What to expect for lactation care during your hospital stay.

Breastfeeding doesn’t always come easily to new mothers, but we believe that knowledge is empowering. Give yourself a leg up by understanding your hospital’s approach to lactation, in addition to common obstacles you may encounter once the baby arrives.

We asked our resident IBCLC, Katie McGee to walk us through what to expect from lactation care during all stages of your hospital stay:

Structure and Service

To start, structure and services of lactation teams vary greatly from hospital to hospital, which is why it’s very important to be educated on what your hospital provides. There may be a single lactation consultant covering an entire hospital with limited part-time hours, or, there may be an entire team with at least one member accessible 24/7.  Some prioritize lactation care in the mother baby units with NICUs are given access to lactation consultants only when time allows, while others have entire teams dedicated to each area.

International board certified lactation consultants (IBCLCs) have had extensive training to earn the gold standard credential for lactation care. Some IBCLCs are RNs, others are not. Labor & Delivery and Mother Baby nurses are typically a great resource for getting you started with breastfeeding.  Regardless of who is helping you get started, make sure to communicate your wishes—what may be very important to you may not be as crucial to the next dozen mothers. For example:

“I am planning to exclusively breastfeed, and I am hoping to have her skin to skin right after delivery if at all possible.” Tell this to everyone as often as you can. It is important for everyone involved to know your priorities.

Right after delivery:  

Immediately after delivery, there begins a “golden hour” during which time the newborn is often alert and able to breastfeed. Don’t miss this beautiful opportunity because it is normal for a large portion of the following day or two to be spent asleep–just trying to adjust to life outside the womb and recover from being born.

If breastfeeding does not happen in the delivery room, just keep your baby close, skin to skin whenever possible, and attempt to nurse frequently–whenever the baby shows any subtle readiness cues (hands to mouth, going from sleepy to awake, displaying the rooting reflex) that’s the perfect time to breastfeed. During your stay, take advantage of the lactation care to provide a feeding assessment including close observation, coaching and feedback prior to your discharge. This expert feedback early and often may make a positive difference in reaching your goal.   

What you may or may not hear:

“You have flat nipples”

Flat nipples are not uncommon and don’t have to be a hindrance to breastfeeding.  Are they everted at all?  An IBCLC may be able to assist in compressing your areola and nipple into a shape to ease breastfeeding.  If you are concerned about flat nipples, get professional assistance early and often in your stay.  An IBCLC will also be able to provide tricks of the trade.  Breasts change a lot in the first few days and you may find after a couple of days of nursing or pumping your nipples have been transformed.

“You’re having trouble with early breastfeeding” or “You need a nipple shield”

Don’t panic.  Let your default be holding the baby skin to skin and placing the baby to the breast any time you observe even subtle hunger cues. If breastfeeding has repeatedly been challenging, a nipple shield may be a temporary answer. Just ensure you have tried multiple times before introducing the shield.  For the full term population of babies, a nipple shield may be a valuable tool to get the baby to go to the breast. However, why not avoid any apparatus that may not be necessary? Keep trying and access all the professional help you can prior to starting with the shield. You can say:

“I would like to see an IBCLC first, because I would like to avoid it if possible.”

“I’m not comfortable doing this until I speak to a lactation consultant. Can you please page them right now?”

Your milk is not “in”

First time mothers can have a slower onset of large amounts of milk or their milk “coming in”. There are many health and delivery related factors that impact the timing of the onset of lactation.  If you find you or your baby are anxiously awaiting the onset of lactation, remember you have colostrum. The colostrum is available in tiny amounts but packed with immune protection and live cells. Each time your newborn nurses effectively, he or she will be accessing some colostrum. The colostrum can appear clear or very thick and sticky. If you end up hand expressing or pumping, it is important that any colostrum you express or pump is given to the baby.

Blood sugar concerns or Hyperbilirubinemia (Jaundice)

Sometimes the first few days don’t always go exactly as expected. If your baby needs milk faster than it seems to be coming in, the good news is that this is typically a brief period of time. Soon your milk will most likely be available in ounces, not drops. In the meantime, a lactation consultant can get you started with pumping milk with a hospital grade pump and/or hand expressing milk. There are many ways to deliver the colostrum to your newborn such as syringe feeding, finger feeding, cup feeding and bottle feeding.

The baby’s medical team might suggest supplementing with formula. Ask about alternatives first such as hand expressing colostrum or getting an extra hour to try to pump before introducing formula.

Pumping with a high quality hospital grade pump can be a temporary bridge to protect your milk supply until the baby takes over.

Communicating with your medical team:

There are many unknowns when it comes to childbirth, from when you might go into labor, to how you will progress. So with all of the unknowns, wouldn’t it be nice to enter the hospital with as much information as possible about your lactation care post delivery?

Speak with a member of your hospital’s lactation team now, before your delivery, and find out:

  • Will an IBCLC be available to you throughout your stay?
  • Are there certain hours/days of availability?
  • Is a visit automatic and if so, how soon after delivery? In other words, are the IBCLC/lactation team members routinely seeing all newly delivered mothers or are they only called in for complicated cases?
  • Are all locations within the hospital covered by an IBCLC? No one wants to envision the NICU, but if a NICU stay is needed, is there a lactation NICU team or is there any lactation care in the NICU at all?  

If you have any questions or would like to speak with an IBCLC, please contact Ashland Women’s Health. You don’t have to wait until your baby arrives. We are committed to helping your breastfeeding journey run as smoothly as possible.