Transforming the Modern Breastfeeding Experience

beginning with the first 100 hours after birth

Why does it need to be transformed?

Talk to almost anyone who has initiated breastfeeding recently (according to hospital initiation data, the vast majority of those giving birth do, in fact, initiate breastfeeding in the hospital), and they’ll fill you in. It’s overwhelming, everyone tells them something different about how “worth it” it is, and they encounter conflicting information on a daily basis. That is all on top of the inherent nature of how huge a change it is to go from not having a newborn to having a newborn that you are responsible for 24/7 with essentially very little help from anyone you know plus feeling like you are a different person all of a sudden.

Then talk to any health care provider who works with new babies and their parents in an OB/GYN office, a hospital, a pediatric office, or a well-baby clinic. Ask them something about breastfeeding, and you’ll probably get a different answer from each one; some would be evidence-based and/or very helpful, others might be based on personal experiences or semi-educated guesses about how lactation probably works since formal medical education for health care providers contains minimal information about human lactation.

Breastfeeding in the U.S. today is a confusing scenario even in the best of situations.

It starts very early. Since acquiring knowledge about breastfeeding through a class or course during pregnancy has really fallen out of favor, the reality is that most people have to learn on the job when baby is born. It’s not ideal, but we really have to face up to it and improve how we handle it.

Here’s the magic, though: the earliest hours of lactation are actually a good time to physically experience feeding from the body and milk expression - to really feel how it feels to latch a baby, the rhythmic suckling, the sensations of compressing breast tissue with your hands to get some milk out. The first 100 hours or so are a time of recuperation from labor and birth, a time to get to know your new baby, and a time to hear and internalize some pretty simple messages about babies, breastfeeding, and making milk.

Envision going through those first 100 hours or so with your newborn skin to skin most of the time, telling you when they need to be on the breast, being in comfortable and sustainable positions to facilitate baby latching and staying on for as long as they like, getting rest in a semi-reclined or lying down position even when you’re not asleep, hearing really smart and compassionate nurses, doctors, and hospital staff explaining the things you’ll need to know over the first week or so in simple terms you can remember, making a smooth transition from the hospital or birth center to home where you are able to get settled with baby relatively quickly so you can both recover from traveling, feeling confident about when you need to put baby down somewhere safe so you can take care of your own bodily needs and being able to quickly respond to them as soon as they need you, learning baby’s communication cues and seeing them relax as you respond, feeling the relief when all the things that nurses and doctors are telling you should happen begin to happen.

The first 100 hours is actually a good time for this. It’s a perfect time to simply experience what breastfeeding, latching, and holding baby skin to skin actually feel like. If choosing not to latch baby, it’s a perfect time to experience the rhythm and routine of expressing milk regularly around the clock, feeding baby using a device of your choosing, and holding baby skin to skin.

This doesn’t have to be as difficult as it turns out to be for so many people.

We’ve got to return to trusting breastfeeding.

We’ve got to remember that most babies latch and breastfeed well, and that most babies do not need to have formula in the earliest hours of their life.

We’ve got to remind new parents that babies belong skin to skin instead of wrapped up in layers in a plastic box.

We’ve got to give people the luxury of being able to relax in comfortable positions while breastfeeding.

We’ve got to help people learn to express milk and massage their breasts with their own hands.

We’ve got to remember that the answer to almost any breastfeeding problem is going to involve more breastfeeding.

What I’m saying here is that we’ve got to return to breastfeeding as the default, with the interventions as the outliers that need to be medically justified or chosen by informed lactating parents.

For those opting to exclusively express their milk for their babies, we’ve got to set them up better from the very beginning with the routines, skills, and techniques that will facilitate optimal milk production right from the start with minimal delays or complications.

There are too many people out there invested in old or inaccurate beliefs about breastfeeding who are actively working against it. The falsehoods they convey, their skeptical attitudes and doubting comments are harmful.

One of the most frustrating things is that many of the outcomes that are feared when a baby is exclusively breastfeeding are already being addressed in other ways. A safety net is already in place in hospitals and through early pediatrician and clinic visits to catch low blood sugars in newborns, excessively high bilirubin levels, and early excessive weight loss. Doubting breastfeeding does not need to be part of this equation. In fact, more skin to skin, more breastfeeding, and more human milk are top-line interventions for all of these situations according to all major national and international health organizations’ protocols for managing them.

There are too many health care professionals using vastly outdated information about human lactation or allowing their own personal experiences to dictate what they tell people who are trying to breastfeed and make milk.

We can transform this. We can support people to breastfeed while allowing both new parents and their babies to thrive, and we can demonstrate that breastfeeding works, it is reliable, and it is also fixable if problems arise.

We can change things for the future. We can entrain consistency in communication about and support for lactation in the health workforce and build trust in the process of breastfeeding while fostering a collective ability to facilitate success in the health care world. We can start with The First 100 Hours approach.