. Accelerates BRAIN DEVELOPMENT

2. Reduces Crying/Stress (negative effects of separation)

3. Regulates BODY TEMPERATURE

4. Improves QUALITY OF SLEEP

5. Enhances IMMUNE SYSTEM

6. Stimulates DIGESTION & WEIGHT GAIN

7. Synchronizes HEART RATE & BREATHING

8. Encourages BREASTFEEDING BEHAVIOR (aids in attachment)

 

Benefits to the mother:
1. Reduces risk of POSTPARTUM DEPRESSION

2. Increases MILK PRODUCTION

3. Speeds RECOVERY TIME

4. Promotes PSYCHOLOGICAL WELL BEING

Skin to skin contact and breastfeeding are hot topics at this time in the hospital with The Joint Commission Perinatal Care Core Measures and Baby Friendly Hospital Initiative goals all aligning to promote the practice. As a nurse in Labor and Delivery, I want to stress that we must be educated and adjust our plan of care and interventions to allow for this. This process change from what we are used to will only show positive outcomes, as we all know! For the mother (parents), please come educated on your rights as a patient and be ready to let the hospital know your specific wishes. Do not allow your medical team to adjust the plan unless deemed necessary! You deserve to have this special time with your newborn, as you will never get that one hour of skin to skin directly after birth ever again! Enjoy every second!

Edited by Sara Steelman, MPH (2/25/2015)

Benefits of Breastfeeding

By, Kristi Ryall, RN, IBCLC

When a new baby is brought into this world, there are many decisions parents are faced with. What should we name the little one? Who will be the Pediatrician? Where will they go to College? Which car seat will we buy? One of the most important decisions for parents is what type of feeding they will choose to nourish their baby: breastmilk or formula.

According to the World Health Organization (WHO, 2002): 

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.

Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.

In addition to the ease and availability of breastmilk, there are many benefits of breastfeeding to both the mother and the baby that should be considered when choosing a feeding method.

For Mom, breastfeeding:

1. Decreases the risk of breast cancer-a reduction as much as 25% is equal to the proportion of the lifetime duration of breastfeeding. The more time spent breastfeeding, the lower her risk.

2. Decreases risk of uterine/ovarian cancer – one reason is that estrogen levels are lower during lactation, so the risk decreases when a mom is breastfeeding.

3. Lowers the risk of developing osteoporosis – non-breastfeeding women have a 4 times greater chance of developing it during their lifetime than a woman who breastfed her children.

4. Can allow natural spacing of children – since exclusive breastfeeding (meaning no supplementation of any kind) delays ovulation, it can prevent a pregnancy. However, this is often not recommended to use as the sole birth control method because it is not a 100% guarantee.

5. Promotes emotional health – breastfeeding benefits the body and the mind. Breastfeeding moms show less anxiety and depression related to the natural release of endorphins and oxytocin.

6. Promotes weight loss after baby – breastfeeding moms report a larger weight loss back to pre-pregnancy weight than non-breastfeeding moms.

7. Is cost effective – formula can be very expensive and must also include the purchase of bottles and supplies. Breastfeeding is free and always available; no need to mix and prepare or worry about running out in the middle of the night.

8. Helps the uterus return to its normal size – natural hormones are released while breastfeeding that cause the uterus to contract and begin to shrink back to where it was pre-pregnancy.

In addition to the benefits to Mom, there are also benefits to Baby. They include:

1. Higher IQ

2. Fewer ear infections

3. Fewer respiratory infections

4. Breastmilk is easier to digest, so baby is less fussy

5. Provides all the right nutrients and changes as baby grows to meet their needs at all times

6. Always available and at the right temperature

7. May have protective effect against SIDS

8. Stimulates the senses of taste and smell

© Vcarmstrong | Dreamstime.com - Breastfeeding Photo

There are many resources available to help mothers in their early breastfeeding days, and to assist them if any problems arise thereafter. Make sure talk to your healthcare provider about any concerns you may have, and ask about who to contact in your community for help. La Leche League and WIC are great resources with a lot of education and knowledge to help you get the support you need. While at the hospital, be sure to see a Lactation Consultant who can provide hands on assistance and education, as well as direct you to follow-up resources in your community. With lots of support and guidance, your breastfeeding experience can be very enjoyable and rewarding to both you and your new baby.

       

References:

World Health Organization. (2002). Infant and young child nutrition: Global strategy on infant and young child feeding. FIFTY-FIFTH WORLD HEALTH ASSEMBLY, A55/15, Provisional agenda item 13.10. Retrieved from http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf?ua=1

Edited 2/19/2015 by Sara Steelman, MPH

Breastfeeding in Winter

By, Janelle Webb, MBA, CLE

(Image Courtesy of Microsoft Clip Art)

Breastfeeding during the cold winter months presents some unique challenges for moms.  Removing jackets or sweatshirts to allow babies access to mom’s breasts exposes moms to the cold temperatures.  This can be minimized by mom layering her clothing or choosing a long sleeved nursing top, zip-up sweatshirt, or button-up sweater to wear.  Babies can be kept warm in swaddling blankets, one piece, long-sleeved sleepers or sleep sacks, and a removable lightweight jacket in case the day warms up unexpectedly.  A set of hat and mittens will keep baby warm in especially chilly weather. Skin-to-skin contact that was initiated in the hospital as a means of calming the baby, promoting bonding between baby and parents, facilitating breastfeeding and regulating baby’s temperature should be continued throughout the winter to keep baby warm and cozy in their moms’ loving embrace.

Some doctors have reported a higher incidence of plugged ducts during the winter months.  This could be due to the restricting nature of tighter cold weather clothes or from the colder weather.  Treatment for plugged ducts includes frequent feedings, breast massage, warm compresses, and wearing looser clothing.  Some moms may experience nipple coldness, pain, or discoloration when exposed to cold temperatures for a long time.  This can be prevented by taking steps to prevent cold exposure, including warming the rooms where baby will be breastfeeding, wearing warm clothing, and using warming packs before nursing.

Cold winter months are often times when moms get sick with illnesses such as a cold or the flu.  This is not a reason to stop breastfeeding; baby has been exposed to mom’s germs before mom showed symptoms of getting sick.  Mom’s breastmilk gives the antibodies she makes against the illness to the baby, strengthening his or her immune system, and it’s likely baby will not get sick, or at least less sick than mom was.  If mom must take medications, be sure to the doctor chooses a medication that is safe for breastfeeding, and if buying an over the counter medication, ask the pharmacist if the medicine is safe for baby.  As always, practice good hygiene including washing hands frequently, coughing or sneezing away from baby, and getting plenty of rest. 

Remember, breastfeeding warms babies’ bodies and hearts during the cold winter months!

It takes a village: How families can support a breastfeeding mother

By, Sara Steelman, MPH



(Photo obtained from http://wicworks.nal.usda.gov/topics-z/image-gallery)

As the old proverb goes, “It takes a village to raise a child”. Well, the same can be said of breastfeeding, but not in the way you might think. It may not take a “village” to actually breastfeed a baby, but it does take a “village” to support a mother’s decision to breastfeed. In fact, one of the most common reasons a woman decides not to breastfeed or to stop breastfeeding is a lack of family and social support. Many of my close friends and family decided to stop breastfeeding early on because of this.

Where is this lack of support coming from?  I believe it stems from our society’s acceptance of formula as the primary source of nutrition for infants. We have been a formula feeding culture for over 50 years now, and that significantly affects the way that families perceive and understand breastfeeding. From birth, we look to our mothers for advice and guidance. Many of the new parents today have mothers and grandmothers that have never breastfed, and grew up in a time where formula was thought to be as good (if not better) than breastmilk. Often times, the family support system that has little education on breastfeeding and no personal experience can adversely impact a mother’s decision to breastfeed and continue breastfeeding.

What can families do to support a breastfeeding mother?  If a family has little to no experience with breastfeeding, they can still support a breastfeeding mother in a variety of ways. First is to be informed! The family support system (mother, grandmother, spouse/partner, etc.) can attend local breastfeeding classes to gain knowledge on breastfeeding. This will allow them to assist the new mother if a problem arises. Secondly, affirm and encourage the new mother. At times breastfeeding can be challenging, especially for a new mother, so build her confidence. Studies show that breastfeeding women who are confident in their ability and committed to making it work are significantly more successful at breastfeeding (Avery et. al., 2009). Families should avoid encouraging the mother to give the baby formula to resolve breastfeeding challenges, but rather encourage her that she can do this. If challenges persist, point her to the lactation resources in the community. Thirdly, partners and family members can help a breastfeeding mother with daily tasks that might otherwise be overwhelming while nursing such as housework or helping with her other children. Lastly, for those family members who provide childcare once the mother goes back to work, encourage her to pump her milk so that the baby can still receive all the beneficial properties of breastmilk.

With emerging research confirming the benefits of breastfeeding, there has been an increase in the professional lactation support available to breastfeeding mothers, and an increase in breastfeeding education. Although mothers today are becoming more knowledgeable about breastfeeding, lack of family and social support continues to be a significant barrier to success. Let us all work together to ensure that we provide support and encouragement to our childbearing family members!

 

References:

Avery, A., Zimmermann, K, Underwood, P.W., and Magnus, J. (2009). Confident Commitment Is a Key Factor for Sustained Breastfeeding. Birth: 36 (2), 141-148. DOI: 10.1111/j.1523-536X.2009.00312.x

Welcome to the KCBC blog!

The Kern County Breastfeeding Coalition (KCBC) has been active in the community since 2010. The coalition consists of a team of healthcare and public health professionals from all over Kern County that are dedicated to improving our exclusive breastfeeding rates, and increasing access to proper breastfeeding support. Our members have a passion for breastfeeding advocacy because of the many positive health outcomes that arise when a majority of women breastfeed.

Our Mission: 

To improve the health of Kern County residents by promoting, supporting and protecting breastfeeding.

Our 2014-2015 Goals:

1. To increase access to professional lactation support in Kern County through education, advocacy, and collaboration.
2. To increase lactation accommodation in Kern County for breastfeeding employees, and ensure businesses are compliant with the California and Federal Breastfeeding Laws through education and advocacy.

Our current members include representatives from:

Baby Café Bakersfield 

California Health Collaborative
Central Valley Lactation Association
Clinica Sierra Vista WIC
Community Action Partnership of Kern WIC
First 5 Kern
Healthnet
Kaiser Permanente
Kern County Call to Action
Kern County Department of Public Health Nursing 

Kern Family Health Care
Kern Medical Center
La Leche League
Maternal, Child, & Adolescent Health (MCAH)
Medically Vulnerable Care Coordination Project (MVCCP)
Mercy Southwest Hospital
Ridgecrest Regional Hospital

San Joaquin Community Hospital

The U.S. Surgeon General’s Call to Action to Support Breastfeeding of 2011 stated, “Only through the support of family members, communities, healthcare systems, and employers will we be able to make breastfeeding become the easy choice, the default choice”. 

The Kern County Breastfeeding Coalition believes that in order to improve the breastfeeding rates in our county, and ensure women have seamless access to breastfeeding support, we must work as a team! All members of the community are welcome to join the coalition.  We invite you to become a part of the coalition, and help us strategize on how to increase support for breastfeeding mothers, and raise awareness of the benefits associated with breastfeeding.

Coalition Meeting Information:

Where: Healthnet Community Solutions, 6013 E. Niles St, Bakersfield, CA 93306

When: Every 3rd Monday of the Month

Time: 12:30 PM to 2:00 PM (Feel free to bring your lunch!)

*You may also join meetings via conference call: (888) 584-2113, code: 308 146 9348

Whether you are a family member, friend, co-worker, healthcare professional, or a mother yourself, you play an important role in promoting, supporting, and protecting breastfeeding!