With my C-section date quickly approaching for Baby #3, I’ve thought a lot about the twins’ birth and my last C-section. While I had a good birth experience, my in-hospital postpartum experience was … difficult. Since giving birth to the twins’, I learned that Kaiser Permanente’s Los Angeles hospital is a designated “baby-friendly” hospital under the Baby-Friendly Hospital Initiative which means they have a lot of policies. I totally understand why the Baby-Friendly Hospital Initiative was started. However, in my opinion, the goals of the initiative, over time, have been replaced with strict black-and-white hospital policies that do not take into account the individual aspects of the mother or the baby (or in my case, babies). And, while these policies might be considered “baby-friendly,” they certainly are not “mother-friendly.” So, given what I know now, I’m definitely going into this birth with a different “birth plan.” I’ve always approached healthcare from a standpoint of “being my own advocate,” but now I know how I need to better advocate for myself. Basically, I have a birth plan for giving birth in a “baby-friendly” hospital.
Note: I made this plan and wrote this post before the current COVID-19 pandemic and will obviously be flexible and open-minded about whatever needs to change in order to comply with any changed hospital policies and whatever I need to do to keep myself and my baby healthy and safe. I’ve written my thoughts on Expecting Without Knowing What to Expect (aka giving birth during the COVID-19 Pandemic) and you can read them here. Currently, my husband is not allowed into the OR with me and I’m still trying to figure out what else might change. However, I figured I would still share my birth plan in case it helps a mama who is preparing her birth plan in the future.
My Birth Plan for Giving Birth in a “Baby-Friendly” Hospital
MY PERSONAL BACKGROUND INFO
In 2018, I gave birth to my twins at Kaiser Permanente’s Los Angeles Medical Center, a WHO-designated “Baby-Friendly” hospital.
Just to make it clear, I absolutely LOVE being a Kaiser Permanente healthcare member. The vast majority of my experiences with Kaiser Permanente have been very positive. The doctors, nurses, and staff are always great! I love my OBGYN and if I make it to my scheduled C-section with Baby #3, she will be delivering him as she did with my twins.
I had a scheduled C-section for the twins’ birth at 38 weeks, and while surgery is not fun, the birthing experience went as well as it could. I didn’t have a specific birth plan set out other than planning to have a C-section and getting my babies out safely at 38 weeks (doctors don’t recommend going past 38 weeks with a twin pregnancy, plus my daughter, Baby B, was breech and I didn’t want to have a vaginal birth for Baby A and then an emergency C-section for Baby B if she didn’t flip, so I elected for a C-section), so really, there wasn’t much room in my so-called “birth plan” for disappointment.
However, my in-hospital postpartum experience was extremely stressful, difficult, and disappointing. You can read My Scheduled C-Section Twin Birth Story here for all the factual details, but I go more into the background info and below. Basically, between the “rooming-in” and the stress and pressure of learning how to breastfeed while the twins’ birth weights were dropping, I wasn’t given any time to rest physically, mentally, or emotionally. I went from a very medicated surgery birth to having two babies and what seemed like an endless parade of doctors and nurses coming in and out of our hospital room.
BACKGROUND INFO ABOUT BFHI
Here’s a little background information about the Baby-Friendly Hospital Initiative (BHFI). The BFHI is guided by the Ten Steps to Successful Breastfeed and in order for a facility to receive and retain the Baby-Friendly designation, the facility must adhere to these ten steps. One of these core tenants is “rooming-in” where mother and baby (or in my case, babies) are kept together for 24-hours a day. Another of the core tenants is “exclusive breastfeeding” in which the ten steps dictate to “[g]ive infants no food or drink other than breast-milk, unless medically indicated.”
On the surface level, these appear to be great policies! Yes, I want my babies with me so I can learn how to care for them along with the help of the nurses. And yes, I was planning to breastfeed. However, in reality, these policies exhausted me, stressed me out, and perhaps added to my inability to successfully breastfeed my babies (I instead exclusively pumped for 5 months.)
MY PREVIOUS ROOMING-IN & SLEEP EXPERIENCE
As for the “Rooming-In” policy, the policy is supposedly in place in order to promote mother-baby bonding and increase successful breastfeeding rates. I get it – the baby is hungry, the baby cries, everyone is right there together, the mother breastfeeds. While the BFHI does not demand that the designated hospital’s baby nursery close down, many hospitals have closed down their nurseries. In fact, I recently asked my OBGYN if the Kaiser Permanente Los Angeles Medical Center still has a baby nursery and she said yes, but it isn’t used.
The reason I asked my OBGYN to confirm the existence of the baby nursery is that during my postpartum stay with the twins, I asked the nurse if she could take the twins to the nursery for a couple of hours during the day so I could take a short nap. I was told no, that there wasn’t a nursery and that the twins were to stay in the room with me the entire time.
All mothers are tired after giving birth. It’s a physically, mentally, and emotionally draining experience. My anesthesiologist stopped by to check on me post-op and he commented that he was shocked I was still awake. He weirdly asked if I drank a lot in the past and had a high tolerance (I mean, c’mon guy, I hadn’t had a drink in 9 months, so no … ) because he had given me a lot of pain medication and he expected me to be asleep based on the medications I had been given.
But I didn’t sleep. I was tired, and I wasn’t getting any rest.
Is a tired mom really the best mom to be caring for and attempting to breastfeed her baby? There were several times during my hospital stay when I was afraid I was going to fall asleep while holding one of my twins and that I might drop them or they might suffocate in a pillow. This fear is not okay. This doesn’t create a conducive breastfeeding experience.
In order to eventually get some sleep after the twins’ birth, the nurse advised us to have the staff give the babies their first baths and then run all their newborn tests at the same time, so that would give me a little time (maybe an hour) to rest. And then during our last night, the nurse recommended a Do Not Disturb notice on our room so staff wouldn’t come into the room in the middle of the night or first thing in the morning to take vitals, etc. Yes, we were still waking up with the babies every few hours, but it wasn’t babies plus doctors, nurses, food orders, janitors, etc. etc. etc.
MY ROOMING-IN & SLEEP PLAN THIS TIME
This time, with Baby #3, I’m already planning to leave the hospital after only 1 night (2 nights tops if there is a medical reason for an additional stay) as opposed to the 3 nights I stayed with the twins. I plan to ask for hospital staff to give him his first bath and run any tests all at the same time in order to give me a moment to rest. I’m also bringing a sound machine with us! I love the sound machine we use the twins’ nursery and I ordered another one to use in our room while the baby is sharing the Master Bedroom with us, so I’ve already put it in the hospital bag to bring it with us and hopefully it will block out any hospital noise.
I also plan to have my husband ask to do some skin-to-skin bonding time IN ANOTHER ROOM (perhaps maybe the hospital’s unused baby nursery for instance) in order to give me a chance to sleep. And I will ask for them to start the discharge process first thing in the morning the next day (because it took us HOURS to get discharged last time.)
MY PREVIOUS BREASTFEEDING EXPERIENCE
Since the mandated rooming-in is supposedly in order to increase successful breast-feeding, I figured I should discuss my previous breastfeeding experience.
I didn’t get to really meet my babies or experience skin-to-skin bonding until an hour and twenty minutes after giving birth. I got to meet my babies for maybe 20 seconds during surgery and then they were taken to recovery.
We were offered the hospital’s lactation consultant the same day as the babies’ births, but she never stopped by our room despite multiple requests, and, eventually, we learned that she had left for the day. It was a Friday and if my memory is correct, the lactation consultants don’t work on weekends. So I was left to figure out how to breastfeed TWO babies, on my own, using only the support of the nursing staff. Yes, all of the maternity ward nurses are also supposedly trained breastfeeding specialists, but they’re not board-certified lactation consultants. They’re there to monitor my health, the babies’ health, and do things like taking out my catheter or make me get out of bed and walk around the hospital floor. Plus, my milk wasn’t coming in and we weren’t getting the babies to latch.
I struggled with breastfeeding. My milk wasn’t coming in. I didn’t have a breast pump. I didn’t know what I was doing. And with two babies born two weeks early, they started losing their birth weight. The nurses and staff seemed really alarmed with their weights, it was very stressful, and eventually, it was “okayed” to give them formula (after my husband and I asked for it.)
I’ll admit, my baby feeding philosophy is “Fed is Best.” I understand the benefits of breastfeeding, I believe that all mothers should be informed about the benefits of breastfeeding, encouraged to breastfeed upon delivery, and instructed on how to breastfeed (because it isn’t that simple), but a one-size-fits-all approach is not “Mother-Friendly.”
In my case, I needed more sleep in order to really attempt to breastfeed. Perhaps my “baby-friendly” hospital (which in 2015 had $21.7 billion in cash reserves) needed to hire lactation consultants to be available on the weekends. A friend of mine who also gave birth in a Kaiser hospital was stressfully encouraged (shamed) to breastfeed even though she had had a breast reduction surgery with nipple reconstruction and was unlikely to ever be able to breastfeed. A one-size-fits-all policy that comes along with stress and shaming is not okay.
While we were in the hospital, I was given a medical-grade breast pump and briefly instructed how to use it. However, no one checked to make sure the breast shields that come with the pump were the right size for me. They weren’t. They were too small. I can’t tell you how many I ordered online until I found the right size. Oh wait, I can, let me check my Amazon history. I ordered 5 different sizes from 26mm, 27mm, 29mm, 30mm, and 36mm. I have photos on my phone of my husband trying to measure my nipple size against a tape measure.
I eventually met with the hospital’s lactation consultant while we were trying to get discharged, and while she was a very nice person, it was a little bit of “too little, too late.” I didn’t work with her on latching, breastfeeding, etc. She pretty much just gave me more “gear” for the breast pump and made me feel guilty for already using formula. My husband had to step in and explain that hospital staff was stressing us out over the babies’ weight loss and my milk wasn’t coming in. Overall, it wasn’t a positive experience with her.
After taking the babies home, I later developed nipple thrush, although I didn’t know this until my 6-week follow-up appointment with my OBGYN. I simply thought my breast pump’s breast shields were rubbing my nipples in a bad way (see the story above). When I broke down crying at my appointment and explained how much my nipples hurt, my OBGYN examined them and told me that she expected thrush. I told her my kids didn’t have oral thrush and she explained that she had nipple thrush with all of her kids even though her kids never developed oral thrush either. That sometimes it’s just the PH balance and hormones of the mom and you develop nipple thrush. I used a topical treatment for a few days and then switched to an oral medication when the topical treatment failed.
MY PLAN THIS TIME
I’m planning to ask my doctor about doing immediate skin-to-skin contact after Baby #3 is born, as long as both the baby and I are healthy. If my husband can stand near my head and hold him so we can do some skin-to-skin contact while my doctor is finishing my surgery, then that’s better than waiting an hour and 20 minutes to do it.
Also, if I had to do it all over again, I would have hired my own lactation consultant to meet us at the hospital the day after the twins’ birth and then meet us again at home a few days later and again a week later. The lactation consultant we did eventually hire was AWESOME and so helpful. I learned a lot from her which I did not learn from the hospital’s lactation consultant.
This time, since I’m not planning on staying in the hospital very long, I’m planning on requesting the hospital’s lactation consultant ASAP and having my own private lactation consultant meet us at our home 2-3 days after birth.
I’m also planning on bringing a Boppy Nursing Pillow to the hospital because I learned (thanks to my private lactation consultant) that the first step to successful breastfeeding is a comfortable mama. We have two Boppy pillows from when the twins were babies, so I’ll be bringing one and then once we get home, I’ll throw the entire pillow in the washing machine and use the other.
Overall, I had a positive birthing experience, but my postpartum hospital experience was difficult and overwhelming. Yes, I understand the reasoning behind the BFHI and I went to the hospital with every intent to breastfeed my babies, but looking back, I truly feel as though hospital policies did not set me up for success and had I known certain things, I would have planned otherwise. Honestly, with my twins’ birth, I left the hospital in tears. Going into this C-Section with Baby #3 as a second-time mom, I’m definitely going into it with a plan and that plan includes advocating more for myself and my baby.