The Importance of Breastfeeding Initiation After Delivery
Jenny Murray, BSN, RN / June 2020
Every mom who desires to breastfeed should begin her breastfeeding journey in an appropriate manner. Ideally this means that mom and baby begin breastfeeding within the first hour after birth and have repeated skin to skin contact¹. Research shows what happens in the beginning sets mom (and baby up) long term.
"I know this is important, but a mother who has just given birth is exhausted and anxious to show off her newborn. Why should we or would we set this kind of expectation for her?"
There is compelling evidence that shows in order for mom to meet her breastfeeding goals, a lot has to happen in the first few days - beginning in the first few hours after birth. The success of building her milk supply depends on secretory activation or the lactogenesis II phase that focuses upon stimulation and the frequent emptying of the breast¹’². After this onset of lactogenesis, continued milk removal drives more milk production².
"So what does all of this mean?"
Once an infant and placenta are delivered, there is a dramatic decline in progesterone which then inhibits prolactin levels. Prolactin levels increase milk production. Keeping the prolactin levels elevated in the first few days set the foundation for adequate milk volumes. These prolactin levels are elevated by an infant sucking. We know, through research, that this newborn infant sucking behavior enhances the onset of a copious milk supply¹׳³. With the low volume of colostrum, the intermittent sucking pattern of the newborn and increased vacuum levels provided by the infant provide stimulation to the prolactin receptors. If mom is unable to breastfeed or an infant provides inadequate stimulation, it is important to stimulate secretory activation through breast expression by pumping⁴. Medela's Symphony PLUS® with Initiation Technology™ was designed, based on research, to provide this kind of stimulation¹.
"I understand now why it is important, but a mom may feel anxious about this type of breastfeeding work in the beginning. I hear many moms say they will work on it when they get home and into a more comfortable setting."
While the rates of initiation have increased over the years, the rates of exclusive breastfeeding for 3 months and 6 months are dramatically declining. Much of this is attributed to low milk volumes².
In one study by Parker et al, 60% of mothers of very low birth weight (VLBW) infants who initiated pumping within the first hour were still lactating 6 weeks post-delivery, compared to the 20% of mothers who initiated after 6 hours¹.
We have all heard the mom who says she quit breastfeeding because "I didn't have enough milk". Supporting this early stimulation increases moms' chances of building a milk supply that supports her baby and, in turn, gives her the confidence she needs to continue breastfeeding and/or pumping.
"How do we support the mom in those first few hours, days, and weeks?"
It begins with education. All moms want what's best for their baby. We know breast milk is the preferred nutrition for all babies. If a mom chooses to breastfeed, it is important to help her set realistic expectations with supportive care and education. Medela developed a program called The Moms' Room, which was designed to empower moms to reach their breastfeeding goals, help them connect with other moms, and get the support they need. The program starts as early as 6 weeks prenatal and goes through 2 years postnatal.
If a mom's education starts in the hospital, it is imperative that nurses understand the "why" behind the importance of early stimulation and that they are aware of any risk factors that may mean a mom needs to pump. What we do early can affect each mom's breastfeeding success.
All mothers who desire to breastfeed should receive evidence-based care that allows the infant to begin breastfeeding early after delivery and continues to breastfeed frequently. This is not always possible. The most obvious situation would involve a preterm or sick infant who is admitted to the NICU. There are other factors that can contribute to suboptimal lactation or inadequate stimulation¹’⁵. Some risk factors include:
- First time mom
- Mom over the age of 30
- Increased BMI
- Twin gestation
- Late pre-term infant
Case: "A 35-year old, G1P0 mom ws just admitted to L&D. She desires to breastfeed. She will be having a C-section for placenta previa. The baby is 35 weeks. How do I assist her and give her every chance to meet her breastfeeding goals?"
This mom has several of the risk factors we know put her at risk for suboptimal lactation. If the 35-weeker is stable and can attempt to breastfeed, that will be important. It should be followed by pumping with the Symphony PLUS breast pump using the initiation pattern. This will provide mom with crucial stimulation that will allow her to meet her breastfeeding goals. It is critically important to explain to mom the importance of this stimulation. Many do not see long-term. They focus on the here and now, and this sets them up for anxiety, depression, and an overall negative birthing experience because they did not meet their goals. This disappointment can leave lasting scars. When we understand how to help our children, we do what we can to do what is best for them. Armed with supportive education, this will increase moms' chances of meeting their goals while fulfilling what we know is the very best medicine for an infant - mother's own milk.
Parker LA, Sullivan S, Krueger C, Mueller M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med. 2015;10(2):84-91.
Rhodes, J. Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers White Paper. 2017.
Meier, P.P., Engstrom J.L., Janes, J.E., Jegier, R.J., Loera, F. Breast pump suction patterns that mimic the human infant during breast feeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. Journal of Perinatology. 2012; 32(2):102-110.
Rhodes, J. Initiation Support Strategies to Optimize Maternal Milk Volumes. Neonatal Intensive Care. 2017; 30(2):33-36.
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003; 112(3 Pt 1):607-619.
About the Author
Jenny Murray, BSN, RN, began her career 18 years ago as a neonatal nurse in neonatal intensive care. She has since served in a variety of nursing leadership roles within the NICU. Her experience in those roles has driven her love for education and research, especially educating and supporting clinicians in the advancing, innovative world of neonatology. Jenny currently works as a Clinical NICU Specialist for Medela LLC.