NURSING & PUMPING: Part 1

August 11, 2021 9 min read

A Conversation with Corky Harvey, IBCLC & Callan, Editor

Corky Harvey, MS, RN, IBCLC is the co-founder of The Pump Station & Nurtury®, the first new parent resource center of its kind in Santa Monica, CA. She is a registered nurse with a master's degree in maternal/newborn nursing, a certified Happiest Baby on the Block educator, and was a long-time Childbirth Educator.

In part one of our interview series, she and Motherhood Editor Callan, who was nursing her 15-month-old daughter, chat about what a lactation consultant is, the importance of breastfeeding support groups, and the 411 on nipple confusion.

CALLAN: Can you explain what services a lactation consultant provides, why a mother might want to consult one, and what you can expect during your first consultation?
CORKY: First and foremost, I think she provides tremendous support. So many parents struggle because they think that breastfeeding is natural. And although the physiology of it is natural, it can be kind of mucked up if people don't know what they're doing. Lactation consultants should have the educational piece, as well as the heart for it to be there to support people no matter what. Secondly, they should have hand skills. And I think this is a variable thing within the organization, especially depending on how much experience a person has going in. But she should have good hand skills and skills to help mothers with each individual problem within breastfeeding. We like to say: It can be pretty easy, but it can also be pretty tough.

And I think that's a fair approach. There's evidence to support that every woman could use lactation support and that women who seek lactation consultants have more success with their breastfeeding. I did a support group yesterday that got eight moms in there and every single one of them was experiencing some level of difficulty with their breastfeeding. Unfortunately, hospitals don't have the budget or see that as a priority. So, we don't have as much lactation consulting available within the hospital setting or even after women get home.

What if the baby isn't latching or a mother has a lot of pain? Maybe she thinks her milk supply isn't there. A baby isn't gaining weight. It’s a myriad of things. And it depends on what phase of breastfeeding you're talking about. But in the early days, what we see the most is not nipple pain. That's number two, probably. What is number one is low milk supply concerns, something quite being right, or lack of latch - that's really high.

CALLAN: What does a typical consultation look like? What can new moms expect?
CORKY: It depends on your situation and what you're there for. But in our situation, it always includes a history, and it includes an evaluation of what the problem is, and how the mother feels about that problem. In other words, what makes her think her milk supply is low? And then it would include an evaluation for a weight check. A complete evaluation of the baby, the baby's mouth, how the baby looks, and then an evaluation of the mother – what her breasts look like, what her nipples look like, how they feel. So, it's a complete physical with a history. And our group is almost exclusively RNs, so we have that skill set with good evaluation and they can expect to have our help and hopefully leave with a plan.

CALLAN: I sought out a consultant after I had my daughter very early – I needed the reassurance of somebody telling me, you're doing this right. And yes, your baby's getting food - I needed that weight checked to make myself not so crazy.
CORKY: I just wrote a blog for this yesterday. Getting to know where your helpers are before you have the baby, getting as much help as you possibly can in the hospital, and then calling a consultant immediately upon discharge. For instance, milk supply, that's something we need to address really early. We can address it later, but the success rate is higher with the earlier we can intervene, interfere, or intercede.

CALLAN: Can you tell us more about breastfeeding support groups?
CORKY: Women need community. And women really need the support of each other. And in a support group, you'd be amazed how many of the questions are asked and answered by other mothers. Yesterday, I had a one-week-old baby who was struggling with low milk supply, and two of the mothers have had that same problem. And they were able to say, “Here's what I did. Here's where I am now. Hang in.” We need that community around new mothers.

Even one hundred years ago, women lived in communities where they met in each other's kitchens and supported each other. Now we're alone in our apartments going, “What the hell's wrong with me?” The consultants, they're saying, “Yeah, you need to be pumping a little bit more than that, because here's the deal.” The support groups are really, really vital as are Mommy and Me's, where you can have that support of a roomful of women who are saying, “Well, my baby is like that too, and my baby never did that.” It just is such a vital piece.

CALLAN: When should moms begin pumping? When I had my daughter, I questioned if I should have been pumping as I was breastfeeding. But she cluster fed for a month, so I was like, when can I possibly pump?
CORKY: It so depends on the circumstance. If your baby latches right from the beginning and is nursing well - like your baby did - and the baby's gaining weight, well, you shouldn't have to pump. Then, we would then suggest to that particular mother that she begin pumping when she wants to give a bottle, but somewhere between two and four weeks, because if you wait too long, some babies will not take a bottle and the partner often really wants to be involved. We would say if you could give breastfeeding on the breast about two weeks, so the baby really establishes supply and has that system down before you introduce a bottle, then start pumping somewhere close to the end of the first week to begin to play with your pump and see how it works so that you have a bottle by two weeks to let your partner enjoy doing that.

To the mother whose baby isn't latching or is separated from her in the NICU, she needs to start pumping day one within the first six to eight hours after birth and be fastidious with her pumping at least every two to three hours. Because, again, it's the removal of milk that drives milk supply. If we're not doing that, we're not going to have a good supply. And then we have mothers with low supply who are nursing, but they're pumping after every breastfeeding. In breastfeeding - if your baby is being supplemented, you have to pump, otherwise the milk supply cannot come up. It'll go down. That’s a piece a lot of moms don't hear and don't know. And then they're really in trouble with low milk supply.

Then there's the mothers that have huge supply and they're only pumping every other day when their partner is giving a bottle because they're milk goes too high. And the mother who's going to go back to work is pumping enough for her partner to give a bottle every three days, not more than once a day, so her partner could give the bottle and she can store a bit every day. We would say, again, for the mother who's not able to put her baby to breast for whatever reason, she starts immediately and for the rest of us, depending on the circumstance, somewhere between two and four weeks.

CALLAN: I'm very interested in the discussion of introducing a bottle to a breastfed baby because I had a horrible time with my daughter. I feel like I've read lots of different guidelines that we can't give them a bottle because of nipple confusion. So, I waited until she was about five weeks and I think that was too long. It then took me two months to get her to take a bottle and I had to try every bottle on the market.
CORKY: The bottom line is, if you don't have to do it because your baby took it, then good. So that's why the next baby you have - I'm assuming you have one child - you will start at two weeks because of what you went through. We recommend not waiting past the fourth week – some books will say six weeks – but we see so many babies refuse the bottle around that third, fourth week. You've got to stay consistent.

The other opposite is also true, though. If babies get lots of bottles, they'll refuse the breast oftentimes. We say one bottle a day maximum. That said, we get that life happens and there might be a day when you had to go to the doctor or something and you gave two bottles. But don't do that consistently. We have moms who have to go back to work. And it is just one of the biggest frustrations. And even then, we will have some babies who will still refuse at about three months. They get so smart.

By the way, it's a myth that if you starve a baby, they'll finally take it. That is a myth and its heart wrenching, and you just can't do that. And it's also a myth that it should be someone else other than the mother at that phase trying to work it out with baby. The mother really has the best skill set and usually more patience.

CALLAN: I did everything wrong then, because it was a week until I had to go back to work, and she still wasn't taking a bottle. So, I did the ‘I'm dumping you at grandma's house and hopefully you'll take a bottle from her.’ She finally did, but I had to drop off five different bottles and the bottle she ended up taking was the Nanobébé that looks like a boob.
CORKY: I don't know that you did anything wrong. I think you did what you needed to do at the time, and it finally worked.

CALLAN: Yeah. It was hard though. I was really scared. I was like, am I going to have to quit my job because this baby won't eat? I was trying to think of any solution.
CORKY: She didn't starve. She went to grandma’s. She kept trying. She got a little bit and finally she said, OK. The unfortunate thing is babies are too young at that age to actually have a learning experience. And I know it still hurts you to think about it. So next baby, you'll start probably at two weeks.

CALLAN: Can you talk about what nipple confusion is and how that can happen?
CORKY: I don't think most lactation consultants like that term. It's really not so much about the nipple, it's about the flow. We reference it as flow preferencing. A bottle is immediate, constant, and often fast. And a breast is not. A breast has to be suckled before it releases milk. And that may take a minute or so before milk flows. It’s a hormonal response called a letdown reflex or, in medical terms, the milk injection reflex. When a baby suckles at the breast, it sends a message to the brain, the brain tells the pituitary to release oxytocin into the bloodstream. When it comes to the breast and hits the breast, there's a little muscle band around every cell in the breast where the milk is made and it contracts.

A baby who's getting lots of bottles doesn't know that…they get used to that flow of immediacy. And then they're on the breast just pulling off like, where's the milk? Another concept is that the breast ebbs and flows, so that oxytocin surge happens, milk flows, and then goes quiet. Our pituitary doesn't just pour it out, it pulses it out while the baby's sucking. This is healthy for babies because it gives them a respite from the heavy flow, it gives them a chance to sort of breathe.
Sometimes we have no choice - they can't latch at first or they're in the NICU or whatever the reason. And so we try to encourage moms to relax about that, but to do the best they can to not use bottles in the first two weeks, if possible.

Wherever we can, we say no bottles and no pacifiers. But we're not anti-pacifiers. If you need to use one, don't get all worked up about it, do it, but be sort of minimal as that baby's learning to suckle at the breast. I get upset because it's one of the wonderful things about the breast, is that can be used to calm your baby and it should be used that way, too. And it also helps drive milk supply, etc. So, it's wonderful.

PART TWO COMING SOON & READ MORE INTERVIEWS ON BEAN TO BABE



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