Postpartum Breastfeeding Support: The Need to Be Available and Timely

One Hour Post-Delivery

“I would like to see lactation please.” My first request when my third baby was born. (That, and a turkey sandwich.) I had struggled with breastfeeding in a multitude of ways for both of my first two kids, but I was determined to give it a try again. I asked for a lactation consult before I had left the delivery floor, and over the next 36 hours I asked repeatedly, to each nurse who came on shift. “The order is in,” they assured me. “You’re on the list.” But the list was long; everyone wanted help with lactation. Apparently, lactation consultants didn’t see mothers during the first 24 hours because the baby might be sleepy and not be on a “feeding schedule” yet, and on nights and weekends there was only one consultant, so mothers being discharged were prioritized. Despite my best efforts to breastfeed, I was quickly sore and frustrated; I gave my hungry baby formula the second night.

One Day Post-Delivery

“Is now a good time?” I startled in the middle of brushing my hair. Her name tag identified her as a lactation consultant, but I was 10 minutes away from being discharged from the hospital. My ride was almost to the parking garage, and I had accepted that I was not going to see anyone for lactation support. “Well, let’s do a quick feed,” she insisted, and in disbelief I agreed while simultaneously already deciding to myself that it wouldn’t help.

“So, this is your third child,” she said. I think it was meant to be kind, a recognition of my previous experience as a mother, but I took it defensively. I tried to explain how I had struggled to breastfeed my first two kids while my newest baby, now perfectly positioned on a cascade of pillows elaborately set up by the consultant, latched perfectly and began breastfeeding. “Great!” she exclaimed, “keep doing what you’re doing!” And she was gone.

One Week Post-Delivery

After arriving home, I tried to breastfeed a handful of times, but it continued to be painful and anxiety inducing. Thanks to pumping and supplementing with formula, my baby was gaining weight back appropriately at his 1-week doctor’s visit. I talked to the pediatrician about my struggles with latching and asked if there was a way to see a lactation consultant through the pediatrician’s office. “There’s no one here today, but you can schedule an appointment next week,” the doctor assured me. The soonest appointment was in 9 days at a location much farther away from where I lived. I cried the entire drive home—frustrated, overwhelmed, and unsure how the next week would go.

The next morning, I wearily tried to feed my baby the single ounce I had pumped overnight. When he refused the bottle yet frantically gave every hungry cue in the book, I tried to syringe it into his mouth and ended up spilling the breast milk everywhere. I laid my head in my hands and, again, I cried, feeling ready to give up on breastfeeding altogether.

Breastfeeding does not come easily to many mothers, and nearly all mothers who try to breastfeed have at least one concern within the first week. ¹ Lactation support can play a huge role in helping a mother who wants to breastfeed. While 84% of mothers initiate breastfeeding, only 27% are exclusively breastfeeding by 6 months. ² The time a mother spends in the hospital post-delivery is a key time for intervention. Lactation support needs to be offered to all mothers immediately upon arrival to the postpartum floor. The American Academy of Pediatrics (AAP) recommends that “a health professional trained in formal assessment of breastfeeding perform and document an assessment of breastfeeding effectiveness … at least once every 8 to 12 hours during the hospitalization of the mother and infant, including once within 8 hours before hospital discharge.” ³ The goal needs to be for mothers to feel confident in trying to breastfeed and ready to handle the inevitable concerns that will arise.

Additionally, having a lactation consultant check in with all mothers at the 1-week newborn appointment would identify those struggling with breastfeeding since being discharged home. Mothers who report breastfeeding concerns in the days immediately post-hospitalization are at an increased risk of stopping breastfeeding. ¹ Unfortunately, the current health care system functions as an “opt-in” service, with most pediatric practices viewing lactation support as a bonus offering as opposed to an essential part of the 1-week well child check. If available at pediatric practices, there is often only one part-time lactation consultant who may work one day a week and requires appointments to be scheduled a week or more in advance. The pediatricians, while often knowledgeable about the benefits of breastfeeding, may or may not be comfortable offering direct breastfeeding guidance and certainly don’t have time to provide true lactation support during a 15-minute appointment. This is another critical opportunity for intervention that is being missed and goes against the AAP guidelines to “incorporate breastfeeding observation into routine care.” ³ Instead, the 1-week newborn appointment should be scheduled for at least 30 minutes and automatically include an in-person check-in with a lactation consultant who, if the mother wishes, is able to observe a feeding in-office and provide direct and immediate lactation support.

My personal breastfeeding story has a positive outcome. Two weeks post-delivery I saw a lactation consultant. It took 45 minutes to get there, but she was kind and patient and made the drive worth it. Again, my baby latched perfectly, but this time she observed the whole feeding and offered specific advice and recommendations. I left with a renewed sense of hope that I could breastfeed, and perhaps most importantly, she connected me to a weekly virtual support group. I often look back and think about how I—a pediatrician—almost gave up on my goal of breastfeeding simply due to a lack of support. It is crucial that the health care system provides better support to mothers who want to breastfeed, starting with having readily available in-person lactation support, both throughout the postpartum hospitalization and at the initial newborn appointment.