Dear Loved Ones
The early days of motherhood - hospital robes, adult diapers, nurses checking on you constantly and visitors coming in and out like a rotating door when you look and feel your most vulnerable and exposed (literally). Perhaps not quite what you expected and yet, perfect in all its messy, sore and sleep deprived beauty.
The hours and days following birth can be a whirlwind and we often have no idea what to truly expect as we make this transition into motherhood. This also means we're unsure how or when to ask for help and support that align with our breastfeeding goals.
So we've made this task a little easier for you and compiled 5 things all support members should know for those first few days postpartum.
1. We love you, but give us space.
Or, in other words, reduce the visitors and visitation time. Okay, hear us out. Having family and friends flock to the hospital to see the newborn baby is exciting and fun but it can also be very overwhelming and exhausting for new parents. Labor is like completing the most intense marathon of your life, you're tired, sore, uncomfortable, perhaps in downright pain as you recover whether vaginal delivery or cesarean. Then you have a beautiful little newborn nursing 24/7 as you try to figure out how exactly to breastfeed, which means your breasts may be out more often than not. Skin to skin is essential in those early hours and days as it regulates baby's heartbeat, temperature, breathing and lowers their stress levels (1,2). It also provides open ended access to nurse and this open access is what helps your baby flush the meconium from their body through frequent sucking at the breast, provides them with an incredible protection for their immune system through your colostrum, communicates to your body to make more milk and helps shrink your uterus after delivery (2).
When we have visitors here is what happens - baby is passed around to be snuggled by all, which means baby is not with mama, not doing skin to skin and not having access to nurse on demand. We are also much less likely to pull our breasts out in front of visitors so we delay feeds and again, miss out on crucial time with our baby.
This is not to say do not allow anyone to handle your baby - of course, let your loved ones say hello! But we recommend keeping it brief and using those first 48-72 hours to rest, recover and soak up your new life as parents.
2. Keep baby near me.
Just as baby and mom were one unit during pregnancy, baby and mom should remain together as much as possible. This means advocating to do as many procedures in your hospital room - delaying bathing (that vernix coating on their skin is great for them, no need to rush to bathe is off), and rooming-in which means baby spends as little time in the nursery as possible(3). Why is this so important? Remember, the role of skin to skin and open ended nursing. When baby and mom are separated we introduce some potential risks such as not being able to nurse on demand and help baby push out that meconium, which can sometimes cause jaundice simply from not breastfeeding enough - yes, this is real and it is preventable by breastfeeding on demand. When baby and mom are separated they're also missing out on time to practice breastfeeding, while breastfeeding is the biological norm it can take a bit of practice for both mom and baby. We also need this closeness to help baby communicate to our bodies to make more milk! The frequency of nursing in those early hours and days can have a significant impact on our supply down the road.
All of these components work together to set mom and baby up for success in these early hours and weeks. Having your support team on board for keeping baby close to you will allow you to feel confident that in those moments where you can rest, baby will stay with you and you won't wake up feeling disoriented with baby being in the nursery.
3. Trust me and learn what is normal.
There is nothing like feeling uncertain or even undermined as a result of incorrect advice and misinformation. Although intentions may be well meaning, we need our loved ones to be confident that we know what we're doing and support and encourage us to do what we know is best.
Family and friends - ALL babies lose weight after birth. Every single one of them. About 7% of weight loss can be completely normal for babies after their born and this is no need for alarm nor is this a representation of a mother's milk supply (2). Even 10% of weight loss can be normal as long as baby is producing sufficient wet/dirty diapers for their age (e.g. day 1: 1 wet/1 dirty, day 2: 2 wet, 2 dirty) and their medical examination checks out okay (2). Weight loss happens because babies are shedding excess fluid and meconium (those thick and tarry first stools) and sometimes when we introduce interventions like epidurals or undergo cesareans we also introduce more fluids that need to be shed. So let's repeat, it is absolutely normal for baby to lose weight for the first few days and then weight should start to pick up around days 4-5 once the meconium is out and your milk increases in volume. Many times we are quick to jump on the need for supplementation when there is no need and mom's body is working just fine.
While we are at it - babies eat A LOT. Frequent nursing in the early hours, days, weeks and even months is baby's way of communicating to our body to continue making milk, to get nutrients and calories, to help fight off viruses and infections, to help their brains and bodies grow and develop, to soothe and comfort in times of stress or pain. Frequent nursing, on its own, does not indicate issues with milk supply. No need to top baby off with additional milk via bottle or adding fillers to milk in the bottle which will cause more harm than good. Again, trust that mom's body is working just fine and this is normal baby behavior.
Some other useful bits of information. Reduce swaddling - swaddling is a great tool and can be very useful to keep babies cozy and calm. Swaddling can also prevent babies from communicating early hunger cues and cause us to wait until baby is crying (a late hunger cue) before we realize its time to feed. In lieu of constant swaddling, try mixing it up with plenty of skin to skin time which will also keep baby warm and calm but will allow for opportunity to nurse more easily and follow baby's cues. And limit pacifiers - at least in the early days. Pacifiers are not bad but they can prevent baby from sucking at the breast and communicating those early hunger cues which is important for stimulation and milk supply.
4. Help me get comfortable.
Regardless of birthing method, labor and delivery take their toll on the body. There may be aches and pains in places you never knew existed so learning how to get comfortable is key to early breastfeeding. In the first few days and weeks as you're healing, you will likely be feeding around the clock and without the proper support for your body, breastfeeding can get uncomfortable quickly. For most mothers, laid back breastfeeding or biological breastfeeding, is the most comfortable and most intuitive position for moms and babies to breastfeed. Simply lay back and rest baby on top of you. This positioning works well for moms who delivered vaginally and via cesarean however, moms with a c-section should protect the incision using a pillow over their stomach and baby on top of the pillow.
Some other tips for comfort: a rolled up swaddle works great for additional support under baby's head and under your wrists, especially for positions such as cradle where a lot of pressure rests on your wrists supporting baby's head. And pillows for mom! While nursing pillows can work, you don't specifically need a nursing pillow to get comfortable - regular pillows will do the trick too. Have pillows supporting your back, your arms and under baby. Sometimes it helps to turn the pillow on its side rather than flat, to provide more support and raise baby higher. You may even find a pillow underneath a nursing pillow helps you from hunching over during feeds as it lifts baby up higher so you can sit more comfortably. If at any point you feel pressure or discomfort, adjust. In order for us to sustain breastfeeding and not dread nursing sessions, we need to feel comfortable.
5. Offer nourishment.
Once baby arrives, everyone focuses on the new little life and, while babies are certainly top priority, so is mom. Your support team should ensure you're being taken care of as well - this means making sure you are eating well (lots of fruits and veggies to get the vitamins we need to fuel our bodies), eating enough (breastfeeding burns 500-700 calories extra a day and breastfeeding moms need at least 1800 calories/day), and getting enough water (while we do not need excessive amounts of water, we should make sure we are drinking plenty to stay hydrated throughout the day) (3, 4,5).
Remember, nourishment isn't always a physical need. After baby is born, postpartum hormones will run rampant. That paired with sleep deprivation and anxiety can make us very emotional and vulnerable. We need to hear every now and again that we're doing a good job. And when we feel confused, scared or like giving up, we need our loved ones to provide encouragement and get us help and support.
And there you have it.
These key points are important to discuss with your support team and loved ones who will surround you following baby's birth. This is also a good jumping off point to talk to your inner circle about your breastfeeding goals and tell them other ways you may need support - like help with cooking and laundry! It takes a village, especially a well-informed and supportive village.
(1) Hurst, N.M. et al. (1997). Skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume. J Perinatol, 17, 213-217
(2)Lawrence, R.A. & Lawrence, R.M. (2010). Breastfeeding: A Guide for the Medical Profession (7th ed.). Elsevier Mosby, Philadelphia
(3) Lauwers, J. & Swisher, A. (2015). Counseling the Nursing Mother: A Lactation Consultants Guide. Burlington, MA: Jones & Bartlett Learning.
(4) Institute of Medicine. (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fatty Acids, Cholesterol, Protein, Amino Acids (Macronutrients). Washington, DC: National Academies Press.
(5) Food and Agriculture Organization of the United Nations. Human energy requirements. Retrieved from http://www.fao.org/docrep/007/y5686e/y5686e0b.htm