Category Archives: How to have a baby guide

#3 Figure out how you will get help with breastfeeding

Welcome to my birth and postpartum guide, item #3. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

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If you are planning to breastfeed, and you can swing it financially in any way, I STRONGLY recommend finding a lactation consultant in your area who specializes in home visits. I recommend interviewing at least two of them and going with the one that you like best. This does sometimes require scheduling a first home consult for the interview. Arrange for your lactation consultant to be on call and ready to visit you in the day or two after you return home from the hospital to check-in and offer any tips. This will likely be expensive. Insurance companies are required to cover breastfeeding support under the Affordable Care Act, but they often make you jump through a TON of hoops, use their preferred provider (of which there is often only one in a metro area) and may not cover home visits (and you DO NOT want to be traveling ANYWHERE the first two weeks after birth, when you most need lactation support). If you cannot afford one out of pocket, I strongly recommend asking for this as a baby shower gift — even if your friends and family pool together to support the roughly $250 that it might cost to have a prenatal and two postnatal consults in the comfort of your home. If you cannot find a way to have someone visit you at home, then figure out where you will go if you need help before you need it (you will not be thinking clearly in the week after your baby is born). Look for hospitals and practices that specialize in lactation support. Insurance is more likely to cover a visit at a hospital. Alternatively, find a neighborhood support group at a store that specializes in maternity services, which will be less expensive.

Also, once you arrive at the hospital for your birth (if delivering in a hospital), ask about the lactation consultants, and the folks who keep donor breast milk around. The lactation consultants at the hospital are often very helpful. If the hospital has donor milk on hand, definitely scout out options for getting some, if you think your baby is hungrier than you can manage in the days after birth or losing weight too quickly (which is common). Using a bit of supplemental food in the days after birth is unlikely to impact long-term breastfeeding success. And donor milk has the added benefit of conferring a mixed microbiome onto your little babe. 

Also, read everything on McSweeney’s about breastfeeding — it’s everything you need to know 🙂 Good places to start — 

HOW TO LATCH YOUR BABY TO YOUR LEFT BREAST IN A CROSS CRADLE HOLD IN 33 EASY-TO-MASTER STEPS 

TEN MEETINGS WITH LACTATION CONSULTANTS

WELCOME TO BREASTFEEDING CLASS, SURRENDER ALL HOPE

MY BREASTS’ LIST OF GRIEVANCES AGAINST THE BABY

Lastly, remember that millions of women around the world are trying and struggling and failing and succeeding at nursing their little dictators at 3AM too — you are not alone.

#2. Decide where you will have your baby

Welcome to my birth and postpartum guide, item #2. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

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If you plan to birth in a hospital, this will be largely determined by where your provider has hospital privileges. If you live in a metro area, and have a choice between two or more hospitals, I find that Google and Yelp reviews are often the most informative — search for “birth.” 

There are also some more objective hospital quality reporting systems, however, these are often so objective as to be rendered meaningless and rarely show statistically significant differences. 

A Health Affairs article (free access) summarized the state of maternity quality reporting:

“Despite the substantial morbidity associated with childbirth in the United States, there is currently no national system for reporting maternal complications.The number of obstetrical deliveries far exceeds other common causes of hospitalizations for which performance reporting already exists, but the quality of obstetrical care is not systematically reported in the United States. The Joint Commission collects a small number of quality measures, but maternal outcomes are not publicly reported.30

And yet, quality varies dramatically, “Working with a large nationally representative sample of more than 750,000 obstetrical deliveries in 2010, we found substantial differences in rates of major complications in US hospitals. Women delivering vaginally in a low-performing hospital were twice as likely to experience a major complication, and those delivering by cesarean section were nearly five times more likely to experience a major complication, compared to women giving birth in a high-performing hospital.” 

The most widely-available “quality” measure is the rate of c-sections performed in first-time births. However, from the Health Affairs article, “Interestingly, we found that hospitals with higher cesarean delivery rates had lower complication rates for women having either a vaginal or a cesarean delivery, compared to hospitals with lower cesarean rates.” And as a mom who experienced both a 4th degree tear from a vaginal birth and planned c-section, healing from the c-section was a piece of cake compared to the botched vaginal birth. I was pretty much completely recovered from the C-section by 8 weeks postpartum, while I experience ongoing issues from my tear.

Here are a few other places to check:

This USA Today database contains data from a minority of states.

A minority of hospitals nationwide also provide data to Leapfrog, including some helpful maternal quality measures. 

Medicare Hospital Compare has data from all hospitals, but is limited around maternity data. Once you go to their website, you can choose hospitals in your area to compare.

You will also want to consider what makes sense for your baby. If you think you are likely to need NICU services, then find a hospital with a strong NICU offering all of the services you are likely to need. 

Lastly, if you think (or know) you might need a c-section, I strongly recommend finding a hospital that provides family-centered cesareans as policy.

All that said, my last piece of advice (again from VERY limited experience) is that I would be cautious about choosing a “baby friendly” hospital. These practices can be implemented poorly. For example, these hospitals sometimes push breastfeeding so hard as to make it impossible to get supplemental food for your baby, even if you think he is hungry and your milk hasn’t come in. I struggled to get supplemental food for my first child until he had lost 12 percent of his birth weight and was dropping quickly. There are stories of women sneaking in formula to feed their baby at these hospitals, even though formula use in the early days when a mother is also trying to breastfeed her infant does not appear to reduce long-term breastfeeding success

EDIT: Oh look, several smart folks have written about the downfalls of “baby-friendly” hospitals. See “No Nursery, No Formula, No Pacifier Are “baby-friendly” hospitals unfriendly to new mothers?” and “The Failure Of “Baby-Friendly” Initiatives.” An article in the Journal of Pediatrics found that “baby-friendly” hospitals do not increase breastfeeding rates. And a review in Pediatrics noted that some baby-friendly practices have been associated with “near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds.”