Keep calm and breastfeed on!

I love breastfeeding! I also love breastfeeding the most when battling the stigmatization and logistical difficulties and still making it happen. I have found that this battle can be especially difficult in urban settings, with adolescents still in high school, with women and babies riding public transportation, with supporting a family and needing to return to work quickly postpartum, with a busy hospital staff focused on the complicated and forgetting the normal, etc. Here are a few ways I've been supporting breastfeeding, recently. I would love to hear your strategies and what has worked in your practice as well! 

Photo courtesy of The Great Letdown. 

I talk about how beautiful birth can be, including when the baby is placed right on the chest for skin-to-skin contact, for warmth, bonding, and breastfeeding initiation. I talk about this during prenatal care, early on and often. I'll reference a woman's recent birth experience and how beautiful it was and how easily the baby started feeding. Especially for adolescents or women who have had difficult birth experiences before, I find that painting a picture of what a positive and normal birth experience can be is transformative in creating a new picture of what she might want, or expect, from her birth.I take breastfeeding continuing education opportunities. Thanks to a recent one of these, I always discuss baby's "Second Night," to encourage especially new, tired moms to keep pushing through during a commonly fussy second night after an easy first one!I think about ways to normalize not only the act of infant feeding, but also consider the assumed terminology around it, including "breastmilk" and "breastfeeding," and its reference to anatomy that is possibly unnecessary.I support a pregnant woman breastfeeding her growing infant, and talk to her about how safe it is to breastfeed during pregnancy, and how the taste of milk might change late in pregnancy and her child might notice and start to wean naturally (or not!).At the 28-30 week visit, I ask everyone three questions: How are you planning to manage contractions during labor? (and here I discuss the benefits of natural labor, and the options for pain relief including walking, massage, hydrotherapy, and the risks/benefits of IV medication and epidural); What are you thinking about breastfeeding? (and this lets me know where she's at so I can direct my support appropriately); and What are you considering for family planning and contraception after the baby? (if the other questions have taken up most of the visit, and she has no idea what she wants to use, here I will give the fantastic Reproductive Health Access Project handout on all of the options and let her know we will discuss them more the next visit). Starting the breastfeeding conversation early on, and then bringing it up for the rest of the visits, lets her know I support it, encourage it, and want her to be thinking about it as much as I do. I encourage her to talk with friends and family members to create her breastfeeding support community, discuss the availability of lactation consultants at the hospital and myself earlier than the two-week visit if needed, and normalizes breastfeeding as part of the pregnancy experience.I hand out resources, like these great ones from ACNM.I talk with nurses, Residents, and Attendings about skin-to-skin contact and its role in breastfeeding.Breast pumps are covered under public aid - I order one for every pregnant woman who doesn't already have one at the 32-34wk visit. Caveat - she can't have had one ordered in the past 5 years, so I tell her to keep it for future use! I do not distribute "breastfeeding support" packs from formula companies.I ask women to return for two postpartum visits. The first, at 2 weeks postpartum, is the best and most important time to screen for postpartum depression, and a prime opportunity to check-in on breastfeeding, and support the pair through any difficulties. The second postpartum visit, at 4 weeks, is the standard visit to check for all other issues, and re-check the same issues of mental health and lactation.I encourage nurses to delay their logistical newborn tasks, or to do them on mom's chest, as much as possible.I talk about how great it is that our hospital is working toward Baby-Friendly status (it's a long way away at the moment, but anything's possible!).I compliment women on breastfeeding in public, and often comment on how beautiful they look while breastfeeding.I hand out this great resource about freezing/storing/using breast milk.For women encouraging others to bond with the baby through feeding time, I encourage them to use pumped or expressed milk rather than formula, which seems to be the default idea.I research milk bank donations for babies born premature.I am working on refining my strategies to support women who believe they have low milk supply (great ideas here), including researching medication options.I support a woman's decision if she has decided to not breastfeed, and discuss how many decisions will be involved in motherhood and that it's important for her to make each one of them for herself and her family, and that I'm proud of her for all that she's doing.I tell women that every breastfeeding pair has their own rhythm, and sometimes it's not easy at the beginning, and that's okay and we'll work through it together.I say, "I love breastfeeding!" multiple times per day.Keep calm and breastfeed on, y'all.Let me know what strategies you have found helpful lately! I'm always looking for better ways!