By: Natalie Jarrett, MSN, IBCLC

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So you’ve heard about breastfeeding and you think you want to try it. What now? Throughout this blog, we are going to review some tips and tricks that will help you prepare for breastfeeding in your last couple months of pregnancy.

Get Your Pump and Other Essentials

Even if you are planning on exclusively breastfeeding, go ahead and get your breast pump before your due date. Most insurance companies will cover part, if not all, of the cost of your pump. You can check what pumps are covered directly with your insurance company or online at Acelleron, Edgepark, or Storkpump. You may end up needing your pump sooner than you expect, so having it cleaned, sanitized, and ready-to-go can make the first use a smoother experience. Read through the instruction manual to get a general idea of how to use it, so you will be prepared before you need it.

Buy a few nursing bras and one pumping bra. A nursing bra has a flap on front which opens up, so that you do not have to remove your whole bra to breastfeed. A pumping bra has slots in the front for your pump flanges to fit into to make pumping hands-free. A pumping bra that you can adjust and then take on and off when you need to pump will often be more secure than a nursing/pumping bra combo type bra, since nursing/pumping bra combo type bras do not tend work for all breast types to hold pump flanges snug enough against the breast for maximum pump output. A pumping bra is essential to be able to hands-on pump or multi-task. Some moms find wearing a robe with a nursing bra around the house in the early days is the best way to have quick, hassle-free access to breastfeed.

Plan Ahead

Make freezer meals or have a friend set up a meal train. Put together a nursing cart where you can keep supplies like your pump, snacks, water, burp cloths, nipple cream, such as Lanolin, and even a few special toys you might set aside for an older child to play with while you nurse your new baby. Consider which family members and friends might come over to help with housework or cooking after the baby is born. If you do not have people close by who can support you, consider using a postpartum doula, if this is a financial option for you. Put together a hospital bag with any necessary breastfeeding supplies, such as Lanolin and nursing bras. The hospital should be able to provide you a pump, if this is needed, so you can leave yours at home.

Do Skin-to-Skin Right After Birth

See if you can find out your delivery hospital’s policy on skin-to-skin. If possible, try to do skin-to-skin immediately following your baby’s birth. There are many benefits of skin-to-skin for both mother and baby. For the mother, benefits include less bleeding, lower stress, and an increase in breastfeeding confidence (1). For the baby, immediate skin-to-skin helps provide a sense of calm, regulate temperature, and reduce crying (1). Skin-to-skin also stimulates the hormones needed for breastfeeding and can encourage the baby to feed.

Make a Birth Plan

Having a plan written up that you can give to your providers at the hospital can help get breastfeeding off to a good start. Try to breastfeed your baby for the first time within an hour after birth. Let the staff know you want to do skin-to-skin immediately and ask the staff not to give your baby a pacifier, formula, or sugar water, unless it is medically necessary. If your baby does need supplementation, consider using an alternative feeding method to a bottle, such as a syringe or spoon in order to limit the use of artificial nipples. Have your baby stay in your room around-the-clock, so that you are available to breastfeed on-demand.

Learn How to Hand Express

According to Le Leche League, in order to hand express, you need to “press, compress, release” (2). Start by holding your breast in a C-shape, slightly away from your areola. Then press straight back toward your chest. Next, compress your breast between your thumb and fingers, moving them slightly forward. Release the compression without removing your hand from your breast. Repeat and occasionally move your hand to another spot on your breast. Think about moving around your breast like a clock to ensure you remove milk from all of the milk ducts. You can practice this at home before you have your baby, but be sure to wait until later in your pregnancy, around 37 weeks. If you want more support on this, take our Breastfeeding 101 self-paced, online course or schedule a prenatal lactation appointment.

Managing Expectations

One of the most helpful things you can do to prepare for breastfeeding is to know what to expect in the first few days of your baby's life. Your milk starts out as colostrum, which is thick and nutrient-rich. However, this means it can be difficult to remove and babies may spend up to an hour feeding at the breast at each feed for the first 2-5 days of life while they are working to get this milk out. Regularly feeding this often and long can lead to sensitive or painful nipples. It is fairly common to experience some nipple discomfort in the first week or so of your baby's life, so knowing to expect this can help you be prepared for when it happens. Using nipple creams or oils like olive or coconut oil from the very start can help with some of this discomfort.

It is also important to know that babies will typically cluster feed on the second night of life, as this is nature's way of telling your body you need to continue producing breast milk and for it to start to transition from colostrum to mature milk. People will often refer to this change as your milk "coming in," which often will make feeds quicker, but also typically comes with some discomfort as your breasts swell with milk and become engorged. This usually doesn't last long, but can be painful in the interim, so it is good to be aware of.

During the first few days of life, it is very important to try not to give your baby any supplemental milk, if possible, so the body's natural process of increasing your milk supply is not disrupted. If supplementation is necessary, try to hand express at the time you are trying to feed your baby and give your own colostrum instead whenever possible. This continues to tell your body to increase your milk supply for your baby. Keep in mind that your baby's tummy is very small on the first day of life. On the first day of life, your baby only needs about 5 mL of milk per feeding, which is about the size of a teaspoon. It's important to not offer too much supplemental milk to your baby in this early window, so that their tummy isn't stretched out for future feedings - making it potentially difficult to keep your supply up to their needs. If you need help hand expressing or feeding your baby expressed milk, definitely ask one of the hospital nurses for help right away!

Talk to Your OB-GYN

Tell your OB-GYN you plan to breastfeed and discuss your health history to see if there are any underlying issues that might make breastfeeding difficult. PCOS, thyroid problems, diabetes, and obesity can all play a role in breastfeeding. You can also discuss all your current medications with your OB-GYN and be sure they are all safe in breastfeeding.

Discussing mental health with your OBGYN can also be beneficial. They can help you understand what is normal and what is not in the first few weeks postpartum and who to reach out to for help, if you are concerned about your mental health. If you have a history of anxiety or depression or other mental health concerns, it may be helpful to go ahead and reach out to a therapist who specializes in postpartum mental health, so that you can get established in their care before your baby comes. Taking care of your mental health helps you take care of your baby, because it is hard to care for others when you are struggling yourself. The hormonal shifts that occur after birth can lead to lots of mood shifts as well. Knowing what to watch out for can help you know what to do in the moment, if you are struggling with mental health concerns. Postpartum Support International has a lot of online resources. If you are ever concerned about harming yourself or others, call 911 for your nearest emergency workers or 988 to connect to the suicide and crisis lifeline.

Choose a Lactation Consultant

When finding a lactation consultant, your pediatrician’s office may have a lactation consultant available for you to see or you can find someone in a local private practice. Knowing in advance who you plan to work with if you have any problems can relieve some stress when issues do arise. Many lactation consultants - including us - offer prenatal consults to discuss your health history and give general breastfeeding advice. If your OB-GYN identifies any issues in your health history, a lactation consultant can help you make a plan for how to best feed your baby. If you would like to speak to someone today, you can make an appointment at www.milestonesnutrition.com/lactation.