Breastfeeding and the Doula

All babies have an innate instinct towards breastfeeding. Babies are naturally born knowing the way to the breast. What gets lost in the ability to successfully breastfeed is often the lack of support for mothers.

Babies know how to signal to the mother when they are hungry and when they are full. They know how to regulate the breast milk and make adjustments so that they get their individual nutritional needs met. Feeding in shorted periods can make more liquid / more water and longer feedings make for thicker nutrient milk.

Breastfeeding is best for the neuro-biology and brain development of the baby. Baby lead latching is a form of self attachment for the babies and is a part of the bounding process between mothers and babies that ensures safe secure attachment. The World Health Organization (WHO) has done research that says a lot of babies born in hospitals die if they do not get that first initial feeding of colostrum which has many anti-bodies that protect the baby.

The best way a doula can support mothers around breastfeeding is to help build their confidence and trust in her and her baby’s innate instinctual wisdom around breastfeeding. Hospital protocols sometimes conflict with the time and space a mother needs for her and her baby to figure out breastfeeding, along with many different angles of advice from the medical staff in the first days during a postpartum hospital stay. Hospitals are busy places and typically offer many disruptions particularly for babies having trouble breastfeeding.

The most important member in breastfeeding team is the baby. Babies need access to the breast. Skin-to- skin contact on the chest help, mother’s learn her baby’s ques. Crying is an indicator that a queue has been missed. Follow the natural instinct of babies: access to the breast, skin-to-skin, no clothing (clothing is confusing to babies), no artificial nipples and, patience it can take anywhere between 20 minutes to 90 minutes to attach particularly for the first time. If a baby is taking longer to attach that is fine, and a doula can point out all the positive steps along the way. The natural ways for babies to find the breast and latch on is to look to the mothers face, figure out, and then adjust to orient towards the breast. When babies pull away from the breast it is to look at the mother’s face and see where the nipple is, not to necessarily protest.

There are 4 major ways babies orient to the breast for feeding.

 Sight – the darker color of the nipple makes it clear for the newborn, where to go to breastfeed

Touch- feeling the skin, massaging the breast.

Smell – the embryonic fluid on the baby’s hands is a similar smell as the smell of the mother’s nipple

Taste – use their tongue and a sense of taste to find the taste of milk which they are hard wired to like.  

A good latch is important for effective feedings. No lips means latched really well. You shouldn’t be able to see the baby’s lips. Laying back can be helpful for babies to figure out the latch. Laying down can also encourage a deeper latch. Babies also seem to like being in an angle to that they can push their feet on to something like the belly. For painful nursing, try to move the baby and see if you can move the baby deeper without unlatching. Continuous pulling the baby off a latch to try again can be more damaging as the baby may become frustrated. Instead, move the baby’s shoulders and hips in closer. Help the baby tip his head back further to bring the chin in closer. The chin should be buried in the breast.

In the early days after birth nipple shields are more likely to cause problems. What babies need is access to the breast, constant skin to skin and lots of space to move to and from the breast on its own time.

The continued process of producing milk let down is based on what happens the first few days after birth, in how often the baby is nursing and how effectively the baby is nursing. Frequency of feeding is more important than length of feeding in terms of increasing milk production. Getting lots of feedings in the early days determine the success of breast milk production. Breast size is what determines the frequency of baby needing to feed (this is why feeding on baby’s queues is more important than scheduled feedings).

Milk is made most quickly when the breast is empty. When the breasts begin to fill up, the breast is actually beginning to make less milk. So waiting to feed when the breasts feel full is really a recipe for diminished milk supply. Frequently feedings build the receptors for prolastin which is what triggers the milk supply. 12 feedings a day is better than 8 feedings a day, in the early days after the baby is born.

Studies show that co-sleeping  and sleeping in a side cart next to be bed has better breastfeeding outcomes because babies in the days after birth tend to feed more often when they are in close proximity of mother, then is they are in a basinet across the room or in a nursery. 80% of babies co-sleeping or in a side car breastfeed successfully, while 40% of babies in bassinets or separate sleeping arrangements will breastfeed successfully. Supplementation is linked to early weaning. For a baby away from the mother for any amount of time, it is important for mothers to express milk or colostrum to prevent supplementation. Supplementation is also very hard on a baby’s digestive system.

What happens during birth affects breastfeeding in a huge way. Prolonged IV fluids during labor, increases the fluids in the breast and causes swelling in the feet and hands. Some of those IV fluids also go to the baby and they are born inflated with water weight which will be lost in the next day or so; but can make the medical staff want to push formula because the baby’s weight will go down a bit more than usual from birth.

Epidurals affect the baby’s ability to latch well. The longer the mother has the epidural during labor the longer the remnant of the medication will be in her system which can last for days and sometimes weeks and can greatly affect breastfeeding success. Doulas can encourage women to hold off as long as possible for an epidural which in turn can help with breastfeeding. Epidurals can also sometimes cause mothers to get a fever in the days after labor and that can often lead to separation between moms and babies as the medical staff try to protect against possible infection.  Narcotics can make the baby sleepier and harder to feed well. Episiotomy can make it harder to find a comfortable position. C-section babies are significantly less likely to breastfeed successfully.

Doulas help to make breastfeeding much more successful because they lessen the risk of all of those interventions. Just simply being there to support a mother through birth is giving her a better chance to start breastfeeding.

Weight loss is normal for babies after birth but people get concerned if it is more than 7-10%. Babies that lose weight within that range tend to wean earlier and the reason for this is because formula is often introduced. Within this scenario what mothers need is more support around breastfeeding, more frequent feedings, breast compression (hand expressing while the baby is at the breast by squeezing when the baby sucks). Breast compressing is also good for sleepy babies and difficulty latching. If a baby needs to be separated from mom it is always best to express some milk and colostrum to be feed to the baby to avoid formula.

Nipple damage is caused by bad latch and tough tie causes a large amount of this. When a woman has engorged breasts the baby can’t latch. It can helpful to use reverse pressure softening by taking a finger around the nipple, press back extra fluid, then latch baby on. Mothers should be discouraged from pumping in this situation because it encourages more let down and leads to more engorgement.

The role of a doula as a member of the breastfeeding team is to offer continuous emotional and physical support. Encourage the mother to ask questions and remind her of her options as they arise. The mere presence of a doula greatly reduces interventions which affect breastfeeding. A doula can encourage support for breastfeeding around the mother if she has to navigate the medical side of birth. And a doula can offer positive reflection about the instincts between mom and baby point the way.