Breastfeeding - The Right Hospital & Pediatrician

Excerpted from
The American Academy of Pediatrics New Mother's Guide to Breastfeeding
By The American Academy of Pediatrics, Joan Younger Meek, M.D., Sherill Tippins

The Right Hospital

To ensure a successful start for breastfeeding, choose a breastfeeding-friendly location in which to give birth-a place where mothers are encouraged to stay with their newborns around the clock (called "rooming in") and babies are not offered pacifiers or supplemental feedings that will interfere with their ability to nurse. In recent years many hospitals have become more active in this area as the demand for breastfeeding has increased, but be sure to check.

Tour the hospitals that are available to you and ask your tour guide what the facility's maternity policies are. Does this hospital officially encourage breastfeeding on demand, and are all health staff instructed to implement and support this policy? Are mothers and babies kept together immediately after birth and helped to initiate breastfeeding within the first hour? Are supplemental feedings given only for medical reasons or if the mother has requested otherwise? Are babies allowed to stay in the mother's room full-time? Ask whether the hospital or birthing center maintains one or more lactation specialists on staff and whether the regular nursing staff both supports breastfeeding and spends time helping new mothers learn to nurse. Finally, find out whether they routinely refer new mothers to breastfeeding support groups in the area and other sources of postpartum help. Some hospitals and birthing centers in the United States have been certified as Baby Friendly Hospitals, which means that the hospital has complied with a specified ten-step process of training, education, and support to provide breastfeeding mothers and babies with the best start in breastfeeding. (The Baby Friendly Hospital Initiative, developed internationally by UNICEF, the World Health Organization, and other organizations such as Wellstart International, is administered in (he United States by Baby Friendly USA.)

Your choice of a hospital or birthing center may be limited by geographic location, insurance or HMO coverage, and doctor-hospital affiliations. Inspecting busy hospitals can sometimes be intimidating. Keep in mind, however, that childbirth is a competitive market in this country and your business is wanted. Choose a facility that will help you begin your life with your baby in the way you know is best.

The Right Pediatrician

Another invaluable source of breastfeeding support in the period immediately following childbirth is your child's pediatrician. Since this medical professional may need to make decisions regarding feedings immediately after childbirth, when you may or may not be able to participate depending on your medical condition, it is important to choose the most appropriate person ahead of time and communicate your plans for breastfeeding.

The best way to create a "shortlist" of potential pediatricians is to solicit recommendations from friends with babies or young children, your obstetrician, your hospital or birthing center, and the volunteers at your local La Leche League. Once you've collected several names, interview each candidate, selecting one who inspires your confidence and with whom you feel a certain amount of personal affinity. Be sure he or she is knowledgeable and supportive of breastfeeding practices, aware of any potential problems you have discovered, and willing to support your efforts to nurse from the beginning. You might want to ask the pediatrician the following questions-but be sure to customize this list to suit your own needs.

• What percentage of the infants in your practice are breastfed?

• How soon after birth do you recommend that a mother begin breastfeeding?

• What is your opinion regarding rooming-in for mother and baby?

• How long do you typically recommend exclusive breastfeeding?

• About how long do most of the mothers in your practice breastfeed?

• How will I be able to tell if my breastfed baby is getting enough milk and growing properly?

• Is there an age at which you recommend weaning?

• What are your views on mothers of babies returning to work?

Don't hesitate to ask for time just to talk. Pediatricians understand that it's important for parents to find an appropriate caregiver for their child. Few patient-doctor matches are absolutely perfect, but you should feel a certain amount of personal ease with your child's doctor. In some situations, you may choose a family physician to care for your child, in which case the same selection process would apply.

More Breastfeeding Support

You can secure support from professionals trained specifically in breastfeeding practices before you have your baby as well. These advisers-volunteer breastfeeding consultants, baby nurses, doulas (women who care for the mother during labor, delivery, and after childbirth so she can focus on her baby), and lactation specialists-may be recommended by your obstetrician, made available by your hospital or birthing center, or may even be suggested by other mothers who have benefited from their services.

Lactation specialists come from a variety of backgrounds. Many are nurses with special expertise in mother-baby care. Others are certified IBCLCs (International Board Certified Lactation Consultants) who have completed course work, clinical practice hours, and passed a standardized exam that covers infant feeding, breast anatomy, milk production, management of breastfeeding complications, and stages of infant development. Unlike a nurse or physician, the IBCLC designation alone does not mean a person is licensed by the state to practice in the capacity of a health-care professional, but most IBCLCs do have a great deal of experience working with breastfeeding mothers. It's a good idea to interview a potential lactation specialist before the birth, if possible, to discuss such issues as training, number of nursing mothers assisted, fee structures, references, and the possibility and frequency of postpartum visits to your home or at her office. You might also inquire about backup arrangements in case she is unavailable.

Family Support

Ideally, by your due date you will have formed relationships with a pediatrician, members of your local La Leche League, and/ or WIC office, and perhaps a doula, baby nurse, or lactation specialist. Now is also the time to assemble the family members and friends whom you expect to support you in this new venture. Talk with your baby's father about how he can make it possible for you to focus on the baby during the first vital weeks of breastfeeding. Talk with your older children, if you have any, in a matter-of-fact way about how you will breastfeed this baby and what they might do to help. Welcome offers from other family members to help as long as they understand and support your determination to breastfeed. Well-meaning friends and loved ones believe they are helping when they offer to give the baby a bottle or ignore the baby's demands for a feeding to "let you get some rest." But you will not want or need anyone, no matter how close, to discourage you from getting breastfeeding off to a good start. If you feel this may happen, provide your helper with other activities (washing dishes, doing laundry, changing the baby's diaper, playing with her) that can help you get some rest or ask her to visit a couple of months after the birth, when your nursing routine has been established.