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I speak with many women around the world who plan to breastfeed, try to breastfeed, and then struggle with breastfeeding until they wean to formula. The most common barrier to successful nursing for these women seems to be a lack of support at critical times.
We've known for years that the strongest predictor of nursing success is good advice and support for breastfeeding moms. Today we have more resources, more knowledge, and more support for breastfeeding than we've had for years. Why isn't it enough?
The problem is simple: babies' needs can't be scheduled.
I've told my nursing mothers, "I want you to call if nursing hurts, I want you to call if you're getting frustrated, and I want you to call if you're even thinking about giving your baby a bottle formula." More often than not, I call them when their baby is a few days old and ask them how nursing is going. If they indicate any problems at all, I go to them—not the following day, not three hours later, but within the hour. I rarely spend more than a half hour with them at their houses. When I sit with them and watch them struggle to nurse, I usually need to only help make a small adjustment, pull a lip here, place a hand there, calm the baby down, calm the mom down. Small things. The baby will latch and the mom will see it can be done. This scenario might happen at eleven in the morning, but just as often it happens at ten at night. If it happens during the day, I call a few hours later and ask how it is going. If it happens at night, I call the next morning. I always get one of two answers: either everything is fine (in which case I will call back the next day just to make sure), or there is still a problem. Sometimes I refer my clients to lactation consultants, other times I simply get back in my car and go sit with them.
We have an extraordinary pool of talent and resources to draw on right now. We have doulas, La Leche League, lactation consultants, midwives, childbirth educators, nurses, and postpartum doulas. We have cellular telephones, pagers, e-mail, and the Internet. We also have a growing foundation of scientific and practical knowledge about breastfeeding.
My dream is that a mother learning to nurse her baby will be able to pick up her phone, call someone knowledgeable, talk about what is going on with her and her baby, and have a "milk angel" sitting on her couch to help her through any crisis within forty-five minutes. It would be a form of triage. This on-call crisis breastfeeding support service would be offered by doulas, experienced moms, and La Leche League leaders. For the majority of women, a half hour of assistance would be all that is necessary, as long as it is provided when it is needed. If that crisis visit does not solve the problem, a visit with a lactation consultant would be scheduled for more-intensive help.
A Milk Angels program would be funded by grants, insurance companies, doctors, and hospitals. It should be part of standard care. Clients could have the option of paying on a sliding scale.
A Model for Ideal Breastfeeding Support
- From the beginning, moms need good help getting the baby latched on.
- When milk comes in, it is important that someone contact moms to make sure they are doing well emotionally and that nursing is going well.
- If nursing is not going well on the second or third day postpartum (when someone checks in with mom via telephone), a milk angel will be sent to observe the mom breastfeed and provide basic assistance.
- Breastfeeding help via phone should be available 24 hours per day. If phone help is not enough, a milk angel should be sent to help mom in her home.
- Lactation consultants will be available for more-intensive help for more-complicated cases.
- Breastfeeding support groups such as La Leche League and peer-support programs should be available for all women who want them.
Positive Messages for New Breastfeeding Moms
- You can do this.
- It gets better.
- Your baby is learning with you. It's no one's fault.
- In the next two days or so it will get much easier.
- It's OK to need help learning to breastfeed.
- When we figure this out, it will probably get better more quickly than you think is possible.
— Excerpted from "Milk Angels," by Jennifer Rosenberg ICCE, CD;
Paths to Becoming a Midwife: Getting an Education, a Midwifery Today book
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