Mama in the City

A blog about raising my family in downtown Vancouver

Breastfeeding Booby Traps: A Perinatal Nurse's Opinion

There is a lot of talk amongst the mom breastfeeding blogging community about factors that interfere with successful breastfeeding. They call these booby traps and they have added the hospital setting as one of the reasons breastfeeding is not successful for some women. Does giving birth inside a hospital dictate your overall success with breastfeeding or is it the culture that we live in that is the real boobytrap?

I had to think about that one for a minute but not before I got defensive and angry. I work inside a hospital with women giving birth and I help teach breastfeeding too. If I was to be your nurse I am passionate and caring and understanding around breastfeeding. I also work with some amazing nurses who feel the same way as I do. We often talk about breastfeeding at work and the challenges around it and trouble shoot with each other when we encounter different issues.

The argument from the pro breastfeeding community, or lactivists as they call themselves, is that hospitals births and post partum care is not really breastfeeding friendly. Meaning, the people who care for the post partum families are more likely to offer an artificial nipple or a bottle filled with formula than help and educate and promote breastfeeding. Of course I can be honest and say that I do see this. I do see pediatricians and nurses alike thinking they are being helpful to the tired overwhelmed new mother by giving the baby just a 'wee bit' of formula or a pacifier before breastfeeding is established. However, you are more likely to meet someone more like me than not. We truly want YOU to love breastfeeding! We want your baby to latch on and feed like a champ! We want you to have oodles of milk!

My stance on this hot topic is this: mothers need to take the time to educate and surround themselves with positive breastfeeding information BEFORE they give birth. So much prep is done for the babies birth or for their gorgeous little nurseries but how much time is spent learning about breastfeeding by watching videos or reading books or just talking to other breastfeeding mothers? From my practice I know that it does not even compare.

I can spot a new mother who is passionate about breastfeeding from a mile away. She has read books and has knowledge around what is normal and what is to be expected with breastfeeding. I can also spot the exact opposite person from even further away. In my professional practice it seems that more times than not a new mom really has no information about what to expect with breastfeeding during the early days. Now, ask her about what outfit the baby will wear home and you've got yourself a conversation!

Of course this is not about putting blame on anyone! I don't roll that way and I truly want mothers to have positive breastfeeding experiences because I believe in it so very much. So, what can a mama to be do to help prepare herself to have a positive breastfeeding relationship? Here are my thoughts:

1. Make the decision to be dedicated to breastfeeding. Knowing that it might be difficult at first but it will get so much more easier.
2. Buy a breastfeeding book or peruse some on line sites that are pro breastfeeding. Some good sites that I recommend are: Dr. Jack Newman's awesome breastfeeding website.
The La Leche Leauge is also a great resource and a group can be found within your community. Click here to go and learn something about breastfeeding.
3.No matter what type of birth you have advocate that you want to do skin to skin right after your birth. Do skin to skin as much as you can. With the baby naked and laying right over your breasts. There many many amazing benefits for you and your baby by doing one hour of skin to skin right after birth. Go and see what The Canadian Breastfeeding Foundation has to tell you about this.
4. If you have to be separated from your baby for a medical reason start stimulating your breasts ASAP. Use hand expression to to help stimulate your milk production.
5.Know that there is not just one way to breastfeed. Every breast, nipple, baby is different and there is 101 different pieces of advice out there. Some of it will work for you and some will not. Try to go with the flow and keep the basic principles in focus. A good latch is where it is at!

Breastfeeding can be challenging and it can take patience and dedication and focus. Have you encountered any boobytraps when you breastfed?

Check out some of my past posts about breastfeeding:
Breastfeeding in Public: Six Tips To Help You Feel Totally Awesome
Behind the times: The Breastfeeding Veil In North America
Oh The Mammaries! Tales Of Engorgement During World Breastfeeding Week

Go to my husbands blog and see some amazing black and white photography of babies doing skin to skin after birth in the hospital. He is working on a project with the hospital that promotes skin to skin and breastfeeding. We are a PRO breastfeeding family all around!


Accidental Pharmacist said...

Fantastic advice! We weren't lucky enough to have nurses like you when we delivered and were offered the formula while also being given no support (she was out of room in the NICU). However, I'm grateful that I had had some experience with LLL and had read Jack Newman's book, among other things. Based on this experience, I've been recommending to pregnant moms that they do just what you say - read ahead of time, do your research, get prepared and not just from a 1 hour prenatal class on breastfeeding. Even take your books with you in your hospital bag and have your husband familiarize himself with them. So important. It's such a shame that our culture is more intent on making sure you've purchased all you need before baby rather than making sure you know all you need. I'll be passing this post on.

That said, so many nurses and physicians really need to get on board with this and stop offering 'booby traps'. There's no excuse for a nurse telling someone to go back to bed and not feed a baby because rest is more important, but it happens way too often. This goes for breastfeeding 'friendly' and 'unfriendly' hospitals alike. Kudos to you for making an effort to fix this.

February 7, 2010 at 1:04 PM  
Hannah said...

Well done! I hate when people paint everyone with the same brush. I am sure there are women who have bad breastfeeding experiences because of people they deal with but they really should not put all their hope for success on that. In life adults need to be responsible for THEIR own success and so I like your advice a lot.

Your list of resources is great and hopefully it empowers at least one woman to take responsibility for her own learning and understanding about the huge topic of breastfeeding.

February 7, 2010 at 1:55 PM  
Kristen said...

How timely for me - My latest arrival arrived 5 weeks early and is currently in the NICU. I'm dedicated to breastfeeding her and we've been working hard at it. The majority of the nurses are very supportive of this (though I have run into the occassional one who wants to give her a bottle over the breast to 'hurry her home') The good news is that she is working through the lack of jaw and muscle development due to her prematurity and is now feeding 63% orally (the rest tube fed) over the 7% she was a week ago.
Thank you for your encouraging post.

February 7, 2010 at 3:35 PM  
Mama in the City said...

Ahh yes. All it really takes it for one nurse to rock the boat and unintentionally not be a breastfeeding supporter. I know that they really are thinking that they are giving their best advice but we both know that isn't the case. Good for you for ignoring that advice and having a breastfeeding plan with your unexpected early delivery!

February 7, 2010 at 4:44 PM  
Mama in the City said...

So true Hannah. There is a fine line between getting the mom to do be 100% responsible for establishing a good relationship and also giving her the needed support and education that she needs. The bottom line is that you will have your best success if you come prepared.

February 7, 2010 at 4:47 PM  
Mama in the City said...

Good news about the 63% oral feeds! What a big difference from the 7%. You can almost see how it is easy to 'sway' someone with bottles of formula when they are in the NICU and under stress. This is a great example of passion for breastfeeding!!

February 7, 2010 at 4:51 PM  
BestforBabes said...

I am so glad you wrote this wonderful post with great information with expecting mothers. I will never forget the L&D nurse that kept encouraging me in the NYC hospital where I gave birth the first time. She cheered me on, and went against protocol to postpone my checkout time until I had seen an excellent lactation consultant. I was the mom who had not prepared for breastfeeding (but I hadn't prepared the nursery either, lol) that you mention above. I am sure no-one thought I would make it, but that nurse did not quit on me! I will always be indebted to her . . . one of the things I am proud of is that I wrote a letter to the hospital commending her for her care and compassion.

Sadly, she and you are in the minority, and it is not intended to make anyone defensive when we refer to some hospitals as "booby traps". This statement is based on a study by the Centers for Disease Control that found that 70% of maternity centers perform poorly on breastfeeding support, scoring an average of 60 out of 100. That is a D. Only 3% of the nations maternity centers are designated Baby Friendly by the Unicef BFHI.

So, how can we change this, so that all mothers who want to breastfeed can achieve their personal breastfeeding goals? We believe that by raising awareness of the booby traps--including negative cultural barriers, employers, physicians, insurers, stores, hospitals and even the breastfeeding movement itself---we can motivate those institutions to change and take some of the pressure off moms who think that they failed or that their bodies failed them when in fact they could have made it with better support. Whether she decides to breastfeed for 2 days, 2 weeks, 2 months, 2 years or not at all, we believe every mother--no matter her level of preparation--deserves to have a positive experience and to feel good about her decision.

Yes, expecting mothers need to be more prepared and to take more responsibility for their breastfeeding success but by the same token we should not expect them to run a marathon in flip-flops. The baby industry makes it so that women get more information about decorating the nursery or which stroller to buy than how to nurse, we need to help them bridge the gap!

I saw Bobbi Phillips, MD do a great presentation on getting her hospital to become Baby-Friendly; there are great resources available. It is not easy and there is often resistance but as a health-care worker who is so supportive of mothers and breastfeeding there is much you can do, and you would be an asset!

February 7, 2010 at 5:32 PM  
Lori Lynn McDonald said...

I had a difficult time with breastfeeding. I had a natural birth in a hospital with nice kind nurses but a baby who just would not latch. I ended up being sent home and still could not properly latch my baby.
I often felt that the nurses giving me advice had a mixed bag of advice to give me and that was confusing. I know that it is true that there is not just one way to breastfeed but like you said, 101 different things. I think what helped me to be successful was my internal drive and constant dedication to making it work.
Once I got home I just kept on perservering and figuring things out. It was hard and challenging and I didn't get a lot of support. Mostly because my friends had not had children and no concept of how difficult breastfeeding could be. Eventually by a few weeks we both got it and 'ta da!' I had a beautiful experience. My advice for new moms would be to not give up, seek help early, listen to different opinions but ultimately form your own educated ones too.
Great post!!

February 7, 2010 at 6:20 PM  
Heather Liddly said...

Great resource list, I agree on that one. My personal opinion is that the hospital system was invented after women had babies and breastfed and is still trying to play catch up on providing care for a natural occurence. I am betting that back in the day when ALL women gave birth at home there were still these "booby traps" and women still had problems but there was no option to get formula.

It is human nature to do this kind of behavior and try to place the blame on someone. It's the hospital! It's society! It's the mother! etc etc. When it comes down to it it is really a mix of reasons that booby traps exist.

It should be commen knowledge that breastfeeding can be difficult and that people will give you bad advice so listen closely! People always have a opinion on topics like this because it is something that many many people do.

February 7, 2010 at 7:31 PM  
Amber said...

I had two hospital births, and they were very different. My first birth was at 34 weeks, and I suffered a post-partum hemorrhage. I was separated from my baby and very physically weak, and I feel that absolutely created 'booby traps'.

I was committed to breastfeeding, and I had educated myself about it during pregnancy. I had NOT, however, educated myself about what to do if I didn't have a healthy, full-term infant. And, in retrospect, even if I had educated myself I'm not sure it would have made much difference. As soon as your baby is in the NICU there will be bottles and pacifiers and many different doctors and nurses all with different opinions.

It is the last bit - the many different professionals one can encounter - that I see as the biggest potential issue in a hospital setting. If someone is in the hospital for 4 days as I was, with a different nurse on each shift, that's at least 8 people. Even those who are well-meaning and knowledgeable can give conflicting information that can be overwhelming to a new mom, ESPECIALLY when things aren't going well. Combine that with the 12 nurses who cared for my daughter over her thankfully brief 6 day stay and it's just a lot of people with a lot of different advice, and pretty normal complications because the infant is preterm.

My second birth, thankfully, was full-term. I was able to do skin-to-skin and I left the hospital within hours of giving birth. I was also more experienced. It's like night and day, when you are able to keep your baby with you and they are mature enough to feed well right off the bat. All the same, I think that there could be improvements made to the way that 'special cases' are handled to reduce obstacles that moms face.

February 7, 2010 at 8:45 PM  
Mama in the City said...

This is such an excellent point Amber. You are so right how everything changes when you have a pre term baby and also the confusion with the mass of health care professionals involved.

I think in cases that are not the 'norm' breastfeeding plans need to be tailor made for each family. It is easier to give advice when you are talking about the term baby and a healthy post partum mother.

When my son was born at 36 weeks I was also a mom with type 1 diabetes and pregnancy induced high blood pressure. There were many interruptions with learning to breastfeed and many challenges because of all of those things. For me these things aren't so much 'booby traps' but just the way things were.

February 7, 2010 at 9:01 PM  
Tired of all nonsense! said...

I think that people expect too much! For goodness sakes! You would think people would be happy to have healthy alive babies. I totally get that breastfeeding is hard. I get that. I get that it requires a lot of different supports but stop the blame game already!

When people don't have their ideal experience they seem to go right to, 'who can I blame?' Of course not everyone does but some do.

Maybe have a pre term baby is obviously not the ideal and you shouldn't put the same expectations on a pre term baby breastfeeding as you can for a term baby. Thinking that way is your own "booby trap".

Breastfeeding has been around forever and pre term babies have not. Not until the advances in medicine paved the way for younger and younger babies to live outside of the womb. If we have issues helping women learn breastfeeding with their healthy term babies it should be expected the multiple issues a preterm would have.

- Jackie

February 8, 2010 at 11:38 AM  
Nat said...

Hi there

Great post Andrea!! As an RN who works alongside Andrea and a mom who is currently still breastfeeding my own baby, I agree with you 100%. In my experience expectations and lack of knowledge when arriving to the hospital play a huge part in occuring booby traps.
I can't even recall the number of times a new mom has asked me for formula in the middle of the night because she is exhausted and the baby is fussing and acting hungry. This would be the same mom who had visitors all day and didn't really follow the advice of limting visitors and the old saying of "sleep when baby sleeps".

I think there is lack of information out there of what the first few days after birth will look like and there is an expectation that baby will come out, latch beautifully, and sleep for 2-3 hours at a time. Breastfeeding for the most part is a HARD job to learn (speaking personally and professionally) but if you enter the hospital with the determination to breastfeed and an understanding of "normals" after delivery, you will have a much higher chance of success. Us nurses really do want everyone to breastfeed and for the majority of us are there to help you get started with this great journey!

February 8, 2010 at 3:27 PM  
Lindsey said...

Andrea, great post...
I think you have brought up a great point, self learning = empowerment. I think this is the take home message of your post. As nurses, we have many roles, one of those roles includes supporting our clients in whatever decisions they make, and I agree with you that preparing for the postpartum period is as equally important as preparing for the nursery (lol) and the labour aspect of pregnancy. I also think that it is important that we as nurses have taken the time to educate ourselves and continue to further our learning on the subject of breastfeeding - we do not want to be teaching bad information! I have noted that we as a group (LDRP Nurses) are generally pro breastfeeding (I have met a few that are not - SHOCKING) and for the most part try to encourage our Mom's to breastfeed due to all the proven benefits, however, I also see the set-up for failure when times are difficult ie: the nurse isn't available to help with a feed, the baby is 'fussy' on day 2 and the thought of formula means an hour or two of sleep, the nurses' and/or patients' lack of education etc. I could go on forever!

Giving women the consistent support they require during this vulnerable time is really important. From a nurses perspective (mine) I feel that at times, extenuating circumstances can be a big factor in why patients may feel unsupported in their immediate postpartum experiences with breastfeeding. The way to combat these 'Booby traps' are to educate yourself and be prepared for this time period so that you as Mom's can feel empowered to make the right decisions for you and your baby. Nat makes a wonderful point that "the majority of us are there to help you get started with this great journey".

February 8, 2010 at 6:09 PM  
Amanda Brown said...

I'm curious what your experience with mothers who have flat nipples has been. My boobs are both plagued by what I affectionately call "Pancake Syndrome" meaning the nipples are basically flat and only stick out a little bit when they're freezing cold. It made latching impossible! And I mean impossible: we swaddled our daughter so tight so her angry arms wouldn't flail about as we tried to mash her face onto my taut-as-a-drum nipple for weeks and it was agonizing for all parties. In the end I pumped for 7 months and began supplementing with formula at the 3 month mark when my supply couldn't keep up with her demand. I am just curious if you've ever seen boobs that simply aren't capable of nursing, because I think I am a strong candidate.

February 9, 2010 at 7:38 PM  
Mama in the City said...

Oh Amanda! Your comment was too funny. Not that I am laughing at your lack of nipple but because your description was so good. The real funny thing is that often when we see a patient with really flat nipples we say, 'Oh man. It's a tricky one. Flat nipples. It's like an orange.'

Flat nipples seem to always be challenging for us. We do see some vigorous babies that magically latch on and nurse away but for the most part we find mum's with flat nipples need much more support.

Generally we would either work with a nipple shield under close watch and would always set them up with the breastfeeding clinic for post partum care. We do have some babies that latch to flat flat nipples but it usually takes more effort and more time with learning to latch. Good for you for pumping! It is really a true dedication because you have the physical work of pumping the milk and then you have to bottle and feed! Triple work really.

It will be interesting to see what happens when baby #3 gets here. Maybe you will be back to the ol' pump or maybe this will be the baby that latches??

February 9, 2010 at 8:03 PM  
Frustrated dad. said...

My wife was never able to breastfeed. She read up in advance, she went to the classes, she took the drugs, hired lactation consultants, pumped till she bled, nada. No matter how bad she felt she kept trying because of all the pressure around her and all the well meaning people making her feel horrible about herself. In the end she was briefly checked in to the hospital for depression. To this day she regrets all the time she put in to trying to breast feed rather than spending it with our son.

People who chose not to or cannot breastfeed (for any reason) are made to feel like failures and unfit parents by so many people in the childcare community. At the end of the day, we must all accept the choices that parents make and be supportive wether or not they are our choices.

February 10, 2010 at 2:07 PM  
Mama in the City said...

I absolutely love that a dad has responded! Thank you!!! Thank you!!!

I also really hear you about supporting people for the choices that they make. It sounds like your wife did everything to try and breastfeed and I am so sorry that she ended up feeling such stress from all of the pressures and just overall difficulties.

You are absolutely right that it is better to have happy healthy parents than have stress from other things, like breastfeeding. I know breastfeeding is not for everyone and for many many different reasons.

I am betting your wife would be totally tickled pink knowing that you wrote a comment on breastfeeding. Awesome!

February 10, 2010 at 2:25 PM  
Ashley said...

Good for you for being pro-breastfeeding! It's probably one of the most important things we can do as mothers for our kids, if our bodies will let us. I planned to breastfeed my kids. While I had reservations like every new mother, I knew that I wanted my girls to have the very best, and the day I decided to conceive them i decided to dedicate my body to them.

I had relatively good births with both of them. We did skin to skin, I had my first daughter latched on shortly there after (with my Mom's help a former LPN/lactation consultant) and stayed on it as much as possible. I followed the rules, I did everything i was told, but I didn't produce milk. By her first weigh in at home, they were threatening to send us back her weight had dropped so much. We subbed formula inbetween feeds, to keep her weight up. I went on domperidone, I took fenugreek and blessed thistle (all together) I went to local breastfeeding clinics every monday and friday. And all i ever had was maybe 1 ounce per feed. Then I heard of an SNS, which helped, and between that and the medication, I breastfed for 6 months. By then I was so exhausted from the whole process, because each feed took 1 hour that I was done.

My second baby they said it would be easier. They said that my milk would come in better because I'd had some the first time. It didn't, I had a 2 year old to take care of and struggle as I may, I made it to 6 weeks.

I'm super pro breastfeeding and I'm happy to hear people promote and support it. I just wish that somewhere in all the information I'd read while pregnant that someone would have told me that I might not get milk. That try as I might it wouldn't happen, and when I had to come to terms with that, I wish they would have said it was ok. I wish that public health and other medical professionals I saw afterwards would have been understanding not condeming. It took a long time to get over the guilt of not being able to give them the "best" and it wasn't until on public health nurse told me that, if you stood 2 20 year old people side by side nobody would know the breastfed one from the formula fed one that I realized, I did my best for my girls and that's what counted.

February 10, 2010 at 7:16 PM  
Anonymous said...

Interesting post! I would just like to throw my experiences in there. I really dont think that it's necessarily one reason that contributes to the "booby trap".

I had a midwife for both my son's births. One was a hospital birth, the other a home birth. My first son born in a hospital was a perfect breastfeeder. He latched right away no problems with milk supply or anything. We never had any problems with thrush or mastisys cracked or sore nipples or anything. I breastfed him for 7 months and it was great!

My second son whom was born at home just this December has had nothing but trouble!! He's had touble latching, has had thrush 4 times, my nipples were bleeding and sore, my milk supply has been less than stellar. It has been HARD!!!! I was so close to giving up, so close but I persevered and finally it has gotten better just this past month.

I think that what threw me the most is that I wasnt prepared for any problems with this baby because the first one was so simple. I felt betrayed by my body for tricking me into thinking that I wouldnt have any problems this time, becuase I've already done it once. I was a pro, or so I thought. Some women cannot breastfeed, no matter how hard or long you try for.

I think that there are many reasons why there are booby traps. One thing like a hospital setting, or having a nurse or whatever won't be the deciding factor. I think that being educated, ready for any outcome and accepting the curveballs will make it easier to make the commitment to breastfeed you baby.

February 16, 2010 at 5:47 PM  

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