BREASTFEEDING 101: Part 1

August 05, 2021 9 min read

A Conversation with Jennifer Ritchie, IBCLC & Callan, Editor
Jennifer Ritchie is an Internationally Board-Certified Lactation Consultant (IBCLC) who has spent more than a decade helping countless parents navigate breastfeeding challenges, including latching difficulties, painful nursing, low milk production, inadequate weight gain, and induced lactation. 
In part one of our interview series, she and Motherhood Editor Callan, who was nursing her 15-month-old daughter, discuss lactation consultants & their services, birth complications that impact milk supply & Jennifer’s advice for newly breastfeeding moms.

Callan:  What services does a lactation consultant provide?
Jennifer: A lactation consultant is specialized in lactation for all mammals. So, it's amazing to think that every mammal on the planet breastfeeds, you know dolphins and horses, and in terms of lactation and having a baby, all the hormones are the same. So, all physicians that go through medical school, regardless of their practice, they get one general curriculum on lactation. So even if they're a pediatrician, they could get five hours of training on lactation. So, Lactation Consultants are specialists, and there are board-certified specialists, and our expertise is in the evidence-based practice of lactation. So instead of our opinion, we function more like a physician and we solve problems based on the evidence.

Callan: When should a mom consult a lactation consultant?
Jennifer: A lot of times, people can see a lactation consultant before they have the baby, which people don't think about. We spend a lot of time getting ready to bring the baby home, but we don't spend a lot of time thinking about what's going to happen when we get home. And we're so tired. The bottom line is, if you have problems getting pregnant, I recommend seeing a lactation consultant before you have your baby. The same hormones that allow you to get pregnant, allow you to make enough milk. There are things that you can do and prepare for before you have the baby, because it's going to be chaos when you bring the baby home.

There's also a potential for 1% of women to not have enough breast tissue to make milk. Again, it's only 1%. But if your breasts don't change size during pregnancy, I would see a lactation consultant before you deliver. And sometimes we don't know. It's a good thing to ask your partner: have my breasts gotten bigger? They'll be like, "oh, yeah." They know more than we do. But that's always a possibility. It's insufficient mammary tissue. But generally, you'll see a lactation consultant in the hospital before you put the baby to breast.

Callan: And then if a mom does decide to have a consultation, what should she expect that experience to be like?
Jennifer: When you're 10 weeks pregnant, you go into the first stage of lactation. So that's when you make colostrum. You have colostrum in your breast ready to go to feed that baby when it's born from 10 weeks pregnant and on. So that's all the baby is going to get for the first couple of days. So, the first couple of days, a lactation consultant is there to help you feel comfortable while you're nursing, because you're going to be doing it for long periods of time. That baby is going to be on your breast just doing a lot of sucking and getting a small amount of volume. So, depending on where you are, if you're in the hospital or not, typically around day three after the baby is born is when your milk increases in volume. You go from the breasts you're used to, to like instant breast augmentation overnight. The amount of milk that you're making goes from a teaspoon to about 32 ounces every 24 hours. So that transition is really when moms experience problems, around day three.

Callan So I had a C-section and then my baby lost 11% of her body weight. So, I had to do multiple weight checks. And my consultant was said she saw that happen a lot, and that she wished doctors wouldn't take the baby’s weight right after a C-section because their weight is inflated since they weren’t squeezed through the birth canal. So, I had to supplement with a bottle because of that and I was kind of heartbroken, feeling like I already failed at breastfeeding.
Jennifer: This right there, your experience, is what needs to stop. So, let me tell you what happened. So, with more interventions with birth, you get more IV fluids to prevent you from having a heart attack. So, if you labored first and then had a C-section, you got IV fluids that entire time. What happens is the fluid, because it's given intravenously, has to get out of your body and it goes to anything pendulous: your hands, your feet, your butt, your nose, your breasts. It shuts off your milk, like shutting off a hose. It's called third-spacing. So, your milk doesn't come in when it should. Your baby's still getting that tiny amount when it's supposed to get more, and they end up losing too much weight.

Babies are born with their own red blood cells and their mother’s cells. And they need to flush those out, and if they don't, they get jaundice. There are different types of jaundice, but jaundice can cause irreversible brain damage. And the way they flush out those red blood cells is by eating. So, if you didn't supplement when you did, your baby could have had irreversible brain damage. So why would you feel guilty about that? That was the best first decision as a mother that you could have possibly made, you saved your baby. So, the whole guilt thing, that's what pisses me off. Why not give moms the real information and let them know exactly what's going on: This is why we need to feed your baby, because it can have long term effects on their brain. And then you wouldn't have felt guilty! But it's a process, and they just don't take the time to tell you what's going on.

So, what you experienced is called third spacing, you had to flush out that fluid and no one told you to. The only way to get rid of that extra water, because it was given to intravenously, is by peeing it out. So that's one thing I would love to get across. About 14 hours after you deliver, look at your feet. If you can push your feet and a crater is made, like edema, you have third spacing. Your goal is to drink as much water as possible. Eat a watermelon. It doesn't have to be water – it can be vitamin water. It could be anything that tastes good. The goal is to pee. And the faster you get that fluid out of your body, the faster your milk will increase in volume and come in and the less likely the weight loss. The 11% weight loss should not have happened. Someone should have been there and helped you and intervened, but they didn't. So, you did the absolute right thing. You supplemented and you saved your baby. So, I don't know if that makes you feel better.

Callan: It does, and I've never heard any of that information before, so that was amazing. I just heard that one quick little thing from the lactation consultant. I didn't know what it meant.
Jennifer: No, you hear weight loss, jaundice, and then you hear all this misinformation. And that's the difference. Especially now in the world that we're living in, we don't have time for BS. We need to know the information, what's going on, how to fix it, and focus on the priorities. So, this whole time you've felt guilty about that, when in reality, your baby could have suffered long term brain damage and that's the first decision that you made. So, what you are is an amazing mom. And you did it on your own, so you should feel even better. You totally made that decision on your own. But we don't get enough support from the medical staff to help us form these right decisions. So, there is a lot of guilt. And that is why my goal in life is to just give this information out to new moms. So especially right now with everything going on, they can focus on what's important. And supplementing at that moment was the most important thing. And luckily, you did it. There are women that wouldn't do it and then they would suffer the consequences.

Callan: Love that. Thank you. OK, so what is your number one piece of advice that you give to new moms breastfeeding for the first time?
Jennifer: Focus on the first two weeks. If you look at the statistics, a lot of women start breastfeeding in the hospital, but by two weeks they've thrown in the towel. And it's because they don't get the proper support that they need, and they deal a lot with pain.  My advice is, is if there's pain, there's a problem.

The nipple is a ligament, and you should feel it stretching and it should feel weird. There's no way to prepare your nipples for what they're about to go through. If you put your tongue on the roof of your mouth, you can feel a bump, your nipple's going all the way past that bump in the baby's mouth. It's being stretched, and you should feel that. But not bloody, cracked, sore nipples. So, if you're feeling pain, try to get help as soon as possible. Or if you can't get help - buy my book, I guess! Because I try to help you solve those problems, and there's many tools to help. It's all about asking yourself: do the risks outweigh the benefits?  It's all about just keeping going. If you hit a problem, not giving up, just pushing through and finding a solution and moving forward because your baby needs that breast milk more than ever.

Callan: And then what can a brand-new mom expect when they first start breastfeeding?
Jennifer: The main hormone that controls milk coming out, and the delivery of the baby, is a hormone called oxytocin. It's the love hormone, but it also helps things contract. So, think of your breasts as a bushel of grapes. It's got all these ducts and these little sacks of milk. And when the baby latches on or you latch onto a pump, it squeezes the sacks of milk and that's what shoots the milk out. But oxytocin also contracts the uterus. So, when you're nursing or pumping, one of the things you're going to feel is your uterus cramping. So, you may have some bleeding. But this is actually good, we want the uterus to go back to its normal shape as soon as possible, so cramping and bleeding and feeling that uterus contract is completely, totally normal. And we don't talk about that very often, but that's a completely normal thing to feel right when you first start nursing, and it should subside within a couple of weeks.

Again, the nipple is a ligament. So, it's going to stretch. There's no way to toughen up your nipple and get it ready. The only way to get a nipple ready for breastfeeding would be to put a vacuum on it and stretch that ligament. And if you did that, you would release oxytocin and may go into preterm labor. So, it's going to feel like a ligament stretching. But again, if you put your tongue on the roof of your mouth, that's your hard palate and then there's a bump, then behind that is your soft palate. The baby's tongue should be compressing the nipple against soft tissue, so there shouldn't be any pain. Bloody, cracked nipples don’t happen overnight, but you will feel pain if the baby is not latched properly. So, if you feel pain, seek help as soon as possible, because the baby is smashing your nipple against bone. And if you have a wound and you scratch it every three hours for three days, it's going to get worse. And it's the same exact thing with the nipple.

Callan: When I was breastfeeding in the early days, it made me so tired, I don't know if it was just exhaustion? My daughter and I would just fall asleep. And my lactation consultant told me to stop rubbing the baby, because it was relaxing us both, and she would fall asleep with my nipple in her mouth. But I was like - why are we designed this way if I can't do this?!
Jennifer: That's oxytocin. Oxytocin is the same hormone that's released when you have an orgasm, so you feel like super relaxed, and you feel great after. But you're compounding that on top of complete and total exhaustion. So, it is very common to doze off.

Callan: I feel like I fell asleep every time. And my daughter, she cluster fed like every hour.
Jennifer: And we know why: because you had third spacing and your milk didn't come in when it should have.

Learn more about Jennifer Ritchie & her books by visiting her website.



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