67 | Breastfeeding Q&A: Common Question I Get Asked about Breastfeeding

• Episode Title: Common Questions I Get Asked about Breastfeeding
• Host: Dr. Kailyn Galloway
• Podcast: New Mom Naturopath
• Episode Number: 66
• Date: 01/11/24
• Duration: 26:34:23 

Episode Summary: In this episode, Dr. Galloway discusses various aspects of breastfeeding, focusing on the challenges and concerns new mothers often face. She delves into the initial stages of breastfeeding, explaining the importance of colostrum, the baby’s nutritional needs in the first few days, and how to recognize a proper latch. The episode also covers common issues such as infections, engorgement, and emotional aspects of breastfeeding.

Key Points Discussed:

1. The Early Stages of Breastfeeding:

   • Colostrum and its benefits.
   • Normal intake for newborns in the first few days.

2. Recognizing a Proper Latch:

   • Signs of good positioning and latch.
   • Dealing with nipple pain and latch issues.

3. Common Breastfeeding Challenges:

   • Dealing with infections, engorgement, and oversupply.
   • Understanding the signs of vasospasm.

4. Emotional Aspects of Breastfeeding:

   • Navigating the emotions and decisions around breastfeeding.
   • When to consider alternatives like formula feeding.

5. Practical Tips and Advice:

   • How to measure feeding success.
   • When to seek help from a lactation consultant.

Transcription:

    📍 I'm here. I'm kind of sick, so I'm gonna have to play a lot of pause, restart, pause, restart on this to avoid editing. But today I really wanted to talk about the common things that happen which make breastfeeding or nursing very difficult for new moms. And At first, I want to talk about what's normal. So, what's typically normal is that the first 24 hours, your child's going to have between 2 and 10 milliliters of breast milk intake.

And technically speaking, this is not breast milk, this is what is called colostrum.  And it's the very sticky first part of the  production of milk in the breast tissue. And it's got a very high density, high caloric density and high amounts of nutrients for your child to really wake up their, their bowels and to wake up their body and to give them the nutrients they need to maintain their glucose levels, to maintain  all the changes that are rapidly happening in the body.

It's actually really. Like, the physiology of childbirth from the baby's perspective, what they have to go through in terms of changes of their physiology is fascinating and I'm probably going to do a, an episode on that in the future,  but  during this day they're going to have two to ten milliliters of feeding.

So for all you Americans, two to ten milliliters of feeding is only    ten milliliters is two teaspoons.   Which is not very much. So, we're talking about half a teaspoon to two teaspoons  in the first day. Now, they're going to get that over numerous feedings.  Which seems kind of crazy, and you kind of will feel during this time that nothing is coming out or they're not getting enough.

In reality, they don't need very much to be able to be satisfied in that first 24 hour period.  What's really important during this time frame is that they actually do have their first bowel movement, which is called  meconium.  It's the first bit of  of poop that your body will, that your baby will ever secrete.

And it's really important that it passes within the first 24 to 48 hours.  And so your  Care team is going to be looking for that and making sure it occurs. And then between 24 and 48 hours, you'll have the infant take anywhere from 5 to 15 milliliters, which is 1 to 3 teaspoons of colostrum. And they'll probably have around 2 bowel movements in the second day.

And it should be this dark green to black, and it's sticky.   And then after that, we have between 48 and 72 hours, they're going to have between 15 and 30 milliliters.  And this is when you'll have a huge spike  of 6 to 8 stools per day.  And that stays fairly consistent throughout the newborn phase.  The poop in this part, the color of the stool, is going to start changing from green and moving to a light mustard.

seed.  It's totally normal for it then to have green colored poop until  96 hours or 4 days after birth.  After 5 days,  the breast milk should definitely be in. So the patient, the    infant will be taking in around 60 to 120 milliliters of breast milk per day.  Or per, not per day, per feeding, and that is  2 to 4 ounces.

Most newborns are going to be around that 2 to 3 ounces per  meal.  But the crazy thing about this, you're sitting there going,  but how do I measure that?  How do I measure, how do I know if they're going to be getting enough? Because it's coming out of me, I'm not like measuring it before it goes into their mouth. 

So there's a lot of milestones  that happen in the first five days that people look at to make sure that you're actually meeting targets for feeding your baby enough.  It's super difficult  to   measure without some sort of external help. So for a totally healthy baby,  newborns are going to feed between 10 and 12 times per day. 

Transcribed by https: otter. ai In a totally healthy, normal feeding pattern, which sounds crazy, and it is.    

They're going to have  about 6 milliliters of breast milk per feeding after that first 24 hours, and eventually it'll increase, like I said, to go. Greater than. After the first couple of weeks, your baby is going to gain  about 105 to 210 grams per week, which is  around 15 to 30 grams per day.  Milestones that some physicians will look at is going to be is the patient or is the infant  Losing more than 7 percent of their birth weight, that's kind of a red flag that a clinician is going to look for.

And then, is the  infant losing weight after 3 days of life?  When they latch and they are nursing, the baby isn't actually swallowing, there's no sound of the swallowing.  Which, it is a very nuanced sound. So,  at first you probably as a new mom are not going to know about what it is.  So make sure when the lactation consultant comes to your room, you ask them to like kind of walk you through when you hear it and to help you get the pattern of what is actually going on during a feeding. 

If they have fewer than six wet diapers a day after four days of life, if they have fewer than three stools per day after four days of life, that's kind of a red flag. And then minimally.  Or the minimal breast changes after five days. So if mom starts to not have her milk come in, which is when you have  a significant change in the structure of your breasts, and the  all the milk comes, it's, I don't know how else to describe it.

It's  quite crazy. You'll wake up one day and you will have boobs that look like they've had   some real good work done and they'll be really painful. So if that doesn't actually occur after five days, usually it happens between two and three days.  And then if you actually end up having nipple pain as a result of latching,  there are many reasons why nipple pain would be associated with a latch issue. 

But if that is occurring, there's reason to have that explored, either by a lactation consultant immediately, or going to your pediatrician for some extra support and guidance, and seeing what they are saying.  So in terms of a good latch, what does a good latch look like? How do you know if you're doing it right?

You know, the one thing I will say before I do any of this, you are learning. And baby is learning in this moment in time. And when you're learning something for the first time and you don't know what you're doing, you feel really dumb. So it is completely normal in this instant, especially during nursing, to feel stupid  and to be really frustrated that things are not going the way you want.

Give your brain the rest it needs. Go, hey   I knew I was going to have this issue.  I'm going to learn how to overcome it, rather than think you're a failure for not being able to have the immediate latch that you desire.  So signs of a good positioning for latch. The infant's nose is free from the breast.

How a baby actually ends up nursing is they have their nose free so they can breathe through their nose while they're swallowing, not while they're swallowing, but while they're taking in milk.  The infant's chin should be on the lower end of their breast, the breast tissue.   And it should be touching.

The infant's cheeks should be  rounded. They shouldn't be sucked in. Like, it shouldn't be as if the baby is drinking out of a straw. It should be, they should be flat.  And then their mouth needs to be open like a yawn.  There shouldn't really be a lot of areola seen, so your nipples should be like all the way in their mouth.  

And then, the infant's lower lip needs to be flanged outward. So, no curling the lips inward. That will cause, that will show that you don't really have a great latch. And they won't be able to get that sucking   feeling.  They need to get   The infant's body should be in line with the head, and facing towards mother.

Now, this is kind of a caveat. This is only if you're talking about cross playing position. There are many, many, many different types of nursing positions. I encourage you to Google it and to go on YouTube to find different ways that you can get comfortable. But the most common position, especially the one that most lactation consultants start out with, is cross lying position, where you lay the baby across your chest and you have  The side that their head is on that arm is underneath their head supporting them and you have one arm over the baby to try to guide them  Babies are strong  So you'll be really surprised at how much they'll fight you  But that extra arm can help you to guide them in the way that they need to go lastly  the mother's Should not feel pain after the initial 30 seconds to a minute.

So, if you're just, you've never had someone nurse on your nipple, it's going to hurt a little bit. And I don't  mean, like, agonizing pain, but it is an uncomfortable sensation.  Especially if it is an improper latch.  It will last past that minute long  feeling. And so if that's happening  You definitely want to go talk to a lactation consultant, definitely want to get someone to assist you in how to go about  fixing the latch, whether that be something in your positioning or something in your  the development of your child's mouth, something of that nature. 

And then the last thing that is a really good sign of a good latch is a rhythmic suck and swallow pattern.  And I think that this is something that I didn't have real knowledge of, but there is a very definitive, like.  pattern that you will notice your infant  undergoing, I don't know how else to say  during a nursing session, and it really is helpful to know that they've got a great latch if you know what you're trying to listen for.

So asking your lactation consultant to point out the rhythmic suck and swallow pattern that is present. when an appropriate latch is formed. 

So how do you know if your child is getting enough milk from you? Well, you're meeting the milestones of regaining,  they're regaining weight  consistently every day, and then at the two week mark they've actually started to increase  in  back to their birth weight.  Those are really good signs.  being able to nurse consistently without fussiness and making sure that your latch is really good can be really solid signs that you're getting enough milk.

Now, if you're concerned and you feel like something's wrong, there's no reason why you shouldn't call a lactation consultant who can come either. You go to their office and they work with you in their office about how to get the appropriate latch, how to get comfortable,  and then do a  a weighed milk session.

So they weigh the baby before without a diaper, and then you nurse, and then they weigh the baby again, and then they kind of establish how much they're actually getting each nursing session, which can be really helpful for letting you know that they're actually getting the two to four. ounces each time from me, because it's really kind of hard, especially when you stop having the engorgement issues, like, because when,  you can kind of feel your breast tissue emptying, but it's sometimes really difficult to know how much was there to begin with, and as you regulate later on,  your body will regulate to your child's needs, and whenever you're actually If you're going to start nursing, you'll notice that you'll get more engorged or have a larger amount of milk supply in your, in your breast tissue versus times when your baby doesn't typically nurse. 

And so if you feed on demand, it will stimulate to have your body to have the exact amount of milk that you really do need for your one infant. Or if you're having multiples, your body can adapt and learn to produce more based on how many you've actually had.  But, there are some really common problems that can happen with moms that are new to nursing  and one of them would be an infection.  

A lot of times if you're having pain either outside of nursing and or during nursing, a lot of times the, there is sometimes where you'll get lesions of sores that end up being infected and because it's a tissue that's being disrupted. It's very sensitive, you've got a lot of hormonal changes, and then you've got a child that's learning how to eat.

And even if they don't have teeth yet, it's, they're, they've got very strong jaws.  And there's always the chance that you're going to have some form of infection, either bacterial or fungal. So, if your skin starts to look really red, you start to have salmon colored nipples  You have some sort of discharge, anything like that that doesn't look like milk, obviously.

Or if they start to burn or itch, those are all real, real positive signs that you probably do have some sort of infection. But it can also be that you have some sort of dermatitis because you've inflamed that area and your body for some reason is creating more of an inflammatory response.  And so all those are signs that you should probably talk to your physician about a  medication.   

You can have them do a compounded cream called triple cream and it can be applied to your nipple to prevent an infection and or to treat one. So that's something that you can ask for.  Other issues that you can have are engorgement. And that sounds so fun, doesn't it?  It's actually really hard for a baby to nurse when your breasts are full.

And so those first couple of days where you have your milk come in and you are engorged, it's very difficult for you to get the appropriate latch.  So in those days, it's really important that you watch for engorgement. If you're having a difficulty latching, if your baby is having a difficulty to attach, and or your flow is really strong, two things that you can do is self express into a  A towel, or a pad, or   like a nipple shield of some sort, or collect that into a    a haka cup, which is kind of like a manual.

It's like a, a leak catcher, if you will say.  Breast milk is very leaky. It gets everywhere. Especially if you overproduce, like I did.  It gets everywhere.  It's everywhere.  But a haka can be placed and you can do a couple of expressions, a little bit of expression of the milk. That can help reduce a lot of the overwhelm some infants get from you having a really heavy flow and also change the shape of your breast tissue so that they can actually get an appropriate latch.  

You also can use a hand pump because that is really helpful in reducing the size of your, of your breasts so that they can actually do really well.  The other thing is if you are trying to pump in those first six weeks, there's no problem with that,  but  the more you stimulate your tissues to secrete milk, the more milk it's going to secrete and it's not going to necessarily be regulated to your child or infant's needs and it can produce an oversupply. 

And an oversupply sounds like this amazing thing until you experience it  because it can lead you to having Milk just sitting in your ducts of your breast tissue, and when that happens, it can result in a clogged, clogged duct, which is painful, but also leads you to be more susceptible to things like mastitis. 

Which is when you have an infection within the breast tissue itself, and that has to be treated with antibiotics. And it's actually really easy for that to become a very serious infection. And so, you can get a fever, nausea, and it actually can lead to sepsis if it's not treated appropriately.  It's pretty scary and a reason for hospitalization.

So oversupply is not necessarily the goal. Even though we watch on Instagram, there's these people with freezers of breast milk. It's not, one, it's not necessary and two, it's not necessarily a good thing. They're having to continue  to produce that much because their body is, if they stop, they can actually  have engorgement and lead to, be more prone to having  clogged ducts and having infections, which is no fun.

And so, those are common reasons why you'd have pain. The last kind is going to be called a vasospasm.  And this kind of happens for a variety of reasons, most of them we don't actually know why.  But there is a lot of vasodilation and vasoconstriction that happens in order to get the blood, the  the blood and the milk, because it all is from the same fluid.  

In order to get the milk out of the tissue sometimes, there ends up being an extra   constriction of the blood vessels in some women and so there actually can be a discoloration of the nipple to turn kind of blue and Because of the lack of blood supply and the lack of oxygen it can result in a lot of pain  and so  It usually if it is a vasospasm the pain occurs after you have  After  You're done nursing, and after nursing is over, and it also happens in those that are in colder environments.

So if you're colder,  if you're not in a warm environment, it can happen more often. So,  the way that they treat this is usually to help you get a warm pad on your nipple after you are done nursing. Make sure you're in a warmer environment. And then also if there are medications you can take to help reduce the pain afterwards. 

The other concern that some women have, and this is still a very rare disorder, but sometimes  the changes in hormones that are happening as a result of you nursing.  prolactin and oxytocin, some women have a very negative response to that, whether they get a sense of vertigo, which is the room spinning around you, or intense nausea, or just a feeling of a very hot feeling in their head. 

And  there are also some women that get intense amounts of depression. And  sadness and doomsday feelings as soon as they start to nurse. All of that can be something that you should probably discuss with your physician. But it is, it is something that can happen. It's very rare.  And so,  I just say all of these things because I want you to be aware that there are going to be issues that come in between you and your desire to nurse.

If you want to have a relationship with your child that involves nursing, involves breastfeeding,  then by all means, there's no reason why you shouldn't be able to.  But,  some people have to try exceptionally hard to get that to work. And so sometimes you're going to have to decide where your commitment levels lie and whether or not that's a priority for you.

There is nothing wrong with not nursing your child.  As much as people on the internet will try to shame you for that, there's no reason why in the 21st century we should not have formula for you available. And while there have been shortages, there has been formula available and  it's  There's nothing wrong with using that as a way to feed your baby.

It's not a cop out. It's not easier.  And honestly, comparing what I spent on pumps and cleaning supplies and bottles and, you know. Pillows for nursing, and pillows for me, and pillows for baby, and like all kinds of gadgets, like nipple shields, and  kind of like massagers, and all kinds of things that were superfluous, like they were not necessary for my nursing journey.

But I was so, so insistent that I needed to nurse, that I had every single thing that I purchased in order to  just if I keep moving and keep trying, and not actually giving my child.  formula. And I didn't get a trophy. Like there was no trophy at the end of the day for me choosing to nurse.  None.  So,  making the decision to nurse is a commitment.

It's a decision to stick with it and to learn  and to suck at it at first. Pun intended. 

But there is no shame in choosing a different plan, a different game.  And I wish someone had told me that.  Because I really struggle with that in postpartum. There was a lot of emotions going on in my brain, and I really struggle with that.  Lastly, I will say that if you're having difficulties with latch, even if your pediatrician doesn't recommend it, it's always a good idea to have your child assessed for a tongue tie, or  lip ties, if you  really don't feel like they're getting the appropriate latch.

And the appropriate people to Assess for this, it would be a international board certified lactation consultant  or  a dentist that is certified to look at   tongue ties in general.  And I will also say this, that I had the pediatrician look at his tongue tie  and. One, a couple of them in the hospital just dismissed it and moved on.

One said, hmm, we probably need to clip that. And we actually even had our pediatrician clip his tongue tie in office.  And it was ineffective. It still didn't change our  latch issues. And so going to see a lactation consultant, they actually assessed that it wasn't actually cut enough during that first initial   Phrenectomy is what it's called. 

And so we had to go in and get it done via a laser at a specialty clinic. So  I will say that if you have had issues with LATCH, it's always a really good idea to go to someone that actually specializes in that specific treatment option instead of just going to a pediatrician who is a  very knowledgeable, amazing resource for so many things. 

If you're having a very, very tailored or specific issue, sometimes they're not going to know how to help you. And breastfeeding and nursing is something that, if it's a common issue, they're going to know how to troubleshoot. But if you're having something that's abnormal, they're probably just going to give you some samples for formula and tell you to be happy.

No, they're not going to be like, my, my pediatrician was super supportive. But,  it's not going, they're not going to get the solution to your answer if you don't go to the right source.  All this information, I'm going to say it very clearly, is all,  it's all going to be educational and it's not recommendation by your doctor.

Of course, follow the guidelines of your pediatrician, wherever you're at in the world, and make sure that you're following their guidelines as to how to go about your nursing. journey and your baby's feeding schedule and overall health. I hope this was a really informative episode and I know it was longer than my usual, but I think it was really fun to dive into why you should really know ahead of time that the journey of nursing is not a simple one and it's not always going to be straightforward. 

So let me know if you have any questions. You can always find me at Dr. Kalyn Galloway on Instagram, or you can message me at admin at the new mom naturopath.com. I hope you have a wonderful Thursday and I'll see you Monday.  I.

Contact Information:

• Instagram: @Dr.KalynGalloway
• Email: [email protected]