After Baby is Born

Standard of Care Series Part Seven

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Early Cord Clamping

For many years now, standard care has been to clamp the umbilical cord immediately following the birth of the baby. This practice is also known as early cord clamping, where the cord is clamped within 30-60 seconds after the birth of the baby. What some parents may not realize is that there is a difference between clamping and cutting the umbilical cord. We now know that when we immediately clamp the umbilical cord after birth, 30% of the baby’s blood is still in the placenta. “In contrast, if you leave the cord unclamped for a longer period of time, the baby will get 80% of their blood within 60 seconds, and 87% within 3 to 5 minutes” (Dekker, 2019, p 31).

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The benefits of delayed cord clamping include increased blood volume, providing baby with blood rich in stem cells and iron (which is used to make hemoglobin), and helping the flow of blood to important organs like the lungs. Essentially, delayed cord clamping helps baby to transition to life outside the womb. The practice of delayed cord clamping has been found to be so beneficial, in fact, that some researchers feel there are ethical considerations before conducting any more randomized trials on this matter. Additionally, delayed cord clamping has not been found to be associated with an increased risk of maternal postpartum hemorrhage. Skin-to-skin care can still take place immediately after the birth with delayed cord clamping.

If you would like delayed cord clamping for your baby, having a conversation with your provider prenatally about delayed cord clamping is beneficial. Open communication allows everyone on the birth team to be on the same page. For some providers, delayed cord clamping means a minute or two, while some parents prefer to specify waiting to clamp the cord until the cord stops pulsing. The World Health Organization (WHO) recommends late cord clamping (performed 1-3 minutes after the birth) for all births (both vaginal and Cesarean and both term and preterm infants) while early umbilical cord clamping (less than 1 minute after birth) is not recommended for healthy newborns (both term and preterm infants) (2012).

 

You can find more information regarding WHO’s guidelines here.  

Read more about delayed cord clamping here.

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Separation from Baby

 The Golden Hour is a term used to refer to the first hour immediately following the baby’s birth. It is a window of opportunity for bonding and establishing the breastfeeding relationship. Elevated levels of oxytocin following the birth, which are further elevated through skin-to-skin care, promote maternal/infant attachment, lower maternal and infant stress, and ease the newborn’s transition to life outside the womb. Immediate skin-to-skin is when the naked newborn is placed on the birthing person’s bare chest. A blanket may be placed over the baby and mother to keep the baby warm and dry, but having any clothing or blankets between the mother and the baby is not the same as skin-to-skin care. It is the actual skin contact between the baby and the mother that “allows hormones between the mom and baby to ‘communicate’ with each other” (Dekker, 2019, p 33). 

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The benefits of skin-to-skin care between a mother and her baby include maternal and infant lower stress levels, better success with breastfeeding, and more stable blood sugar, breathing, heart rate, body temperature, and oxygen levels for the baby. Separating babies from their mothers interferes with the breastfeeding relationship and causes distress and anxiety for both the mother and the newborn. This one to two hour window immediately following the birth is a very sensitive time for bonding between a mother and her baby. Immediate skin-to-skin care is a practice that can take place for healthy mothers and babies whether the birth was vaginal or Cesarean and regardless of feeding preferences. Studies have shown that mothers who were separated from their babies during this Golden Hour (or two) following the birth were less responsive towards their infants a year after the baby’s birth, while the babies were more irritable, impulsive and had a harder time self-regulating. In short, separating babies from their mothers during this critical time immediately following the birth is a harmful practice.

It is also important to note that skin-to-skin care can take place beyond the first hour or two after birth. The benefits of skin-to-skin care (or kangaroo care) mentioned above are still relevant during the fourth trimester. Additionally, skin-to-skin care between the baby and the partner of the birthing person can be practiced as well during this time. 

 Thankfully, more and more hospitals are adopting rooming-in policies where the baby is not separated from the mother throughout the hospital stay following the birth, and are encouraging skin-to-skin care during the Golden Hour.

More information about the short- and long-term health benefits of keeping mother and baby together can be found here.


Sign up for our EBB Childbirth Class today to gain the knowledge and confidence for an empowered birth! 

*Disclaimer: These posts are not intended to be construed as medical advice and are for educational purposes only. Each pregnancy and labor is unique. If you have questions or concerns, please consult your provider.

World Breastfeeding Week: an IBCLC Interview

World Breastfeeding Week 2019

An Interview with Sally Wood, IBCLC RN

In celebration of World Breastfeeding Week, we have an exclusive interview with Sally Wood, IBCLC, RN, to learn some breastfeeding basics and a little about the IBCLC profession. Though breastfeeding is natural, it is certainly not always easy. Whether this is your first baby or fifth, or if your nursling is a newborn or toddler, breastfeeding can come with challenges and frustration. Sally shares some tips and tricks for parents to help prepare and navigate their breastfeeding journey, what to expect in the early days, why IBCLCs are a great resource, and more!

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Sally and her husband have been married for 34 years and they have three awesome adult children. Sally’s youngest just started her first job at the end of July, so they are truly empty-nesters! In her spare time (what’s that??) Sally is either relaxing with friends, reading a book or traveling with her husband.  She has been a nurse for over 20 years; 15 have been spent solely in lactation. Sally’s absolute passion, aside from her family, is helping moms! She loves it! It never gets old and she gets to help moms achieve their individual goals in breastfeeding!

What is an IBCLC? 

An International Board Certified Lactation Consultant is the gold-standard in lactation knowledge and counseling.  It’s a worldwide certification and can be obtained by taking various paths, all of which include science/social courses, lactation-specific education hours and hands-on clinical experience.  You can find out more by visiting the IBLCE website.

What are some of the benefits of breastfeeding? 

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There are SOOOOOO many benefits to breastfeeding!!!  What some people tend to forget is that the benefit is not just to the baby, but to mom, as well.  There are the well-known benefits such as decreased allergies, asthma, ear infections and stomach issues for babies, but other benefits are decreased risks of Type 2 diabetes, celiac disease and childhood leukemia.  For moms, breastfeeding can decrease the risk of Type 2 diabetes, osteoporosis, cardiac disease and even multiple sclerosis. These benefits are just a few of the many benefits and we are learning more all of the time.

What can I expect from an IBCLC in the hospital after my baby’s birth? 

First of all, before delivering at any hospital, check to make sure that there IS an IBCLC. This will say a lot about the importance of breastfeeding to the hospital.  Most hospitals do have at least one, but I still hear of some that don’t have any. Second, I would suggest that you ask how much breastfeeding training the staff has. IBCLCs are generally not staffed around the clock and well-trained nurses are a critical part of getting breastfeeding off to a good start. You should be seen at least ONCE during your stay, if not everyday, by an IBCLC. If you haven’t seen one, even if you think breastfeeding is going well, ask for her. Sometimes we get busy with only the couplets who are having difficulties and can’t get around to see everyone. An IBCLC should at least ask enough questions to determine if it sounds like breastfeeding is going well, including your previous breastfeeding experiences if you have any.  We don’t want to have the same problems if we can help it. It would be FANTASTIC if the IBCLC could observe baby latching and feeding. Last, but not least, you should be given information for contacting her after discharge ….. And DO IT, if you have any questions or are having any problems!

Does insurance cover IBCLC visits? 

This is a GOOD question! According to the Affordable Care Act, insurance plans should cover up to six lactation consults a year.  If mom’s plan was already in existence prior to 2010, then it was “grandfathered in” and doesn’t have to follow the law. Having said that, it’s always a fight to get insurance to pay. If the IBCLC, or practice/hospital, is in-network with an insurance company, it’s much easier, but not guaranteed. Lactation consults are considered preventive care and the family should not incur ANY costs.  I honestly haven’t seen that happen on a consistent basis. Luckily, in Augusta, all of the hospitals have IBCLCs and the majority of the time the visits are free. As some may know, I have a private practice that moms choose for a variety of reasons. I’m in-network with Aetna, but have had NO luck so far with other companies (a common problem across the US). My suggestion to any mom who wants to see an IBCLC who charges a fee is to call her insurance company, ask about coverage and write down the name of the person she spoke to and get a confirmation number.  Here is a great resource from the National Women’s Law Center about all of this and it even includes a script to follow when you call!

What can I expect in the early days of breastfeeding? 

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Simply put, you know all of those books that you’ve read about breastfeeding and how it’s supposed to go?  Put that information to the side for the first three days …. Because it’s not going to look anything like that. I don’t like to say NEVER, but I pretty much have NEVER seen a newborn baby breastfeed every 2-3 hours (8-12 times a day) during that time, especially the first 24 hours.  There’s absolutely no rhyme or reason as to when your baby will feed. So, what do you do? Keep your baby close. We are mammals ….. Where do other baby mammals hang out at first? I tell moms that there are two things you can’t do too much of: 1) keep baby skin-to-skin and 2) ask questions and for assistance.  Try to put yourself in your babies “booties” … the ONLY world your baby has ever known is your uterus. No matter how peaceful, or not, your birth environment is, it’s the absolute OPPOSITE of your uterus. So, your baby needs time to acclimate and get used to it all. Plus, you and your baby together have to LEARN to breastfeed.  Keeping your baby in the “breastaurant” is important. So, watch for feeding cues. If your baby continues to snooze and it’s been 3-4 hours since the last feeding, wake baby up (or attempt to) by stripping her down to the diaper. Offer the breast and hand express colostrum into her mouth. If she refuses (which would be normal), put her skin to skin and keep her there until she DOES feed.

Should breastfeeding hurt?

No, no, never, never, NO. However, there’s lots of confusion about this sometimes, I think.  Everyone has a different definition of “pain”. A latch that hurts throughout the entire feeding is never normal, no matter what your definition is.  But, let’s think about this … babies have a very strong suck. Your nipples and areolae will become tender and sore. This is normal. It’s also VERY common for moms to say it “kinda hurts” right when baby latches. If the latch is deep and wide, this will decrease within 10-15 seconds or fewer, and then you may be left with just a slight tenderness.  ALL of this should be gone by two weeks or so. If there’s any discomfort outside of what I just described, the latch isn’t deep enough. A very small percentage of nipple pain may be caused by a tongue tie. The first thing to do if the latch hurts is to assess the latch.

How do I know if my baby is getting enough milk? 

During the first three days (before your big amount of milk comes in) it can be a challenge.  Your baby should look satisfied after a feeding. However, during those first days, baby may also be very overstimulated.  If you are still seeing hunger cues, latch your baby again and WATCH. Is baby sucking and swallowing, or is he only sucking?  A mammal’s instinct it to suckle at mama’s breast for comfort. Also, look at poops and pees. Again, the first three days are different. So be sure to ask your nurse, midwife or doula what is normal.  AFTER the blessed event of your milk “coming in”, your baby SHOULD look totally satisfied and the number of poops and pees are a good indication of baby getting enough. The final say is the scale. Adequate weight-gain will definitely determine it!

When might it be a good idea to meet with an IBCLC?

Prenatal classes or consults are always a great idea. Not only can the IBCLC educate about what to expect those first few days, but a rapport is built for any future needs.  Also, when baby is 4-5 days old, it would be valuable to have an IBCLC observe a feeding and, even if everything is going great, mom always has lots of questions and useful tips can be given.

I need to return to work...when do I start pumping? 

I beg of you … PLEASE don’t pump until three weeks. Give your supply time to establish and give you and your baby time to master breastfeeding.  You WILL have too much milk when it comes in. Pumping it out will only make it worse. Giving bottles during the first three weeks can cause lots of problems. I’ve seen them. I know moms who have done both of these and had no problems. I’ve known more who have. We don’t have a crystal ball. All moms and babies are different. So, wait, please!  As far as pumping for work, you can either start pumping after the first 1-2 morning feedings and start storing that milk, or some moms will wait until 2-3 weeks before going back to work and pump after every feeding during the day. There really is no right or wrong way. If a mom is unsure about what she should do, call an IBCLC!

How do I find an IBCLC? 

Besides locating the IBCLCs found in the hospitals, the best place is the ILCA (International Lactation Consultant Association) directory.  This is a worldwide resource, so you can find one no matter where you are! Of course, there’s always GOOGLE, too!!

What is the best way to prepare for a successful breastfeeding relationship? 

It’s really simple. Surround yourself with supportive people, plan to keep your baby skin to skin as much as possible and never hesitate to ask for help.  I bet you thought I was going to say go to a class! It would be GREAT if everyone went to class, but the reality is that not everyone can. I have helped many moms who never went to a class and successfully breastfed because they did the three things above!

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What other options are there for mothers needing breastfeeding support or encouragement? 

La Leche League has an active group here in Augusta. It would actually be great if pregnant moms would attend these meetings!  [Meetings are held twice each month, one in the evening and one in the morning. You can follow the LLL of Augusta Facebook page to stay up to date on meetings.] Also, our WIC Breastfeeding Program is, seriously, one of the best in the state. I know this because I’ve been in meetings with other hospitals and their WIC representatives. I knew the program here was great, I had NO IDEA just how great!!!  Also, I hate to even open up this can of worms, but the internet can be great or awful, depending on where you go. I honestly tell moms to stick to Kellymom.com and LLLI.org If you can’t find the answer you are looking for there, call an IBCLC.  Of course, blogs can also be great, but just be sure that you KNOW the blogger is knowledgeable and using evidence-based information. (That would include this blog [Empowered Birth CSRA] and my blog at The Breastfeeding Guru) Hint, hint. ;)

Are there any other local resources?

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Yes! Besides the resources listed above, I have a private lactation practice! It’s called Sally Wood Lactation. Quite original, don’t you think? It used to be called Baby Azur, but who knows what THAT is? Haha! I provide in-home lactation consultations and Medela Symphony breast pump rentals. In the near future, I will be offering some office consults as well. I’m in-network with Aetna and am continuously pursuing contracts with other insurance companies. I currently offer a breastfeeding class called “Boobies for Newbies”. I think the title pretty much sums up the content. I’m working on a Pumping/Back to Work class. My classes are very small so that I can somewhat customize the content to the families’ unique needs.

For more information on the services Sally Wood, IBCLC, RN, provides, you can visit her website at The Breastfeeding Guru or contact her at sally@thebreastfeedingguru.com.

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