Lactation & Breastfeeding Specialist Interview by Jennifer L (CLC) (IBCLC)

Q: Tell us who you are and what’s your background?

A: My name is Jennifer L., and I am a Registered Nurse with a BSN degree. I also hold the certifications CLC (Certified Lactation Counselor) and IBCLC (International Board-Certified Lactation Consultant). I have been employed in the childbirth area of a 500-bed hospital for more than 30 years. Most of that time has been spent in the clinical setting, working with mothers at the bedside as a nurse, which includes providing extensive early breastfeeding support. Currently, I teach prenatal classes on breastfeeding and infant care for soon-to-be parents, and I contact new mothers to support them during their first week at home after delivery. I love being able to encourage mothers as they navigate infant care, self-care, and breastfeeding.

Q: What made you want to go into this career?

A: At the age of 16, I volunteered as a candy striper at a small hospital. Although my primary task was to deliver flowers, I was also given the opportunity to work alongside bedside nurses. I thoroughly enjoyed the hospital setting and interacting with patients. As I progressed through nursing school, I discovered that my favorite rotation was obstetrics. Within a few months of graduating, I began working on a maternity unit, where I continued to develop a passion for helping mothers get off to a great start with breastfeeding. Personally, I had a positive experience breastfeeding both of my children, despite some minor hiccups along the way. Because of this, I wanted to help other mothers feel the same sense of empowerment.

Q: Top misconceptions of breastfeeding?

A: There are several misconceptions out there.  Let me touch on 3:

1. It is often assumed that breastfeeding mothers get less sleep because they cannot share the task of feeding the baby. However, data actually shows that breastfeeding mothers get slightly more and higher quality sleep than mothers using formula. Breastfeeding mothers can keep the baby close (in the same room), perform a quick diaper change, and feed while lying on their side. The fact that they don't need to get up to warm a bottle, expose themselves to artificial light, or miss out on the high prolactin levels that lactating mothers experience is thought to play a part in this.

Partners can help by handling the tasks before and after the feeding, such as changing the diaper, handing the baby to the mother, and settling the baby after a feeding. These "bookends" are all components of a feeding event. Another option is for mothers to pump their milk for their partners to feed the baby. By setting up the pump at the bedside, mothers can awaken just long enough to pump in a dimly lit room, then turn over and go back to sleep. The milk doesn't even need to be refrigerated, as it can safely sit at room temperature for 4 hours.

2. A common myth is that babies will feed every 2-3 hours, but this is rarely the case. Newborns need to eat at least eight times in a 24-hour period, and these feedings are often not evenly spaced out. Regardless of the baby's age, responsive feeding is the best approach, which means there should be no restrictions on the intervals between feeds or active suckling time.

3. A common misconception is that breast milk and formula are the same. This frequently becomes a contentious topic. While formula does provide the necessary nutrients for a baby to grow and develop, human breast milk contains unique components that offer added immunological and brain growth benefits. Breastfeeding also presents numerous health advantages for the mother, such as reducing the risk of breast cancer. It is essential for mothers to be fully informed of all the facts in order to make a personal decision she is comfortable with for both herself and her family. Some mothers may not have all feeding options available to them due to circumstances beyond their control. Regardless of the choice made, it is crucial that mothers receive support no matter what they decide.

Q: What’s “latching” mean?

A: The term "latching" refers to the infant's attachment to the breast for feeding. The quality of the latch and feeding depends significantly on the amount of breast in the baby's mouth (deep versus shallow), the effectiveness of the mouth's seal, and the baby's ability to extend their tongue over the gum line and use their oral muscles for feeding. A deep latch is crucial for efficient milk transfer to the baby and also helps protect the mother's nipples.

Q: What your view on drinking alcohol while breastfeeding? Are there any negative side affects having a glass of wine or two while breastfeeding? Do women really need to “pump and dump” if they’ve had an alcoholic beverage?

A: Consuming alcohol while breastfeeding can be acceptable if mothers plan ahead, as the risks are not as well-defined as they are during pregnancy. Alcohol does enter breast milk, with levels peaking about 30-60 minutes after consumption. Detectable levels can be present for approximately 2-3 hours after one drink, and even longer for multiple drinks. As the alcohol is metabolized in the mother's bloodstream, it leaves the milk. Therefore, if the mother feels tipsy, her milk contains alcohol. It is essential for mothers to ensure they feel neurologically normal before feeding their babies.

Pumping will not remove alcohol from the milk. Babies may not enjoy the taste of alcohol, so they might consume less milk if they can taste it, potentially affecting the mother's milk supply. Alcohol metabolism is slower in babies, and younger infants are more likely to be affected if they ingest alcohol. Research indicates that daily alcohol consumption can negatively impact motor development and alter sleep patterns in babies. Most importantly, a sober caregiver should be available for the baby.

If a mother becomes too full while under the influence of alcohol, she may need to pump and discard the milk to avoid engorgement and maintain her milk supply.  To plan ahead, mothers can limit their alcohol consumption and feed their babies right before drinking, allowing more time to pass before the next feeding.

Q: Do you recommend any specific supplements to help with supply?

A: A galactagogue is a substance that promotes lactation or enhances milk supply. However, there is no convincing evidence to suggest that any foods or herbs can effectively increase supply. If a difference is observed, it is likely due to the placebo effect. Moreover, there are concerns regarding contaminants and allergens in some of these substances. The number one factor for adequate milk supply is adequate demand. Milk removal tells the breasts to make milk. For mothers concerned about their milk supply, the first step should be to consult a lactation specialist for evaluation and identification of any underlying issues. Interventions can then be tailored to address the specific problem. In most cases, a galactagogue would not be recommended.

Q: Top 5 tips for Breastfeeding?

A: 1. Take a breastfeeding class - In general, we don't see much information about breastfeeding passed through generations. Attending a class can help you understand how breastfeeding works, set realistic expectations, and distinguish between normal and worrisome issues.

2. Engage in plenty of skin-to-skin contact and room-in with your baby at the hospital and home. Keeping your baby close can make breastfeeding easier, and you may get more sleep as well. Ensuring that your baby is breastfed early and often sets the stage for establishing a good milk supply.

3. Position yourself and your baby comfortably, belly-to-belly, and achieve a deep latch. Aim to have a substantial amount of your breast in your baby's mouth. This helps prevent nipple soreness and improves milk transfer. Remember, it is breastfeeding, not nipple feeding.

4. If possible, avoid using pacifiers, bottles, and formula during the early weeks. Sometimes there are medical reasons that necessitate the use of these items. However, waiting at least three weeks before introducing them can increase your chances of exclusively breastfeeding.

5. Seek support and obtain help promptly if you sense a problem. Early intervention can make a significant difference. It is easier to resolve minor issues before they escalate into more significant problems.

Q: Tips for engorgement?

A: Engorgement can occur when milk first comes in or at any time when there is a long delay in removing milk from your breasts. Before feedings, warm up your breasts for about 10 minutes. You can use a warm, moist towel, or some mothers prefer to take a quick shower. Gently massaging and expressing some milk can also help soften the breast and aid in letdown. Some mothers like to use a Haakaa on the opposite side while the baby feeds.

After feeding, applying ice packs for about 10 minutes can provide relief. A frozen bag of peas or corn, wrapped in a light towel, works well because it can be shaped to cover a large area of the breast. Many mothers find using a breast pump helpful in managing engorgement. However, be cautious not to over-pump, as this can exacerbate the problem by encouraging even more milk production. Focus on comfort rather than completely emptying the breasts.

Q: What do I do if BF is painful? Is it normal to possibly bleed from cracked nipples?

A: Breastfeeding should not be painful. You may experience some tugging and pulling, but it should not cause pain. There can be slight soreness when the baby initially latches on sucking vigorously to stimulate milk flow. However, this should only last for about 60 seconds. Once the letdown occurs and milk stores are released, babies usually ease up, and any discomfort should dissipate. A shallow latch is a common cause of nipple soreness. If you are experiencing nipple pain, seek the help of a lactation professional who can help identify the issue.

If you notice damage to your nipples, it is essential to get evaluated. An ineffective latch, thrush, and tongue-tie are some causes of tissue breakdown. It is crucial to determine the cause so you can heal and prevent ongoing damage. A compounded topical ointment called APNO is often prescribed to help with healing. Broken skin increases the risk of mastitis. Pain and nipple damage can be reasons for mothers to discontinue breastfeeding, so seeking help is vital.

Q: Is there a “best” holding position to BF baby?

A: There is no single best position for breastfeeding in general. However, some positions may be better suited for specific situations. For instance, during the early days, mothers can use the cross-cradle position to gain more control over their baby's head and observe the latching process. If a mother has a forceful letdown, some babies might manage the fast milk flow better when feeding in the laid-back position. For a mother who is experiencing pain from a cesarean section, the football position can be helpful in keeping the baby off the incision area. The side-lying position is excellent for resting while nursing, but it can be a bit more challenging if the baby needs assistance latching. These examples are not exhaustive. The best position is the one that works well and is comfortable for both you and your baby.

Q: When does milk supply usually come in?

A: Breasts begin to produce colostrum, the newborn milk, during the second trimester of pregnancy. This highly important and immunological fluid becomes available to babies immediately after birth. Its small quantity is perfect for newborns as their stomachs are only the size of an almond at that stage. A significant hormone shift occurs at birth, initiating the process of producing the larger volume of mature milk. This typically happens about 3-5 days after delivery.

During this time, a mother may notice her breasts becoming heavier and larger. Some of this may be due to milk production, while some could be swelling in the tissue during the transition. A delay in the production of mature milk can occur if a mother has a cesarean section or a long induction. However, this does not mean a mother cannot breastfeed. In such cases, interventions may be necessary to help catch up with the process.

Q: What if my baby is favoring one side Vs the other?

A: It is not uncommon for a baby to prefer one breast over the other, and there can be several reasons for this preference. The cause might be discomfort from birth, an ear infection, or the mother feeling awkward using her non-dominant arm to position the baby. It could also be related to a forceful letdown, lower milk supply, clogged ducts, or a history of breast surgery. However, you may never pinpoint the exact reason.

To encourage your baby to feed from the less preferred breast, try the following tips:

1. Feed your baby in a non-distracting environment, or when they are slightly drowsy, so they may be less aware they are not eating from their favorite breast.

2. Change positions on the less preferred side, as this can sometimes help.

3. Offer the least preferred breast first when your baby is very hungry, or alternatively, offer the preferred breast after you have experienced letdown, then gently switch the baby to the other side.

It is important to protect your milk supply by pumping if your baby is not removing milk adequately from the less preferred side. If you continue to have difficulty, do not hesitate to reach out to a lactation professional for assistance. They are eager to help mothers achieve their breastfeeding goals.