Now parents are overwhelmed with well-meaning advice from a variety of sources on infant care as well and breastfeeding, before they leave the hospital. As lactation consultants, we want to tell parents they are doing a good job. We know that encouragement from a health care provider improves breastfeeding initiation and duration rates. Yet many families worry about whether or not their babies are “getting enough”. It is a common concern amongst mothers across the world. Parents want to know what things to watch for in the early weeks and how to know they are being successful. Lactation Consultants need to listen to parents concerns. There are articles and blogs on the internet that scare parents about breastfeeding. Their concerns are real and should not be dismissed as a “nervous new parent”. After we listen, we can support them by providing the appropriate anticipatory guidance to give parents objective standards, so THEY can evaluate if their babies are “doing great”.
What does that mean? Instead of saying, “you’re doing great, mom” as a parent is discharged from your hospital, describe to them what you see and how they compare to these objective measures. Some scripts many nurses and lactation consultants find helpful are:
Evaluate hydration
*Show them how their baby is hydrated, “see how the baby’s mouth is wet and moist”. Or “notice how your baby’s pee doesn’t smell like urine? That is exactly what we expect.” Or “today your baby is one day old and you noticed those uric crystals. You should not notice them when you are home. If you do, you may want to contact your pediatric provider or lactation consultant”.
*“Continue to write down the pees and poops to know if your baby is transferring colostrum. Remember, what goes in, comes out! If the baby has >3-4 wet and >3-4 bowel movements per 24 hours, that is a good sign that the baby is transferring well. The poop should be yellow in color by day four. Keep a chart by the changing table or use an app, which is shared by all who are caring for the baby, to help you keep track. Everyone is tired and may become forgetful in the first few days you are home.”
*“If, during the first week of life, the baby goes more than 24 hours without a bowel movement, contact the pediatric provider or lactation consultant. It may be a sign that the baby is not sucking in a way to transfer the milk.” It is highly correlated in the research that if, during the first week of life, a baby does not have a bowel movement in 24 hours, the baby is not transferring adequately, and thorough evaluation is necessary.
Evaluate swallowing
*Show them how to tell WHEN their baby is swallowing, indicating a nutritive suck.
*Tell them HOW you know the baby is transferring appropriately. “We expect babies to lose weight in the first few days. Your baby has lost 5% of birth weight, which is in the range of normal weight loss. The baby may continue to lose weight for the next 24 hours. It is ok and we expect a baby to begin to regain birth weight around day 4 or 5”.
Sleeping patterns
*” The first night or two when the baby is home, it is normal for the baby to be awake at night. Their circadian rhythms are opposite of yours. They are a bit jet lagged! Expect the baby to wake at night and feed almost every hour on the hour. It doesn’t mean that your baby isn’t getting enough. The output is what tells you that. Their wakefulness shows you they are ready for a feeding. They will get into a better schedule to be up more during the daytime soon.”
Nipple pain
Nipple pain and trauma are a top reason why people stop breastfeeding. Many families want a skilled nurse or lactation consultant to evaluate the latch prior to discharge or in the early days. Instead of saying “the latch looks good to me”, explain how it looks appropriate:
* “You seem to be in a comfortable position to bring the baby to the breast.”
* “The pillows you are using have brought the baby up to the level of the breast.”
* “Keeping the baby’s nose near your nipple will help the baby to open more widely.”
* “Notice how your baby’s mouth is open wide before you bring the baby to the breast.”
* “Holding the baby’s neck with your hand can help to guide the baby to the breast.”
* “Creating a sandwich of your breast with your hand can help to orient the breast to the baby’s mouth and allow for a wide latch.”
* “You should feel tugging and pulling of the breast and nipple but not pain.”
If a mother is in pain, it doesn’t matter that the latch “looks good to you”. It matters what it feels like to her. Nipple discomfort in the early days is common but not normal. She needs to find a solution otherwise, she will stop breastfeeding, either temporarily or permanently. Please refer to the appropriate lactation consultant for a more thorough evaluation.
Empower parents
Show them how they are capable to care for their baby. Telling them they are doing a good job without demonstrating how you know it, puts their need for an evaluation into someone else’s hands. Give them the tools they need to be successful.
What are some of the things that you say to parents to give them the confidence they need to know they are doing well with breastfeeding?
Provider encouragement increases initiation and duration rates:
https://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF
Concern about whether baby is “getting enough”.
International Lactation Consultant Association: Guidelines for the Establishment of Exclusive Breastfeeding (2014) (Can be found at ILCA.org)
https://breastfeedingusa.org/content/article/diaper-output-and-milk-intake-early-weeks