Originally posted March 2012:
When a mom wants to breastfeed I am passionate about helping her achieve that goal whenever possible. My birth and postpartum doula certifications both included training in breastfeeding support, but I took some additional training in managing breastfeeding complications and I hope to later take a course on breastfeeding the compromised infant (which is for premature or babies with any special needs.)
As doulas I think it’s incredibly important that we provide accurate information for moms and that we know when an issue is beyond our scope. We’re fortunate to have several IBCLCs (International Board Certified Lactation Consultants) in our area, and I’m quick to refer to them if any mom needs them!
Many moms simply need some initial information and support to establish a great nursing relationship, but we all have questions at times! For a doula going in to provide breastfeeding support here are some questions I ask based on my trainings. I wanted to record them here to remind me when I go to postpartum or lactation support visits knowing there is a breastfeeding concern:
What factors may be contributing to this challenge?
- prior breastfeeding problems
- prior hormone issues or currently on hormonal birth control (can decrease supply)
- history of or current postpartum depression (can inhibit letdown)*
- perinatal complications
- surgical birth, currently on pain meds (pain inhibits letdown)
- flat or inverted nipples
- previous breast surgeries (can impact supply)
- lack of breast enlargement or variation in appearance (may indicate milk duct issue)
- supplementation with formula or early pacifier use
- mother-baby separation
- lack of nursing support
Questions to ask mom:
- What is your concern?
- Are you in pain? Where?
- When does it hurt?
- What makes it feel better?
- What have you tried so far?
- What do YOU think is going on?
Questions to assess:
- What do baby’s cheeks look like when latched on? (Sunken is bad.)
- Where are baby’s lips and tongue? (Open wide, tongue extended to bottom lip – tongue tie?)
- Any noise when baby is sucking? (Swallowing good, clicking bad.)
- Seal on breast?
- Chin touching breast?
- Good position (belly to belly, head support, back in line?)
- Mouth covers nipple and about inch/aereola?
What should NOT be felt:
- Pain after first few seconds. (Often an issue of improper latch if just the nipple area, but can indicate plugged duct or mastitis if entire breast hurts.)
- Burning. (Can indicate thrush.)
- Soreness after first couple weeks. (There is often pain/tenderness in the first couple weeks as your breasts become accustomed to this new activity and the skin is stretching, but it shouldn’t persist.)
This is a very, very small summary of the information provided in the Breastfeeding Basics Course (which is about 8 hours with exams) and the Managing Breastfeeding Complications Course (which is 4 hours) and my own experience (nursing for 7+ years between my six babies!) So please take what I say with a grain of salt as my breastfeeding training is very limited. I highly encourage you to contact your local resources to gain more breastfeeding training and support!
*Postpartum depression should always be checked as well when a mom is experiencing nursing concerns. Not only can it impact letdown, it can influence how mom is responding to her baby and whether she’s picking up on early hunger cues or not realizing the baby is hungry until the baby is already crying. The baby’s cry can also cause a strong response from the depressed mom, and both may end up overwhelmed from the miscommunication! While assessing nursing concerns we can also be asking questions about how mom & baby are sleeping, how mom feels about her ability to read baby’s cues, and how she perceives the baby’s temperament/behavior – calm, mellow, fussy, demanding, etc?