BREASTFEEDING 101: Part 1

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.

 

Callan:  OK, so clogged ducts. Why do  those happen and how can you resolve them?
Jennifer:  So, you know when you leave mayonnaise out and it gets kind of hard? Fat can get thick and sticky, and you have between 9 to 19 openings on your nipple. So again, if you think about your breast as a bushel of grapes with all these vines, they all lead to the nipple. If the nipple opening gets clogged, milk can't come out.

And that's considered plug ducts, which would lead into mastitis. This is caused by insufficient milk removal, which happens. It's nothing the mom did. If the mom is sleep training and trying to get her baby to sleep through the night, which is when we make the most milk, that can lead to insufficient milk removal. What it boils down to is a baby should be on the breast eight times every 24 hours. And if the mom can't put the baby on the breast, the mom should be pumping. If you reach that goal of eight times every 24 hours, it shouldn't happen. Though some people are prone to fatty milk and can get clogged ducts often. So, some women are just prone to it. And you make more milk the more kids you have, so a mom could have a great experience breastfeeding her first kid and then her second kid have issues with plugged ducts. And it's because she's making more, and she needs to get it out. Or she may have fattier milk.

Callan:  I  had,  I don't know if it was a plugged duct, but  these hard white spots  on the end of my nipple.
Jennifer:  Yup. That's exactly it. It looks like a like a white head. There's no rhyme or reason to the anatomy, there's ducts that link to certain spots and one spot might necessarily not go to a specific area. But if one of those openings is blocked, that's an entire section of the breast. My recommendation, if a mom has one, especially if she's home, soak your nipple in some warm water. Take a warm shower, and then gently exfoliate the nipple with a wet washcloth or, my favorite thing in the whole world, a sea sponge. They're all-natural, antibacterial, and antifungal and provide a very gentle exfoliation. And that's a great thing for every breastfeeding mom to have.

Callan:  Could you talk about signs of mastitis and what you need to do to treat it?
Jennifer:  We've studied mastitis over the years by culturing women's milk. We take their milk and look at it under a microscope to see what bacteria is causing the mastitis. The research shows that the number one bacteria found in mastitis is a certain type of staph. It's called Staphylococcus aureus. And mastitis is caused by insufficient milk removal. The first signs of mastitis are soreness. It feels like someone punched you in the breast. It's sore. It's showing you that an infection is starting. Then the infection can progress. The breast can get red and hot. If you catch it early and you feel it when it's just sore, there's just milk trapped in there. If you get that milk out, the body's going to fight the infection on its own and you're fine. You'll be better in 24 hours. If you can't get that milk out, you must go on antibiotics or that infection could potentially turn into an abscess, and if that infection gets in your bloodstream, it can be life threatening. So if you feel breast tenderness and you feel full, do whatever you can to get that milk out. Use the baby or use a breast pump.

To go back to oxytocin, this is the only hormone in the body we control with our brain. When you put a baby to the breast, the milk lets down whether you like it or not. If you put your breast on a pump, you control the oxytocin, so there's many women who can’t get any milk out with a pump. And it all depends on the personality. So, if you're the type of person who is very structured, you might not have the hippie mentality to just let it flow. So, one of the tricks that you can do if you have milk stuck in the breast and you're trying to pump it out, you can put the baby on one breast while you pump the infected one. Let the breast be controlled by the baby instead of your own brain.

Callan:  I've heard a lot of people say that they like to look at pictures of their baby when they're pumping, that it helps. And I guess – there you go.  It makes you happy.
Jennifer: There's two hormones with lactation. One is oxytocin, and one is prolactin. The brain really controls breastfeeding.

Callan:  What is the biggest challenge most mothers experience?
Jennifer:  I think getting comfortable breastfeeding, whether it's position wise or how often they need to do it: this baby's feeding so much, how do I know if they're getting enough? And it's a full-time job, especially the first two weeks. I love breastfeeding pillows that build a shelf. My favorite one is My Brest Friend, and it's because it clips, and it builds a shelf, and it brings the baby to the table. You can turn the pillow to the side and feed in the football hold or use it to feed the baby in front of you in the cradle position. But I think getting comfortable because it's so new is the biggest challenge and finding a good schedule. We go from being very independent women to our life changing overnight. And the next thing you know, you're up all the time taking care of this baby. We don't have an instruction manual. So, the goal is to stick to that schedule of feeding eight times a day, realizing that the feeds in the beginning are going to take a long time. Once the baby hits about three months old, they could drain that breast in three minutes. But in the very beginning, you're going to be nursing nine hours a day. By the time the baby's three months old, you'll be nursing about 45 minutes every 24 hours. So, pretend you're starting a new job, get yourself psyched up for it, get what you need, and get organized with a breastfeeding pillow. And realize, this is going to be tough in the beginning, but you’re going to get through it and you’re going to make it to the point where it's super easy because it will be super easy over time.

Callan:  You mentioned something that made me think. I was talking to some  other  moms,  and I  shared  that, I think what surprised me most with breastfeeding  –  and  what I  really  felt  unprepared for –  is that it's a physical takeover. You would think pregnancy would be more of "giving up your body." But I felt that nursing a newborn, I was basically not even part of the equation. I just had to be a  boob  for this baby.
Jennifer:  So, the Orange County Fair down here had this pig cam, and it was all these baby pigs and this mom. And this poor mommy pig is just laying down exhausted and all these little babies are nursing on her nonstop. And that's how you feel. I mean, it's true. And that's we don't think about that, and we don't think about the sacrifice. And it is a sacrifice, but it's keeping your eye on the prize and realizing that 85% of your baby's brain is developed by the time they're three years old. And the most important thing is infant nutrition. It's the most important thing for developing their brain. Breastfeeding makes it very easy for you to get them the right nutrition because it's specifically designed for them. And they get benefits from being held and being close to you. They're setting up their own oxytocin receptor sites in their brain.

So, it's taking a step back and realizing that it’s going to be tough, but you’re laying a good foundation. But guess who ends up sacrificing it for it? The mom. It's a big responsibility, but you're looking towards the future. And we know that, based on the science, if you lay down that good foundation for brain development, it not only affects them in terms of intelligence, but it affects their behavior.

Callan:  Can you touch on how breastfeeding does sort of change as your baby gets older?
Jennifer:  There's a lot of misinformation in terms of the evidence, but now, believe it or not, it's the formula companies that allow us to study breast milk and how it changes and what's in it. The main purpose of breast milk in terms of helping your baby with their compromised immune system are the antibodies. We're exposed to things through our mucosae. And one drop of breast milk has 1 million living white blood cells. So those white blood cells coat the baby's mucosae to repel bacteria. So that's one benefit. Then the mom’s antibodies change based on what she's been exposed to. The mom has antibodies for every vaccine that she got when she was a kid and every cold and flu up until that moment. And every day it changes, so every time a mom goes to the store and touches the cart and is exposed to a new germ, she develops the antibodies and gives those to the baby. So, her breast milk is changing every day with new antibodies to combat whatever is out there in the world.

In terms of nutrition, the milk in the very beginning, the colostrum, is a super, highly concentrated milk because the baby doesn't need a lot of volume in the beginning. It's higher in protein and higher in antioxidants. But in terms of the nutrition, studying breast milk, the DHA appears to be the same throughout the whole course of lactation. We're just like cows. If a cow has a baby and they're on a dairy farm and they milk them, the cow can lactate till the day they die. The milk doesn't necessarily change in terms of nutrition. It can change in flavor based on what we're eating. But generally, the nutrition and the antibodies are always there. It changes based on the age of the baby and based on the time of the day. So, for example, in the morning our milk is more watered down because the baby wakes up thirstier. At the end of the day, the milk is fattier, and it's designed to get the baby to sleep longer. So, it can change, but it's all specifically designed to change at the right time under the right circumstances.

Callan:  So interesting, the more you learn about breast milk, the more magical it seems.
Jennifer:  It's crazy because it's like every time I go to the zoo and I see a monkey breastfeeding, it's like, I know! Being a mom is being a mom. And we share that with every other mammal. Once you've breastfed, you have a whole new appreciation for moms, whether they're a whale or your best friend. We all go through the same things and the same hormones. It kind of unifies us. And I think in the world right now, with all the craziness, what better timing to unify all moms and say, it's a struggle for all of us. I don't care what's being posted on social media. If someone's telling you that breastfeeding was easy in the beginning, they're either lying or they don't remember. It's not easy. But neither is having a kid.

If you can lay down that good foundation with good nutrition, and if you can't breastfeed, the goal would be to focus on getting them as much breast milk as you can. Even if it's a teaspoon every 24 hours. You'll be giving the baby those antibodies, and then you can supplement the rest with formula. It's a great time to supplement with formula. Formula is the most like breast milk it's ever been. So, no guilt. Love on your baby, get them the best nutrition that you can, get them to the pediatrician appointments, and you're a great mom.

Callan:  On that note, can you share why some women or babies may not be able to breastfeed  long term  or possibly at all? What do you say to these moms?
Jennifer:  I've always been a black sheep in the lactation world because I do crazy things like induce lactation for mothers who are adopting or for lesbian couples who both want to breastfeed. So, we talked a lot about oxytocin. The other hormone that controls breastfeeding is a hormone called prolactin, and it's from the pituitary gland in the brain. You get prolactin surges when the baby is on the breast, not with the pump. So, if you're separated from your baby, maybe you have to go back to work and you're pumping, your milk supply is going to go down. And that's just how it is. That's just the way it works, but you can synthetically boost your prolactin and get your supply up. So, again, if you're able to be home and put the baby on the breast several times a day, you shouldn't struggle with low milk supply. If you have a realistic life where you have to work and make money to have a roof over your head, your supply might go down. But it's OK. There's a way to fix that. All you have to do is synthetically boost your prolactin and the supply will go up. It may seem like a big problem, but there is a solution for every problem.

Callan:  So how do you do that, how do you  boost prolactin  so there's an increase in your supply?
Jennifer:  In terms of the research, there's an herb called fenugreek and that boosts prolactin levels. A liquid tincture seems to be the most effective. They sell milk boosting teas and shakes. It's all fenugreek. That's the one herb that's been clinically proven to boost milk supply by boosting prolactin. But it's not necessarily quantity, it's quality. So, for example, the tea, you'd have to drink 92 cups of that tea to get the same fenugreek found in a liquid tincture capsule. So, fenugreek is the key. Some women that are away from their babies, maybe they're a nurse and they're gone for 13 hours, may need a more potent version of the fenugreek. And as a disclaimer, if you have a peanut allergy, fenugreek is not recommended.

Callan:  How would you know if you have a supply  issue, like what are some of the signs early on that you need to address it?
Jennifer:  The first stage of lactation starts when you're 10 weeks pregnant. The second stage of lactation happens after the delivery of the placenta. Typically, within 72 hours of the baby being born, you should go from boobs like this, to boobs like THIS. Issues that can cause that from happening are third spacing or too many IV fluids. Generally, whether you like it or not, the milk should increase in volume, whether you stimulate your breasts or not. So directly after birth, the number one thing that suppresses milk supply is IV fluids.

In terms of later milk supply, that's the hardest part. And social media is the worst. You go on and people are like, “I just pumped 17 ounces!” And, no. A full blown milk supply for a 12 lbs. and up baby (so whether the baby is 12 lbs. or 25 lbs.) is 32 ounces of milk every 24 hours. So, if you break it down into eight feeds per day, a mom should be able to pump and get four to five ounces between both breasts. That is a great milk supply, but we have these giant bottles on our pumps, these six-ounce bottles. But if you pumped three ounces out of each breast, you've got a rockin' milk supply.

Callan:  That's interesting because  you look at  the ounces and it doesn't look like a lot. And I know when I went back to work, I was like wow, this is disappointing. I wanted to have like a gallon of milk by the end of the day, but it's just not reality.
Jennifer: It's based on the baby's weight. So, we've considered how many calories the baby needs to survive, and then how much food on top of that, breast milk or formula, they need in order to gain one ounce per day. Once a baby hits 12 lbs., they need 32 ounces of milk every 24 hours, and it stays that way. So that is an amazing milk supply. And that's really what a mom makes right after the baby's born on that day three. You go from a teaspoon to 32 ounces because your body's preparing for if you delivered a 10 lb. baby. You don't have to pump 10 ounces, that's not realistic. And when people talk like that, it just makes everybody feel terrible. They should make those bottles smaller. Pump companies hear me! Make three-ounce bottles. If a mom needs to empty it into another one, great. But you should be able to pump and feel good if you get four to six ounces out of both breasts.

Callan:  What about multiples?  When you have twins or more children, how does it work? Are you making more milk?
Jennifer:  I got invited to talk to a group of about 50 moms pregnant with twins, and I felt totally like Debbie Downer. But I got up there and said, in order to fully, exclusively breastfeed twins, you have to make 64 ounces of milk every 24 hours. And if you did, you would be the most miserable person on the planet. It's not possible. So supplementing is in the cards. When you have twins or triplets, you're going to have to supplement with some formula. And I felt bad saying that because I know everybody wants to fully, exclusively breastfeed. But then talking to those moms after the babies were born, they were like, thank you, because you gave me realistic expectations. The baby needs to get a certain amount of food every 24 hours and a full-blown great milk supply is 32 ounces every 24 hours. When you've got two babies or three, they still need that amount. It's almost physically impossible for a mom to fully exclusively breastfeed with twins. Very difficult. You make more milk the more kids you have. So, if a mom has twins, after already having kids, she could possibly do it. But the chances are super slim. The goal should be getting the baby as much breast milk as possible and try to get on some sort of schedule. Maybe breastfeed one and bottle feed the other and vice versa, work on some sort of schedule where you can feed them at the same time just for your sanity and do the best you can.

Callan: If you are supplementing, what are your thoughts on nipple confusion, and introducing a bottle to a breastfed baby? Is that really something you should be worried about? 

Jennifer: There's absolutely no evidence that nipple confusion exists. It's never been proven. The first three months, babies are basic reflexes, so if anything touches the roof of a baby's mouth the first 12 weeks, they're going to start sucking on it, whether it's your finger or the nipple or a bottle or a pacifier. They don't get used to a nipple. It's a reflex, just like when you go to the doctor and they hit your knee and your leg goes up, it's a reflex that's out of their control. They can get a flow preference. If a mom has no breast milk and she's offering the breast and the baby is hungry and they get on and there's nothing there, they get mad. It's not a nipple preference, it's a flow preference. There's been no research to prove that there is such a thing as nipple confusion. And sucking is a reflex, it lowers the heart rate and the blood pressure of the baby, and you can't take your boob and put it in the backseat of a car. The first three months, they're incapable of manipulation or learning. It is what it is, you touch the roof of their mouth, they're going to suck on it, no matter what it is. So those first three months, you do whatever you need to do to get through and get that baby the proper nutrition and don’t worry about nipple confusion because their brain is not capable of being confused yet. They are basic reflexes.  

Callan: So, after I gave my daughter the initial formula when she was like a day old, I didn't try to give her a bottle again until she was maybe five or six weeks old, and she would not take it.  

Jennifer: So, it's not the bottle. It's how you were doing it and the nipple. A lot of nipples now are like more like boobs. Every baby has a suck reflex trigger. Sometimes it's farther back, sometimes it's forward. If a baby doesn't take a bottle within the first 12 weeks, it's just because the nipple is not stimulating that suck reflex. It has nothing to do with the baby wanting the bottle or not wanting the bottle. So, in that case, if you were my patient, I would have switched you to like a harder, longer nipple, like a Dr. Brown and the baby would have taken it in two seconds.  

Callan: I killed myself trying 25 different bottles. She eventually took the Nanobébé. 

Jennifer: It takes 22 muscles in the face to breastfeed. It takes one muscle to bottle feed. But I have had over the past 11 years a handful of babies that can breastfeed but can't bottle feed. It's crazy and makes no sense, so it can happen, but most of the time it's just reflexes. The nipple has to stimulate the suck reflex. And I'm sure if you were to try to a pacifier, you would have had difficulty as well. So, it wasn't anything that you did. It was her anatomy, and this is probably why. And you can tell me if I'm wrong. I bet you a million dollars you have an ultrasound picture of her sucking her thumb or finger in utero or she sucked her finger or thumb in utero because the babies that have a hard time with certain bottles...when they had their thumb in their mouth in utero, they created a palate that’s higher than usual. And the bottle has to hit that perfect spot.  

Callan: You go crazy when your baby won't take a bottle and you need to leave them.  

Jennifer: I know. But the first three months a baby is alive, they can't tell you what they want or manipulate you or reject something or not like something. It's just not how their brain works. If something's not working, you switch to the next thing and find something that does. And it's that simple. If this nipple's short and your baby's not taking it, switch to a nipple that's long, and boom. It's that simple.  

Callan: Can we talk about latch. How do you know if you have a good versus bad latch and how do you fix it? When I saw a lactation consultant, what I was amazed by, and this was such a simple fix that you would think I would just know how to do this, was that I could unlatch the baby if it hurt to fix it. But it was like I needed somebody to give me permission because I was also so paranoid that she wasn't getting enough milk at that point that I did not want to take her off my nipple.  

Jennifer: To go back to the vacuum, in order to extract milk from the breast, the baby is on there with a vacuum seal. So, it all goes back to what's happening. If you put your tongue on the roof of your mouth, hard palate, then there's a bump and behind there is the soft palate. In order to extract the milk, the baby's using their tongue. The tongue is moving to create a vacuum suction to get the milk out. But if the nipple is being smashed against the hard palate, it's going to cause you pain. So, yeah, if you latch the baby on and it hurts, you unlatch the baby and then latch the baby on again. This is one thing that hopefully you can get across because it seems so simple, but we all do it wrong. You compress the breast to align with the baby's mouth. If you're feeding the baby in a football hold, you have to compress the breast to align with the baby's mouth. It's either like a sandwich or a taco. If the baby is in the football hole right here, you have to compress the breast like a sandwich. If the baby is in front of you, you have to compress it like a taco because the baby's mouth is up and down. Imagine the breast is like a big burger, you have to squeeze that burger to get it in your mouth. That's how you should think of the breast when you're latching: this is a big burger, I have to compress it. But if you feed a baby a sandwich sideways, they're going to bite their way on and hurt you. So that's great advice, and I used to teach a breastfeeding class and all the OBs in Orange County would know if I worked with their new parents. They would hear them saying, "Wait, is it a sandwich or a taco?" Because if you only remember one thing: sandwich or taco. So, football hold: sandwich. Feeding in front of you: taco.  

Callan: You know, you think it's going to be so simple, but then all of a sudden you have this tiny little baby head with an even tinier little mouth and then your giant boob and you're like, oh, my God.  

Jennifer: So, I just took 11 years of working with parents and wrote a book that's specific for what's needed. In the very beginning of the book, it's the first two weeks. What you really need to know, because you don't need to know everything, just what to do to survive the first two weeks. And it's exactly that: how to position the baby properly and how to latch the baby properly. Later in the book, it's all the things that can happen: overgrowth of yeast, mastitis, and how to fix it based on the evidence. The back of the book is a baby feeding requirements chart, how much food the baby needs based on their weight. If moms go back to work or they want to take a nap and they want to pump and leave their milk and give it to a family member, they know how much to feed because the baby will eat 30% more than they need to out of a bottle because it just flows. So, they'll pound milk like crazy even though they don't need it.  

And in the very end of the book there is a log of what to focus on day to day. Day one, what do you want? One poop, one pee. Check, check. Because during those first two weeks, that's the first question a pediatrician is going to ask you, because that's how they know if the baby's doing well. The parent doesn't need to know everything, they have the support of the medical community. But they do need to know what to keep track of. And what things can come up that they need to tell the doctor about. I tried to make it very simple and only focus on what's important. The goal is to protect the baby with the antibodies from your breastmilk for as long as you can. It can take four years for a baby to have a complete immune system. But those first three months, the baby is immune compromised. It's like someone going under chemo, they are very vulnerable. So the first couple months, whatever you can do to get that baby at least a teaspoon of breast milk, you're putting them in this little bubble and protecting them with all those antibodies.  

Callan: And then what's the deal with nipple shields? I had one person recommend that I use them. I didn't end up using it, but I had to buy them. And I was like, what size do I get? How do people know this? Is there a whole hidden world of people who know their nipple sizes?  

Jennifer: I know! We spend our entire lives hiding our boobs. And then you have a baby, and a guy comes in to take your food order and your breast is out. You're like, I don't even care anymore, you know? So again, that's preparation while you're pregnant. And I put pictures in my book of different nipples, like flat nipples. What's normal in terms of a nipple? Because when we're with our girlfriends, we're not looking at their breasts and their nipples. So, you don't even know what kind of nipple you have.  

So, again, it all goes back to the latch. If you have a flat nipple, the baby is going to smash your nipple against the roof of their mouth. A nipple shield is a thin piece of silicone that fits over your nipple and makes it impossible for the baby to smash your nipple. It does come in different sizes but 95% of the time, I would use a 20-millimeter nipple shield from Medela. It's my favorite. It's a contact nipple shield, so part of the shield is cut out so that the baby's nose is in contact with the breast, not with the silicone. There's no evidence that a nipple shield can decrease your milk supply or cause long term damage to your milk supply. But there's a lot of people that don't like them. But because of prolactin and the fact that you only get prolactin surges when the baby is on the breast nursing, you don't get prolactin with the pump. If you pull the baby off the breast and tell a mom to exclusively pump, that's going to damage her milk supply long term. So do the risks outweigh the benefits? That thin piece of silicone over the nipple, if that gets the baby on the breast breastfeeding and gives that mom pain relief? 100% go for it. I love them, absolutely love them.  

The goal is to keep the baby on the breast and have the mom be comfortable. But there are different sizes and misconceptions about the sizes. The baby should be flush against the breast, you should not see any of the nipple shield, so I put pictures in my book of right versus wrong. And if you have a small baby and you're using a big nipple shield and you see part of the shield, they can still smash your nipple. So generally, with the nipple shield, the smaller the better. But I'm sure there's going to be people that disagree with me, but again, I'm going back to the evidence. People can disagree with my opinion, and I have my own opinion about things, but I am 100% evidence based. I'm only giving you the information on what's best for lactation, more as a medical professional than just a breastfeeding advocate. 

I think it's time to take breastfeeding and make it less of a "rah rah, you can do it!" It's like, I want my boyfriend to propose, but I can't make him. You can want things to happen the way you want them, but sometimes they don't. And just wanting to breastfeed doesn't seem to be enough to keep people breastfeeding. We all want it, we all know it's good, and they've done a great job at telling us that it's good. Now it's time to help us fix these problems so that we can continue doing it. Remind us why we’re doing it all the time, every time we go to a doctor's appointment, tell us how amazing we are for doing all that we're doing. The entire time I was breastfeeding, between both kids I breastfed for about five years, I just wanted to find other breastfeeding moms. And that's what bums me out so much about COVID is the lack of the sisterhood. We can't get together with our friends. We can't go to lactation clinics. So, I wrote my book literally so fast because I wanted to get it out there, because I want every mom to be able to do this and have the support that they need. I can't even imagine having a baby and how they must feel right now.  

Callan: Having other moms to talk to definitely helps. One of my best friends had her daughter about two months after me, so it was just nice both being on maternity leave. I'm like, "I just had to eat a pork chop cold with one hand because she's cluster feeding!" Just to have somebody who can understand how exhausting it is.  

 Jennifer: We're so good at forgetting the hard times.  

 Callan: I completely blacked out the first two and a half months of my daughter's life. 

Jennifer: All I had was my mom. And I'm like, "Mom, how long did you breastfeed me?" She's like, "Too long." And that's not an answer! So that's the thing. Moms need to able to get together and support each other in a non-judgmental way. And I learned that really fast working with new parents – and I've worked with a lot of new parents. Every race, color, creed, religion, sexual orientation, marital status, like it doesn't matter. Every new mom is the same and we have the same problems. And I wish that women could put aside all their differences and bond together during this time. Let's support each other through this first year because it's hard. It's the hardest thing I've ever done.  

Callan: Breastfeeding is obviously a huge commitment, and I feel like our society is not really set up to support it. For a lot of women when they end up going back to work, it's just it's too much – emotionally, physically, and they're just exhausted. So, what do you say to those women? I remember my coworker, and this is years before I had my daughter, crying in the cube next to me because her milk supply was low, and she didn't have time to be pumping all day at work. And I didn't understand her pain because I was, again, not even thinking about being a parent at that point. But I remember feeling so bad that she felt so guilty. And I told her, “But you're giving your baby formula, you're still feeding her, it's OK.” And she said, thank you for saying that. And I thought, is this like a “thing”? And now that I'm a mom, it is a thing. You feel guilty. And I think some women come so close to their breaking point trying to make it work when it's just not working.  

Jennifer: There's so much pressure to do an all or nothing approach that you end up doing nothing. And the message I would love to spread, is that some is better than none. 99% of women can extract a teaspoon of breast milk every 24 hours. If that's your goal, that's an achievable goal. You could pump once a day the first thing in the morning. That's your goal: one teaspoon. So even these moms who adopted a baby that I helped to induce lactation for, that was our goal: five CCs every 24 hours. We made it work, and that is enough. There are formulas now that are designed more like breast milk than ever.  So, find a formula that's the most like breast milk and reach that achievable goal of five CCs of breast milk every 24 hours.