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, new moms must be
prepared for childbirth to have the best shot at successfully reaching their breastfeeding
goals. The birth of a healthy, full-term baby provides the smoothest transition into
Every healthcare facility is different, with the most variation being in hospitals, so it is
important to be aware of the various policies. Typically, I would tell parents to ask these
questions on a hospital tour. Now with COVID, tours aren’t happening. Don’t let that
allow you to be unprepared!
Take advantage of virtual education classes. If they are not held in-person, speak with
somebody in the education department. They should be able to answer all your
questions or refer you to a person who can. With that in mind, below is a list of pertinent
questions to ask your birth facility to help you reach your breastfeeding goals.
Questions to ask your birth facility:
1) When should I come to the hospital?
A good question that is easy to answer. This also 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 only need to 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, nurse or doctor, should be able to give you a thorough answer to this
question. Ideally, this would be a standard topic that is normally discussed with
expecting parents. Look out for images of formula on the wall or in the waiting
room. This is a red flag. Some hospitals have contact information for 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 post-partum nurses trained in
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 event 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 mother’s 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 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.