When women learn they are pregnant, the race begins to have everything ready for the new arrival. Expecting mothers always ask what can they do while pregnant to prepare for breastfeeding. Much of breastfeeding is on-the-job training, but proper education as to the norms and expectations is essential. Most importantly, to give themselves the best shot at successfully reaching their breastfeeding goals, new moms must be prepared for childbirth. The birth of a healthy full term baby provides the smoothest transition into successfully breastfeeding. Every healthcare facility is different, with the most variation being hospitals, so it is important to be aware of the various policies. With that in mind, below is a list of pertinent questions to ask on a hospital tour in order to help you reach your breastfeeding goals.
Questions to ask on hospital tour:
1. When should I come to the hospital?
A good question that is easy to answer and gives you an idea of how the hospital operates. Women should not come to the hospital until they are in active labor. By the time a woman is in active labor, most of her labor is over. This may sound daunting, however the longest part of labor is also the easiest part of labor. Women will be at the hospital when things are the most intense. When expecting mothers come to any hospital too soon, it increases the chances for a cesarean section. Compared to a vaginal birth, breastfeeding is far more challenging after a cesarean. Any staff person giving a tour, be it a nurse, educator, or volunteer should be well versed in answering this question. If you are nervous about jumping the gun and coming into the hospital too soon, you can hire an experienced doula that can assist you in early labor and insure you come to the hospital at the appropriate time.
2. What are your policies on formula supplementation?
Anyone giving a tour should be able to give you a thorough answer to this question. Ideally, this would be a standard topic that is normally discussed during the tour.Look out for images of formula on the wall or in the waiting room. This is a red flag. Some hospitals have contact information of formula reps posted at the nurse’s station. This is a huge RED FLAG.
A hospital should only give formula if medically necessary, or if the mother chooses to formula feed. Furthermore, no hospital should give free “samples” of formula to parents upon discharge. Hospitals should pay for their formula just as they pay for diapers, equipment, swaddling blankets, and all other supplies used. There should be no hidden incentive for any facility to promote a product that is not in the best interest of the mother, and baby and formula is no exception.
3. Are your labor and delivery and postpartum nurses trained in breastfeeding?
The answer should be “Yes!” The process of the first breastfeeding session should take place immediately after birth, yet most mothers do not see the lactation consultant until much later. Since mothers and babies should breastfeed within the first hour, it is very important that staff is knowledgeable, willing, and able to assist with the first breastfeeding session.
4. Are you a Baby Friendly facility?
Baby Friendly is a designation created by WHO and UNICEF. This is intended to show that a facility is supportive of breastfeeding. The criteria in order to become Baby Friendly is rigorous, and it can take years for a hospital to accomplish this. It requires training among all staff, as well as implementation of evidenced-based breastfeeding information. There is also an auditing process. If the hospital is Baby Friendly, then you can trust that a number of these issues listed will already be addressed by the facility.
5. Where is your NICU located?
No parent wants their baby to need specialized care from the Neonatal Intensive Care Unit (NICU), but this does happen sometimes. In the evet your baby should need to go, it is good to know its location. When a new mother is building a milk supply, it is important that she stimulate her breast shortly after birth. The best way to do this is through breastfeeding. If a baby is in the NICU, the location and convenience of getting to the NICU to breastfeed and/or pump can make a tremendous difference. This is especially true if a mother has had a cesarean. In the event the baby is not able to breastfeed for some medical reason, it is still preferable to have skin-to-skin contact with the baby, as this also boosts milk supply. Sometimes, parents are responsible for delivering expressed breastmilk to the baby for feeds. It is always preferable to have babies close by.
6. When do you do newborn procedures?
There is a set of routine procedures that occur very soon after a birth. Usually this includes: wiping the baby down to remove the amniotic fluid, a vitamin K shot, weighing the baby, and placing an antibiotic called erythromycin in the baby’s eyes. These procedures can interrupt the initial breastfeeding process. Conversely, they can be delayed to give mother and baby an opportunity to breastfeed. Women and babies who breastfeed the first hour after birth are more likely to be successful breastfeeding long term. This “golden hour” after birth is important and shouldn’t be disrupted unless medically necessary.
7. Can I room in with my baby?
Rooming in with your baby is vitally important for successful breastfeeding. Babies give very subtle hunger cues that easily go undetected by staff working in a baby-filled nursery. Even if a nurse did pick up on early hunger cues, babies escalate very quickly and can be overly frustrated by the time they get back to the mothers room. This may make it far more difficult to latch the baby. Much of breastfeeding is hormonal. Mothers produce milk better, and babies’ breastfeed best, with lots of skin-to-skin contact and no separation. All they know is being inside of you. The further a new baby is away from their mother, the more distressed they can become.
8. Do you offer donor breastmilk?
Many new parents do not realize that donor breastmilk is a medically safer and preferred method of supplementation to formula. This expressed milk comes from carefully screened mothers, and is then pasteurized and prepared for use. It is far less disruptive to a newborn baby’s digestive system. If for some reason a newborn needs supplementation before discharge, donor milk is the next best thing to mother’s own milk.
Additionally, it is always a good idea to take notes when on the hospital tour, and to write down all questions you want to ask. Being informed puts you in the best position to make good decisions to maximize the chances of a good breastfeeding start.