Hospital lactation care
What to expect for lactation care during your hospital stay
Breastfeeding is a skill that must be taught, and at The Lactation Network, we believe we believe that support and knowledge is empowering. Give yourself a leg up by understanding your hospital’s approach to lactation, in addition to common obstacles (or myths) you may encounter once the baby arrives.
We asked International Board Certified Lactation Consultant Katie McGee to walk us through what to expect from lactation care during all stages of your hospital stay:
Structure and service
To start, the structure and services of lactation teams vary greatly from hospital to hospital, which is why it’s very important to be educated on what your hospital provides. There may be a single lactation consultant covering an entire hospital with limited part-time hours, or there may be an entire team with at least one member accessible 24/7. Some prioritize lactation care, some provide access to lactation consultants only when time allows, and others have entire teams dedicated to each area.
IBCLCs have had extensive training to earn the gold standard credential for lactation care. Some IBCLCs are RNs; others are not. The nurses (RNs) who work directly on the labor and delivery or postpartum floor may only know the breastfeeding basics to get you started. Asking what their certifications are or asking to see the staff IBCLC specifically could provide additional support if you feel as though you need more expert care during your time at the hospital. Regardless of who is helping you get started, make sure to communicate your wishes — what may be very important to you may not be as crucial to the next dozen parents.
For example:
“I am planning to exclusively breastfeed, and I am hoping to have my baby skin-to-skin right after delivery if at all possible.” Tell this to everyone as often as you can. It is important for everyone involved in your birth to know your priorities.
Right after delivery
Immediately after delivery, there begins a “golden hour” during which time the newborn is often alert and able to breastfeed. Don’t miss this beautiful opportunity because it is normal for a large portion of the following day or two to be spent asleep — just trying to adjust to life outside the womb and recover from being born.
If breastfeeding does not happen in the delivery room, just keep your baby close, skin to skin whenever possible, and attempt to breastfeed frequently — whenever the baby shows any subtle readiness cues (hands to mouth, going from sleepy to awake, displaying the rooting reflex) that’s the perfect time to breastfeed. During your stay, take advantage of the available lactation care: Get a feeding assessment including close observation, coaching, and feedback prior to your discharge. This expert feedback early and often may make a positive difference in reaching your goals.
What you may or may not hear
“You have flat nipples”
Flat nipples are not uncommon and don’t have to be a hindrance to breastfeeding. Are they everted at all? An IBCLC may be able to assist in compressing your areola and nipple into a shape to ease breastfeeding. If you are concerned about flat nipples, get professional assistance during your stay. An IBCLC will also be able to provide tricks of the trade. Breasts change a lot in the first few days post-birth and you may find your nipples have been transformed after a couple of days of nursing or pumping.
“You’re having trouble with early breastfeeding” or “You need a nipple shield”
Don’t panic. Let your default be holding the baby skin to skin and placing the baby to the breast any time you observe even subtle hunger cues. If breastfeeding has repeatedly been challenging, a nipple shield may be a temporary tool for some specific challenges early on, not for all. Ensure you have tried breastfeeding consistently before introducing the shield, and most importantly, work with an IBCLC while using it. You can find an IBCLC to continue to support you (at home!) after discharge if you are still utilizing a shield at home. For the full-term population of babies, a nipple shield may be a valuable tool to get the baby to go to the breast. However, nipple shields aren’t beneficial in every situation and can come with drawbacks that should be discussed with your IBCLC before introducing. Plus, it’s helpful to evaluate your nipple shield’s efficacy if using it long term. Keep trying and access all the professional help you can prior to starting with the shield. You can say:
“I would like to see an IBCLC first, because I would like to avoid it if possible.”
“I’m not comfortable doing this until I speak to a lactation consultant. Can you please page them right now?”
“Your milk is not in”
A common misconception is that first-time mothers can have a slower onset of large amounts of milk or their milk “coming in.” Actually, colostrum is milk! Milk transitions from colostrum to mature milk over the first week postpartum. First-time mothers or parents (or in some situations due to health conditions or specifics of the birth) may experience a slower transition process from the colostrum to mature milk over that first week. There are many health and delivery-related factors that impact the timing of the transition process. If you find you or your baby are anxiously awaiting the milk to transition from colostrum to mature milk, remember, you have colostrum already, and baby’s stomach size is very small in the early days. The colostrum is available in tiny amounts but packed with immune protection and live cells. Each time your newborn breastfeeds effectively, they will be accessing some colostrum. The colostrum can appear gold, yellow, clear, or very thick and sticky. If you end up hand expressing or pumping, it is important that any colostrum you express or pump is given to the baby.
Blood sugar concerns or Hyperbilirubinemia (Jaundice)
Sometimes the first few days don’t always go exactly as expected. If your baby needs milk faster than they are able to extract on their own during the early days before milk transitions, remember this is a temporary concern, and with adequate stimulation, your milk will transition to mature milk with higher volumes for your baby’s needs. Soon your milk will most likely be available in ounces, not drops. In the meantime, a lactation consultant can get you started with pumping milk with a hospital-grade pump and/or hand-expressing milk. There are many ways to deliver the colostrum to your newborn such as syringe feeding, finger feeding, cup feeding, and bottle feeding.
The baby’s medical team might suggest supplementing with formula. Ask about alternatives first such as hand expressing colostrum, getting an extra hour to try to pump before introducing formula, or if the facility has access to donor milk available for medically indicated cases.
Pumping with a high-quality hospital-grade pump can be a temporary bridge to protect your milk supply until the baby takes over.
Communicating with your medical team
There are many unknowns when it comes to childbirth, from when you might go into labor, to how you will progress. So with all the unknowns, wouldn’t it be nice to enter the hospital with as much information as possible about your lactation care post-delivery?
Speak with a member of your hospital’s lactation team now, before your delivery, and find out:
- Will an IBCLC be available to you throughout your stay?
- Are there certain hours/days of availability?
- Is a visit automatic and if so, how soon after delivery? In other words, are the IBCLC/lactation team members routinely seeing all newly delivered parents or are they only called in for complicated cases?
- Are all locations within the hospital covered by an IBCLC? No one wants to envision the NICU, but if a NICU stay is needed, is there a lactation NICU team or is there any lactation care in the NICU at all?
If you have any questions or would like to speak with an IBCLC, please request an insurance-covered consultation. You don’t have to wait until your baby arrives — most consultations from TLN IBCLCs are done in the comfort of parent homes.
Remember, you can set up a visit with your IBCLC well in advance of coming home after birth. The same way we don’t want to be scrambling to find a dentist if we have a dental emergency, it’s so much more helpful to go home from the hospital already having an established relationship with an IBCLC you trust to reach out to for support. Many families don’t think about this until they’re in the thick of week one with a crying baby (and while running on little sleep)! Since pediatricians or OB-GYNs don’t see birthing parents until six weeks after birth, an IBCLC is uniquely qualified to help with lactation challenges.
We are committed to helping your lactation journey run as smoothly as possible.
We’re here for you, every step of the way. We work with your insurance to provide in-home, in-office, or telehealth visits with an IBCLC.
