August is National Breastfeeding Month, and Daily Nurse sat down with Dr. Susan Crowe, an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health to answer some of the frequently asked questions about supporting moms on their breastfeeding journey.
Dr. Susan Crowe is an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health
How can nurses make breastfeeding/chestfeeding a safer practice?
Nurses are critically important to the safety of the delivery process and postpartum care. They play a pivotal role in assisting with skin-to-skin contact during a cesarean section delivery when the mother is unable to care for her baby. They can also help with skin-to-skin during hospital recovery. In addition, the World Health Organization recommends initiation of lactation one hour after giving birth. Nurses help facilitate this process to ensure it goes smoothly for the mother and child. Nurses can closely monitor vitals and help the newborn breastfeed for the first time, giving families the best start to life during critical hours post-birth.
How do weight loss drugs impact pregnant women and their babies?
Although dietary supplements can help support good health, they may also cause side effects and health problems, which is why the U.S. Food and Drug Administration recommends talking to your healthcare provider about what kind of prenatal vitamins and other supplements you should take.
Depending if the pregnant person needs to be on a weight gain program during pregnancy, it is usually okay for mothers to lose about 1-2 pounds per week postpartum. It’s important to note that this will happen naturally during the weeks after delivery. Even though lactation requires two-to-three times the caloric needs of a pregnancy, many women will find themselves hungry during lactation. If they choose to undergo medical treatment, it is always encouraged to follow the instructions and guidance from their healthcare provider. They can determine what is appropriate based on individual medical history and health condition.
Regarding weight loss drugs like Ozempic or Wegovy, there have not been enough research studies to determine their effectiveness or safety during lactation. As healthcare providers, we think about medication that would have to be absorbed by the newborn to have an impact.
What are the benefits of breastfeeding/ vs. formula feeding?
There are numerous benefits of breastfeeding/chestfeeding for both the infant or toddler and the mother. Babies often see decreased ear infections, lower respiratory infections, and even reduced hospitalization rates. Throughout the years, healthcare providers have seen positive correlations between nutrients in breast milk and a child’s brain development.
There are also health benefits to the lactating individual. For example, for patients with diabetes, I educate them about the limited opportunity that lactation offers as a “vaccine of sorts” against diabetes. It can lower the risk of diabetes when lactation continues to six months and even further reduces the lifetime risk when lactation is extended beyond a year. Lactation also brings about a long-term metabolic effect. Research shows a correlation between lactation and a decrease in breast and ovarian cancers – and the longer the lactation period, the greater the associated benefits. Emerging evidence also shows the potential cardiovascular benefits of lactating.
What diseases can spread through breast milk?
Some infants have rare metabolic diseases, meaning they cannot metabolize human milk (i.e., galactosemia). In these cases, newborns and infants require a special formula. Concerning these diseases, it’s important to screen every newborn for galactosemia (galactose in the blood) and other inherited metabolic diseases, which are, fortunately, very rare.
Pending a conversation with your health care provider, it is generally encouraged for people with infections such as hepatitis B and C to continue breastfeeding. There are excellent vaccines for these diseases, and we do not see an increase in hepatitis C for lactating infants compared with infants that do not lactate. Fortunately, we do not see these as widely transmitted through human milk. However, there are several diseases where recommendations may differ by country or region, and this is an evolving conversation as it relates to people living with HIV who have undetectable viral loads.
Do you have any advice for lactation consultants or clinicians?
My advice to advanced practice providers, nurse practitioners, and midwives is that we continue to talk about lactation. We must discuss it before pregnancy, during pregnancy, during a breast exam, and more. We must look to see if there are particular challenges someone might encounter, and we should prepare to address those challenges accordingly. Those conversations should address why we recommend breastfeeding, including many of the health benefits already discussed. Most importantly, we can use those discussions to reassure mothers and give them the confidence that they can successfully take on the breastfeeding journey. When I ask people if they plan to breastfeed, the most common answer I get is, “I’ll try.” There remains an underlying lack of confidence in the body’s ability to make enough milk, so anything we can do to educate, encourage and support the lactation journey goes a long way.
Why is keeping mothers breastfeeding so important?
I see it from my vantage point and the countless conversations I’ve had with expecting and new mothers that people want to breastfeed. We continue to see high initiation rates. Breastfeeding is a healthy way for pregnancy to transition to the postpartum phase. People are choosing to lactate. The entire healthcare community must ensure that we provide the societal and medical structure to support individuals in this choice.
How can nurses best support moms on their breastfeeding journey?
Nurses help patients postpartum for a much shorter time than they did in the past. Now, nurses are only with individuals 24-48 hours after birth, slightly longer after a cesarean or a delivery with complications. During this time, nurses must take the opportunity to instill confidence and educate mothers on the basics of lactation (and dispel any myths or misconceptions, which is a large part of the task at hand). For example, people come in thinking lactation only happens every three hours. That’s not true. It can be much more frequent. During these times, nurses can help with initial latches when the baby is learning to feed, help families notice the signs their infant is hungry, and show how important frequent lactation is to milk supply.
Additionally, nurses can teach patients about normal lactation volumes and what determines adequate feeding. Initially, normal feeding volumes might be close to a teaspoon, shocking many people. So, setting these expectations is vital.
Anything else to add?
I encourage everyone involved in birthing and postpartum to remember that each individual’s pregnancy journey is unique. Getting “back to normal” after giving birth looks different for everyone, and that doesn’t mean striving for unrealistic weight loss goals one might see on social media, for example. And I am grateful for all the work nurses do to bring attention to lactation and the positive health benefits it can provide both the parent and child.
