Caitlin Whyte (Host): Welcome to BayCare HealthChat, the official podcast series where BayCare professionals discuss essential health and wellness topics for you and your family. I'm your host, Caitlin Whyte. Today we're joined by Dawn Baltz, a seasoned lactation consultant with a vast background in maternal child health, who has been a registered nurse since 1992.

Dawn works at Morton Plant Hospital and is here to share invaluable insights on breastfeeding and infant care. Dawn, what are some key points to know about normal infant behavior for new moms and parents learning to breastfeed? 

Dawn Baltz: So, your first week is really about the baby learning to eat. Their first times eating are during this first week. So sometimes they'll do really well with some latches and then some are gonna be not so good. The big thing is while you're in the hospital is to really lean on your nurses.

All of them are trained in positioning and latching and call them for help.

They're not bothered by you asking for help. That's what they really wanna do. For those times, once you get home and you're trying to do the latching on your own, the big thing is to make sure you're lining up your nipple right where the baby's nose is and their upper lip.

So that when they do open, that's gonna help direct the nipple to the back of the palate of where the suck reflex is. And then you wanna make sure that you're getting both the nipple and the areola in the mouth, and that should fill the baby's mouth. Otherwise, if you're noticing any flattening or creasing of your nipple, that can sometimes signal that the latch is shallow and that can actually impede the flow of your milk. So then the baby doesn't get as much. 

Some of the other key things to remember is that babies have to learn. So it's gonna take some time, just try to be patient. I use the example when I'm working with moms that, you know, breastfeeding's like riding a bike, you have to keep getting on the bike to learn how to use it, and how to make yourself successful on it.

So a lot of times this is a repetition for babies, for them practicing, and that's how they learn a skill. 

Caitlin Whyte (Host): That is a great analogy. What advice do you have for moms who feel discouraged during those first few days? 

Dawn Baltz: Your pediatrician and your lactation consultant are very good resources and are very helpful for after discharge. And then some women do still experience a little bit of discomfort with latching.

It should be gradually lessening over time as the baby gets better at the latching. Or sometimes it's an initial pinch when the baby first gets on, but then it subsides. If it isn't going away, then that's definitely when you need to seek out help for that latch. 

Caitlin Whyte (Host): That’s really helpful, especially the point about leaning on hospital staff. It’s reassuring for new parents to know they’re not expected to figure it all out alone. So, once you’re back home, is there anything else you should keep an eye on? 

Dawn Baltz:  You're gonna be watching your diaper count. So, you're gonna be counting how often the baby pees, how often the baby poops, because it's gonna keep increasing each day. So, the example we use is by day four, they're up to four wet diapers, four dirty diapers. So, it kind of goes along with each day during that first week. And then that just helps you know that they're getting enough fluids. And then that stool will go from that thick meconium, which is kind of a thick, greenish, black looking stool in the beginning. And then by the end of the week, it should be getting softer. It'll be yellow or yellow-brown.

And then it also looks kind of what we call seedy, where it looks almost like sesame seeds. It's not actually hard like seeds. It just kind of looks like little tiny seeds are sprinkled there. So that's kind of our first week of the normal newborn, I should say.

Caitlin Whyte (Host): Well, what are some important breastfeeding behaviors and milestones to expect from weeks two to eight, and if you haven't already by that point, when should you seek help from a pediatrician or lactation consultant?  

Dawn Baltz: So, usually once you've gotten past that first week, infants are gonna eat on demand. So, your baby's gonna wake up every few hours to want to eat, and your milk is still coming in during that second week and beyond.

So eventually, they'll get better at feeding, so it won't take as long for feedings. But then also they're starting to understand their circadian rhythm from nights and days, so then they can also start sleeping a little bit longer at night. 

Caitlin Whyte (Host): So, once babies start to settle into those longer night sleeps and more efficient feedings, are there any other shifts in their feeding behavior? 

Dawn Baltz: Ideally, they have some growth spurts., Pretty common around that two to three week mark. And then also usually that six to eight week mark. And this is where babies tend to do what we call a cluster feeding, where they're feeding very often. And they're just increasing their caloric intake because they're going to do some bone growth. And so all of a sudden they get longer or that little onesie doesn't fit them like it used to. So, that's kind of their little growth spurts. 

This frequent feeding also can increase your milk supply as well. And then, your latch should be getting really established during that first two weeks. 

Caitlin Whyte (Host): So, in those early weeks, the latch should really be getting established— but what happens if it’s not? If feeding is still painful or uncomfortable, when should moms think about reaching out for help? 

Dawn Baltz: So, if you're still having painful latches, then again, definitely reach out to a lactation consultant or the hospital that you birthed at should have a lactation line. The first thing, always, is try to relatch them. But if that's not working, then we probably wanna have it further evaluated. And then the other thing is, if you're hearing a lot of clicking noises when the baby's nursing or you're starting to notice any kind of bleeding or cracking of the nipple, again, you wanna reach out to either your pediatrician or your lactation consultant.

Pediatricians also have some good advice, but also they may be able to point you to a lactation consultant in your area if you're not sure where to go.

Caitlin Whyte (Host): Well, let's talk about that milk supply. What should moms and parents know in the early weeks of postpartum including how to support milk production?  

Dawn Baltz: The colostrum is really what that first milk is that the moms have for the first few days. And it's a very thick and sticky liquid, but it's power packed with sugars and proteins and immunoglobulins and stem cells. So, it's like a little concentrated energy drink for babies.

And that's because their stomachs are not very big these first few days. As they start to eat, their stomach starts to get bigger. So, somewhere between 48 and 96 hours after a person delivers, then the milk starts to come in. So, a lot of times moms will notice it on the third night or fourth day, for those first time moms.

Sometimes if they've had a previous baby, it may come in quicker. But as that milk comes in, it's gonna start to mature and they're gonna start going from milliliters to ounces. And usually, we have about two ounces by the end of the first week, and then it continues to increase over the next few weeks. And so that's where we say your milk supply gets established in those first two to three weeks. 

Caitlin Whyte (Host): That’s so helpful to understand, especially that shift from colostrum to more mature milk. Once that milk supply starts to increase, what else should moms know about how the milk itself changes, and how to make sure their baby is getting the right balance during a feed? 

Dawn Baltz: It's important to notice that once your milk is in is that you have two kinds of milk. So, the first milk, when the baby first latches on, is called the foremilk, and that's a little bit more watery. But then as they nurse, this higher fat and calorie dense milk comes down and it's called the hind milk. And that's what they really need for growth. So, you wanna make sure that you're nursing that first breast until it's really empty, soft, squishy, light before you offer that second breast. Some women get told to limit the time at breast or only use a certain number of minutes, but this can cause the baby not to get that higher fat and calorie milk. And then they'll have problems with weight gain, or they'll be excessively gassy because that foremilk can make them a little more gassy. 

So, after that supply is really determined from the demand mom stimulating the breast. However, moms do need to drink a lot of water and fluids to maintain a good milk supply, as well as have good nutrition. For water intake, some women are drinking 12 or more glasses of water a day, and the thing we really encourage is drink lots of fluids and drink to whenever you're thirsty.

When you were pregnant, your blood volume was going up to about two and a

half times what your normal blood volume is during pregnancy, but in that postpartum period, now you're starting to diuresis and get rid of that fluid. However, you still need that extra fluid to flush your body and also maintain your milk supply.

And then, typically babies are gonna be eating anywhere from three to five ounces per feeding. So, that's water that you actually need to replace in your body because your body's using water to make that milk. And a lot of moms will tell you they keep water handy while they're nursing or pumping because you can get really thirsty during those activities. So, it doesn't hurt to have that on hand. 

Caitlin Whyte (Host): That makes a lot of sense. I never realized how much fluid is used just in the process of making milk—and that thirst during feeding or pumping seems like the body’s built-in reminder. And how can new moms maintain a healthy diet while breastfeeding? 

Dawn Baltz: As far as nutrition goes, making milk for your infant takes energy, so you need to make sure you're maintaining that healthy diet. Some women require an extra 400 to 500 calories per day, but not everyone does. We don't wanna have you trying to diet or anything like that or trying to exceed your caloric intake.

Really just making sure that you're eating a well-balanced diet, including those fresh fruits and vegetables. Definitely good, adequate sources of protein and that includes fish and seafood because of those omega fatty acids are also good for your milk. And then the big thing is avoiding alcohol and caffeine. Those substances can tend to dehydrate you and some of that can also be passed into the milk and affect your baby.

Caitlin Whyte (Host): Well, on that note, what are some other essential dos and don'ts to keep in mind for successful breastfeeding and maintaining that proper care?

Dawn Baltz: So, my biggest do is do take a breastfeeding class. There are many options online or in person. BayCare does offer both in person and online classes under their maternity services options. Local WIC offices do provide breastfeeding classes, as well as some local private lactation consultants also provide a breastfeeding class.

The other thing I do recommend is ordering your breast pump from your insurance in advance, just so that you have it at home. It allays some of those fears. However, you don't need to bring it to the hospital. If you were to need to pump in the hospital, hospitals actually have special pumps that are meant to help stimulate and bring your milk in because you're in that colostrum stage.

Caitlin Whyte (Host): That’s good to know—so there really is a difference between a hospital-grade pump and one you use at home? 

Dawn Baltz: So, we wanna have you use that hospital pump because you're gonna get better stimulation. Home pumps are really meant to extract milk, so that is what their purpose is. They're very good at it, but they're not very good at getting colostrum out. 

One of the other things you'll see a lot or hear a lot about is you don't need to pump it home and save up your colostrum. If you're concerned about issues that may prevent your baby from nursing well, then call the lactation consultant at your hospital and have a prenatal consult or talk it over with your pediatrician. 

Research was done on some prenatal expression and that's why you'll hear about it. But that really was hand expression and it was for a certain gestational issue. So, that was really what they were researching. They were not using a pump. 

Caitlin Whyte (Host): Got it. Once a mom’s milk comes in, are there tools that can help during feeding? 

Dawn Baltz: Some women do use what’s called a haka or a milk collection device on the other breast that the baby's not nursing on. So sometimes those are helpful. 

The other big do I would say is join a support group. Breastfeeding is hard work and it's really nice to have the support of others around you. Some of them are going through the same stages as you or they've been there, and then they can give you tips and assistance with what they did or what worked for them.

BayCare also has many support groups throughout our region and so again, you would look on your events page and just put breastfeeding in the search bar and it'll bring you up the different breastfeeding support groups that we have. 

Caitlin Whyte (Host): That’s all great advice. Now, what are some things you would recommend new moms steer clear of? 

Dawn Baltz: The big don't is don't believe everything you see on TikTok or Instagram. Again, BayCare has lactation lines for all of our maternity hospitals, so feel free to reach out and talk to an expert. Your local WIC office also has lactation professionals to talk to as well or ask your pediatrician. We'd really rather you talk to an expert versus considering something that you've heard about online. 

One of my other big don'ts is don't use a nipple shield unless you've been advised to buy a lactation consultant. There can be a lot of pros, but there are a lot of cons to using that. So, it really would be something you wanna get an expert opinion on before you would start to use that. 

However good nipple care is another do. You wanna make sure you're doing good nipple care. The best thing for your nipples is your breast milk. So, you know, putting a little drop on after a feeding, allowing that to dry. If needed, if there's some drying or irritation, there is lanolin, you can find that purified lanolin available as well. And that can help and that is odorless and tasteless and does not need to be wiped off prior to nursing.

You'll see those little silver nursing caps that can go over the nipples. Those have been actually used for a very long time. Silver is naturally antifungal and antibacterial, so it is something that some women do like to put over. But it's not necessary if your nipples are not feeling any issues.

And then, if you're having ongoing breast pain, nipple irritation, cracking, anything like that, definitely see a lactation consultant or follow up with your OB provider because we wanna make sure that it’s being addressed and it's not maybe an underlying infection or something else going on. 

The other thing is there's a lot of things that I would say don't use the supplements that there are out there. You're gonna see lots of things about how to increase your milk supply. Really, most of those are not recommended. We just don't want you to buy a bunch of things and take a bunch of supplements that you really don't need. 

And then, the big other do is if you get engorged, use ice rather than heat. You'll see a lot of back and forth about that. But ice and gentle massage from your nipple towards your axilla is really the best way to get rid of engorgement. Engorgement is usually just some extra fluid being trapped in the breast during the milk making process, especially in those first few days when your body's figuring out what it's doing. So, ice packs are usually the best way to do that.

Caitlin Whyte (Host): And to wrap up our conversation today, Dawn, what are the circumstances under which supplementation may be necessary and what options are available to mothers and parents to support breastfeeding?

Dawn Baltz: So, sometimes there are occurrences in the hospital when supplementation is necessary. It's usually due to a medical issue, such as the baby's having low blood sugar or their jaundice level is elevated. Or they're not doing a really good job at breastfeeding, and so their weight loss is a little bit more excessive.

There's a little bit of a wiggle room with weight loss that we expect for babies because they're learning to eat, but sometimes it's a little more than what the pediatrician is happy with. So, we have options. Some of our BayCare hospitals have donor milk, which we get from the Milk Bank of Florida that is the same kind of donor milk that is sent to the NICUs for premature babies.

We all have formula to use if that is needed. And then the other thing is, if we are needing to supplement, a lot of times we want to get the mom pumping. So we can offer the colostrum because sometimes all we need to do is, especially if the baby's not latching well, is get the colostrum out so we can get the baby fed. But your pediatric provider will also follow up with other options in the outpatient setting after discharge if we need to continue the supplementation. 

And then if your infant does need to supplement, we usually do recommend that you pump for stimulation, again with the hospital pump, that's meant to help stimulate and get that colostrum out and also do some hormonal stimulation to increase that milk supply.

The nurses are all trained in the use of the pumps, and they can assist you with getting started. And the pumping is meant to mimic the feeding schedule, not to cause overstimulation or breast irritation. So, it would be a quick little pump after a feeding, so that you would be only pumping when the baby's nursing.

Caitlin Whyte (Host): Thank you so much, Dawn, for the work that you do and for sharing with us today.

And that wraps up this episode of BayCare HealthChat. Head on over to our website BayCare.org for more information and to connect with one of our providers. Remember to subscribe, rate and review this podcast and explore all of the other BayCare podcasts for more information, health tips and updates.

Thank you for listening.