As I do with all my clients, I sat down with a sweet new client the other day to discuss the challenges she had been facing in the early weeks. It’s essential to me to create a safe space for clients to share their vulnerable feelings within the context of their feeding challenges. Logistics and plans are just one part of lactation support. The feelings and desires behind the challenges are not only important to me from an empathetic standpoint, but it's been my experience that diving into these feelings can aid in a more transformative experience with feeding and beyond.
Early in the consult, this momma shared that she wasn’t bonding much with her baby. She felt that her live-in newborn hired care provider was keeping them separate a lot of the time. This client concluded that many of her feeding challenges were related to this provider’s philosophy and style of interaction. She felt both undermined and intimidated, and her confidence was taking a hit. Of course, this mom only wanted the best for her baby in choosing supportive care for her family. I imagine, too, like most newborn care providers, this person wanted to do her job to the best of her ability using the knowledge she had gained through years of experience. I was sad to hear about this mom’s experience, but glad that I was there to validate her feelings and help her find a voice and a new trajectory.
Over the years, I’ve learned that well-meaning care providers can inadvertently thwart breastfeeding plans under the guise of helping parents get more sleep overnight and longer stretches between feeds in general. Often, these stretches are achieved by topping babies off with bottles after breastfeeds when unnecessary and/or giving large bottles to babies who are having challenges with breastfeeding. New parents rarely know that longer stretches of sleep, while glorious, can significantly impact breastfeeding goals. They’ll often feel that the care provider is the expert and trust that they are offering correct support, requiring no discussion of goals.
Don’t get me wrong! I fully support a family’s desire to have an individual feeding experience, including longer stretches of sleep for some, and will help parents with plans to get there. I simply believe that parents should be empowered to make informed decisions about their feeding choices (and anything else related to their child). When you don’t know what you don’t know, it can be nearly impossible to do so, AND it can set you on a course that can be challenging to correct.
So this brings me to my goal for this post. I want to provide some tips to contemplate when deciding if 24-hour care is right for your family, and if so, what are some considerations when choosing who will be the one sharing the responsibility of care for both you and your baby in the early weeks.
A feeding schedule is often necessary in the first few weeks before a baby gains their birthweight back. In general, babies must eat at least 8 times in 24 hours and with no more than 3 hours from the start of one feed to the next. If a parent desires to do exclusive or mostly-exclusive breastfeeding (incorporating one or two bottles a day), once the baby is back to their birthweight, baby-led feeding is important to help the baby gain weight appropriately, to build and maintain supply, to help baby soothe and bond, and for baby to learn satiety cues from breastfeeding-associated belly fullness. These babies may need to nurse 10 to even 14 times a day, and this is considered within normal limits. If you’ve been in a routine of waking a baby every 3 hours to feed and giving them a set amount in a bottle at these feeds, this can feel especially challenging to you. Sometimes babies will wake even 20 minutes after their last feed, sometimes 3 hours, sometimes they will eat for what seems like 5 hours at a time. This is all normal for breastfeeding babies, but because of the earlier experience of proactively waking babies on a 3-hour schedule, parents may feel that there is something wrong. Babies take varying amounts of breastmilk each time they feed, and the amount of time they spend doesn’t necessarily correlate with the amount they have taken in. As long as they get the total number of ounces they need to grow over 24 hours, we aren’t particularly concerned with how much they get at an individual feed.
Maybe you started out with low milk supply or a baby who is having challenges getting all the milk they need from the breast. It is imperative that the baby gain weight, so of course, offering breastmilk or formula in a bottle, syringe, cup, spoon, tube, etc. is needed to help the baby grow. The baby maybe has been getting the same amount of milk at each feed using these methods. Sometimes, they are getting way more than they need at any particular feed because the hired caregiver has a goal of having the baby fall asleep and stay asleep for a long time. Babies can also get used to the immediate gratification of a bottle. Once the baby is back at birthweight and a parent wants to do more direct breastfeeding, these babies are used to the sensation a possibly over-full stomach provides and/or having the milk flow immediately and constantly, and start to get frustrated with their experiences on the breast.
Care providers can be quick to move in to help when a baby is fussy. Again, it is their job, right?! But what this can do is undermine the parent’s need to learn what their baby needs and to be the one to provide it. Some moms tell me that the care provider gets the baby ready for the feed, brings the baby to mom to feed for 15 minutes per side, and as soon as the baby fusses, the care provider will step in to bottle feed. There is very little time for invaluable skin-to-skin with mom.
Contact naps are ok! Encouraged even. Some parents will be told that they must teach their baby to sleep separately from them as soon as they are Earthside. This couldn’t be further from the truth. For the first 3 months of life outside of the womb, babies have fetal qualities and, as such, require significant closeness with mom for all sorts of cool processes, including optimal latching and milk transfer, and milk generation even when the baby isn’t directly feeding at the moment. Babies may sleep longer when being held as opposed to when placed in a bassinet. It isn’t possible to spoil a baby this young, as they haven’t yet developed the ability to distinguish between cause and effect. They simply have a need, and it is our job to meet it so they can regulate their states.
This is your baby. All new parents need to learn to advocate for their needs along with their child’s in all sorts of situations as they grow. This can be one of the first times that you stretch those muscles. You can let your desires and goals be known and make it into an ongoing conversation between you and your care provider. As mentioned above, blindly relying on their expertise may get you into difficult feeding patterns, but also undermine your confidence, making you question your instincts. I suggest not operating in a vacuum - ask friends, colleagues, family members, your pediatrician, your lactation consultant, etc. to weigh in on things that may feel a little off to you. Answers may help guide your discussions so you and your care provider can live harmoniously while they provide optimized care for your individual kiddo.