Welcome to the October Carnival of Breastfeeding! Check the bottom of this posts for links to other posts on this topic.
This carnival topic was inspired by a podcast interview I recently did with Linda Smith, author of The Impact of Birthing Practices on Breastfeeding. In it, she discusses the effects of epidurals, c-sections, and other common birthing practices on breastfeeding.
This interview made me think a lot about my two births and how they may have affected breastfeeding.
My first birth was with nurse midwives and a doula in a California hospital with great birth statistics. After stalling at 7 cm, my labor was augmented with pitocin, and I reached full dilation. After a 34 hour labor (unmedicated until the 32nd hour) my son was born by cesarean section. My son had some respiratory difficulty which led to him being whisked away and returning to me at about one hour after the birth. He then had respiratory infection which led to pnemonia, and he stayed in the nursery for 10 days to receive antibiotics. The whole experience ended up being very traumatic for me.
Surprisingly, given all of these problems, breastfeeding went off without a hitch. My son latched on by himself, which I missed seeing because I was looking at my doula when it happened. I remember seeing her jaw drop, and looking down to see him latched on. I had no pain, no supply problems, no latching difficulty. There was no lactation consultant at this hospital at the time, and I don't remember receiving any help other than to set up the pump during our separation.
My second birth was with nurse midwives and a doula at a Massachusetts hospital with outstanding birth statistics. After stalling (yes, again) at 7 cm, I had an epidural and quickly reached full dilation. The birth was a VBAC, after a 30 hour labor and over 3 1/2 hours of pushing. All newborn procedures were done with my baby on my chest. My daughter also appeared to be fighting an infection (though this appeared to be mild and nothing was ever cultured), and stayed at the hospital to receive a seven day course of antibiotics. She stayed in my room during the treatment. I was so thrilled to have had a healthy baby and to have done so by VBAC. I can't remember how long I held her skin to skin, but my husband says it was a lot.
Breastfeeding again went beautifully. My daughter didn't self attach, but did nurse well in the first hour. No latch difficulty, pain, or supply problems. My milk was late in coming in, but when it did there was a lot of it. The lactation consultant at this hospital, whom I love, was on vacation when I delivered, but since I'm a lactation consultant myself I didn't really feel the need for any help. The only comment about breastfeeding was from one nurse, who said, "You're nursing so much, are you sure you aren't in any pain?"
Here are a few thoughts I have about the relationship between my births and my breastfeeding experiences, in no particular order:
- Thinking back on it, there were a number of things I did that set me up to have a good breastfeeding experience, though at the time I'm not sure I was thinking about breastfeeding as much as trying to have an intervention-free birth. They included my choice of providers, hiring doulas, and writing birth plans stressing as few interventions as possible.
- The most difficult part of my son's birth was to not have been able to see and hold him until the end of the first hour. I know that at some hospitals things are changing, and that babies born by c-section (barring complications) are placed on their mother's chest immediately after the birth. I do hope that this becomes standard practice.
- My daughter didn't self attach after the birth, and I attribute this to the medication I had in labor.
- I'm pretty sure that the epidural used in the labor with my daughter caused me to have a fever postpartum, which probably led to closer examination of my daughter. Linda Smith notes that "Epidural analgesia raises the mother's temperature in a dose-dependent manner. Elevated maternal temperature is associated with increased risk of infant fever, possibly due to an inflammatory effect; increased investigation for infant sepsis..."
- In both cases of infections after birth, I was able to remain at the hospital. This obviously made a huge difference in terms of breastfeeding; having to commute back and forth to the hospital would have made breastfeeding far more challenging.
- Having my daughter in the room with us was also a lot more supportive of breastfeeding than having my son in the nursery, especially after c-section surgery.
Looking back, what's conspicuous about these experiences from a breastfeeding point of view is what didn't happen. In both situations the assumption was that things would go fine as long as I was breastfeeding on cue and pumping when a separation was necessary. I felt no pressure to anything than what I was doing, which was nursing a lot and holding my baby skin to skin (as much as I could). The lesson? Pick your providers, both for birth and for breastfeeding, carefully.
What can you do to have a birth that gives you the best odds of having a good start with breastfeeding? Listen to the interview and you'll hear what the evidence says. You can also write a breastfeeding-friendly birth plan to make sure that your providers know your wishes in advance.
Check out these posts from other bloggers on our theme (updated throughout the day):
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