Is it good enough?

I used to worry that reading my experience would scare expecting moms.  But now I realize that while breastfeeding skill doesn't always come "naturally," if you are on the lookout for these "Breastfeeding Booby Traps,"  you have a better chance of overcoming problems. Here's my list of tactics for pre-emptively overcoming the "breastfeeding booby traps" at your birthplace (in my opinion, the place where we need the most help).

You call your hospital and ask about lacation consultants.
Their answer: "Yes, we have a lactation consultant."
Is it good enough?  No. You need to hear, "Yes, we have full-time international board certified lactation consultants available to you around the clock during your stay." 

You ask them about breastfeeding after Caesarian, and what their intervention rate is.
Their answer: "We don't have a protocol to support breastfeeding; the doctors treat the babies on a case by case basis.  Our intervention rate is average."
Is it good enough: No.  You need to hear: "Yes, our breastfeeding after ceasarian protocol is to give no baby any nutritional supplement, unless medically indicated and approved by you or your representative.  And the chance of your having a Caesarian to begin with is much lower than average."

You ask if they routinely give healthy babies formula or other supplements.
Their answer: If it's anything other than a resounding, "No," it's not good enough.

If their answers aren't good enough, call around to see if there are other hospitals in your area that give better ones.  If there aren't, plan to to find supplemental help on your own from a traveling lactation consultant and be vigilant and unapologetic when asking everyone caring for you and your baby to abide by your requirements--verbally and in writing when possible, and plan to have your partner, doula, or support person be responsible for tracking what's happening with your baby at all times.

Breast pump recommendations

The right breast pump is an important part of a breastfeeding plan and can even bail you out in the case of latch problems like I had.  (Disclaimer: I am not a doctor or lactation consultant and all views below are from my own experience and research.)

Your first question might be: do I need a pump?  Some say no if you are not planning to be apart from your baby, but I would suggest every nursing mom should have one on hand in case of unexpected separation or problems nursing.

The next question is whether you need an electric or manual pump.  Do you plan to be away from your baby for more than a few hours at a time at any time during the period you hope to breastfeed?  If so, you need a double electric pump (double means can pump both breasts at once) to maintain your supply and make regular pumping realistic and manageable.  If you will be home with your baby, you may be able to use a manual pump for brief outings--these are fairly inexpensive, $30-$60.  Electric pumps cost more ($60-$350) but are generally faster and more effective at extracting milk. 

My desk with PISA.

Double-electric pumps can be rented from some hospitals, and home models are almost as good at extracting milk.   A good way to start your search for an electric pump is by calling your hospital or birthing center and asking what pumps they provide to new moms, because you may end up taking home from the birthing center a set of parts that will fit home pumps, too.  For example, Medela parts that a hospital provides will fit home Medela pump, a cost savings and convenience.  You could also inquire about rental. (It's also just good to ask your birthing center what they do to help new nursing moms--whether they offer pump instruction, have lactation consultants on staff to help you, etc.  You will rely heavily on these services in those first few days.)

Finally, decide which brand/model is right for you.   I use a Medela Pump in Style (PISA) and have been pleased with it, though there are several good brands of double electric pumps.  When reviewing your options, here are some features to consider.

• Hands-free: some pumps offer hands-free devices so you can read, use the computer, drive, etc. while pumping, which is important as pumping sessions can be long and boring.  However, I found it easy to make something like this for my PISA out of an old tube top or sports bra.
• Bottles: you may want to choose a brand that has bottles you like for feeding so that you don't have to pour milk from one kind to the other.  Some bottles are interchangeable with other brands' nipples and vice versa.  For me, I prefer a wide-mouth-style bottle for feeding (Born Free) but Medela bottles are narrow-mouth, so I "store and pour."  (Bottle choice could be a whole other post, but in short, some bottles have research behind them that shows them to be better for babies who switch back and forth from bottle to breast; other considerations include air management, number of parts that need washing, BPA-free, etc.)
• Portability/style: If you work, this thing will be over your shoulder a lot.
• Power: Look for a model that has an alternate power source such as a car charger or battery pack because you will almost certainly face having to pump in a bathroom stall, storage closet, car, etc. during your time as a breastfeeding mom.

I do not recommend purchasing or borrowing a used pump since there is a risk of disease transmission through home pumps' open airflow system, unlike hospital-grade pumps which have a closed airflow system.  If cost is prohibitive for you, I suggest looking into renting a hospital pump, or putting your pump (or cash toward a pump) on the top of your baby shower list.

Afterward, if you choose a pump and find it's not working well for you, you may need to fine-tune the horn sizes, power, or even try another pump.  Different arrangements work better for different people.

The bottom line: if you don't set yourself up for success in maintaining milk supply, which requires frequent emptying of the breast by baby or pump, you could be looking at making another big investment: baby formula.

(For more information on pumping, kellymom.com is a great resource.)