Hospital Birth: How Does It Affect Breastfeeding?

The hospital environment and medical practices can influence a mother's ability to breastfeed. Some hospitals have implemented Baby-Friendly practices, which include breastfeeding within an hour of birth, exclusive breastfeeding, rooming-in, breastfeeding on-demand, and providing breastfeeding support. These practices aim to facilitate breastfeeding and help mothers achieve their prenatal intentions. However, various factors in the hospital setting, such as medical interventions, pain medication, and separation of mother and baby, can present challenges to establishing successful breastfeeding. Understanding the impact of hospital birth on breastfeeding is crucial for empowering mothers and promoting infant health.

Skin-to-skin contact

In the case of a Caesarean section, a longer hospital stay can assist in establishing breastfeeding, especially with supportive and knowledgeable staff. If the mother is unable to hold the baby immediately after birth, a family member can facilitate skin-to-skin contact until she is able to do so.

If, for medical reasons, skin-to-skin contact is not possible, alternative methods can be employed. For instance, if the mother is sore from an episiotomy, she can lie down to feed and cuddle her baby. Additionally, if the baby is affected by medications, such as epidural anaesthetics, keeping them in skin-to-skin contact can help, even while they are asleep.

In summary, skin-to-skin contact is an essential aspect of the Baby-Friendly Hospital Initiative, which aims to support breastfeeding mothers and their newborns. This practice has multiple benefits, including facilitating breastfeeding and promoting the overall well-being of both mother and baby.

Baby-friendly hospital practices

The World Health Organization and the United Nations Children's Fund developed the Baby-Friendly Hospital Initiative (BFHI) in 1991 to protect, promote, and support breastfeeding. The BFHI is a set of 10 evidence-based practices that hospitals and maternity units should implement to support breastfeeding.

• Skin-to-skin contact between mother and baby immediately after delivery and throughout the hospital stay. Skin-to-skin contact has been shown to benefit both mothers and babies. Babies who are held skin-to-skin enjoy more stable vital signs, cry less, sleep and feed better, and absorb and digest their food better. Mothers also benefit from improved pain management and milk production.
• Rooming-in, which keeps mother and baby together even during routine assessments of the baby's health. This practice has been shown to improve breastfeeding success, as babies who stay in the room with their mothers cry less, sleep more, breastfeed better and longer, and gain more weight each day.
• Breastfeeding within one hour of birth.
• Giving only breast milk during the hospital stay.
• Breastfeeding on demand.
• Limiting pacifier use.
• Providing information about breastfeeding support on discharge.

In addition to these specific practices, a supportive and knowledgeable staff can also assist in establishing breastfeeding. Emotional support during labour, attention to the effects of pain medication on the baby, offering light foods and fluids during early labour, freedom of movement during labour, and avoiding unnecessary caesarean sections can all help to facilitate breastfeeding.

Pain medication and breastfeeding

While in the hospital, there are several pain medications that a woman can take while breastfeeding. Paracetamol, ibuprofen, and celecoxib (Celebrex®) are all options that are considered safe for breastfeeding mothers. Only a very small amount of paracetamol passes into breast milk, and ibuprofen has been used by many breastfeeding mothers without any reports of problems. Celecoxib is thought to pass into breast milk in such small amounts that it is not harmful to the baby.

On the other hand, certain pain medications should be avoided by breastfeeding mothers. Products containing aspirin, such as Anadin Original® and Disprin®, are not recommended due to a possible link with Reye's syndrome in children, especially if the child has a viral infection or fever. While the risk is very low, it is best avoided as there are alternative options available. Codeine and dihydrocodeine, which are weak opioids available over the counter, are also not recommended during breastfeeding.

Naproxen and indomethacin are not typically the first choice for NSAID pain relief while breastfeeding, especially for newborns or premature babies, due to some reports of possible side effects. However, they can be used with caution if alternative options are not suitable. If a breastfeeding mother must take low-dose aspirin for certain medical conditions, she should be cautious if her baby develops a fever.

To ensure the best outcome for both mother and baby, it is important for hospitals to provide knowledgeable and supportive staff, especially following a Caesarean section. Early skin-to-skin contact and facilitating the first feed are beneficial for both mother and baby. Hospitals should also avoid harmful practices that may hinder early mother-baby contact and breastfeeding, such as requiring the mother to lie in bed during labour and birth, withholding food and fluids during early labour, and performing unnecessary caesarean sections.

Breastfeeding after a C-section

A C-section is major abdominal surgery, which means that your body will need more time to recover after giving birth. This can be a difficult experience, especially if you were hoping for a vaginal birth. However, it is still possible to breastfeed after a C-section, and doing so can help to heal any feelings of sadness or disappointment.

If you are planning a C-section, knowing in advance can help you prepare for breastfeeding. When possible, going into labour first can make breastfeeding easier. During pregnancy, try to find out as much as you can about labour and breastfeeding. You can also contact a La Leche League (LLL) Leader, attend an LLL meeting, or join an LLL Facebook group to establish a support network.

After a C-section, you will need practical support from friends and family. It is important to choose a healthcare facility with current, evidence-based policies on breastfeeding. Maternity hospitals that have been designated as Baby-Friendly Hospitals™ (BFHI) are especially understanding and supportive of breastfeeding. If your birth facility is BFHI-designated, the staff will be trained to help you achieve your goal of early and exclusive breastfeeding.

To initiate breastfeeding, it is recommended that babies are placed on their mother's chest, skin-to-skin, immediately after birth. This can be done in the operating room or in the recovery area. There should be no clothing or blankets between the baby's body and the mother's body, as immediate and uninterrupted direct skin-to-skin contact is important for both parties. Most babies will move to the breast and begin nursing by themselves within the first hour or so after birth. If the facility does not support immediate skin-to-skin policies, talk to healthcare providers and request that a medical order be written for immediate and uninterrupted skin-to-skin contact.

The type of anaesthetic used during C-section surgery can directly affect breastfeeding. In non-emergency cases, most mothers are given a regional anaesthetic so that they are awake and aware during the birth. You can ask that your hospital gown, IV tubing, blood pressure cuff, and any other monitoring equipment be arranged so that your baby can be placed on your bare chest immediately after birth.

Breastfeeding after an instrumental birth

An instrumental birth, which involves the use of forceps or a vacuum extraction device, can be a traumatic experience for both the mother and the baby. This type of birth can disrupt the alignment of the baby's head bones and impact nerve and muscle function, sometimes resulting in feeding difficulties.

Hospitals can play a crucial role in supporting mothers who have undergone an instrumental birth and wish to breastfeed. Here are some practices that can help:

• Early skin-to-skin contact: Placing the baby on the mother's chest with skin-to-skin contact immediately after birth encourages breastfeeding. The baby is drawn to the breast odour and begins to exhibit pre-feeding behaviours such as sucking motions and touching the nipple. This early contact also helps regulate the baby's body temperature and exposes them to beneficial bacteria from the mother's skin, boosting their immune system.
• Supportive staff: Knowledgeable and supportive hospital staff can make a significant difference in a mother's breastfeeding journey after an instrumental birth. They can provide emotional support during labour, guidance on recognising pre-feeding cues, and assistance with the first feed.
• Avoid unnecessary interventions: Some interventions, such as requiring the mother to lie in bed during labour and birth or withholding food and fluids during early labour, can hinder early mother-baby contact and the establishment of breastfeeding. Hospitals should avoid unnecessary interventions and instead promote freedom of movement during labour and early skin-to-skin contact.
• Facilitate early feeding: Initiating breastfeeding within the first hour after birth gives newborns the best chance of survival and development. Hospitals should encourage early feeding, providing support and guidance to mothers as needed.
• Breastfeeding support and education: Hospitals can provide information and resources on breastfeeding techniques, the benefits of breastfeeding, and where to seek additional support if needed.

There are several challenges that mothers may encounter when breastfeeding after an instrumental birth:

• Pain and discomfort: Mothers who have undergone an instrumental birth may experience pain and soreness, which can make it difficult to find a comfortable position for breastfeeding.
• Baby's feeding difficulties: As mentioned earlier, instrumental births can sometimes affect the baby's nerve and muscle function, making it challenging for them to coordinate their sucking and swallowing reflexes.
• Separation from the baby: In some cases, the baby may need to be temporarily separated from the mother after birth due to medical reasons, such as testing or special treatment. This separation can delay the initiation of breastfeeding and impact the mother's confidence.
• Effects of anaesthesia: If anaesthesia was administered during labour, it can impact the mother's energy levels and ability to care for the baby immediately after birth. Additionally, it can affect the baby's sucking and swallowing reflexes in the first few days.

Frequently asked questions