Recently our group and clients had the opportunity to speak with Sarah Willis of Tennessee Valley Lactation Support about “How to Prepare for Breastfeeding While Pregnant.” Sarah has been a Registered Nurse for 10 years and specifically an OB nurse for 5 years. She has always had a passion and interest in birth and becoming a lactation educator but it wasn’t until after her 1st birth, which did not go as planned, when she became an IBCLC and shifted roles as an OB nurse. She helps run Mamas, Munchkins, and Milk in Pulaski,TN and was the founder of their support group. She is also a part of Mama Circle in Huntsville, AL.
The knowledge and information she shared was so helpful. We wanted to share with our viewers the questions we asked and her answers to them.
What are some ways NOT to prepare to breastfed?
Be mindful of how you’re preparing. There are resources out there that may seem very informative and helpful. When you look at the source though, it’s not going to have a positive influence in your experience. She said that she is not anti-formula but a lot of these sources with misinformation come from formula companies. She said she remembered getting a bag when she first found out she was pregnant from the OBGYN office and it had several formula samples and then breastfeeding handouts that were sponsored by those big formula companies. Be mindful of where you get information from!
Sometimes family members influence the choice to breastfed too, positive and negative. She shared that in the hospital there were family members that would say breastfeeding would/would not work for you because it did/did not work for me. She said that is not a factor and she always tried to consider their experience and education but gives her patients information for the best start possible.
Also let’s debunk this myth: No need to rub your nipples or ice your nipples!!
So how would you suggest pregnant people to prepare?
La Leche League is a great place to start. Find a local support group and invest in their resources. The Womanly Art of Breastfeeding and Sweet Sleep are great. We’ve linked those below!
If reading is not an option for you, there are some great podcasts including Breastfeeding Outside the Box (covers lots of topics including relactation and breastfeeding when adopting), Badass Breastfeeding Podcast, Born to Be Breastfed.
When looking for a breastfeeding class, take a course from a hospital that is Baby Friendly because one of those goals is to have increasing rates of successful breastfeeding. Madison Hospital is the closest hospital that is Baby Friendly and offers classes.
If this is not available to you, know that breastfeeding takes more than an hour! So when looking for a course look for one that is a few hours long or even several sessions. Online options are available if there are no local in-person classes near you. Look for IBCLC or Lactation Educator lead courses who are paid by large corporations to ensure there are no alternative motives and their goals will align with yours.
Walk us through immediately after the birth and what the Golden Hour is all about.
Babies are born alert and ready to root! Whether you have a medical or unmedicated, vaginal or cesarean birth, the baby is looking for it’s familiar setting. If the baby is removed or disrupted from this environment by overwhelming sounds, smells, and scenery, they could get overstimulated and not want to nurse. The 1st hour, even the 2nd hour, is recommended to utilize skin-to-skin and attempted breastfeeding. For Sarah, she recommends skin-to-skin after birth until a good first breastfeeding instead of a certain time frame.
There are so many benefits to skin-to-skin that Sarah discussed. She says if you’re not busy getting showered, eating, taking care of yourself, do skin-to-skin! She even mentioned the lack of hospital visitors right now due to Covid hospital visitor policies that her patient’s babies have had better breastfeeding success and even have gained weight in the hospital!
What can be expected the first few days after birth?
When you have colostrum, which is very easily digested, they are transitioning the energy that they have received continuously in utero in the womb. 8 times in 24 hours is the minimum for the first few days. Frequent nursing is normal! The more your baby breastfeeds, the better your start!
However, if your baby is falling at the breast frequently, this is a sign that milk is not transferring milk well. This is a sign to have your latch evaluated by a lactation professional.
The first day the baby tends to sleep more. It picks up more each day. At this point is when mother’s like to implement pacifiers or formula because they assume if the baby wants to nurse often something is wrong. The opposite is true; it is likely that the baby is having issues if they’re sleeping more, not waking more.
What are some signs that breastfeeding may not be going well?
Again, sleepy baby is a sign. If they are waking up to nurse but are not able to stay awake at the breast, this is an indication that the milk transfer is not going well. This could be because they are not getting energy from the milk to stay up to nurse. Babies can fall asleep at the breast but that’s after 10-15 minutes of nursing. If this is an issue in the first few days, then Sarah recommends transferring milk through hand expressions and giving it to the baby from a spoon or syringe.
Major weight loss. There are several factors that play into this such as birth method, how long the mother was in labor, medications used, fluids, etc. Generally, we don’t start being concerned until they’ve lost 7%. Sarah says she really evaluates them but doesn’t suggest supplementing until the weight loss is at 10% and she suggests supplementing with mother’s milk.
Pain is another sign that breastfeeding may not be going well. If you think about a water hose, if you pinch the top of it, the water cannot come out as well. It’s the same with breastfeeding. A wide, deep latch is what is needed for a healthy transfer from breast to baby. Soreness can be normal but it should not last longer than 2 weeks and should be getting better each day.
What are some signs that it IS going well?
In the first couple days, you notice your baby is waking every couple hours and staying awake at the breast.
You can hear swallowing when they nurse.
Weight gain is a good indicator. There tends to be a higher expectation than necessary from some pediatricians for breastfed babies so keep that in mind.
After the meconium is passed, 4 stools a day is a good indication. Some babies do pass stools less often though.
A relaxed baby after feeding is good. Some babies are just generally fussier than others but if you are doing skin-to-skin and the baby is still fussy, they could be struggling with a latch issue.
What are some things that are commonly mistaken for breastfeeding issues that aren’t? (Cluster feedings, leaps, comfort)
All of those things! Frequent feedings, cluster feedings, leaps, and comfort feeding are when your baby is needing your milk; not that it is not creating enough. Babies are ever changing and ever developing. They sense when they need more and when they need less. They do not go by clocks and do not know what time it is!
What factors about birth need to be considered before assuming the baby isn’t nursing well? (ie medicated birth, fluids during labor)
These things are factors because they simply affect mom and baby. Another issue we didn’t discuss are narcotics. They can make mom and baby drowsy and off to a slower start.
None of these things means that you should not have these options during your birth, it’s just good to be aware that you and baby may struggle and to expect and prepare for it.
We also discussed blood sugar issues. This can often start if the baby is separated from mom. For example, if the baby is bathed early and then has temperature issues and then needs to be underneath a warmer, they may have their blood sugar drop. This is where supplementation may be started if the parents are not aware and not prepared to hand express or pump. Some of these issues are cascade and Sarah encourages parents just to be aware.
How often are nipple shields truly necessary?
They are a wonderful tool, just like epidurals, and there is a time and place for them. If you are experiencing nipple pain and need a shield, there is an issue with the latch. The shield can help you with the pain but it won’t fix the root of the problem.
However, if you use them for a premature baby, the success rate with breastfeeding actually goes up! They use a lot less energy with shields so this is a great tool for them.
If you continue to use one, just work with a lactation consultant to be sure the issues are working themselves out.
When should pumping be introduced for women needing to go back to work? What about for those who don’t need to go back to work?
If you are having issues with the baby latching or milk transfer, you should be pumping 6 hours after birth.
However, if the baby is nursing well and milk is well established, there is something called the “bottle window” of when is the good time period to introduce the bottle. This is around 3 weeks.
Keep in mind that you really need however much the baby needs the first day. You do not need a freezer full of milk and a big stash. We understand that women may feel more comfortable with more milk but the idea is that you pump while you are away for the next day’s milk. The best time to try and build some extra milk is to pump first thing in the morning.
Thank you, Sarah, for sharing all this information and resources for our clients and the community. Please reach out to us if you ever have needs or concerns related to breastfeeding support!
Sarah offers virtual lactation support through her business:
The Lactation Network can bill their insurance for Sarah’s virtual or in-person visits at up to 3 visits with no costs to them:
Online Breastfeeding Course:
Black Breastfeeding Resources:
Breastfeeding Facebook Support Groups: