design-breastfeeding-preparation-plan

Design Breastfeeding Preparation Plan

Build knowledge, support network, and equipment before delivery to maximize breastfeeding success.

Why This Is Best Practice

Adopted by: WHO, UNICEF, ACOG, AAP — WHO recommends exclusive breastfeeding for 6 months; AAP extended recommendation to 2 years in 2022. Impact: Prenatal breastfeeding education increases breastfeeding initiation rates by 40% and exclusivity at 3 months by 25% (Lumbiganon et al., Cochrane 2016). Early lactation consultant contact reduces early cessation by 30% (Patel & Patel, 2016, JOGNN). Why best: Most breastfeeding failures occur in the first 2 weeks due to latch problems and supply concerns that are preventable with preparation.

Steps

1. Education (weeks 30–36):
   • Attend a prenatal breastfeeding class (hospital, birth center, or virtual)
   • Learn latch basics: baby's mouth wide open, lips flanged, chin and nose close to breast, asymmetric latch (more areola covered below nipple)
   • Understand supply mechanics: supply = demand; early frequent feeds establish supply
2. Lactation consultant (LC) consultation (prenatal):
   • Identify your LC contact before delivery — hospital LC or IBCLC in community
   • Discuss flat/inverted nipples, prior breast surgery, or anticipated challenges
3. Breast pump setup (weeks 32–36):
   • Hospital-grade double electric pump is gold standard for establishing supply
   • Order through insurance (covered in US under ACA); allow 2–4 weeks processing time
   • Confirm correct flange size (most pumps default to 24mm — many women need 21mm or 15mm)
4. Antenatal colostrum harvesting (weeks 36–37 onward if indicated):
   • Collect and freeze colostrum (5–10 min hand expression 2–3×/day)
   • Indicated for: GDM, IUGR, cleft palate, NICU anticipated, supplementation planned
   • Not standard for all — discuss with midwife/OB first; contractions are rare but possible
5. Hospital birth plan line items:
   • Request immediate skin-to-skin (first breastfeed within 1 hour of birth)
   • Request no formula supplementation unless medically indicated
   • Request no pacifiers until breastfeeding established (3–6 weeks)
6. Post-delivery plan: LC visit within 24–48 hours of birth; follow-up at 1 week.

Rules

• Flat/inverted nipples do not preclude breastfeeding — nipple shields and LC guidance overcome most cases.
• Do not start antenatal expressing before 36 weeks without provider guidance — risk of uterine contractions.
• Engorgement in days 2–5 (milk "coming in") is normal — feed frequently and use hand expression to soften before latch.

Examples

GDM patient (30 weeks): Start antenatal colostrum collection at 36 weeks; freeze in labeled 1 mL syringes; bring to hospital for newborn supplementation if needed to stabilize blood glucose. Prior breast reduction: Consult IBCLC at 34 weeks — may have reduced glandular tissue; discuss supplementation plan alongside breastfeeding attempt.

Common Mistakes

• Waiting until after delivery to contact a lactation consultant — first 24 hours with latch problems are critical; LC should be identified prenatal.
• Assuming breastfeeding is "natural so it should be easy" — 44% of women stop in first 2 weeks due to latch pain (CDC 2022); preparation and support prevent most of these.
• Ordering wrong flange size — ill-fitting flange causes pain and reduces output by 20–40%; measure nipple diameter before ordering.

Health Disclaimer: Breastfeeding is influenced by medical, anatomical, and psychosocial factors. Formula feeding is a valid alternative. Support from an International Board Certified Lactation Consultant (IBCLC) is recommended for personalized guidance.