In the final article for our four-part Health and Wellness Series, we end with the pinnacle of care providers for Women’s Health: midwives. We spoke with members from the amazing Stony Brook Midwives to learn more.
What are some of the main misconceptions you find women to have when it comes to breastfeeding?
Many women believe they will not be able to go back to work and continue breastfeeding, so they are hesitant to begin the nursing relationship. Another misconception is that breastfeeding will be easy and it will “just come naturally”. Yes, breastfeeding is natural and it can come easily to some women, but the truth is it can be difficult in the beginning to establish supply and adjust to the life of a newborn who needs to nurse frequently.
What would you recommend to be the top things an expectant mom could do to prepare for successfully breastfeeding?
The midwives recommend both the expectant mother and partner read about the benefits of breastfeeding before the baby arrives. Maria Fisher explains, “Research shows that a supportive partner is the single most important factor in a woman’s success with regard to nursing. Research also supports that women who make a commitment to nursing before birth will breastfeed longer because they are less likely to turn to the bottle when encountering a stumbling block.”
Midwife Amy Mia Hall suggests prenatal breastfeeding classes are very helpful and cover topics such as nursing within the first 45-60 minutes of the baby’s life, the benefits of skin-to-skin contact and non-separation. Hall says breastfeeding support groups after discharge are invaluable. “Research shows that supported mothers who receive such assistance are much more like to be breastfeeding at the end of one month versus those not supported with 68% not breastfeeding at the end of the first month.”
Hall further asserts that pregnant women should have their breasts and nipples evaluated prenatally. This would provide a baseline for the pregnant woman and her care provider to know ahead of time if she has flat, inverted, or very large nipples – which may make the first latch attempts difficult.
What specific recommendations would you make to an expectant mom who would like to gain as much support for breastfeeding as possible while she's in the hospital?
Dr. Kocis and her staff recommend women to deliver with a provider and at an institution which is Baby Friendly or at least practices the “Ten Steps to Successful Breastfeeding” as part of their standard of care. These are outlined here:
1. Having a written breastfeeding policy that is communicated to all health care staff.
2. Train all health care staff in the skills needed to implement the policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within the first hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breastmilk, unless medically indicated.
7. Practice non-separation, allowing mothers and infants to remain together 24 hours/day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from hospital or birth center.
What can support people (such as dads, partners, and grandparents) do to best help a breastfeeding or pumping mom?
“Relieve her of other responsibilities like care of other children and household. Allow her to rest as much as possible and offer frequent drinks and nourishment. Remind her of the fact that breastfeeding is the least expensive and healthiest way to feed her baby and that there are risks to not breastfeeding,” shares Dr. Kocis. Her colleague Maria Fisher suggests a key to supporting the nursing mom is to avoid making statements that may undermine her confidence. “If she encounters a breastfeeding challenge, help her find an expert to fix the breastfeeding – rather than give up on the breastfeeding.”
We hear frequently of women stating their milk doesn't come in. Can you share the typical timeline for lactation to begin? How does it differ for vaginal birth vs Caesarian delivery? How does it differ if the mom has an epidural or not?
Dr. Kocis and her team shared a tremendous amount of important information for this key question. Colostrum, or the first milk, is available to the baby at birth and is rich in proteins, calories and protective antibodies. The volume of colostrum is small but is enough to meet baby’s needs right after birth. More milk comes by days 3-5 after a vaginal or a Caesarian birth. The milk volume will then increase continuously over the next 6-7 weeks in response to the baby’s feeding times. Feeding often and at night helps increase the supply. It is best to delay any bottle use or pacifier use until after the baby is at least 3-4 weeks old. The epidural should not impact breastfeeding as long as mom has the opportunity to initiate breastfeeding within the first hour after birth, have skin to skin time with baby and not be separated from baby.
Most women achieve Stage 2 lactogenesis (milk production) by Day 5, according to Maria Fisher. “Factors that affect this are complex and include underlying medical conditions such as thyroid conditions, diabetes, anemia, hypertension, PCOS, or breast surgery.” She goes on to further share that certain conditions could also slow milk production. Such conditions are retained placenta, use of narcotics, use of an epidural, hemorrhage, a sick mother or a sick baby, and antiquated hospital practices that routinely separate mother and baby.”
Hall adds, “Exclusive breastfeeding for at least the first 3-4 weeks is one of the most important factors in establishing an adequate milk supply. Any factor that disrupts exclusive breastfeeding may put mom at risk of decreased milk production over time.” She further asserts that medication from an epidural might cause a delay in the milk production because of fluid boluses which can cause engorgement. The boluses also cause heavier birth weights, and subsequent increased weight loss in the newborn baby, which is very interesting because most hospital pediatricians use weight loss percentages to determine if a baby may need formula to supplement. Hall expresses, “Mothers may feel pressured to give formula simply because her baby was born with the extra fluid…and this may complicate lactation due to both newborn factors and maternal factors.”
We meet many moms who say they felt pressured by hospital staff to give formula. Can you provide specific, concrete ways for moms to help advocate for breast-only while in the hospital?
In New York State (and in many others), maternity care follows a “Breastfeeding Mothers Bill of Rights”. Kocis recommends that moms obtain this document and familiarize themselves with their rights so they can self-advocate. “She can also ask to speak to a lactation consultant before making any decisions about formula which should not be offered unless there is a medical indication to do so and ask that the reason for supplementation be explained to her by a pediatrician and that a medical indication as well as an order for such be placed in her baby’s chart by the pediatrician.”
Many women (and men) feel midwives are only utilized when a woman is pregnant. Can you share some statistics/information about the wonderful services midwives across the US (and globally) are providing to women?
Midwives support women in their health care from puberty through menopause, not just during the childbearing ages. “Midwives are experts in normal health and can offer support to all patients for maintaining health by assisting women with annual health screenings (such as Paps, mammography testing, STD testing).”
“Midwives believe that the woman is a partner in her health care and deserves to have evidence- based information available to help make informed decisions. Midwives listen to women.”
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Stony Brook Midwifery Practice is affiliated with the School of Medicine in the Department of OB/GYN at the State University of New York at Stony Brook. All of the midwives are faculty members in the Department of OB/GYN. To learn more, visit their website at https://medicine.stonybrookmedicine.edu/midwives and if you’re local to the Long Island area, feel free to participate in their wonderful “Meet the Midwives” events held at the University Hospital.
Special thank you to Dr. Christina Kocis, CNM, DNP, Director of Stony Brook Midwifery for her consistent support and encouragement. Chris helped Moms Pump Here co-founder Kim Harrison deliver her first baby eight years ago at Stony Brook.
