Prenatal Lactation Support
I have recently had the privilege of working with a couple of mothers before the birth of their babies. Each knew she was at risk for low milk supply and breastfeeding difficulties and wanted to set out a plan to get breastfeeding off to the best start possible.
As a lactation consultant, clients like this are some of my favorites to work with. The motivation level is high, and there is so much more that can be done to prevent and minimize difficulties if you start early.
I frequently meet women for the first time at three or more weeks after the birth of their baby when breastfeeding problems - low milk supply or sore nipples most commonly - have really taken hold. Of course there is a lot that can be done to build supply and improve latch and positioning or identify other issues. The thing is, so many of these mothers had risk factors right from the start, and if they had been identified at the birth or prenatally, a lot of difficulties could have been prevented.
Making a Breastfeeding Plan
I met with each of these mothers in the weeks before their baby was born and we put together a plan for how they wanted to manage breastfeeding during the early days postpartum. One mother decided to write a “breastfeeding plan” as part of her birth plan. It included things like “breastfeeding is very important to me and I know how important getting breastfeeding off to a good start is. Because of my history I need as much help and support as I can get in the early hours and days. To any degree possible, will you please help me and my new baby get the great start to breastfeeding for which I’m hoping?” and “I hope to breastfeed my baby for the ﬁrst time as soon after birth as possible and, if at all possible, deﬁnitely within the ﬁrst hour.” Her plan was well received at the hospital and she had a wonderful experience. The hospital staff went out of their way to support her hopes for getting breastfeeding off to a good start.
Part of my job as a lactation consultant is communicating and reporting to my clients’ healthcare providers. Another client who wasn’t planning to write a birth plan gave me permission to send copies of her breastfeeding history and plans not only to her OB and pediatrician, but also to the hospital lactation staff. She went into the birth well prepared to get breastfeeding off to the best start possible, and she also found the staff at the hospital to be extremely motivated to support her any way they could.
I include unlimited email and phone follow-up with my consults, which allows us to check in and follow up after the birth. As milk changes from colostrum to mature milk and babies are learning to latch, more questions inevitably come up, and problems are much easier to solve with mothers who are aware of what to expect and get support early.
Who Benefits From Prenatal Lactation Support?
Not everyone needs prenatal lactation support, but many women would likely have easier breastfeeding experiences if they knew in advance that they were at risk of breastfeeding difficulties and took steps to prepare.
The following is a list of some of the things that can put a mother at risk for breastfeeding problems. Not everyone with these risk factors will experience breastfeeding problems, but they are more likely to.
- Experiencing a high-risk pregnancy
- Having difficulty conceiving and needing IVF or medications to conceive
- Being a first-time mother over the age of 35
- Having multiples
- Having inverted or flat nipples
- Having had a breast surgery or procedure such as any cosmetic breast surgery, lumpectomy, mastectomy or radiation treatment to the breast, or a chest surgery or injury
- Having experienced breastfeeding difficulties with another child
- High blood pressure during pregnancy
- Diabetes, type I, type II or gestational
- Having very large or very small breasts
- Having the first menstrual period at age 10 or younger
- Having polycystic ovary syndrome (PCOS)
- Experiencing postpartum hemorrhage
- Having a baby born early, particularly if born before 38 weeks gestation
- Having a difficult birth such as an induction, a birth where high doses of pitocin were needed or a cesarean section
A mother is unlikely to know in advance about the last three, but knowing beforehand that early babies and difficult births can make breastfeeding more challenging can help mothers who end up having these experiences be proactive and work hard to get breastfeeding going.
What Kinds Of Things Can A Mother Do Prenatally If She Has Risk Factors?
Depending on a mother’s particular situation, there will be different steps she can take to minimize the chance of problems occurring. Taking a breastfeeding class and attending a breastfeeding support meeting prenatally are both valuable ways to learn more about the normal course of breastfeeding and to learn from other breastfeeding mothers.
Mothers at risk of low milk supply can learn how to hand express their breastmilk and plan to hand express after most or all feedings the first days after the birth. They can look into hand expressing colostrum prenatally and collecting it to have ready for the first few days after the birth. This is particularly valuable to mothers with type I diabetes whose babies are very likely to require supplementation in the first hours after the birth. Information and guidelines about prenatal expression of colostrum can be found in The Breastfeeding Mother’s Guide to Making More Milk.
Some mothers take malunggay which, when taken prenatally, has been shown to increase milk supply postpartum by as much as 250%. Mothers can also talk to their healthcare providers about prescription galactogogues. Some mothers will decide to rent a hospital grade breast pump and begin using it after feedings soon after the birth to stimulate their milk supply.
Mothers with inverted or flat nipples can benefit from wearing supple cups on their breasts for several weeks prenatally to prepare their nipples for breastfeeding.
Any mother who knows she is at risk for breastfeeding problems can also ask for extra support after the birth, either from hospital staff or her midwives if she is having a home birth. Lactation consultants are available in most hospitals and in private practice offering home visits in many cities and towns. They can help make sure a baby is latching and breastfeeding effectively, and help with any questions or issues as they arise.
Breastfeeding always comes with questions and challenges. Being proactive prenatally or in the early days after birth and getting support early are great ways to ensure realistic expectations and the best breastfeeding experience possible.