The Birth Doula-Helping to Ensure Breastfeeding Success in the Hospital

Joining a family for the birth experience is both a great honor and a great responsibility.  Doulas enter the most amazing place as they simultaneously witness and support in a miracle.  It is sometimes difficult to focus on the tasks and not get caught up in being merely a spectator in the blooming of a birth, but the focus comes with the realization that the goal is to support the family. A doula plays a crucial part in how the birth will be remembered and how breastfeeding will be initiated.  

Birth and breastfeeding are as closely related as a key to a lock.  Often, moms are discouraged by difficulty in breastfeeding which is often brought on by birth practices or protocols during the immediate postpartum period.  Many routine procedures jeopardize breastfeeding success. Having an understanding of how medications effect a baby can be a huge advantage to assessing the breastfeeding relationship.  Doulas need to keep a mental note of medications being administered and the type of birth a mom experiences in order to provide the best postpartum breastfeeding education and support.  A skilled doula can avoid long-term problems by anticipating possible consequences and formulating immediate solutions to common problems.

A doula can also be proactive by assisting in formulating the Birth Plan.  This is an excellent time for the birth assistant to explain all the procedures and the pros and cons of each intervention.  Once a mother's wishes have been spelled out, the doula is able to advocate for the family throughout the birth day. 

The keys to supporting a mom in the hospital begin before her first contraction.  Statistics show that most families reach their infant feeding decision prenatally.  It is important to offer education during prenatal visits with clients.  These scheduled visits are great opportunities to discuss what the client knows about breastfeeding.  One open-ended question I often begin with is, “What have you heard about breastfeeding?”  This question will often reveal fears, concerns, misconceptions and the mother's confidence level. 

Once the desire to breastfeed has been established, the doula’s role has a new facet.  The mom will rely on the doula to support her in this momentous decision. Breastfeeding is a brief event (in comparison to the entire life of an individual), that has life-long effects.  The research and resources about formula risk is abundant and breastmilk will insure protection from many childhood and adult health conditions.  I take breastfeeding support as seriously as all aspects of my work, and commit to helping a mom reach her breastfeeding goals—whatever they may be.

Observation is the first key to breastfeeding success.  Observations can even be made prenatally.  Statistically, obese, diabetic, and older moms (over 40) may have delayed Lactogenesis II (onset of copious milk supply).  Additionally, clients who birth cesarean may not experience fullness in the breasts until day four.  Being armed with this information is a huge advantage to the mom who is convinced she “has no milk” based on breast fullness postpartum.  Moms need to be reminded that the infant had a direct line to the all-you-can-eat buffet while in utero and does not enter the world starving. 

A doula’s immediate postpartum role is to encourage skin-to-skin and protect the “quiet hour” for bonding.  Doulas may encourage the mom to slightly recline, place Baby between the breasts (somewhat vertically) and assist as the baby scoots down to self-latch.  Doulas and hospital staff may offer additional assistance to the medicated mother if necessary. Most babies when placed skin-to-skin will initiate breastfeeding within the first two hours postpartum.  I encourage a "babymoon" much like a honeymoon where the family commits time and attention to love, learn and hold the new baby.

Medication taken during labor can also affect the breastfeeding outcome.  Natural pain management is the least likely to result in breastfeeding issues.  If medication is necessary, generally, the epidural is more desirable than anesthesia for c-section births.  The epidural allows for earlier contact with mom and longer nursing sessions.  The infant born via cesarean will often be sleepy and lethargic, especially if anesthetics were administered for a prolonged period.  Doulas can help with positioning, supporting the baby at breast, and helping to arouse the sleepy baby.

The baby who was exposed to narcotics during birth may be agitated and restless.  These medications are often administered with a promise to “take the edge off” during labor. Sometimes medical staff try to minimize the effects of labor medications, but it is important to understand that all medications can affect breastfeeding. Fortunately, with the support of a well-prepared doula, the transition from belly to breast can be smooth and natural.