Class 4: Breastfeeding and Postpartum

Processes of Breastfeeding

• Doula Training and Mentorship covers breastfeeding and postpartum processes
• Physiological changes include breasts becoming hard a few days after birth, known as engorgement
• Another physiological change may be experiencing a tingling sensation upon letdown
• Emotional/hormonal changes entail prolactin triggering milk production
• Oxytocin triggers milk to eject
• A warm/fuzzy sensation can be present upon letdown
• Individuals can feel relaxed/sleepy, commonly falling asleep while feeding

Milk Production

• Milk is made by the mammary glands
• The hormone prolactin triggers production
• Production begins in the third trimester
• Foremilk is watery and sits on the surface
• Hindmilk is fattier and is stored further back
• Main production factors are nutrition/hydration, stimulation, and rest

Milk Contents

• Breastmilk is over 80% water
• Less than 2% of what the mother consumes gets into the breastmilk
• Breastmilk contains macronutrients, carbohydrates, protein, and fat
• Human breast milk is composed of 86-88% water, 4% fats, 7% carbohydrates, 1% proteins, 0.2% vitamins and minerals, and 0.5-2% prebiotics

Stages of Breastmilk Maturity

• There are three stages of Breastmilk Maturity: Colostrum, Transitional Milk, and Mature Milk
• Colostrum is produced for 3 days postpartum, is dark yellow/gold in color, and is thick in consistency
• Colostrum is difficult to pump and is high in antibodies immunoglobulin, lactoferrin, leukocytes, and epidermal growth factor
• Transitional Milk is produced from day 3-14, and is yellow in color
• Transitional Milk has a milk-like consistency
• Transitional Milk is easier to pump and is nutritionally balanced for the newborn stage
• Mature Milk is produced from week 2 through the end of the breastfeeding journey
• Mature Milk is whiter and creamier
• Mature Milk contains clear foremilk and hindmilk
• Mature Milk is ever-changing depending on the baby's age, health, and nutritional needs

The First Latch

• The first latch should happen during the first hour of life, known as the golden hour
• The latch is ideally initiated by the mother and/or baby
• The mother may experience some discomfort, but it should not hurt
• It can take several attempts to successfully latch
• The First Latch is not an indicator of long-term issues, practice makes perfect

Latching Positions

• There are variety of Common Breastfeeding Positions, including laid-back nursing, cradle hold, cross-cradle hold, football hold and side-lying

Supply & Demand

• During the first 6 weeks, the body will make the amount it is told to make
• Adding in pump sessions in between nursing sessions can increase supply
• During the first 12 weeks, regulation occurs and production will still fluctuate based on the baby's growth
• During the first 12 weeks Milk will contain carbohydrates to keep up with growth spurts and the body will produce more milk during growth spurts
• After 6 months, it is essentially impossible to increase supply
• After 6 months, the baby's consumption has plateaued
• Many experience a dip in supply upon introducing solids
• After 6 months, milk will typically contain more fat

Feeding Schedule

• From 0-1 months, with breast milk you Nurse every 2-3 hours with 8-12 feedings/day
• From 0-1 months, with formula use 2-3 ounces every 3-4 hours with 8-12 feedings/day
• From 1-2 months, with breast milk you Nurse every 2-3 hours with 8-12 feedings/day
• From 1-2 months, with formula use approximately 4 ounces with 6-8 feedings/day
• From 2-4 months, with formula use 4-6 ounces with 5-6 feedings/day
• From 2-4 months, with breast milk you Nurse every 3-4 hours with 6-7 feedings/day
• From 4-6 months, with breast milk you Nurse every 3-4 hours with 6-7 feedings/day
• From 4-6 months, with formula use 4-8 ounces with 5-7 feedings/day

Assessing for Success

• Assessing is done by measuring the number of wet diapers and not poopy ones
• Weigh the baby before and after the feed to determine how much they consumed
• Offer the baby a bottle with a specific amount of milk
• Bottles should not be introduced for at least 6 weeks
• Follow the percentile charts for weight gain based on the baby's gender and age

Debunking Myths

• Common breastfeeding myths include that breastmilk "comes in" and that formula is just as good as breastmilk
• Breastfeeding hurting, not being able to drink alcohol while breastfeeding, and not being able to take medicine while breastfeeding are common misconceptions
• Additionally, the idea that breastfeeding will make breasts sag, that having a freezer full of milk is normal and that pumping isn't breastfeeding are false

Breastfeeding Complications

• Complications can arise from milk gland dysfunction due to surgery and inverted nipples
• Other complications are hormonal issues with production, cracked nipples/painful feeds, and Dysphoric Milk Ejection Reflex (D-MER)
• Other complications can arise from Breastfeeding aversion (hormonal or trauma-based) and Mastitis
• Clients should stay away from all herbs or supplements that are promoted to increase supply until being assessed by a higher-level professional
• Issues should be escalated to a lactation consultant

Pumping

• People typically pump for a number of reasons, including the baby having difficulty latching
• Milk can be stored for later use
• Pumping can be used when the lactating person will be away from the baby for a feed or longer
• Types of breast pumps: Passive (haakaa), Manual (handheld), Electric (powered machine), and Wearable (rechargeable)

Breastmilk Shelf life

• At Room Temperature, breastmilk lasts up to 4 hours
• In the fridge, breastmilk lasts up to 72 hours
• In a regular frezzer, breastmilk lasts up to 6 months
• In deep freezer, breastmilk lasts up to 12 months

Stigma

• WHO recommends that babies be breastfed for at least 2 years
• CDC recommends babies be exclusively breastfed for 6 months
• Many people opt not to breastfeed due to stigma or fear
• Some employers are still not breastfeeding-friendly
• Breastfeeding rates have been increasing since 2010

Benefits of Breastfeeding

• Benefits include increased bonding with the baby
• Protects the baby from infections because the mother's body will produce antibodies
• Helps develop a strong immune system
• Lowers the risk of asthma, obesity, type 1 diabetes, and SIDS
• Lowers the maternal risk of developing breast cancer
• Can help the birthing parent lose weight, but not always and may prevent periods from returning (not always!)

Pediatric Care

• Choose a pediatrician by 36 weeks gestation
• The pediatric care schedule includes visits at 3 days, 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, and yearly
• Pediatricians may be strict about following vaccine schedules and it may be difficult if anti-vax
• Hepatitis B first dose is usually administered at birth
• Its normal to lose weight the first week
• A pediatrician may have the baby return for an extra visit if weight gain is a concern

Common Newborn Considerations

• A common consideration is circumcision, typically done in the first 48 hours
• High bilirubin levels which can cause jaundice is a consideration, and can be cured by sunlight and breastmilk
• Constipation is a common considerations involving GI adjustments
• Colic is a common consideration marked by extreme fussiness, gassiness, and crying
• Umbilical cord can become infected
• Tongue and Lip ties is a common newborn consideration that may need correction

Sleep Schedule

• Considerations regarding sleep include wake windows and how much the baby should sleep
• Circadian rhythm is an important consideration when putting the baby on a sleep schedule
• Another consideration is Sleep specialist/postpartum doula
• Newborn's wake window is 45 to 60 Minutes
• 1 to 2 Month's wake window is 1 to 2 Hours
• 3 to 4 Month's wake window is 75 Minutes to 2.5 Hours
• 5 to 7 Month's wake window is 2 to 4 Hours
• 8 to 10 Month's wake window is 2.5 to 4.5 Hours
• 11 to 14 Month's wake window is 3 to 5 Hours
• 15 to 24 Month's wake window is 4 to 6 Hours

Immediate Postpartum: Social Support

• During the newborn haze for first 2 weeks, every baby needs 3 adults present
• One person needs to care for the baby's needs and wellbeing
• One needs to care for mama/healing, physical & mental wellbeing
• Someone needs to care for the house and other family members
• Should make sure there is a plan for meals, house supplies, adjustment to new family dynamic and introduction of any pets
• Still at risk for complications for the first 6 weeks (preeclampsia)

The Postpartum Stage

• The entire postpartum stage lasts 7 years
• It involves hormonal and Physical/bodily adjustments
• Ongoing therapies and intentional, consistent follow-up care are needed
• Mood and anxiety disorders can develop at any point within the first year postpartum (and sometimes later)
• It is not recommended that the lactacting parent get pregnant again for two years

Next Class

• It is important to consider resources to share with clients in relation to the postpartum period
• Look up tongue tie and lip tie release procedures
• Familiarize yourself with types of breast pumps and how they function
• Research high lipase breastmilk