Preparing for the Hospital: Advice from a Mother Baby Nurse of 20 Years

Questions are unending when you are preparing for a child. To help bring guidance to our mothers, Nourisher presents a three part series with Kyle Pfahl, a Mother Baby RN, who has over 20 years of experience in delivering babies and caring for mothers. 

Kyle took over Nourisher's Facebook page to answer any and all questions our Nourisher moms might have on the following topics.

Part I: Preparing for the Hospital

Part II: The First Hours Before and After Delivery

Part III: Postpartum Care in The Early Days at Home

Read what our mothers asked during Part I and see Kyle’s responses below.

Preparing for Breastfeeding

Amanda: Is there anything I can do prior to delivery day to make sure my milk comes in on time for the baby?

Kyle: Prior to delivery your breast are naturally undergoing many changes to prepare for feeding your little one. There is no way to speed up your milk prior to the baby being born. However, next Monday we will be discussing what to do immediately after you have the baby to help with milk supply and breastfeeding.

Heather: Should I bring my own breast pump to the hospital to practice with a lactation consultant, or leave at home?

Kyle: It is not necessary to bring your breast pump to the hospital. If you need one during your stay most hospitals are equipped with their own. In normal circumstances it is not recommended to start pumping your breast until three weeks after delivery. You can discuss your situation and any concern you have with the lactation consultant at the hospital. 

Jenny: If I am planning to breastfeed what should I have with me to be prepared and comfortable? And what will nursing be like the first few days?

Kyle: That is a great question that many expecting mothers wonder before they deliver. There are many products that can help you in breastfeeding and although they are not required they can make things easier. First, I would highly recommend some comfortable nursing bras. The sleeping bras are especially comfortable the first few days as you are adjusting to mommy-hood. They make it easy to access your breasts and wear all day. Also nursing tops can provide great coverage for you while feeding especially with family and friends around to see the baby. My number one recommendation would be a nursing pillow. These tools are great when learning the different positions for nursing and also make it easy to hold the baby. Breast pad and nipple cream are also great to have after the baby arrives. We will be expanding on this question next Monday night when we discuss what to expect in the hospital.

Introducing a Pacifier

Lindsey: I have read a pacifier can confuse the baby when learning to breastfeed, what are your recommendations on introducing a pacifier? Thank you in advance!

Kyle: You are right pacifiers can confuse a newborn. It is best to stick with one shaped nipple as babies suck differently on a pacifier than a nipple which may lead to ineffective nursing or pain. But a major concern in the early days is that a pacifier can hide the feeding cues that a mom should be looking for the first few days and weeks. Having said that, if you have a fussy baby whose needs are met, good feedings, the baby has a dry diaper and is swaddled and you just can’t calm him down you might want to try a pacifier. You can use the pacifier to calm the baby and remove once they are asleep. All babies are unique and some babies can take a pacifier with out any problems while other it interferes with suckling at the breast. If you do use a pacifier you can evaluate your feeds and make sure they are comfortable for both you and the baby and use the pacifier as necessary and not all the time which can mask the cues you are looking for.

Taking Care of Your Breasts

Maggie: Do I need to do anything to my breasts to prepare for breastfeeding?

Kyle: Years ago it was recommended that women try and toughen up their nipples by rubbing them with a rough towel….thank goodness that practice has proved no merit! Some products on the market claim to prep nipples, but there is no need to use any of them. While you have been pregnant, your breast have been preparing for breastfeeding. They have been growing and fat stores have been increasing. You may have even noticed some leaking or colostrum towards the end of your pregnancy. Just remember while your uterus and other organs have been nurturing and growing your baby, your breast have also been preparing for the job of breastfeeding your newborn.

Brooke: What is the best cream/ointment for nipple cracking for nursing mothers?

Kyle: Such a great question. And although it is great to have cream and ointment available at home most hospitals will not allow you to bring in outside medicine such as ointments. While at the hospital they will provide you will pure lanolin which is safe for both mother and baby. If your nipples are cracked and sore be sure to talk with the hospitals lactation consultant because most often that is a latch problem creating the issues and lanolin will help but cannot fix that problem. Safety note: do not use anything on your nipples that is not medically recommended - remember your babies will ingest anything you put on your nipples.

Timing the Hospital Trip

Kerstin: What are the top 3 items you recommend to bring with you to the hospital? And how far in advance do you recommend putting these items together?

Kyle: This is a great question that I get asked often. For me the top 3 things you should pack for the hospital are nursing bra, comfortable loose fitting night gown, and nursing pillow. The nursing bra is essential for adequate support and comfort while your milk is coming in, and the sleeping nursing bras are especially useful, because they are generally softer and easier to access your breast. Although the hospital will provide you a gown to wear, I feel you are more comfortable and at ease in your own clothing. Pack something you are comfortable in and has easy access to your breasts. The nursing pillow will come in handy when learning how to handle your baby and explore breast feeding positions. For an even more expansive list you can check out the Nourisher blog!  There is a little flexibility on when you need to pack your bag for the hospital. If you have a high risk pregnancy, I would recommend getting your things together around 35 weeks. In a typical pregnancy I would recommend by 37 weeks.

Molly: How do you know when to actually go to the hospital? I’ve heard horror stories about people waiting too long & then not making it in time.

Kyle: If you have a normal pregnancy and no underlying health issues most physicians say to call them when your contractions are five minutes apart lasting for 60 seconds for over an hour. If this is your first baby and you are able to manage the contractions at home you can continue to stay at home until the contraction are difficult to breathe through. That being said, consider where you live and how long it will take to get to the hospital. Also if you have a history of fast labors usually the rule is the sooner the better. You can discuss with your doctor during your third trimester about their specific recommendations. If at any time you feel something is not quite right, I would call your doctor and head to the hospital, this is one of those times that it is better to be safe than sorry.

Understanding Epidurals

Shibahn: If you are having an epidural, what’s the best position for labor to avoid tearing and/or shorten labor?

Kyle: I understand the thought of an epidural can be scary, many think that labor with out one is too! Once the epidural is effective it will be difficult to move on your own. The nurse will help change your positions frequently from side to side throughout your labor. When you are completely dilated, gravity becomes your friend to help bring the babies head down into a good position in the birth canal. This can take some time, so be patient and calm. Rushing can increase your chance of tearing. There are techniques your nurse and doctor can use such as perineal massage to help reduce tearing. I would recommending discussing this with your doctor prior to delivery. 

Stephanie: What is your advice for the best time to get an epidural? Does an epidural slow down labor?

Kyle: I would recommend that you let your body be your guide. If you are in active labor and are able to deal with the contractions then I would wait. Your nurse can help you monitor your progress and keep an open dialogue about how much pain you are willing to endure. Typically an epideral is not given until you reach at least 3cm of cervical dilation. There are a few things I would take into consideration when thinking of the timeline for an epidural. First, how available is the anesthesiologist. Again talk to the nurse, does it typically take an hour or more to get someone to the room or is it more like fifteen minutes? Also typically the nurses will give you an entire bag of fluids prior to the insertion of the epidural, which can take over an hour. If you are very uncomfortable I would recommend getting the epidural and not waiting. Especially if you have a history of fast labors. However, the epidural can slow down the labor which is why they want you to be in active labor. If your labor slows you will probably be given Pitocin to augment your contractions. Again listen to your body, it was made for this.

Recovering from a Cesarean

Kerstin: If you are having a planned or if you end up having an unplanned c-section, what are your best tips for recovery?

Kyle: Recovery after a C-section does take a little more time. There is a higher level of pain due to the abdominal incision. This can sometimes make caring for your baby more difficult, especially picking up the baby or climbing into a high bed. My advice is to not overdo it and let other people help you. The more you relax and recover the quicker you will feel better and be able to care for yourself and the baby by yourself. For example, if you have stairs you should try to stay on one level most of the day. Going up and down the stairs repeatedly is not advisable. And although rest is important, it is equally important to get up and walk around frequently for a short duration. You may want to schedule your visitors around your rest and bonding time with your baby. From my experience with my daughter, I know that her biggest struggle was getting in and out of a bed. She found it much more comfortable to sleep on the couch for the first few nights. Also positioning a chair next to the bed or couch during the day will help with leverage and make it easier to get up and down as needed. Soon this will pass and you will be back to your normal activity.

Constructing a Birth Plan

Molly: Can you talk a bit about birth plans, please? What decisions regarding my own & my baby’s healthcare should I think about in advance, so that I’m prepared once the craziness begins?

Kyle: Birth plans can be a touchy subject. We cannot loose site of the main goal which is a safe environment and a healthy mommy and baby. Having said that there are many different options for a mother in labor. A birth plan should not be viewed a one document written on a piece of paper but rather the culmination of many discussions with your doctor during your pregnancy. Both of you should be aware of your intentions and desires during labor and delivery. I also suggest to take a tour of your birthing facility and discovery their routine policies and procedures for delivery. This will give you the opportunity to ask questions and see what a delivery at that facility might be like for you. 

Remember your nurse is your friend and advocate during your stay at the hospital. Use her for her resources and discuss your specific expectations and goals. Often you will find that the nurse will ask all of the questions you wanted to address during your admission and you will have gone over your birth plan from pain management to cutting the cord before you even take out your written plan. For a more detailed birth plan there are several helpful websites such as www.americanpregnancy.org.  

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