Birth and Breastfeeding

Your birth experience can impact the initiation of breastfeeding your baby

The Founders of La Leche League (LLL) observed, “We learned early in La Leche League’s existence that a woman’s experience in giving birth affects the beginning of breastfeeding and many of her attitudes about being a mother.” 1  LLL continues to recognize this impact: “Many of today’s interventions have not been shown to improve outcomes as much as they’ve been shown to complicate the birth.  Most women today want to breastfeed, but many are finding it hard, and the way we give birth today is a big part of the problem.” 2

Initiating breastfeeding is easier when birth takes place in a supportive environment where interventions and drugs are minimized.

When you are actively involved during birth and have a trusted support person with you, you are better able to avoid procedures that can compromise the initiation of breastfeeding.  Being active and involved also impacts how capable and confident you feel heading into parenthood. This confidence can help you persevere and overcome challenges.

Learn about birth and breastfeeding

When you understand about the physiology of childbirth and breastfeeding,

  • you have more knowledge of how to manage labor and avoid unnecessary interventions
  • if interventions are necessary, you are better prepared to minimize their effects,
  • you are better able to be helped by your birth attendant to achieve the best birth experience possible, and
  • even if unexpected challenges occur during birth, with support and information you can still get off to a good start with breastfeeding

You and your support person can help prepare during pregnancy by learning about birth options, ways to relax and cope with labor, and how to breastfeed once your baby is born.  Some options include:

  • Childbirth classes
  • Reading on your own
  • Watching videos showing active birth and exercises
  • Building a support network of LLL Leaders and mothers/parents in your local LLL Group – find your local group here

Attending LLL meetings gives you an opportunity to ask others how they prepared for their births:

  • What helped them have the best birth experience?
  • Who was included in their support network?
  • How did they get breastfeeding started?
  • What positions worked best for them?
  • What breastfeeding aids did they find most helpful?
  • Did they use baby wearing devices, and which ones did they find most helpful?

The Group may also have books you can borrow on childbirth topics.

Birth care providers

You will want to learn about different birth attendants and how their childbirth philosophy may impact the birth experience.  Some birth care providers include:

  • Midwife
  • Family physician
  • Obstetrician

If you are in a region where you have choice of provider, it is helpful to take the time to interview potential birth  attendants, beginning early in your pregnancy, to understand their approach to childbirth.

  • Ask obstetricians if they also work with midwives and doulas.
  • If a midwife works with an obstetrician, ask about having partners (and perhaps older children) participating in the birth, and ask for viewpoints on non-medicalized or “natural” childbirth versus a medicalized one.
  • Ask family physicians if they attend births and follow the family afterward.

If you plan to use a doula, ask if support is available only during birth, or if the doula is also available to assist at home in the early days with your baby.  If postpartum services are provided, find out what additional tasks such as light housekeeping and fixing meals can be included.

Where do you plan to give birth?

Your options may include:

  • At home
  • In a birth center
  • In a hospital

NOTE: Many expectant parents are interested to learn whether there is a local facility that has earned the designation of UNICEF Baby-Friendly Hospitaltm.  That information can be found at:
https://www.unicef.org/nutrition/index_24806.html or
https://www.who.int/nutrition/topics/bfhi/en/

Most birthing facilities and centers offer tours of their facilities.  This is an opportunity to learn about their birth and breastfeeding policies.

  • What are the routine labor and birth procedures?
  • What are the policies about fetal monitoring: external? internal? Can you move around while monitored?
  • What specific medical interventions are possible during birth?
  • What is the facility’s rate of cesarean births?
  • Do they have 24-hour rooming-in?
  • What is their ratio of lactation consultants to maternity patients?
  • What is their rate of breastfeeding initiation and of breastfeeding at discharge?

If you are planning a home birth, know the options in an emergency situation:

  • Is there local ambulance service?
  • Are there back up services from a birth center?
  • Where is the nearest hospital with birthing services?
Your birth plan

Your childbirth experience may affect the start of breastfeeding and the early days with your baby.  You might find it helpful to make a birth plan well before the delivery to discuss with your birth support people and health care providers.  Ask ahead of time about any routine procedures used in labor by your physician or midwife, reasons for their use, and for information to help determine if a procedure is necessary.  Be willing to negotiate on issues that are less important to you in order to obtain the aspects most important for achieving the birth experience you want.  For example:

  • During labor, routine procedures can affect your self-confidence and well-being
    o  Discuss which “routine procedures” are essential and whether they can be delayed or eliminated
    o  Will you need fetal monitoring during labor?
    o  Will you be free to walk around during labor?
    o  Will your cultural and religious beliefs be respected?
  • Your support person can advocate for your wishes during labor and birth. Have a clear understanding with your birth attendant of the role your support person will play
  • A difficult labor or medications used during birth may make your baby groggy for several days or decrease the effectiveness of the baby’s suck
    o  Discuss what medications your birth attendant may use, the reasons for their use, at what point in the labor they are used, and whether they are comfortable attending a non-medicated birth
    o  Can drugs be delayed until you feel the need?
    o  What side-effects might you or your baby experience?
  • Ask for their protocols if your pregnancy lasts more than 40 weeks
    o  Do they induce labor at that point?
    o  If so, what methods do they use?
    o  If your labor slows, what approaches do they use?
    o  Are they comfortable with your using natural methods to promote contractions?
  • A premature birth is likely to affect every aspect of the baby’s behavior and care
    Ask about and tour the nearest affiliated neonatal care unit so that it will be a familiar place if your baby needs to be there
    o  Ask about parent participation, rooming-in or sleep rooms for parents, how quickly you can initiate breastfeeding, policies for skin-to-skin (Kangaroo Mother Care), and how to access pumping facilities and lactation consultants on staff

About 20% of all births globally are by cesarean surgery.  You will want to clarify the policies of your birth center for breastfeeding after a cesarean.3

  • Can you initiate skin-to-skin with your baby while they are closing your incision?
  • If not, can your partner hold the baby skin-to-skin until you are able to hold your baby?

Some medical interventions have a direct impact on how breastfeeding will progress once the baby has arrived.  Things to be aware of:

  • Medications for pain relief given in labor may make you and/or your baby groggy in the hours after birth and can cause your baby’s suck to be less organized
  • Epidurals and spinal anesthesia can result in a spinal headache postpartum, which may require you to lie flat for several hours. They can also make your baby less alert and less responsive
  • General anesthetic can cause you to have nausea and vomiting
  • IV fluids can artificially inflate your baby’s weight, which may give the effect of rapid weight loss and result in recommendations for supplementation. It can also result in extra fluid in your breast tissue, which can aggravate engorgement (edema), cause pain, and impede milk flow

Once you have discussed these points, add them to your birth plan. Your birth plan becomes a part of your chart so that labor and postpartum staff can reference it.  You may also want to keep a copy of your plan with you.

Once your baby is born

Your support person will be your advocate to assure that:

  • You and your baby are not separated unnecessarily
  • Your baby will receive only your milk
  • Your baby will receive no supplementation without a medical reason
  • Any testing, bathing or other procedures will be done in your room

Your support person will also be present to:

  • Remind you of tips learned at prenatal classes
  • Be your cheerleader
  • Hold the baby skin-to-skin while you sleep, take a nap or shower
  • Have equal opportunities to learn to change diapers and bathe the baby

While in the birth facility, request to see your hospital’s lactation consultant or infant feeding lead who can help you correct or adjust the positioning of the baby at the breast, identify feeding cues, reinforce what you have learned, discuss what changes to expect once you are home, and answer any additional questions you may have before discharge.  A lactation consultant may also be available to talk with you and/or provide out-patient consultations in their facility if problems persist or if new challenges occur once you are home.

Knowledge can help you feel confident and make informed decisions during birth that can contribute to getting breastfeeding off to a good start.  La Leche League is happy to help and support you during your pregnancy, birth, postpartum and throughout your breastfeeding experience.

The Birth-Breastfeeding Connection

Birth Interventions

Breastfeeding After Cesarean Birth

What My Doctor Taught Me About Birth

Learning to Trust My Body’s Birth & Breastfeeding Powers

(1) La Leche League International. The Womanly Art of Breastfeeding. 8th revised edition. Edited by Diane Wiessinger, Diana West and Teresa  Pitman.  New York, USA: Random House/Ballantine Books.  2010; 18.

(2) La Leche League International. The Womanly Art of Breastfeeding. 8th revised edition. Edited by Diane Wiessinger, Diana West and Teresa  Pitman.  New York, USA: Random House/Ballantine Books.  2010; 49-50.

(3) Stemming the Global Caesarean Section Epidemic, The Lancet, October 2018,  Volume 392, issue 10155, page 1279,  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext (accessed 12 January 2020)