What do my Labor and Delivery have to do with breastfeeding?

All babies are born with innate instincts and reflex to get them to the breast soon after birth. Every baby, when placed skin to skin on their mother immediately after birth, will do the breast crawl and have a first latch within approximately 60 minutes of delivery, even medicated or c-section births. In the first 24 hours, babies are often sleepy. Waking for brief periods to feed and go back to sleep. The second day (and usually the second night) is when babies make up for the first day after delivery, ravenously cluster feeding for hours, much to the dismay of now extremely fatigued parents. But your labor has more of an impact on breastfeeding than you may realize.



We learning and understanding how our bodies prepare for breastfeeding during pregnancy, how what happens during labor and birth sets the stage for breastfeeding, and how the first minutes and hours after birth can have a lasting impact on the entire breastfeeding journey. The way baby is born  powerfully influences the first hours and days of breastfeeding. Unmedicated, vaginal birth sets the stage for problem-free breastfeeding, where biology, instinct and reflex can take center stage. In contrast, a complicated, intervention-intensive labor and birth increases the risk of problems.

How long you labor is really out of your control. The length of your labor may actually increase breastfeeding difficulty. For really long labors (over 24 hours), pushing for 4 hours or more, or very intense short labors, both you and baby may be so exhausted that rest and recovery take precedence over breastfeeding. Baby may be too tired to breastfeed often in the first few days, which increases your risk of not stimulating the breast well which in turn delays colostrum transitioning to mature milk and can decrease the overall volume your breast may be able to make in the future. Long, medically intervened labors also usually mean increased bags of IV fluids, which can cause excess fluid in your body which in turn delays the transition of colostrum to mature milk up to 10-12 days. It can also cause your hand, feet, and breasts to swell with extra fluid, called third spacing, which can make latching baby a challenge. (See my videos on Instagram about reverse pressure softening for help with this).

Events surrounding birth can inadvertently sabotage breastfeeding, as birth is supposed to be a well orchestrated series of events and hormone releases, setting you up for successful breastfeeding. Many of the birthing practices that are considered almost routine (induction, epidurals, separation of the mother and her baby for cleaning, weighing and foot printing) interfere with this hormonal dance resulting in poorer breastfeeding outcomes.

The routine progression of hormonal changes during  labor and birth perfectly prepares the body to breastfeed immediately after birth. During labor, oxytocin surges are responsible for increasingly stronger and more effective contractions. As oxytocin goes up, and the pain that accompanies the strong contractions increases, endorphins are released. High levels of endorphins help you cope with painful contractions and contribute to their becoming more instinctive. As the baby moves down the birth canal, almost ready to be born, catecholamines are released. The surge in catecholamines creates an energy boost and allows the baby is born with high levels of catecholamines as well (; ). This results in a vigorous, alert baby and an energized mother ready to breastfeed for the first time.

 

Skin to skin contact immediately after birth helps these same hormones continue to work in preparation of the first breastfeeding moment. Baby’s body weight on mom’s uterus, baby hand and head movements on her body, and then baby sucking at the breast stimulate even more oxytocin release (). Oxytocin helps the placenta separate and contracts the uterus further, preventing excessive bleeding. After birth, high levels of catecholamine in the baby insure alertness for the breast crawl and first latch. The endorphins present in mom pass on to baby through her breast milk, helping the baby stay calm and relaxed. After the first feeding, these hormones peak and allow both mother and baby 

Prolactin and oxytocin, the. milk making hormones, are released by baby’s sucking at the breast. Prolactin makes milk and oxytocin causes your letdown or release of milk. Prolactin, AKA “the love hormone”, is responsible for nurturing behaviors. Oxytocin makes you feel relaxed, sleepy, or calm feelings during milk letdown. 

All Labor pain-relief drugs have been shown to delay the onset of milk production and increase the risk of breastfeeding difficulties. This was well documented in a 2014 study by Lind et al. Pitocin, unlike naturally occurring oxytocin, does not cross the blood/brain barrier. As a result, the pituitary is not stimulated to release endorphins. Without the pain-relieving help of abundant endorphins, people who are induced with pitocin are more likely to require epidurals. In a vicious cycle, whenever an epidural is given and all pain is removed, naturally occurring oxytocin levels drop, requiring increased amounts of pitocin to continue contractions (Lieberman & O’Donoghue, 2002). Without the high levels of oxytocin and endorphins that would normally be released, a surge in catecholamines does not occur immediately before birth. This hormonal disruption during labor results in women giving birth with relatively low levels of naturally occurring oxytocin, endorphins, and catecholamines. Consequently, the outcome of low hormonal levels is a less responsive mother and baby which in turn impacts vigor at the breast ().

The medication used in the epidural does, in fact, “get to the baby.” Epidural narcotics or anesthetic drugs cross the placenta and can be found in cord blood. More research is needed, but we are starting to learn the neurobehavioral effects of medicated deliveries. Babies exposed to epidurals have a higher risk of have difficulty with latching on and an uncoordinated suck/swallow response for hours or days after birth (; ). Epidurals are also documented to lengthen the second stage of Labor and increase the likelihood of needing a C-section. The trauma of c-section birth, versus the natural positioning of coming through the birth canal, can make it painful for baby to assume the natural, instinctive positioning for breastfeeding and can make it difficult to latch. 

Elective induction of labor is also a risk to breastfeeding because of the potential of added intervention and the increased likelihood of the baby being born prematurely. The more premature a baby is, even at 37-38 weeks, the more immature and uncoordinated sucking and swallowing can be. Babies practice the coordination of sucking and swallowing in utero without expiation to feed, so the longer they are able to practice in utero, the more coordinated and ready they are to feed at birth.

So now what? You’ve had the baby and had a long, medicated delivery. Knowledge is power. You cannot change your birth story, but you can influence your breastfeeding journey.

  • Keep baby in skin to skin contact as long dn often as possible to help restore your oxytocin levels. Every 60 minutes 1-2x/day has been found to exponentially increase milk supply
  • Offer the breast frequent and often. Work on getting baby into a good position to ensure a deep latch
  • If you are separated from your baby or baby is super sleepy, hand express and/or start pumping. You will want to hand express or pump every 2-3 hours during the day and every 3-4 hours at night. You will get more colostrum from hand expression than pumping int he first three days, but pumping will help stimulate the nipples. Don’t be discouraged if you see little milk from a pump. The stimulation is needed until baby is able to latch
  • Stay hydrated and eat good foods full of protein
  • Use a paced bottle feeding technique and try not to over feed baby if you need to supplement. Always supplement with your own milk first, followed by formula. Babies need very little milk in the first 3 days.
  • Find lactation help as soon as possible to help create a plan to get breastfeeding back on track
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Natural Weaning from the Breast

NATURAL WEANING

Natural weaning is the biological process of gradually decreasing milk supply as baby gets older. This process starts around 7-9 months as baby takes more solid foods and progresses toward sleeping longer stretches at night. It ends when baby finally weans (which may not be until 2-3 years old!!). Natural weaning doesn’t mean that you need to wean baby from the breast. Decreasing milk supply doesn’t mean you’re at risk of losing your supply, either. Your breast is designed to match the stage of development your baby is in. 

Milk supply iss highest from month 1-6 when baby is going through multiple growth spurts. They need to double their birth weight by 6 months. Milk is also the only food in their diet.  Therefore, your milk supply is supposed to be at its highest to meet their nutritional needs. From 6-12 months, weight gain slows but their need for milk volume needs remain stable. It is natural as baby transitions from a full milk diet to a milk+solids diet to then a solids+milk diet that breast milk supply will shift along with it. Your milk supply varies compared to baby’s solids intake and there is a wide range of normal based on your individual baby. Some babies love solids and eat them in large quantities many times a day. Other babies continue on a mostly milk diet until almost 1 year.  At 12 months, milk finally takes a back seat to solids, but still fills in nutritional gaps and acts like medicine against illness. From 12 months on there continues to be a wide range of normal for milk supply depending on your child’s eating and feeding habits. Some babies continue to nurse occasionally over night while others seem to become boob barnacles again and would happily stay on the breast all day, every day.

So what does this mean? If you’re exclusively breastfeeding you may not notice anything.  You can continue to bring baby to breast for as long and often as baby wants. You may notice baby spacing out feedings or not nursing as long. They may want the breast more when teething or going through growth spurts or developmental leaps. They have days with little interest in the breast. 

Moms who pump (either exclusively or because of work) report overflowing milk in the early weeks, often able to pump 4-6 or even 8-10 ounces in a morning pump session. By 4 months supply regulates and mom gets about 3-5 ounces per pump in place of a feeding. By 9 or 10 months it can feel like your trying to wring out a wet rag to get even 2-4 ounces a pump session. As long as baby has unrestricted access to the breast when your not working and you still have a regular pump routine in place no intervention is usually needed. Every journey is supposed to look different because it is your unique journey.

Photo Credit Jermaine Love
@jermainelove44

One Breast or Two?

SHOULD I OFFER ONE BREAST OR TWO WHEN BREASTFEEDING?

Just as no rule says you must eat the same amount at every meal, there’s no rule that says your baby must eat from both sides every feeding.

  • Factors that play a role in offering one side or two include your individual breast storage capacity, and milk supply, when your last feeding was, and your unique baby’s volume needs.
  • Storage capacity is not indicated by breast size, but by glandular tissue in the breast. People with lots of glandular tissue have a higher storage capacity in each breast regardless of the actual breast size. Their babies may only want one side per feeding as each side makes plenty of milk. Some people have smaller storage capacities and their babies will want to feed off of both sides (maybe even multiple times!) to get what they want.
  • You will get to know your breast storage capacity and how quickly your breasts make milk as you get to know your body and your baby.  Every feeding can also be different. There’s no right or wrong. Sometimes a baby will want both breasts if they’re really hungry and sometimes they’ll want only one when they just want to comfort nurse to sleep. Some times you may feel like you’re offering each breast 5 or 6 times in a feeding, rotating constantly!! NORMAL!!! Trust your baby and your body. You can always offer the second breast/side but don’t feel stressed if your baby doesn’t always want it. 

BREASTS ARE SISTER, NOT TWINS

You may also feel like baby always prefers one side or even does better feeding on one side!! That’s because breasts are sisters and not twins!!!! One side can be bigger, one side can make more. Nipples can even be different shapes and sizes, making one side easier to latch to from purely an anatomical perspective.

  • Around 70% of us produce more milk on the right. Which means 30% make more on the left. 
  • It is VERY common for one side to produce more than the other, often double. This is not a reason to neglect one side. You want to make sure you rotate which side you offer first. This can also cause one breast to be significantly larger than the other especially if you continue to only feed from one side.
  • Babies may prefer one side over the other for various reasons
    • They like to lay with their head in a certain direction
    • They prefer the flow (one side may flow faster or slower than the other)
    • They may prefer the flavor (YES!! Milk can taste different from each side during the same feeding!!)
    • They may have tension in their body from positioning during pregnancy or from trauma during birth.
  • If you want to help balance out a slacker boob, you can try offering the slacker first more often.
  • Ending on the slacker can also help, especially if baby just wants to use you like a pacifier.
  • Pumping the slacker side after feedings can also help stimulate more milk production.

Don’t stress too much about a slacker boob if it’s not an issue. If baby is happy, there’s really no need to fret over differences between your breasts. If you start to notice one side is increasing in cup sizes significantly from the other, schedule a consultation and we can get to the root of why baby only wants one side and we can work on it together.

How Much Breast Milk Does Baby Need?

HOW MUCH BREAST MILK DOES MY BABY NEED IN A DAY?

How many ounces of breast milk should my exclusively breastfed baby be eating at a feeding? This is usually on the top five questions from families. The answer is: that depends.

  • Some babies are grazers. They like smaller, more frequent feedings to keep their tummy from being too full or uncomfortable. Their feedings can range from 1-3 ounces of breast milk and they may feed 10 or more times a day.
  • Other babies are bingers. They like a big, full tummy and may take 3-5 or even occasionally 6 ounces of breast milk but not as often. They may feed only 6-8 times a day and have longer sleep stretches. Their tummy doesn’t mind being stretched fuller and their bodies tell them it’s ok to go longer between feedings.
  • A helpful question to always be asking is: how many times a day is baby feeding? From one month to one year, babies take between 19-32 ounces of breast milk a day. The average is 25 ounces in 24 hours. There’s a range because, just like us as adults, some days we want to eat more than other days depending on the activities of the day, growth spurts, cravings, and even babies emotionally eat sometimes. Trust your baby to know their stomach better than you do. 
  • Babies get hungry frequently: 8-12 or more times a day. They drink so much breast milk because they grow so rapidly. They will double their birth weight by six months and triple their weight by a year. Imagine how much you would need to eat to double your weight in six months! You may feel like you feed your baby all the time, and you are. Every 1-3 hours in the first few months is normal!! Every feeding is different and breast milk volumes taken vary throughout the day. Sometimes you want a snack and sometimes you want a buffet. 
  • How is pumping going for you and can you keep up with his volume needs? Pumping is never an indication of your breast milk supply, it just indicates what your pump can empty from you. So many people have their breast milk supply sabotaged by baby being overfed from a quick flowing bottle, not enough time spent during the feeding, or interpreting baby’s cues wrong.
  • If your milk supply is keeping up with their demand there’s no problem. If you’re concerned about your baby’s feeding habits, definitely schedule a consultation with me.

Oxytocin

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Oxytocin is a hormone produced by the pituitary gland in the brain. It increases relaxation, lowers stress and anxiety, lowers blood pressure, and causes muscle contractions. Oxytocin, also called the mothering, cuddle or love hormone, is involved in social relationships, bonding, trust, and love. Breastfeeding stimulates the release of oxytocin from your brain.  When your baby latches on to breastfeed, the nerve cells in your breasts send a signal to your brain to release oxytocin. The oxytocin causes the muscles around the milk-making glands in your breast to contract, squeezing the breast milk into the milk ducts. The milk ducts then contract to push the breast milk through your breast, out of the nipple to your baby. This is called the let-down reflex. As baby continues to breastfeed, more oxytocin is released and milk continues to flow. You may experience 2-14 let-downs in one breastfeeding session! The release of oxytocin while you're breastfeeding may make you feel sleepy and relaxed. It can raise your body temperature and is one of the reasons you may feel so hot while nursing. It might also make you feel thirsty or even give you a headache!

Oxytocin can cause your milk to let-down when you're not breastfeeding. Hearing a baby cry, thinking about your baby or even smelling something that reminds you of your baby can trigger oxytocin flow and make you leak!! While oxytocin is responsible for the let-down reflex and the release of breast milk from your body, it has nothing to do with the amount of breast milk that you will make. Prolactin is the hormone that does that. 

Some people feel the oxytocin release (aka Let-Down) and others don’t. Both are totally normal!

Signs of let down include:

  • Tingling or a pins-and-needles sensation in your breasts. It could be a light sensation or even an electrical shock feeling.
  • Hearing baby swallow while at the breast.
  • Leaking milk from the other breast
  • Uterine cramps when breastfeeding, especially the first week.
  • Feeling happy and relaxed after you feed your baby.

Factors that inhibit oxytocin release and let down include: pain, breast surgery or trauma, stress, illness, fatigue, fear, embarrassment, drinking or smoking. 

Some mothers may breastfeed and let-down milk just fine to baby but struggle to release milk to an electric pump. A quality double electric breast pump will have two modes: a quick cycle/light suction or "stimulation" mode, and a slow cycle, hard suction of "expression" mode. By alternating several times between these modes in a pump session, you can trick your body into thinking baby is feeding to stimulate more let-downs of milk. When pumping, you can also help stimulate your body to let-down more often by:

  • Watching videos or looking at pictures of your baby
  • Smelling something that reminds you of your baby (a onesie, your baby shampoo or soap, lavender)
  • Listening to calming music
  • Using heat before and during pumping
  • Massaging your breasts before and during pumping
  • Eating a snack or drinking water while pumping