If breastfeeding is so natural, why do so many women struggle to breastfeed?

By Tania Archbold IBCLC

If you ask a pregnant person prenatally how they intend to feed their babies, about 90% of pregnant people in this area say they intend to breastfeed. They have heard the public health info on the importance of breastfeeding, they have heard the science about the short term and long term risks to the lactating parent and baby of not breastfeeding. They want to do this for themselves and for their babies. But in public health surveys of what happens after birth, it is shown that only about 48% of babies are exclusively breastfed (88% get any breastmilk). What is happening in those critical first few hours after birth to derail these breastfeeding relationships?
So, what happens between pregnancy and when they give birth? The answer is many of the things that are commonly part of birth in our culture today have serious impacts on a parent and baby’s ability to breastfeed.
The first thing is the timing of the baby’s birth. Premature and even late preterm (36 weeks) babies can have a more difficult time initiating breastfeeding than a full term 40 week newborn. Sometimes there are serious health complications with the birthing parent and/or baby. There can be long periods of separation if the baby is in the NICU or hooked up to medical equipment. Sometimes the initiation of breastfeeding is put on the backburner while more pressing medical issues are being dealt with. Sometimes these babies are just a bit more sleepy, tire quicker, and need more coaxing to breastfeed. Skin-to-skin contact (Kangaroo mother care) between lactating parent and baby is critical to help these babies (and all babies) lower their stress levels, maintain their body temp, kick-start their rooting and suckling instincts. Even babies born at 38 weeks can have more difficulties getting feeding on track. This is why it is so important that these lactating parents and babies have access to an experienced IBCLC around the clock. These babies need breastmilk to stay healthy and grow. Pregnant parents and healthcare providers really need to consider all the ramifications of inducing labour before 40 weeks.
The next thing that can interfere with breastfeeding during birth is whether the birthing parent received any IV fluids. After birth, birthing parents who had IV fluids can be quite swollen until those extra fluids pass through their body. This swelling can last for several days. This fluid gathers in the breasts as well. The extra fluid between the cells in the breast can compress the milk making cells (lactocytes) and ductwork and make it difficult for the colostrum to get out to the baby (think of it like pinching a garden hose shut). Pumping will only make things worse by drawing more fluid to the areola. Reverse pressure softening (technique developed by Jean Cotterman) helps move those extra fluids back away from the areola, making it easier for the baby to latch.
Epidurals can also interfere with breastfeeding. Not only will these birthing parents have had IV fluids, some babies find that their rooting and suckling instincts are inhibited by the medication in the epidural. This doesn’t happen with all babies, but it can happen. These babies need lots of skin-to-skin contact to keep them interested in feeding. They may appear sleepy and difficult to wake for feeds.
Health care providers who are uneducated or unsupportive of breastfeeding can make a huge difference in whether a lactating parent and baby can successfully breastfeed in the hours and days after birth. Common things like providing pacifiers, swaddling babies, making negative comments about a lactating parent’s ability to breastfeed all undermine the lactating parent’s confidence and ability to successfully breastfeed. In my opinion any healthcare worker working with lactating parents and babies should be well versed in normal infant behaviour and breastfeeding and should know when they need to refer a parent and baby out for more detailed breastfeeding support from an IBCLC.
Whew! That is a lot to consider in your babies first 24 hours. Your mature milk hasn’t even come in yet!