You have a new baby. You were handed this tiny human, and now a hospital staff member is telling you that she is your night shift nurse. She wants to discuss what your goals for the first night are. "Rest" comes to mind. You are beyond exhausted, and there isn't enough caffeine in the world to help you stay awake any longer. Breastfeeding is something that you have planned for this baby, but your eyes are crossing involuntarily at this point as you try to focus. How will this work? 

As a hospital nurse who provides care at night to families during labor, delivery, and after, I have often been found parents in this situation. In most cases, I can pinpoint multiple things that contribute to the exhaustion. In order to have a more smooth transition that first night, it is so important for parents to prepare prior to the infant's arrival. A discussion with all support persons is in order, and everyone should be in agreement. These are a few things that I have found that contribute to a successful breastfeeding experience and happy, well-rested parents:

Placing Skin to Skin. Whenever I hear medical personnel referring to "the golden hour," I cringe a little bit. Skin to skin isn't only beneficial for an hour. Especially during the first day and even until the mature milk supply is established, the infant should be kept skin to skin whenever the parents are awake. This act promotes a smooth transition to the world outside the womb. Not only does this provide comfort to the infant and stabilization of temperature, heart rate, blood sugar, etc., but it allows the parents to bond with a calm, quiet infant. Also, during this time, parents are able to recognize early feeding cues and offer the breast/chest to the infant before crying ensues. I don't know about you, but I know that I become irritable and less cooperative whenever I'm expected to perform while hungry. I imagine infants work the same way. Calm, happy infants will feed much better than ones who are working hard to stabilize in an environment that is uncomfortable to them. 

Understanding Breastfeeding. Whether attending a formal class or scheduling a one-on-one counseling session with a lactation consultant, being able to identify typical feeding patterns and signs of effective milk transfer gives the feeding parent confidence and reassurance when there is usually much question and insecurity. This knowledge is beneficial to the lactating parent but also to the partner and the support person. In some cases, there may be more than one lactating parent. Even so, understanding the basics to establishing and maintaining lactation can help reaffirm expectations and roles. With breastfeeding off to a great start, the infant will sleep more soundly between feedings. If the infant sleeps well between feedings, so should the parents. 

Setting Boundaries.  You and your partner(s) have waited for what seems like forever for this day. While there are many others who are excited to meet your new addition, the first days are so important in the task of establishing breastfeeding.  Announce to your friends and family beforehand that you plan to limit visitors. Aside from removing the infant from the parent/feeding opportunities, visitors can overstimulate and contribute to difficulty during feedings. Also, with an influx of visitors, parents tend miss out on valuable rest time during the day and then end up exhausted by the time the visitors have left. Allow friends and family to hold and hug the baby once breastfeeding has been established and the parents are resting well. There will be plenty of time in the near future! 

Designating a Support System. For those really difficult nights, choosing another person to offer extra support may be beneficial. In some cultures, the parents' mothers traditionally offer support in the postpartum period. The birthing parent is only expected to feed the child, while these support persons provide all the other care for the infant. With the daily responsibilities taken care of, the parents are able to focus on infant feeding and bonding and rest. If a support system like this is unavailable but the service is desired, consider hiring a postpartum doula. 

Learn hand expression. I truly believe that the skill of hand expressing human milk is a lost art! Whether the infant is having difficulty staying awake during a feeding or having difficulty latching, hand expressing the milk into a spoon or cup and offering it to the infant can be helpful and has been proven to promote long-term breastfeeding. Learning hand expression early can also reduce stress in the event that the parent is separated from the child and without an electric pump. With adequate intake, the infant may rest well between feedings and offer the parents more sleep. 

Communicate with the hospital staff. Nursing staff are required to complete routine assessments and interventions in an effort to ensure health and safety of the parent and infant. While it's in the interest of the family, there are ways that they can be approached to help promote breastfeeding support of the dyad. Requesting that infant remain in the parents' room for assessments and care is not unreasonable, and neither is asking the staff to cluster care around wake times for the infant. Notify the staff of your infant feeding plans. Like a birth plan, providing the hospital staff with written goals and wishes can be useful for the parents and the nurses. 

I have helped many couples in the wee hours of the night with their new little ones, and time after time I come across parents who are teetering on the edge of exhaustion and insanity. With these tips, I truly believe that parental teams can avoid the weariness and get the best start with infant feeding and meeting their goals. You can do it! 

As I am in the beginning stages of developing a lactation consulting business, my biggest dream is that I touch the lives of many individuals and families -- offering them hope and fulfillment. It seems that breastfeeding has been turned into a controversial topic. For those that exclusively breastfed their children, they are considered the successful ones. So what of the parent who was unable to feed their child without supplementation? What of the parent who chose not to breastfeed because of the negative outcomes that had been witnessed in regards to breastfeeding? 

The benefits of breastmilk are undeniable, and the list is continuously growing. The terms "microbiome" and "immunity" are circulating all over social media with images of women breastfeeding infants. According to the latest released Breastfeeding Report Card, 81.1% of new mother's initiated breastfeeding in the hospital. We know that breastmilk is best for our children. So what's the problem? Without the right education, families are being discharged from their obstetrical services with insufficient milk supply and/or infants with feeding problems. Latch assessments are being performed by untrained personnel whom the parents rely on for guidance and reassurance. Health care professionals are unknowingly giving information that is harmful to the parent-child dyad, and then they are sent home. Follow-up generally includes recommendations for a supplement that is not human milk, and then this supplement that is not breast milk is considered to be life-saving.

How can I help? Prenatal education (even pre-pregnancy if possible) can help parents understand the physiological mechanisms behind lactation and infant latch/suck so that they are not relying on possibly incorrect teachings when they are in a sleep-deprived shock. Once the child is born, instead of the parent being discharged from services only to follow up weeks later, I am following the dyad closely. General observations of feedings can give me great insight. If there are challenges, referrals are made to be addressed quickly. For the well baby, I can reassure parents of normal feeding patterns so that they may feel more aware of what to expect. For the parent with insufficient supply, I can customize a feeding plan that suits the dyad's needs, including instruction on the introduction of supplementation as needed. 

All this to say... Give your child the opportunities that come with human milk, and let me help make it a positive experience for everyone. Feed your baby, but be informed. #informedisbest #dontwriteblogpostsatmidnightoryoumayramble