Breastfeeding doesn't have to be a challenge.
We're here today to educate and encourage moms about breastfeeding.
Alyssa C. Rutan, MD, is here to explain that as your breastfeeding journey begins, you can count on us for support, expertise and all the help you need - even after you go home.
Selected Podcast
The ABC's of Breastfeeding
Featured Speaker:
Alyssa Rutan, MD, Bryan Women’s Care Physicians, part of Bryan Physician Network
Dr. Alyssa Rutan is an OB/GYN with Bryan Women's Care Physicians. Transcription:
The ABC's of Breastfeeding
Melanie Cole (Host): Breastfeeding your infant provides more than just good nutrition. It also gives you a chance to hold your newborn close, cuddle them, and make eye contact. There are so many good benefits to breastfeeding. My guest today is Dr. Alyssa Rutan with Bryan Women’s Care Physicians, part of Bryan Physician Network. Welcome to the show, Dr. Rutan. What is the first thing you tell moms-to-be about the benefits of breastfeeding?
Dr. Alyssa Rutan (Guest): Good morning! Yes. Thanks for having me. So, we've definitely started talking more about breastfeeding during pregnancy to make women aware of the benefits of breastfeeding, both to the mom and her baby. A lot of women don't know that she can actually benefit herself from breast feeding. Studies have really established that women have a lower risk of developing Type II Diabetes as well as ovarian cancer and breast cancer later in life if they breastfeed their babies. So, just from a preventative health care standpoint, this is really, really important for women to know--that this can help to decrease their risk. Women are more familiar with the benefits of breastfeeding to the baby, which include decreased incidence of acute ear infections in infancy; definitely a decreased incidence of diarrhea; atopic dermatitis, which is like an allergic reaction on the skin and asthma. Obesity later in life is something that we're really looking into because childhood obesity has become a real problem and then, also Type I and Type II Diabetes in infants, as well as childhood leukemia and other inflammatory diseases of the bowel, like Crohn's disease and ulcerative colitis, in addition to a decreased incidence of SIDS--Sudden Infant Death Syndrome--within the first year of life. So, there are definitely a lot of good things that can come out of breast feeding.
Melanie: How long should a woman potentially think about trying to breastfeed?
Dr. Rutan: Well, I tell my patients that I realize that there are going to be some limitations to their duration of breastfeeding; any breastmilk is better than no breastmilk, so as long as she can would be great. The American Academy of Pediatrics and the World Health Organization recommend that women exclusively breastfeed until at least six months of life and then as long as the child and the mother both desire after that. So, ideally, six months exclusively, but if that's not possible, just as long as she possibly can and any breast milk is better than none.
Melanie: This is a huge topic and we could talk about it for a very long time, Dr. Rutan, but let's start with some breastfeeding basics. With a new mom and the baby is just born, how soon do you work on getting that baby to latch on and what if it doesn't happen right away?
Dr. Rutan: Another thing that's become more talked about lately is the research regarding skin-to-skin and what we call the "magical first hour of the newborn." And so, immediately after the baby's born, whether it's via vaginal delivery or cesarean delivery, it's really beneficial, and has shown to increase the amount of breast milk that the woman makes after six months, if we can get that baby skin-to-skin, the baby's skin to the mom's skin. By doing that, it's not only comforting to the baby, but the baby actually recognizes the smell of the mother as well as the colostrum when they're close to the nipple. So, a lot of times, the baby will become more alert and ready to feed. It's almost like a person waking up in the morning and smelling coffee and saying, "Oh, that smells good.” It's the same thing with the baby. They smell the colostrum, they smell the milk and then they become more interested in feeding. So, ideally, we like to get a latch within the first hour of life. If that doesn't happen, just as much skin-to-skin as possible. Most hospitals now are training our labor and delivery nurses and our postpartum nurses in helping to assist moms in getting the baby latched. If they're having difficulties, most hospitals also now offer lactation consultant services where we have folks who have done additional training to assist in getting a proper latch so that the mom doesn't experience pain and the baby can express the milk effectively.
Melanie: New mothers worry that they're not going to have enough milk to feed their baby. How much milk comes in at the beginning and does that grow over time?
Dr. Rutan: Yes, absolutely. That's a great question because that's the number one reason that women quit breastfeeding is that they feel like they're starving their baby and they're not making enough milk. A lot of women feel that way because the babies want to feed so often. So, really, at first, the baby's stomach is very, very small, about the size of an almond. So, the baby's only extracting a tiny little bit of colostrum to begin with which is just concentrated proteins but after a couple of days of nipple stimulation is when the more mature milk comes in. So, really the most important thing is knowing that frequent feeding is normal. The baby should latch 8-12 times a day and you can liken that to an adult, as well. Think about how many times you put something in your mouth every day. It's certainly more than eight. So, sometimes the babies just want a little bit of a snack instead of a great big meal. So, latching the baby frequently--every two to three hours--is what people should do. Then, the pediatricians, as well as the nurses in the hospital, will help to monitor the weight of the baby. The baby really shouldn't lose weight past day five. After that, the baby should be gaining weight again and re-gain the birth weight by day 14. Babies should gain about a half an ounce to an ounce per day if they're transferring milk effectively. So, we definitely keep an eye on that, but just because a baby wants to feed frequently doesn't mean you're not making enough milk. It's very normal because the human milk is very watery. It's composed of a lot of water versus some other mammals that have a high fat and protein content, so our babies are geared to feed every two to three hours.
Melanie: Is it normal for a baby to spit up after feeding?
Dr. Rutan: Yes. Babies can definitely spit up after feeding. If it's a large amount or if it's every time, you may want to discuss that with either your family doctor or your pediatrician, whoever is helping take care of your baby, but it is very normal for babies to spit up after feeding.
Melanie: Mothers worry that if they catch a cold or the flu that they can't breastfeed.
Dr. Rutan: In fact, that's actually not true. When you catch a cold, you produce a protein in your body called “antibodies” and those antibodies help you fight off the virus or the bacteria that's making you sick. By breastfeeding, you're actually transferring those antibodies through your breast milk and giving them to your baby to decrease the risk that your baby will get that illness. So, it's actually very protective if you feed your baby when you're sick.
Melanie: What about nutrition for mom while she's feeding? Are there any specific guidelines you like to give regarding alcohol, spicy foods, salty foods? Is there anything they really need to watch out for?
Dr. Rutan: So, the first thing that they need to watch out for is making sure that they're taking enough in. Immediately after delivery and in the postpartum period when your milk is not well-established is not the time to be trying to get off your baby weight. So, I counsel my patients to increase their caloric intake by 500 calories a day and making sure that they're getting good nutrition. So, lean meats, vegetables and fruits. The milk actually takes on a specific flavor based on what you eat and so the milk will taste different and the babies will acquire a taste for the things that you eat. So, yes, it's really interesting that toddlers that are breastfed actually appear to be less choosy when it comes to different flavors. They have a wider palate of acceptable foods.
Melanie: That's really cool!
Dr. Rutan: Yeah, it's really cool! You don't necessarily need to alter your diet. You can still eat spicy foods. The alcohol content, that can be an issue. So, for your average 130-pound woman, which equals out to be about 60 kilograms, the Institute of Medicine says that if alcohol is used, that she limit her intake to no more than 0.5 grams of alcohol per kilogram. So, what that ends up being is approximately two ounces of liquor, an 8-ounce glass of table wine or two cans of beer. Now, alcohol is transferred through breast milk to the baby. So overall, drinking and nursing is not recommended. However, if alcohol is used, that is what the Institute of Medicine has given us as a guideline over a 24-hour period; over a day. As far as spicy foods or another thing that I will hear is that the folks have been recommended to really push fluids and really you don't have to over-exert yourself in drinking water. That won't necessarily help with your supply. Just drink to your thirst. Just pay attention to your thirst signals and just drink until you're not thirsty
Melanie: And then, what about bottles? We don't have a lot of time left, Dr. Rutan, but they wonder if pumping is okay and if you give a bottle to a breastfed baby, is that going to ruin all the good work that you've done?
Dr. Rutan: No. There's definitely a lot of women who are gonna have to feed their baby with a bottle because most women go back to work. So, what is usually recommended is that you start to introduce potentially one bottle per day between two and four weeks of age by somebody who is not the mother so that the baby still associates mom with being at the breast. But, to minimize the risk of bottle refusal when the baby has to go to daycare or somebody else is taking care of the baby, one bottle per day making sure that you get the entire nipple in the baby's mouth and that the tip of the nipple is at the back of the baby's mouth toward the upper part of the palate. There are specific nipples that folks can ask their friendly lactation consultant about. There are some that are more friendly to breastfeeding moms but, in general, the wider-based nipples are safer in breastfeeding babies because when a baby attaches to a breast, they open their mouth very, very wide to get a lot of nipple in their mouth. So, we want to replicate that with a bottle as well.
Melanie: In just the last minute here, your best advice for pregnant women, about what they should think about when they know that they're going to want to breastfeed and tell us a little bit about your team at Bryan's Women's Care.
Dr. Rutan: Sure. My best advice would be that if you're committed to breastfeeding and you want to breastfeed, don't get frustrated. There are a lot of folks out here to help. We've seen that a lot of women have the intention to breastfeed and the discharge rates from the hospital are very high but because they worry that they're not doing it right or that there's something wrong, or that they're not making enough milk, they don't seek help. So, my biggest piece of advice would be to seek out folks who can help you--certified lactation consultants, IBCLCs, usually your pediatrician or your family practice doctor can point you in the direction to get some help and usually the problem is with the way that the baby attaches in latching. So, just don't give up, hang in there and get help to make sure that everything's going okay as far as the baby latching and expressing and transferring milk. So, at Bryan, we have lactation consultants on the floor. All of our labor and delivery and postpartum nurses receive extra training to assist moms in getting baby to the breast and we are a breastfeeding-friendly hospital which means that we try to get the baby to the breast as soon as possible and we promote skin-to-skin and don't give formula unless it's medically indicated because that can also decrease your success at breastfeeding. So, we also have some great folks in our community here--several lactation consultants and a clinic area that's specifically dedicated to breastfeeding. So, there are definitely folks out there who can help. La Leche League is a national organization that has folks who are willing to help with breastfeeding moms. So, that would be my biggest advice: just seek help if things aren't going well.
Melanie: Thank you so much. It's absolutely great information. You're listening to Bryan Health Radio and for more information you can go to BryanHealth.org. That's BryanHealth.org. This is Melanie Cole. Thanks so much for listening.
The ABC's of Breastfeeding
Melanie Cole (Host): Breastfeeding your infant provides more than just good nutrition. It also gives you a chance to hold your newborn close, cuddle them, and make eye contact. There are so many good benefits to breastfeeding. My guest today is Dr. Alyssa Rutan with Bryan Women’s Care Physicians, part of Bryan Physician Network. Welcome to the show, Dr. Rutan. What is the first thing you tell moms-to-be about the benefits of breastfeeding?
Dr. Alyssa Rutan (Guest): Good morning! Yes. Thanks for having me. So, we've definitely started talking more about breastfeeding during pregnancy to make women aware of the benefits of breastfeeding, both to the mom and her baby. A lot of women don't know that she can actually benefit herself from breast feeding. Studies have really established that women have a lower risk of developing Type II Diabetes as well as ovarian cancer and breast cancer later in life if they breastfeed their babies. So, just from a preventative health care standpoint, this is really, really important for women to know--that this can help to decrease their risk. Women are more familiar with the benefits of breastfeeding to the baby, which include decreased incidence of acute ear infections in infancy; definitely a decreased incidence of diarrhea; atopic dermatitis, which is like an allergic reaction on the skin and asthma. Obesity later in life is something that we're really looking into because childhood obesity has become a real problem and then, also Type I and Type II Diabetes in infants, as well as childhood leukemia and other inflammatory diseases of the bowel, like Crohn's disease and ulcerative colitis, in addition to a decreased incidence of SIDS--Sudden Infant Death Syndrome--within the first year of life. So, there are definitely a lot of good things that can come out of breast feeding.
Melanie: How long should a woman potentially think about trying to breastfeed?
Dr. Rutan: Well, I tell my patients that I realize that there are going to be some limitations to their duration of breastfeeding; any breastmilk is better than no breastmilk, so as long as she can would be great. The American Academy of Pediatrics and the World Health Organization recommend that women exclusively breastfeed until at least six months of life and then as long as the child and the mother both desire after that. So, ideally, six months exclusively, but if that's not possible, just as long as she possibly can and any breast milk is better than none.
Melanie: This is a huge topic and we could talk about it for a very long time, Dr. Rutan, but let's start with some breastfeeding basics. With a new mom and the baby is just born, how soon do you work on getting that baby to latch on and what if it doesn't happen right away?
Dr. Rutan: Another thing that's become more talked about lately is the research regarding skin-to-skin and what we call the "magical first hour of the newborn." And so, immediately after the baby's born, whether it's via vaginal delivery or cesarean delivery, it's really beneficial, and has shown to increase the amount of breast milk that the woman makes after six months, if we can get that baby skin-to-skin, the baby's skin to the mom's skin. By doing that, it's not only comforting to the baby, but the baby actually recognizes the smell of the mother as well as the colostrum when they're close to the nipple. So, a lot of times, the baby will become more alert and ready to feed. It's almost like a person waking up in the morning and smelling coffee and saying, "Oh, that smells good.” It's the same thing with the baby. They smell the colostrum, they smell the milk and then they become more interested in feeding. So, ideally, we like to get a latch within the first hour of life. If that doesn't happen, just as much skin-to-skin as possible. Most hospitals now are training our labor and delivery nurses and our postpartum nurses in helping to assist moms in getting the baby latched. If they're having difficulties, most hospitals also now offer lactation consultant services where we have folks who have done additional training to assist in getting a proper latch so that the mom doesn't experience pain and the baby can express the milk effectively.
Melanie: New mothers worry that they're not going to have enough milk to feed their baby. How much milk comes in at the beginning and does that grow over time?
Dr. Rutan: Yes, absolutely. That's a great question because that's the number one reason that women quit breastfeeding is that they feel like they're starving their baby and they're not making enough milk. A lot of women feel that way because the babies want to feed so often. So, really, at first, the baby's stomach is very, very small, about the size of an almond. So, the baby's only extracting a tiny little bit of colostrum to begin with which is just concentrated proteins but after a couple of days of nipple stimulation is when the more mature milk comes in. So, really the most important thing is knowing that frequent feeding is normal. The baby should latch 8-12 times a day and you can liken that to an adult, as well. Think about how many times you put something in your mouth every day. It's certainly more than eight. So, sometimes the babies just want a little bit of a snack instead of a great big meal. So, latching the baby frequently--every two to three hours--is what people should do. Then, the pediatricians, as well as the nurses in the hospital, will help to monitor the weight of the baby. The baby really shouldn't lose weight past day five. After that, the baby should be gaining weight again and re-gain the birth weight by day 14. Babies should gain about a half an ounce to an ounce per day if they're transferring milk effectively. So, we definitely keep an eye on that, but just because a baby wants to feed frequently doesn't mean you're not making enough milk. It's very normal because the human milk is very watery. It's composed of a lot of water versus some other mammals that have a high fat and protein content, so our babies are geared to feed every two to three hours.
Melanie: Is it normal for a baby to spit up after feeding?
Dr. Rutan: Yes. Babies can definitely spit up after feeding. If it's a large amount or if it's every time, you may want to discuss that with either your family doctor or your pediatrician, whoever is helping take care of your baby, but it is very normal for babies to spit up after feeding.
Melanie: Mothers worry that if they catch a cold or the flu that they can't breastfeed.
Dr. Rutan: In fact, that's actually not true. When you catch a cold, you produce a protein in your body called “antibodies” and those antibodies help you fight off the virus or the bacteria that's making you sick. By breastfeeding, you're actually transferring those antibodies through your breast milk and giving them to your baby to decrease the risk that your baby will get that illness. So, it's actually very protective if you feed your baby when you're sick.
Melanie: What about nutrition for mom while she's feeding? Are there any specific guidelines you like to give regarding alcohol, spicy foods, salty foods? Is there anything they really need to watch out for?
Dr. Rutan: So, the first thing that they need to watch out for is making sure that they're taking enough in. Immediately after delivery and in the postpartum period when your milk is not well-established is not the time to be trying to get off your baby weight. So, I counsel my patients to increase their caloric intake by 500 calories a day and making sure that they're getting good nutrition. So, lean meats, vegetables and fruits. The milk actually takes on a specific flavor based on what you eat and so the milk will taste different and the babies will acquire a taste for the things that you eat. So, yes, it's really interesting that toddlers that are breastfed actually appear to be less choosy when it comes to different flavors. They have a wider palate of acceptable foods.
Melanie: That's really cool!
Dr. Rutan: Yeah, it's really cool! You don't necessarily need to alter your diet. You can still eat spicy foods. The alcohol content, that can be an issue. So, for your average 130-pound woman, which equals out to be about 60 kilograms, the Institute of Medicine says that if alcohol is used, that she limit her intake to no more than 0.5 grams of alcohol per kilogram. So, what that ends up being is approximately two ounces of liquor, an 8-ounce glass of table wine or two cans of beer. Now, alcohol is transferred through breast milk to the baby. So overall, drinking and nursing is not recommended. However, if alcohol is used, that is what the Institute of Medicine has given us as a guideline over a 24-hour period; over a day. As far as spicy foods or another thing that I will hear is that the folks have been recommended to really push fluids and really you don't have to over-exert yourself in drinking water. That won't necessarily help with your supply. Just drink to your thirst. Just pay attention to your thirst signals and just drink until you're not thirsty
Melanie: And then, what about bottles? We don't have a lot of time left, Dr. Rutan, but they wonder if pumping is okay and if you give a bottle to a breastfed baby, is that going to ruin all the good work that you've done?
Dr. Rutan: No. There's definitely a lot of women who are gonna have to feed their baby with a bottle because most women go back to work. So, what is usually recommended is that you start to introduce potentially one bottle per day between two and four weeks of age by somebody who is not the mother so that the baby still associates mom with being at the breast. But, to minimize the risk of bottle refusal when the baby has to go to daycare or somebody else is taking care of the baby, one bottle per day making sure that you get the entire nipple in the baby's mouth and that the tip of the nipple is at the back of the baby's mouth toward the upper part of the palate. There are specific nipples that folks can ask their friendly lactation consultant about. There are some that are more friendly to breastfeeding moms but, in general, the wider-based nipples are safer in breastfeeding babies because when a baby attaches to a breast, they open their mouth very, very wide to get a lot of nipple in their mouth. So, we want to replicate that with a bottle as well.
Melanie: In just the last minute here, your best advice for pregnant women, about what they should think about when they know that they're going to want to breastfeed and tell us a little bit about your team at Bryan's Women's Care.
Dr. Rutan: Sure. My best advice would be that if you're committed to breastfeeding and you want to breastfeed, don't get frustrated. There are a lot of folks out here to help. We've seen that a lot of women have the intention to breastfeed and the discharge rates from the hospital are very high but because they worry that they're not doing it right or that there's something wrong, or that they're not making enough milk, they don't seek help. So, my biggest piece of advice would be to seek out folks who can help you--certified lactation consultants, IBCLCs, usually your pediatrician or your family practice doctor can point you in the direction to get some help and usually the problem is with the way that the baby attaches in latching. So, just don't give up, hang in there and get help to make sure that everything's going okay as far as the baby latching and expressing and transferring milk. So, at Bryan, we have lactation consultants on the floor. All of our labor and delivery and postpartum nurses receive extra training to assist moms in getting baby to the breast and we are a breastfeeding-friendly hospital which means that we try to get the baby to the breast as soon as possible and we promote skin-to-skin and don't give formula unless it's medically indicated because that can also decrease your success at breastfeeding. So, we also have some great folks in our community here--several lactation consultants and a clinic area that's specifically dedicated to breastfeeding. So, there are definitely folks out there who can help. La Leche League is a national organization that has folks who are willing to help with breastfeeding moms. So, that would be my biggest advice: just seek help if things aren't going well.
Melanie: Thank you so much. It's absolutely great information. You're listening to Bryan Health Radio and for more information you can go to BryanHealth.org. That's BryanHealth.org. This is Melanie Cole. Thanks so much for listening.