The lactation consultant I saw focussed on several issues with respect to me and breastfeeding as a diabetic.
- Babies of women with type one diabetes often spend the first day or two of their lives in the Special Care Nursery, largely separated from their mothers having their blood sugars monitored, as they are prone to hypoglycemia which needs to be treated.
- Babies of women with diabetes are often fed formula from bottles in response to low blood sugars (and sometimes even if their blood sugars are not low). This has some potential to lead to nipple confusion, where the baby gets used to the teat on the bottle and sucking from it rather than the breast.
If the mother isn't able to visit the baby to feed from the breast at each feed (which often happens when babies are in Special Care, especially if the mother has had a caesarean or complication which prevents her visiting her baby to breastfeed) her milk supply may be affected, as the breast makes milk in response to stimulation (sucking).
Breastmilk and it's early form, colostrum, is especially nutritious and protective for babies and a protein in cow's milk (and possibly cow's milk based formula) has been associated (although the link has been called 'weak' and seems controversial) with an increased likelihood of developing type 1 diabetes. Therefore some people may have concerns (as I did) about their baby being fed formula unless it was seriously required.
This separation of mothers from babies may mean that there is less opportunity for bonding and skin to skin contact which can have some influence on establishing breastfeeding. Even more importantly, unless the breast is stimulated regularly eg by sucking or expressing, in these early hours and days, there may be difficulty establishing a milk supply in ther first place.
The first suggesstion my lactation consultant had was to make sure I got as much opportunity to bond and have skin to skin contact with my baby as possible as soon as possible after the birth.
The lactation consultant gave me heaps of 'instructions' or suggestions :-) to help me establish breastfeeding and get breastmilk to my baby as soon as possible after the birth..
So here's what she recommended:
- Try expressing colostrum (the early, concentrated form of breastmilk) from 2 weeks prior to the birth. When I said the birth could 'take me by suprise' and come early, she said that even if I had 24-48 hours notice, I could get enough colostrum to get my baby started. Sounded fair enough but I left her office with my small syringes for colostrum collection feeling a bit sheepish and ignorant about quite how to go about it!
- Buy some Goat's Milk formula and take it in with me to the hospital so that if formula must be given in Special Care, it would be goat's rather than cow's. She felt that goat's milk produced less allergic responses than cow's milk. ** With my second child, I used Neocate instead of Goat's Milk as I figured Goat's milk protein was probably very similar to cow's milk protein and I was more comfortable using the Neocate as it contained proteins broken down into amino acids. My second child only needed one feed to be topped up with Neocate as I had so much pre-collected colostrum on hand and my milk came in early. This was far from the case with my first child's birth.
The lactation consultant emphasised that when he arrived in the Special Care Nursery (with the paediatrician in tow) my husband should insist that "No Cow's Milk Formula. Has Own Goat's Milk Formula' be clearly written on the baby's chart.
- She suggested I get a 'breastfeeding-friendly' paediatrician and meet with him/her to discuss what would happen with my baby after the birth with them in advance. She also suggested I find out who they use as their stand-ins when they cannot attend the birth and make sure that they, too are 'breastfeeding friendly' and have been advised of my wishes.
- Even more radical, suggested I could have an IV drip of glucose given to my baby instead of formula if it's bsls were low. (I couldn't quite bring myself to do this, but could definitely see the point if formula was indeed linked to an increased chance of developing type one diabetes).
- Try to have some colostrum available before the birth so that my baby could have this rather than formula, should it's blood sugar dip low after the birth
Her advice in the event of a caesarean:
- Bubs are normally 'taken away' fairly quickly to special care. When your baby is handed to you (generally just up around your upper body/ head area as they 'sew you up' down below) let the baby smell you and have some skin to skin contact with you. This is tricky as they are generally very well wrapped. She suggested taking the wrap off my baby's head to enable a bit of skin to skin contact and more of my scent to reach them. (We didn't end up doing this. And I only had a tiny 'hold' but it was wonderful :-).
- Get dad to walk with baby against his bare chest to Special Care, holding baby close so he/she can have "skin on skin" contact with dad.
- As much skin to skin contact with me as possible.
- Start expressing breastmilk (colostrum) as soon as possible every 3 hours and get dad or midwife to take it to baby in special care nursery. ** As this can seem difficult at first, don't hesitate to get the midwives to help you hand express or do it for you. They should be happy to. I soon found that using a hospital grade breast pump was the best. That's what finally helped my milk to come in.
This is the most important one as the breasts produce milk in response to stimulation (sucking). If you didn't feed your baby or express while your baby was in special care I imagine your supply (small as it is to begin with!) could dwindle. Also lovely to give the baby colostrum for health reasons.
- While baby is in the Special Care Nursery, be there as often as possible, talking, touching, singing to your baby. If you can't be there for any reason, get your partner to do this bonding. Ask the staff to bring your baby to you. (this was what they eventually did for me and it was wonderful as being separated from your baby can be quite a traumatic experience no matter how well briefed you are that it could be a possibility).