By Sabrina Easterling, MPH, IBCLC, ICCE

When it comes to feeding your baby, many expectant and new parents have heard about the importance of breastfeeding and breast milk.  For instance, you may have heard that breast milk is the perfect food to support a baby’s developing brain, that it completes the development of baby’s immature immune and digestive systems, decreases the risk of reproductive cancers for moms, and provides cost savings for parents and the health care system.  Studies even indicate that parents of breastfed babies get more sleep, on average, than their formula–fed counterparts.  This may explain a bit about why the percentage of U.S. moms who initiate breastfeeding – approximately 77% – is the highest it has been in the past several generations.

Similar to other vitally important health activities, like exercising regularly or consistently eating a balanced diet, knowing that something is good for us is only one small part of the picture.  It may provide the rationale – the “reason why to do this” – but it doesn’t always provide the motivation and support to make it feasible for the long haul. This may be some of the reason why less than 15% of babies are exclusively breastfed for the first six months of life – the length of time that the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) strongly recommend.

For expectant and new parents who are hoping to start the breastfeeding relationship off on the right foot, the great news is that each year there is more research that can serve as a guiding light.  After your baby is born, a combination of education, counseling, and hands-on assistance with breastfeeding techniques and problem-solving provides essential support.  However, studies consistently show that prenatal preparation is a critical, if not crucial, component of breastfeeding promotion, and mothers who are prepared prenatally are likely to nurse their children longer than women who are not.

Here are some key considerations of what to consider or do before you have a baby in your arms:

Take a great breastfeeding class and do some reading on your own time

Studies indicate that breastfeeding knowledge is strongly correlated with breastfeeding confidence, and that learning prenatally about various breastfeeding issues increases the length of both exclusive and total breastfeeding.

Strike the right balance between empowering yourself with information and hitting info overload.  It’s a good idea to bring your partner and/or a close family member along with you to a class, since two brains are better than one when it comes time to remember some of the things that you learned.

Get your obstetrician or midwife in on the action

While it is natural during pregnancy to put a lot of focus on preparing for the big birth day, a common sentiment heard from moms postpartum is that they wish they had spent more time learning about the thing they would have to do every day with their baby – feeding it!

Your health care provider is likely focused on pregnancy and birth-related issues, too, and you may need to be proactive and ask for breastfeeding-related care.  Ask your health care provider to do a breast and nipple exam.  It takes just a few moments, but can provide really helpful information.  For instance, if you have flat or inverted nipples it is helpful to learn a bit more about their potential impact on breastfeeding (and strategies that can help) before your baby’s birth day.

Another thing to discuss with your health care provider before birth is whether there is anything in your health history that may impact initial or long-term milk supply.  While more than 95% of women can produce the milk their baby needs, women with a history of diabetes, anemia, hormone-related difficulties getting pregnant, thyroid issues, or breast surgery sometimes need professional lactation support to help stimulate and maintain milk supply.

Finally, you may want to learn a bit more about the potential effect of birth practices on the early breastfeeding days.  While it may be true that a suggested birth intervention is the most appropriate thing in the moment, making informed decisions also includes considering their potential impact of birth practices on the initiation of breastfeeding (this way you can ask for the breastfeeding support you need immediately).  For instance, some birth practices may have an impact on a baby’s ability to latch and feed effectively.  These include epidural anesthesia or analgesia, assisted delivery, and Cesarean birth.

Know that until recently medical schools and residencies did not provide instruction on breastfeeding-related issues – even for obstetric and pediatric specialties – and many health care providers are still unconvinced or unaware of the research.  You can talk to a breastfeeding educator or lactation consultant about the impact of potential birth interventions on breastfeeding if you prefer.

Choose your pediatrician wisely

While there are likely several important factors at play when you choose your pediatrician, be sure to keep breastfeeding issues in mind. In the first year of life, some of the top reasons why babies need to be seen by their pediatrician or other care provider – diarrhea, ear aches, and colds – are significantly less common among breastfed babies than among formula-fed babies. Some new mothers who want to breastfeed encounter challenges along the way.  Since many parents rely on their pediatrician to offer guidance, studies show that the information and recommendations parents receive from their pediatrician strongly influence their feeding choices. It would serve you well to ask potential pediatricians what kind of training they have regarding breastfeeding issues and how they stay up to date on them.

Learn more about pediatric support for breastfeeding.  Beyond words, what do they do to support breastfeeding?  Things to consider are:

- Do they work in collaboration with an IBCLC (Internationally Board Certified Lactation Consultant)?
- For which medical indications do they recommend the use of formula?
- Do they routinely assess the lingual frenulum of a newborn?  (This is the connective tissue under the tongue that, when short, can affect the mobility of the tongue and a baby’s ability to latch on well to the breast).
- If your baby has jaundice or is born late pre-term or pre-term, what are the things that they do to help you learn more and get the professional lactation support you may need?

Plan for getting support while you are learning the ropes

After the baby is born, most hospitals offer professional breastfeeding support from a Lactation Consultant (IBCLC) during your hospital stay. Before birth, ask your health care team – or directly contact the hospital if need be – to find out how early and often you can anticipate breastfeeding support. Helpful questions to ask are:

- Will someone be available to help my baby to nurse in the first hour or two after birth?
- Will I be able to see a Lactation Consultant before the day I am discharged?
- Will I be able to see a Lactation Consultant more than once if I need the help?
- What level of breastfeeding support can I expect from my postpartum nurses and what kind of training do they have in providing support?

Similar to many medical schools, until recently most nursing schools did not provide lactation-specific training to students and many nurses have not received recent training on the topic.  Therefore, misinformation abounds.  For this reason, many people plan ahead to have a lactation consultant visit them either in the hospital or soon after.

Don’t go it alone:  plan to get support when you need it

Though it is natural, breastfeeding isn’t always as simple as it seems.  If things feel a bit wobbly once the training wheels are off and you are home without a lactation consultant or nurse a call button away, getting help early and often can help you get to the root of what is causing the challenge and get you on your way to resolving it.  As the old adage goes, “An ounce of prevention is worth a pound of cure.”  It’s nice to have a lactation consultant in your back pocket in case you need to tap into her knowledge base, and support may also provide important comfort.

A lactation consultant can guide you and your family on what to expect, assist with trouble-shooting and problem solving, and provide practical advice and solutions.  (Local breastfeeding resources are listed at the bottom of this article.)

Build confidence

Learning about breastfeeding prenatally has been associated with increased confidence about breastfeeding – a valuable ingredient for reaching breastfeeding goals.  Believing you can make it through the early weeks while keeping your breastfeeding relationship intact may help you on the days that you are feeling just darn tired, irritable, and as though you are running on fumes.  Each person has a different tolerance level and capacity for exhaustion and coping when it’s just not smooth sailing.  Having that seed of confidence deep down can be your guiding light when you need it.

Leave pressure and judgment at the door

For those who have breastfeeding challenges, the combination of postpartum exhaustion, significant hormonal shifts, and uncertainty is a recipe for self-doubt.  Many moms start to reconsider whether breastfeeding is really possible for them.  Be kind yourself.  Allowing yourself some emotional flexibility can take some of the pressure off.

Surround yourself with supportive people who do not have any “agenda” other than helping you and supporting the decisions you are making.

If you find yourself wondering if you can “make” it, try not to think of the long haul.  Studies show that women who are nursing at six weeks have a strong likelihood of nursing at six months.  Many women make a commitment to get to six weeks – day-by-day, week-by-week – and take it as it goes from there.  Often by that point breastfeeding takes less time and energy than in the first six weeks and is a pleasurable experience for both mom and baby.

Recognize that breastfeeding has a learning continuum

While you will learn to breastfeed “on the job,” learning about breastfeeding before the baby comes can help expectant parents have realistic expectations, gain some perspective, and anticipate some of the ups and downs of the early breastfeeding relationship.  Learning to breastfeed is like learning to ride a bike:  it takes patience, practice, and for some a bit of perseverance, but once you have it down you don’t have to think much about it – you just do it.

Your Local Resources

- For an abundance of great, researched-based info:  BabyCenter.com or Kellymom.com
- Low-cost breastfeeding clinic (Tuesdays):  BirthWays.org
- Referrals to local lactation consultants (in-office or in-home):  BirthWays.org
- Local Breastfeeding Support Groups:

• TheNurtureCenter.com
• AltaBates.org
• DayOneCenter.com

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