Booby Trap Series: Planning for a breastfeeding-friendly birth

by Tanya Lieberman, IBCLC | March 2, 2011 7:32 am

This is the third in a series of posts on Booby Traps™ during pregnancy, made possible by the generous support of Motherlove Herbal Company.

It’s time to wade into a sensitive topic here: the relationship between birth and breastfeeding.  I’m sure you know by now that Best for Babes stands for discussing breastfeeding in a judgement-free manner.  Of course, that policy extends to the topic of birth.  In this post I’m going to write about what we know about the relationship between birth and breastfeeding, based on the available research.  It may describe your experience, or it may not, but we have an obligation to report the information we have so that we can all make informed decisions.

While we’re pregnant we do a lot of planning for our births.  We learn about labor and birth, practice relaxation techniques, and try out laboring positions.

But how much time do we spend thinking about having a birth that sets us up well for breastfeeding?  I’ll admit that for my first birth I probably devoted more time to picking out which kind of lip balm I was packing than thinking about how my labor and birth might affect breastfeeding.

Research tells us that the way we labor and birth has profound effects on our breastfeeding experience.  So how do we avoid some common Booby Traps™ that occur because of the way we birth?  And what should we be discussing with our OBs and midwives prenatally to get the best possible plan in place?

I’m not going to be talking here about planning for the newborn period – that’ll be in a future post – but if you’d like to skip ahead in preparation for an upcoming birth (a great idea!), check out this breastfeeding-friendly newborn care plan I wrote previously.

I’m going to rely heavily on Linda Smith’s The Impact of Birthing Practices on Breastfeeding, an exhaustive look at what the research has to tell us.  Last year I interviewed Linda for a podcast on birth and breastfeeding, and I asked her to list her top pieces of advice she’d have for mothers who want to have a labor and birth that set them up well for breastfeeding.  Knowing all that she knows about the research on this topic, here’s what she had to say:

1.  Have a doula, or another trained birth support person, present.  Why?  Because doulas and others are skilled at helping you labor with as few interventions as possible.  And it’s these interventions that can cause breastfeeding problems.  We might not like to hear this, but pain medications transfer to your baby (in spite of what you might hear from some providers) and can make them sleepy and poor feeders after the birth.  These medications also slow your labor, which makes induction, IV fluids, vacuum and forceps use, and c-sections more likely – interventions which can cause breastfeeding problems like delays in milk coming in, breast edema, sucking problems, and excess weight loss in the baby (see the podcast for a discussion of each intervention and its effects).

The effects of medications are generally dose-dependent, meaning that the more you get of them, the greater the chance of breastfeeding problems.  So even if you know that you are going to be using pain medications, doulas or other trained support people can help you use less medication and often avoid the “cascade” of interventions that often follow.  Can’t afford a doula?  Linda suggests that you send your mom, sister, friend, or partner to a training.  Or you could have them read up on ways to help mothers labor with more comfort (The Birth Partner, by Penny Simkin is a great resource).  Linda stresses that this support person must be a companion of your choice and that this person reports to you.

2.  Learn non-drug pain relief techniques for use before, in addition to, or instead of, medications. Linda’s second suggestion is along the same lines.  She says, “This doesn’t mean that you can’t use medications, but you’ll probably use less of them because you won’t need them.”  Non-drug means of pain relief are the kinds of things you might learn in a childbirth class, but you may want to supplement what you learn there with extra reading or instruction.  Be sure that you and your partner know lots of laboring positions, massage techniques, acupressure points, visualization and breathing techniques, and about the use of water in a birthing tub or bathtub, for example.  And make sure that your providers are supportive of these things.  (“Will I be able to move around in labor and birth in the position that feels best to me?   Labor in water?”)

3.  Learn your doctor/midwife and hospital’s induction rate, c-section, and epidural rates. Why?  Linda says, “Because if you don’t want any of those, don’t go where they do 80% of them.”  If the rates of any of these are higher than you’re comfortable with, check out other options.  I’d note that Linda’s suggestion is to find out about both your practice’s rates and the hospital’s rates.  At many hospitals there are several different practices working there, and each may have different outcomes.  Hospital data alone won’t show that.  I know mothers who have changed practices at 39 weeks.  It’s possible, and your experience is far more important than any concerns about hurting a provider’s feelings.

Remember that if your birth does involve a lot of interventions, all is not lost.  Just be sure to get skilled help if you need it.  I asked Linda what mothers can do when their births did involve a lot of risk factors for breastfeeding problems, and her advice was “skin to skin, skin to skin, and more skin to skin.”  I’ll come back to that topic in future posts.

I know that this is all easier said than done.  With record c-section rates, high induction rates, limited access to vaginal birth after cesarean, and other policies, you may need feel like you’re swimming uphill.  But doing what you can do to give yourself the best chances at a birth that is supportive of breastfeeding is worth the effort.  Be sure you give it a lot more attention than you give to the flavor of lip balm you’re packing.  You won’t be sorry you did.

How did your birth impact your breastfeeding experience?



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