By Ali Weatherford in consultation with Gail Gresham, IBCLC
When breastfeeding is the goal for you and your baby, getting help is almost always part of a successful breastfeeding story. Babies are born with some great instincts to find a breast and get the first feed, and your body has all the anatomy that you need to feed the baby, but our brains aren’t usually quite as prepared.
Why We Need Help
Humans are very social mammals with very big brains. A lot of what we know and do is LEARNED. We have some survival instincts, but a lot of our instincts are to reach out to and lean on other people. This is actually a very useful skill, because that means we don’t have to know everything, but instead have the ability to LEARN everything we need. That big brain means we can take in a lot of information and use it for our betterment.
We also are starting to live differently from the way most humans have lived since the beginning of humankind. Because of fast and easy transportation, we travel far. Many people move away from their families and places of origin. Families and communities get divided and sometimes by A LOT of distance.
When we decide to start our own families, we don’t have the support of our mothers, grandmothers, aunts, sisters, cousins, and neighbors. It’s harder to create new communities because people spend so much time away from home for work and school. A lot of times we don’t even SEE our neighbors, much less create close relationships.
So when we have our babies, we might not have a lot of support around us. We also might not have ever seen or supported someone else having or caring for newborn babies. And a lot of people have never seen breastfeeding done, or at least not in a very meaningful way. Maybe we see someone feeding a baby under a cover, but not a brand new baby eating for the first time or in close proximity and detail. That is unfortunate, because that is how people have traditionally learned about feeding their babies.
What We Have Now
Breastfeeding rates have dropped dramatically since the creation of breastmilk substitutes. Formula was finally a safe solution for the rare times when human milk was not available. Before that, cow’s milk was most often used, but that often led to bad outcomes for babies. Formula was an important advancement that unfortunately went too far because of predatory marketing and a lack of knowledge and scientific evidence about the benefits of human breast milk.
We are currently in recovery from this era of baby feeding and working hard to normalize breastfeeding, but there is still a lot of misinformation out there and a big generational gap that has left a lot of people in the dark about it. If our mothers and grandmothers bottle-fed, and that is all we grew up witnessing, it will be harder for us to figure out how to breastfeed our own babies. We did not get the benefit of watching and learning from others.
Fortunately, we have more support for breastfeeding in hospitals and birth centers. Many hospital postpartum units are staffed with lactation consultants. These breastfeeding specialists are there to help you get it figured out while you are still in the hospital.
These highly trained breastfeeding specialists (IBCLCs) are an excellent resource to help you get started. There are also lactation consultants in the community providing support in outpatient clinics, community centers, pediatric offices, and doing home or telehealth visits. These care providers are what we have now, since we don’t have those close-knit family and community centers for learning about breastfeeding and parenting.
Because of the Affordable Care Act, almost all health insurance plans “MUST provide breastfeeding support, counseling, and equipment for the duration of breastfeeding.” When a provider of lactation support is an in-network provider, this is easiest to accomplish. Your hospital lactation care specialist will almost definitely be covered by your insurance plan. Breastfeeding Success provides in-hospital lactation support by IBCLCs, and we are an in-network provider with all major insurance plans. Our mission is to provide families with the tools that they need to make informed decisions and reach their own breastfeeding and nutritional goals.
In our experience, we almost never have to send a bill for inpatient services. The exceptions are grandfathered plans that do not recognize the preventative medicine services highlighted in the Affordable Care Act and insurance carriers that have not followed the law to create a breastfeeding policy (mostly small carriers). In both of these instances, Breastfeeding Success will be advocating for you and appealing any insurance coverage denials on your behalf. We may also need your support in this effort, so you may receive a request for a photo of your insurance card or a notification that you need to contact your insurance to verify that there is no other health insurance plan covering you or your baby. In the event that insurance does not cover our services after an appeal, we have a very generous financial assistance policy that would offer up to 100% discount for services based on income.
How IBCLCs Can Help
I would encourage every person to take advantage of IBCLC care while in the hospital. Even if things seem to be going well, the amount of milk that you are making, how often, how long, and the functionally how your baby suckles at the breast is very different every day of the first week. You are typically in the hospital for the first 24-72 hours, which is when your baby is learning how to suckle effectively at the breast. That’s when you are providing colostrum, which contains mostly (90%) immunological protective factors. This is your chance to get hands-on support from the IBCLCs and the nursing staff, day and night.
Most of the time, they will talk to you about general things like how to help your baby get a good latch, how to position yourself and your baby for comfort and better feeding, how often and how much to feed your baby, how to know things are going well and how to tell when things are not going well.
They will also hopefully help you understand that some struggling at first is normal. Most people need a little time and patience to get the hang of breastfeeding. It’s a learned AND new skill, so a lactation consultant will hopefully help you feel a little more confident.
Tips from a Hospital IBCLC
- Get some breastfeeding education while you’re pregnant. This can sometimes make things go more smoothly after your baby is born, and you can get a different kind of support from your hospital lactation consultant.
- Get some birth education too! Sometimes feel very blindsided by birth because they were not prepared. This can definitely make the recovery time and breastfeeding a little more overwhelming and difficult. Evidence shows that better birth experiences lead to more breastfeeding success.
- Most people feel a little overwhelmed right after giving birth. You might not feel quite ready to take in a lot of information about breastfeeding while your lactation consultant is there. A lot of times people forget what they learned during those sessions. For that reason, it might be a great idea to record the conversation or ask your partner to take great notes.
- ASK FOR HELP! In most cases, when the lactation consultants arrive for their shift in the morning, they are given a report by the nursing staff. They get a list of everyone who just had a baby and needs to be seen for lactation support. Unless they see or hear something else, they’ll just start at the top of the list and work their way through. Some people don’t need immediate help, but they might be seen first. If you are struggling, make sure to tell your nurse that you’d like to see an IBCLC as soon as possible and they can make a note of that. You might get moved to the top of the list and be seen more quickly that way.
- Get help each day that you are in the hospital. The goal is for a lactation to see you each day that you are in the hospital with your baby. Even if you think you don’t need any more help, I would encourage you to go ahead and have the consultation. If you don’t have any specific issues or questions, you might just ask them to tell you if there is anything else they think you should know.
- Ask for resources and referrals. Make sure you have the names and contact details for lactation support OUTSIDE of the hospital. Things will change with breastfeeding, and these changes sometimes introduce new problems. Getting a little support might be all you need to keep your breastfeeding on track or make it easier. The hospital lactation specialist may be able to offer you some resources in your local area.
- Babies in the NICU can breastfeed too! Sometimes we have to offer pumped milk to very fragile or premature babies because they aren’t quite strong enough to feed at the breast. It’s a great idea to keep checking in about learning to breastfeed though. It can be surprising to many people that even very tiny fragile babies can get very good at it! It does take some time and effort and lots of skin-to-skin time to get there, but it can be worth it for a lot of people. You can ask for lactation support in the NICU as well.
- Sometimes people get mixed messages related to breastfeeding in the hospital. You may have a nurse telling you one thing, a doctor saying something else, and a lactation specialist (IBCLC) saying another! This can be very confusing and unfortunate. They are all care providers with a certain level of expertise. Ideally, everyone would be reading your chart and working on the same care plan. Sometimes things just get a little out of order, or someone misses the notes. When it’s about breastfeeding, you can probably safely assume that your IBCLC has the best advice. The vast majority of doctors and nurses have very little or NO formal education or training in lactation. That’s why those IBCLCs are in the hospital providing that care for you. The hospital understood that a higher level of lactation care was needed, and they created a department and team for that.
- Some people feel very insecure about their ability to breastfeed. Sometimes people don’t want to breastfeed. If this is the case, seeing a lactation consultant might be extra difficult. You know they are there with the purpose to help you breastfeed. If you say you’re not sure that you want to do it, will they judge you? It is true that IBCLCs want breastfeeding to work. It’s probably safe to say that ALL lactation consultants feel very passionate about breastfeeding. That’s why they chose the specialty and completed A LOT of training to get where they are. Their enthusiasm can sometimes make people feel like they will be judged if they say they want to offer formula to their baby. It’s important to remember that lactation consultants ultimately want to help you reach your baby-FEEDING goals. SO they can also help you know how to best use a pump or bottle, and how to choose and prepare and store formula safely too.
This is a great interview with Gail Gresham. She is a nutritionist and lactation consultant (IBCLC) with a graduate degree in public health. Gail works as a lactation consultant with new families in the hospital and in outpatient clinics, and is also responsible for educating and training other hospital staff including nurses and doctors about lactation. Gail has a lot of great insights about getting lactation support in the hospital!