Monday, October 25, 2010

My breastfeeding relationships: Hospital vs. Homebirth

Welcome to the October Carnival of Breastfeeding! Don't forget to scroll down to the bottom for links to the other participants' posts.

My older daughter, Suzi, was born in the hospital. My younger daughter, Ivey, was born at home. I definitely have opinions on how each experience affected the breastfeeding relationship, but instead of going through the stories (you can read my hospital story and homebirth story for that) I'd like to offer a point-by-point comparison. I won't try to assign fault to each difference; I'm sure some things made a huge difference and some things, at least directly, did not. It's difficult to know for sure which are which, but let's just say I won't be repeating any of the items from my hospital birth in the future.

1) Hospital: Epidural. Homebirth: A warm tub of water and a whole lot of good hormones. Although I didn't want one, in the hospital I ended up with an epidural. I don't think this helped at all with my breastfeeding experience. Most obstetricians will deny this (mine did), but I truly believe an epidural interrupts natural processes and interferes with a number of things. I shivered. I couldn't feel things I should have felt. However, by the time I opted for the epidural--around 7 cm--I felt I had no other choice. At my homebirth I didn't even think about an epidural (not that I could have had one at home, anyway) because I was so relaxed and things were perfectly under control.

2) Hospital: Baby was placed on my chest for a hot second, then whisked away. Homebirth: Baby was placed on my chest. I held her until I remembered Daddy might want to hold her for a minute, too. I quite honestly forgot about anyone and anything but the baby during this amazing hormone rush. I just fell deeper and deeper in love as I held her and looked into her eyes. Tests and weighing were done a little later, right there in front of us. In the hospital, it was upsetting to have my baby taken way across the room for all the hospital procedures. Things felt incomplete in several ways. I had to twist my head around nearly backward to try to see her, while a mean old nurse tried to squish me to get my placenta out. Again, natural processes being interrupted. Big time.

3) Hospital: Baby was quickly swaddled and had a hat pulled down to just above her eyes. Homebirth: Baby was totally naked, but covered with a towel. When I was pregnant with my first and the lactation consultant (and my friend) at the hospital told me to have skin-to-skin contact with the baby immediately following birth, I thought it was a little weird. This is something you have to specifically request in most hospitals, and I didn't. I thought maybe we'd do it at home later. I figured it was some emotional lovey-dovey thing that I didn't necessarily need. I was wrong. It's hard to objectively explain but, having experienced it both ways, there is a big difference.

4) Hospital: Baby was taken for a bath while I got settled in our room. Homebirth: Baby stayed "dirty" and we got settled in our very own bedroom together. The bath was one of the biggest after-birth mistakes we made in the hospital. Suzi had long, thick hair, and it took a long time to dry after her bath. I had been in the mom-baby room a few minutes when I started to wonder what they were doing with my baby, since they were supposed to bring her right back. Jordan nagged the nurses for over an hour, but they said her hair had to dry so she wouldn't get cold. It was around 3 AM and I had been awake for over 24 hours, but I felt wired and panicky. I should have been nursing my baby. She should have been there in my arms. I am still angry over it to this day! At the homebirth, Ivey was born in the water and our midwife rubbed her with a towel as I held her. She wasn't dirty, and really, you'll never convince me that any newborn baby is "dirty" in the conventional sense of the word. In a way, they are cleaner than they'll ever be again! We just dressed our homebirth baby in a little gown and put the bath on hold for a day or two. I remember saying how good she smelled to me. This bath postponement is totally doable in the hospital, as well. A friend of mine recently had a repeat cesarean after trying for a VBAC. She declined the bath until the next day when she and her husband were able to bathe their baby together. I think this is a beautiful family bonding experience, and it gets the baby into mom's (or dad's) arms or onto the breast faster.

5) Hospital: I was given a nipple shield by a nurse. Homebirth: I was given breastfeeding support and detailed information by the midwife I'd spent the past nine months getting to know. Oh, the nipple shield. Nobody told me to stop using it ASAP because it could lead to nipple confusion. Nobody told me it could hurt my milk supply. The lactation consultant would have told me but Suzi was born while she was on vacation. There is only one part-time LC at our local hospital. Several days after Suzi's birth our pediatrician clued me in to the truth about the nipple shield, and I struggled to wean Suzi from it. I still wonder if the stupid thing did us any good in the first place. The morning after Ivey's homebirth, my midwife was back at our house helping me and the baby get a deeper latch. She knew what had happened during my hospital birth and continued to work with us until things were going well. The lesson I learned? For goodness sake, find yourself a maternity care provider who is devoted to lactation support. One guaranteed visit with a lactation expert during your hospital stay is not too much to ask. No, your nurse doesn't count. She'll be busy with lots of other things besides breastfeeding support and she may or may not be experienced with it, anyway. Some nurses are a great help, but don't bank on it. It was a really sweet nurse who gave me that nipple shield with absolutely no instructions. Visit websites and call around to see what level of support is available at different places. There's a hospital about an hour from here with a lactation center and multiple consultants right there on the mom-baby floor! If you can't get reliable lactation support at a hospital you like, seek out an independent breastfeeding guru. Check on rates and add this into your baby budget. It'll be worth the money.

So what happened? Suzi and I worked things out, but it was a rocky start. We ended up having to supplement--not just because of things that happened in the hospital, but I do think the birth experience contributed. It was so hard on me emotionally. In the end, thanks to the help of the hospital lactation consultant (whom I went back to see and talked with at length over the phone) and some hard work, we had a long and happy nursing relationship. We weaned a few months into my pregnancy with her sister when Suzi was 21 months old. With Ivey I was much wiser in general, knowing which things to do and which things to avoid. With the exception of one or two minor issues, breastfeeding came naturally with her. We never had to worry about weight gain or whether she was getting enough milk. We practiced exclusive ecological breastfeeding for seven or eight months, at which time she started solids. She still nurses quite frequently at 14 months old, and I am currently about four months pregnant. This time we are hoping to try tandem nursing once the baby is born.

I think it's important for pregnant women to know, especially for a first birth, that these and other seemingly irrelevant factors can make a huge difference in giving the breastfeeding relationship the best possible start. More importantly, the mother usually has some degree of control over these things no matter what type of birth she has. Take a good childbirth class, hire a doula, and do your best to avoid interventions in the hospital if you can't have or don't want a homebirth. Insist upon skin-to-skin contact as soon as possible. Decline the bath and anything you don't want and delay everything else until you've had a chance to properly greet your baby. Perhaps most importantly, get professional breastfeeding support even if you have to spend a little extra money for it. I couldn't believe the difference these things made for us!

What made a big difference for you in your breastfeeding experience?

Be sure to check out these posts from the other participants in the Breastfeeding Carnival (links will be added as they become available):

Crib Keeper @ Tales from the Crib: On Not Being Discouraged
Suchada @ Mama Eve: Breastfeeding & Birth
Christina @ Massachusetts Friends of Midwives: Early Intervention Lactation Help
Jenny @ Chronicles of a nursing mom: Birth Experiences and Its Effect on Breastfeeding
Michelle @ Mama Bear: Long, wide shadow of bad births
Sarah @ Reproductive Rites: Fighting for Breastfeeding
Tanya @ Motherwear Blog: The Birth/Breastfeeding Continuum
Kate @ Tumbling Boobs: Nursing after Surrogacy or Adoption


Leslie said...

All great points!! And similar to my own experiences. I did have a doula with me for my hospital birth though, and she gave me so much great advice which really helped about delaying the bath and she actually unwrapped the baby right after they wrapped him so that we could have skin to skin. And she stayed to make sure we got a good start too.

You really have to be on your toes in the hospital to make sure that nothing happens that you don't want. Our home birth was so much more relaxed too, because we weren't on our guard about anything.

Congratulations on your third pregnancy!

Suchada @ Mama Eve said...

Love it Jenny. I've read about the differences from women who have had a hospital birth, and from women who have had a home birth, but not many who have had both and can compare directly. It makes me so excited for a friend who had her first at the hospital (and breastfeeding problems), but is having her second at home this spring. Thank you so much for sharing!!

Sheila said...

I had a hospital birth, and it was quite a bit like yours! I had no idea to unwrap the baby after the nurses swaddled him -- like you, I figured skin-to-skin was something optional. It's not!

I sure hope to have the next one(s) at home. I'm sure breastfeeding would be easier. But, as you point out, there are a lot of things you can do in a hospital birth to prevent the breastfeeding sabotage that tends to happen there.

Anonymous said...

I had two unmedicated, midwife-attended hospital births. But my first happened at 34 weeks, and my daughter was removed to the NICU immediately. My second happened at 39.5 weeks, and we spent our first hours skin-to-skin. No contest - being able to be together made a HUGE difference. That, and having a full-term baby. Although there's nothing I could have done about that, pre-term babies generally have a rougher start with all things, including breastfeeding.

Elita said...

Yes, some excellent advise here, particularly about getting a doula, insisting on skin-to-skin and educating yourself on these seemingly safe practices that can have a real negative impact on breastfeeding!

Heidi said...

My sister-in-law had her first at a hospital and her second on the kitchen floor (unplanned, the baby came quickly) and she loved her second birth. I think that it is totally dependent on the woman. You have to make sure you are doing what you are comfortable with, because everyone is different.