Breastfeeding Support After Delivery with Kelly Emery, IBCLC

Breastfeeding Support Immediately After Delivery with Kelly Emery, RN, MSN, IBCLC. Kristin Revere and Kelly Emery discuss ways to seek support from lactation consultants and postpartum nurses after delivery in the hospital. Kelly also offered tips on how to seek support after you return home. 

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Transcript

Kristin Revere talks with Kelly Emery, IBCLC, about breastfeeding support after delivery.  They discuss ways to seek support from lactation consultants and postpartum nurses after delivery in the hospital.  Kelly also offered tips on how to seek support after you return home. 

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am thrilled to bring back Kelly Emery to the podcast.  Kelly is our breastfeeding educator at Gold Coast and owner of Baby Beloved.  She has so many titles in the breastfeeding space, including the highest level of training, an IBCLC, and a master’s in nursing and so much experience. 

Welcome, Kelly! 

Good morning, Kristin!  How are you? 

Doing well!  So I had asked you to chat with our audience about working with lactation consultants within the hospital after delivery, since you have not only had private practice but have worked in pediatrician offices and have worked in multiple hospitals.  So I’d love for you to share a bit more about your background with our listeners. 

Sure.  I have been doing lactation work for about 31 years, and about 10 of those years, I also was interwoven into hospitals, some of that as a postpartum nurse.  So I’ve done it all: the postpartum nurse role, the lactation consultant role, a lactation educator role.  I’ve taught classes.  Just about everything.  So I have a lot of say on this topic! 

Definitely.  That’s why I thought you would be perfect to address this.  And I find that as we are in prenatals with our birth doula clients, we’re discussing preparation and options and not everyone takes a breastfeeding class, although I feel like they should, or a pumping class if their goal is to exclusively pump.  But they feel like it will just be natural and easy to breastfeed after delivery if that is their goal.  And it isn’t always that way, so I’d love to hear your take on preparation before and how to utilize help, whether you have a doula or not, with the first latch.  In many hospitals, you get moved to a postpartum room and then have support from postpartum nurses.  As you mentioned, you had that role in the past.  And also, if it’s a larger hospital, there are lactation consultants that go room to room and offer support with at least one visit, if not multiple.  

Yes, starting way at the beginning while you’re still pregnant is ideal.  I know a lot of moms don’t do that because – I don’t know why exactly.  Maybe they’re working full time.  Maybe they have expectations that it will go well, and sometimes it does.  I don’t want to discount that at all.  Sometimes you can overthink things, and sometimes it does go well.  But studies have repeatedly shown that those who have taken a breastfeeding class, they have more confidence going in, and they know how to pivot easier if something does go awry.  So in my opinion, and research shows, it is better to take a class.  

And if you can’t take a class, the next thing would be to be around people who are breastfeeding.  So if it’s nothing that you’ve ever really seen in your world, if you’ve never really seen a baby latch or talked at length with someone who’s currently breastfeeding, it can be an eye-opener to see what it’s really like.  So I always encourage moms to take a class and go to a support group or be around other women who are breastfeeding currently and just get curious and ask good questions.  That’s another way to learn and to gain your confidence. 

So that’s where I would start.  And then going into the hospital, I always recommend my clients to take whatever questions you have with you.  Like, you can make a note of any questions that are still remaining, so if you do come across a good lactation consultant or a good postpartum nurse or labor and delivery nurse – you can ask everybody.  It’s about being curious and getting different people’s perspective. 

I’m kind of one who likes to stay off the internet a little too much.  That can be really anxiety provoking for some people and not very helpful.  I think conversation with a human who is not making money off the conversation is usually a better resource. 

And those moms groups often give advice that is not evidence based, and it’s based on personal opinion.  Some of those groups where it’s peer to peer, like Baby Center, for example, and it’s not led by a lactation consultant like yourself…

If things are going great and you’re just going to get out of the house, those are wonderful, to be with other mothers.  But if you have something that’s really painful or worrying you or something’s not right about your lactation journey, try to stay off TikTok as much as you can. 

If pumping is in your future, I usually recommend, especially if you are in a more rural area, take your pump to the hospital with you.  And I recommend that because the flange sizes or the breast shields come in different sizes.  Sometimes the buttons on it are kind of confusing and you don’t know how to use it.  So even if there’s not a lactation consultant at your more rural hospital, I know that there are a ton of nurses there in their childbearing years, and I know that there are some that have pumped at work and breastfed their own babies.  Those postpartum nurses can be a treasure trove of information if you don’t have a lactation consultant.  They’ve been there.  They’ve done that.  And they see – they work with moms all the time in the same boat.  So I would say take your pump, and ideally, request right away, even when you’re in labor – tell your labor and delivery nurse what your plans are, that this is important to you.  You want to do skin to skin.  You want to latch right away.  All the things that you do want, let them know right away.  And then also let them know that you have a lot of questions and that you want to see a lactation consultant as soon as you get back to your postpartum room.  Because then the labor and delivery nurse can get the ball rolling, and she can put in a consult.  Sometimes that lactation consultants are busy and they have a long list of people to get to before you.  So if you want to be able to see someone there, get on the list early.  As soon as you enter the hospital, I would try to get on the list and let it be known that you do want to at least once meet with the lactation consultant, if possible.  

That’s a great idea, and certainly if you are writing out a birth preference sheet or a birth plan, having that on there for the nurses as a reminder.  You may forget to tell your nurse, or maybe you don’t have a doula or other support person to make that request.  But I agree, and sometimes, depending on the hospital, if you deliver on the weekend, there may not be lactation on the weekend, so utilizing, as you mentioned, postpartum nurses or support is also important. 

Yeah, because some of the postpartum nurses and doulas, actually, have actually gone through and done some trainings on lactation support.  So you never know who might be walking into your room.  They might have some extra lactation support.  

I remember when I was a postpartum nurse, our nurse manager would assign me to people who were having breastfeeding issues because they knew that I had the extra IBCLC certifications.  So don’t be shy about advocating for yourself. 

Another thing I don’t want you to be shy about, because this has happened before, is if you’re not clicking with anybody – if you’re not clicking with your nurse, if you’re getting a bad vibe with your lactation consultant, anyone – you do have the right to ask the manager or ask someone else for an assignment change, for whatever reason.  I’m just not clicking, I’m not getting the help I need, or whatever your reason is, and then you can ask for somebody else that you might click with, and that includes a lactation consultant.  It’s your stay at the hospital, and so you want to get the most out of it as you can.  If you’re dreading her walking in, then that’s no good.  That’s no good for your lactation journey.  It’s not good for your mental or emotional state, and you deserve comfortable care where you feel safe. 

And as you mentioned, having questions written down in advance to maximize your time, so depending on the schedule of that lactation consultant, they may only have ten minutes with you, or they may be able to spend more time.  

Yeah, and if they don’t – say it is a weekend or a holiday, or they don’t have lactation there and you don’t feel confident going home – you don’t feel like you got answers – know that the first part of your journey, in the hospital just for a day or two, maybe three if you had a C-section – just know that if things didn't go great in those first three days, whatever happens, it doesn’t define the rest of your breastfeeding journey or your healing journey.  It’s just the beginning.  So some beginnings are smooth and some are rocky; expect a little bit of both, in lactation and in parenthood in general.  And also know that you’re not alone and that there are people out there in the community, not just in the hospital, but there are more people out there who have traveled this path before you, and they can show you the way or help you create your own unique path.  There’s support groups, La Leche League, there’s in-home lactation consultations, there’s office visits that you can come to, there’s telehealth if that’s more comfortable to you.  But you don’t have to do it alone. 

Right.  You mentioned a surgical birth and extended time potentially in the hospital.  Any tips for our listeners who are planning a surgical birth and want to breastfeed and how to maximize that support while in the hospital? 

Absolutely.  Things have come a long way in 30 years.  Again, tell your team before you even go in for your surgery what you’d like to do, and if everything is going smoothly, you would love to do the skin to skin right away, even in the OR room, and having the baby close to you if at all hospital so you can try a first latch as soon as everyone is able.  And that may depend on whatever circumstances you have, but let them know that this is important to you.  And the first latch, you’ll need help because you won’t be able to sit up right away.  You might need some extra help and support with that.  Getting that in place early is critical. 

Right, and that’s why partners attending a breastfeeding class can be so helpful with that first latch again, if someone on the team is not able to help at that time, like a nurse. 

Yeah, again, the studies show over and over again that the biggest part of the factor of whether breastfeeding goes well or not is the partner.  And so if they’re there seeing what a latch is supposed to look like, and they get kind of a sense of what breastfeeding is, they can be hugely helpful, even if she has a spinal headache and she has to lay down, the dad can help or the partner can help with latching in that situation.  It is really, really great if the partner can take the class and see the same thing that the birthing woman is seeing. 

Yes, I agree.  And then what happens if the baby goes to the NICU and your goal is to breastfeed? 

Again, let everybody know, but they will probably bring in – or you can ask for it – a hospital grade pump, like Medela is around here, the Medela symphony pump, to get a really great start on your milk supply.  Because when you’re separated from baby, there’s just trickier parts to this.  It’s not fun when you don’t have a sweet baby in your arms to do this with and get this lactation journey going.  So it turns into making friends with a pump.  So getting the right pump in your room pretty soon after delivery, getting the right breast shield sizes so you’re not in pain when you pump, making sure to advocate for yourself about, “Oh, these look too big.  These look too small.  These are hurting me.  I’m not getting very much milk out.”  Constant conversation with your nurse or your lactation consultant to make it right. 

Those first two weeks are pretty important for establishing milk supply, so if your baby is going to be in the NICU long term, having a really good plan in place for protecting your milk supply until your baby can latch is goal number one.  So they will get you in your postpartum room on a pump and get you on a schedule and go over everything that you need to know about the pump, but then also advocating to come down as soon as you’re able to see the baby and hold the baby.  Even if you’re not latching, putting the baby skin to skin and then pumping right after or pumping while, if you can figure it out – that is huge for your oxytocin level, which is something that helps your milk let down.  So all along that NICU journey, reaching out to someone who is their lactation person or a really good nurse who knows the lay of the land when it comes to pumps and latching. 

Right.  And I have found with my daughter’s NICU stay that it was helpful to let my postpartum nurse know my schedule of going back and forth from the NICU and when I might have open time for a lactation consultant to stop by, and that worked out for me.  Because as you mentioned, I had a lot of questions about the pump.  I wanted to keep up my supply since I wasn’t directly breastfeeding my daughter when she was in the NICU.  And so looking at options of renting a hospital grade pump, which I did from you!  So lots of different support options can be given out at the hospital. 

Yep, and finding that right person who will help you navigate all that, that you don’t have to do it all alone.  

Right.  And then with the journey home, it can be – you have all of that support from nurses, whether you’re a first time mom or a seasoned parent, you can have issues with breastfeeding, like with baby three that you didn't have with baby one.  So it can be overwhelming, and as you mentioned, those critical first weeks in the pumping or breastfeeding journey and needing to understand all of your options from, as you mentioned, support groups like La Leche League or hospital breastfeeding groups or going back to the hospital to see a lactation consultant or the groups like your own at Baby Beloved where you can have in-home or in-office or telehealth conversations with an IBCLC.  

Yeah, it’s all out there.  But sometimes the hardest thing is just picking up the phone and making the call or just putting on your clothes to get out the door.  All of that which you just listed can feel overwhelming.  Getting those phone numbers ahead of time and getting not only the phone numbers, but the addresses.  It seems like a simple thing – oh, I’m just going to look up the address and see where to go – but when you’re going on two hours of sleep, it’s a mountain.  It’s not just a little molehill.  It’s a mountain to make all those arrangements and pack the bag and get everybody out the door to go do those things.  This is again where a partner can be super helpful.  All these numbers can be on the refrigerator ahead of time, and the partner can jump in and say, okay, I’m going to make this appointment for you.  It’s a huge load off of her shoulders if someone else can do that.  Or, make it ahead of time.  I just did a prenatal consult yesterday and she knows when she’s going in because she’s having a scheduled C-section, so we just made the appointment for six days after that.  And then it’s done.  It’s already in her calendar.  She doesn’t have to think about it.  She already knows where to come because she came to my office to do her prenatal consultation, so she knows where to go.  All those little barriers – they seem little, but they’re big at the time when you have a lot on your mind.  Planning ahead is ideal. 

Just like doing a trial run to the hospital.  You could do a trial run to the lactation consultant’s office, to your pediatrician’s office.  When you’re traveling with a newborn…

There’s something about that.  There’s something about like, okay, I don’t know where to park, and what door do I go in?  All of those things are so much easier the second time because you already know.  

Exactly.  And it is challenging to, as you mentioned, make appointments and the overwhelm and the sleep deprivation.  Having a partner’s support, or if you have a doula or family member to help make appointments, keep you on track, even accompany you to appointments, can be helpful.  As postpartum doulas, if a client wants to attend a support group, we can go with them, or to a pediatrician’s office or the grocery store for the first time can be overwhelming.  You might be afraid of a blowout or not having all the supplies you need.  

And there’s so much to carry.  There’s the car seat.  There’s the diaper bag.  There’s your own purse.  And then if they’re coming to my office, they bring their pump sometimes and they bring a breastfeeding pillow.  I mean, I have pillows here, but they don’t know that.  They just bring a lot of stuff.  It’s almost like you need an assistant to help you carry this stuff around. 

Exactly.  So any other tips for our listeners about that early support in the hospital?  We also didn't mention home birthing or birth center experiences. 

Same sort of thing.  Just keep advocating for yourself, or have your partner or doula know what your wishes are, because sometimes you don’t have the strength to advocate for yourself.  So at least you have a team.  It doesn’t have to all land on you.  The partner, they have a stake in how your baby is fed as well, so they can take on part of this job of getting help and lining up help if you are struggling at all.  Or even if your confidence is low and you just want someone to look at the latch and say, is this okay?  Is my baby doing okay?  Sometimes that’s just all you need, and that’s huge.  And then you can just exhale and go on with your day.  But for it not to have to be all on you.  Just let everybody know what’s important to you and how they can help. 

Exactly.  So how can our listeners connect with you, Kelly? 

I’m at Baby Beloved Inc.  And I have an assistant that can help set up any kind of appointment that you want, prenatal or postnatal.  And I’m doing home visits, and then I’m in downtown Grand Rapids in the Masonic Center. 

And as you mentioned, you have not only an assistant, but a team of other lactation consultants?  For our listeners who are located in Michigan, what areas do you cover? 

I have stopped doing home visits recently, but Sarah does.  She goes all the way to Kalamazoo, all the way to Big Rapids.  We’ve done all the way over to the lakeshore, so Muskegon, Spring Lake, Grand Haven – yeah, a pretty big radius.  There is a travel fee associated with that, but we’re accepting most insurances, so you would just have to pay the travel fee. 

That’s a good point.  Not all lactation consultants accept insurance.  Looking into that ahead of time can be helpful, if you think you might want support and want insurance to pay for that.  Finding lactation consultants like yourself who take insurance, or most will take a health savings or flex spending account.  

We can verify the benefits ahead of time, too, if you want to contact us while you’re pregnant. 

Saves a step, for sure. 

Absolutely. 

And then you also teach classes for our listeners who are located outside of Michigan.  They’re virtual options for your pumping class, your breastfeeding class.  Tell us more about that. 

It’s called Breastfeeding: Getting a Strong Start.  And then there’s also Work Pump Balance.  You get a discount if you do both of them together.  Over COVID when I had some extra time, I decided to make an online course.  So it’s a three-hour online course about everything that I’ve learned and done in 30 years.  I love it because it’s not just fluff.  It’s also about troubleshooting.  So if something does go wrong… it kind of sets me apart.  I was looking at other online courses to see what they were about, and what the complaints were, what the reviews were.  And a lot of people were like, okay, well, what if I do get a cracked nipple?  What do I do?  So any kind of pitfall that you come across, the evidence-based protocol for that would be in my course.  I like it.  I’m pretty proud of it.  You can get that online at my website, or through Gold Coast Doulas. 

Well, thank you so much for your time and sharing your wisdom, Kelly.  I appreciate you. 

You’re welcome! 

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