Breastfeeding After a Difficult Birth
Sometimes a birth may not go to plan. Labour can be long and tiring for parent and baby. Maybe there was a complication and the baby needed some assistance or maybe Mum is unwell. Whatever the circumstances involved it may not always be possible to feed your baby directly from the breast. My second son was born prematurely and had to be taken into NICU, so I was not able to feed him. I could, however express and give my milk to him. We know that for a baby, receiving colostrum in the first hours after birth is beneficial for their immune system and helps to colonise their immature gut biome and aide their transition into the world . It has the perfect balance of nutrients densely packed into tiny amounts because a babies tummy is very small. It’s a personalised super food full of everything your baby will need for their unique environment. We often refer to colostrum as a ‘living tissue’ or ‘liquid gold’. If you want to know more about how to hand express or learn about antenatal harvesting of colostrum, take a look at my blog.
Colostrum not only has benefits for the baby, early colostrum removal also starts to signal to the parents body, to begin to make mature milk. This transition happens readily when a baby is frequently and effectively removing milk from the breast. When a baby cannot do this for themselves, it’s important to begin this process for them. It’s most effective and beneficial to remove some milk and give it to the baby in the first hour after birth. Colostrum is low in volume and high in nutrients, so hand expressing is particularly helpful so that nothing is lost. Your midwife should be able to show you how, and provide syringes to help collect it. Hopefully, this will then be followed by a good rest and then help to again effectively express within six hours. Milk removal should then commence every three to four hours from both breasts ( ideally eight times in 24hours, including during the night) until you and your baby are re united or they are able to breastfeed. As the setting up of a milk supply is very time sensitive, early and frequent stimulation is extremely important.
As soon as you are able, have skin to skin contact with your baby. This is essential for mum and baby and has been proven to be more effective than any incubator. Our Skin is the biggest sense organ in our body and holding a baby with their chest touching your chest helps to calm parent and baby and set up a chain of hormonal responses. There is a lovely thermal synchronicity and your body will keep your baby at the perfect temperature. Warming and cooling as needed. Your body will also regulate their breathing, heart rate and oxygen levels, encourage physiological instincts to feed and soothe the nervous system. In a NICU you can witness this happening by the sensors connected to a baby. Babies stabilise more easily on a Parents chest than anywhere else. It also supports the parent bond and enables them to continue to be the expert on their baby.
If you have had a Caesarian birth, you may feel sore around your incision site and find it difficult to get comfortable, move and pick your baby up to feed or cuddle, With an elective or planned abdominal birth, your labour hormones may not be present and this can affect breastfeeding and how you feel. If it was an EMCS, it may of come after a long difficult labour. You may be exhausted and in shock from your experience. You may be on pain relief and feel drowsy and your baby may also be more sleepy. Babies born by caesarean are much more likely to have mucous in their lungs, which can affect how interested they are in feeding. The IV fluids during labour can also inflate a baby’s birth weight, which can lead to worries that they’ve lost too much weight and lead to early formula supplementation and less breastfeeding. After this type of birth parents often need lots of loving support, not purely to help with the physical aspects of a surgical birth but also the strong emotions that may accompany this, especially if it was not what you wanted or expected. Skin to skin can be really helpful and is much more than a special cuddle.
If your baby needs to have milk in another way, you don’t need to use a bottle. Evidence suggests that when a baby is given any milk in a bottle in the early days, they are more likely to not meet their feeding goals. A baby can feed from a cup, finger feeding, or NG tube or supplementary nursing system/SNS depending on the circumstances and age of the baby. Its best to discuss your individual circumstances and needs with a feeding specialist. You may have an infant feeding team in your hospital or community based peer support, specialist midwives and or Lactation consultant/IBCLC’s all can help.
The amount of milk your baby will need changes as they grow. Here is a rough guide:
Day One, 5-7mls
Day Three, 22-27mls
Day Seven, 45-60mls
One Month, 80-150mls
Often by day three or four, post birth, your milk will transition from colostrum to mature milk and you may notice a change in volume, colour and viscosity-its often whiter and thinner than colostrum. If you are purely expressing you should aim for between 500-700ml over 24 hours by the second week. If you are expressing less than 350ml by day 6 or under 500mls by day 10 ask for some support from a feeding specialist. We know that on average a baby from one month to six months old will take around 600-950 ml each day. This is important for families to know as they often believe their baby will need more and more milk each week and it simply isn’t the case. A baby’s intake and a mothers supply are generally at capacity from 4-6 weeks after birth.
Hand expressing is important at first, so that you can save each drop of precious colostrum. Once your milk has transitioned a double electric hospital grade pump can be used. If you are in hospital this should be provided, if you are at home you can buy or hire one.
If you are in hospital and expressing colostrum it’s also possible to use a pump with the collecting kit turned upside down so that it’s easier not to loose any precious colostrum.
It’s also vital to have the right size flange to fit your breast properly.
Aim to comfortably double pump for around 10-25 minutes, eight times across a 24hour period. Here is a good video by Dr Jane Morton that explains the benefit of hands on pumping in increasing milk supply.
Sometimes a baby may be given a formula milk top up in hospital. Unfortunately, this is not always necessary or medically indicated. All babies generally loose a small amount of weight in the early days- between 6/8% is considered normal by day five. A healthy term baby is born with an excess, or ‘pack lunch’ on board to see them through their first 24 hours, so topping up during this time without a medical reason is not reccomended. When a baby receives any milk other than from the breast, the mothers body is not getting the signal to produce milk. Breast milk is hormonally driven for the first few days after birth but then becomes more to do with milk removal. We call this, ‘supply and demand’. This is the time that when a baby is directly feeding, there is a lovely synchronicity between the mother and baby. The baby indicates its needs and the mothers body responds. This happens automatically when the baby is effectively removing milk from both breasts a minimum of 8 times a day/night. We call it a ‘top up trap’ when a baby has had any other milk and this feedback is disturbed. Therefore, It’s vital to milk production to suppprt families to effectively remove milk, each time a top up or alternative milk is given.
Positioning and attachment, or how a baby comes to the breast is really important for comfort and milk removal. A baby needs to be really close, facing the breast with the nipple on their nose. They need to be really snug, so that their chin indents the breast, before they gape wide. You don’t want to hold their head as this will prevent them from tilting their heads and opening really wide. They need to approach the breast asymmetrically. Their lower lip will make contact with the breast first and allow their tongues to extend and scoop up a larger amount of breast tissue before the nipple. The nipple needs to aim to the roof of their mouth at the soft palate, or very back of their mouths. When you look down, you should see a smaller amount of areola visible above their top lip than below, this is an asymmetrical latch. If this is uncomfortable or hurts in any way, seek support from an experienced feeding specialist. Here are some pictures of babies in the cross cradle position.
Note how close they are, allowing their babies chins to really indent the breast and help with deep attachment.
Breastfeeding should not cause any trauma or miss shaping to the nipple. If this happens to you, seek support quickly.
The best way to know your baby is getting enough is by their nappy output. A newborn will first pass a dark sticky, meconium stool. On day 2/3 this will get easier to clean and become more green in colour, like pesto. On day 4/5 it will become yellow, with seedy grains a little line English mustard. If your babies poos have transitioned to yellow and they are producing a minimum of two a day, you can be content that they are taking in enough milk. More than 2 is excellent. Have a look at this guide af a babies nappy output.
Breastfeeding and milk making takes time and practice. It does get easier and is not always so labour intensive. If you are having any concerns or worries please do seek help sooner rather than later. Talking things through with an experienced practitioner can make a big difference.
If you are not near me, have a look at this site to find an IBCLC near you.
