Disclaimer: The purpose of this podcast is to share breastfeeding information so parents can make informed decisions about how they feed their babies. Some of the topics we discuss may bring up strong emotions depending on your personal experiences with feeding and parenting. If at any point you feel this is not the right time to listen, we encourage you to pause and return when you're ready.

Every parent's journey is unique and every family makes the choices that are right for them. We honor and support all feeding decisions and, above all, we wish you and your baby a journey filled with love, health, and joy.

Lactation education increasingly uses inclusive gender-neutral language, such as chest feeding, nursing, parents milk, human milk feeding, and lactating person to support gender-diverse families. Clinically, this inclusive approach is communicated with a birth plan that you may have prepared and are huddled during your hospital stay.

Our intention is to create a safe and affirming environment for all parents to achieve their infant feeding goals. Please understand that for this podcast, we will be using breastfeeding and mom often. We do treat our clients as individuals, and we'll adjust our terminology so all feel welcomed.

Cheryl Martin (Host): ​About one in four infants is breastfed exclusively until they are six months old. That's according to the CDC, Centers for Disease Control and Prevention. Here to tell us all about the benefits of breastfeeding for the mother and baby, the challenges and more are two experts on the topic, Disha Gehani and Donna Rubin. They are both international board-certified lactation consultants and part of the Capital Health Maternity Services. Donna is also an occupational therapist with pediatric experience; Disha, a certified educator of infant massage and an infant and young child feeding specialist.

This is the Health Headlines podcast series from Capital Health. I'm Cheryl Martin. Disha and Donna, thanks for coming on

Donna Rubin: Oh, thanks for having us.

Disha Gehani: Thank you for having us, Cheryl.

Host: First of all, tell me about your roles at Capital Health and how you help new mothers with breastfeeding. Donna, let me begin with you.

Donna Rubin: Sure. We offer free breastfeeding prenatal classes. We have an amazing lactation team during patients' hospitalizations. And we offer a breastfeeding club after discharge.

Disha Gehani: I'd also like to add, as lactation consultants, we really try to support the mother-baby dyad with their respective feeding choices. We are here to support the mother and really make sure that we tend to the needs of the dyad. All the needs are, you know, unique. And we work in collaboration with all providers, which include pediatricians, OB-GYNs. We work with the nurses and any specialist that need to be on any case by case basis. We also try to really make sure that we educate them on the benefits that breast milk has to offer, and that breastfeeding also has to offer for both the mother and the baby.

Host: So, let's get into the science of breastfeeding. Why is it so important for new mothers to breastfeed, Disha?

Disha Gehani: I'm going to add a little something here, not quickly starting off with breast milk. What I do want to see is that you know how our body is dynamic, when a mother is pregnant, her body's constantly working and caring for the baby that's growing inside, and it's always adapting to make sure that the baby's growing okay and is protected and fed, and all the good things.

Now, similarly with breast milk, it's really very dynamic in nature. And the milk production starts as early as the 16th week. And right after the baby and the placenta is delivered, breast milk, the first form is colostrum. That's what we have, that's the first form of breast milk. And it's really dynamic in nature, like I said earlier. It's constantly changing to adapt to baby's growing needs by the hour, by the day, by the week, and then going forward for as long as the mother continues to breastfeed. It has all the nutrition that the baby needs, and it provides a lot of immunity support for lifelong health, not just in the early days of life, which is why I feel like it's something that we really like to put in here is that it's organic. It's the best organic food ever. And we really want to educate mothers on how the benefits of breast milk can really affect and impact the baby's health long term.

Donna Rubin: So, I'm always amazed that we keep learning more and more about amazing breast milk, that the milk is modified while an infant is feeding in real time. So in other words, if a baby needs more immune properties, the moms will change her milk. We see a decrease in cancer, respiratory, gastrointestinal, ear infections with breastfeeding. We see a decrease in childhood, obesity, diarrhea, SIDS, sudden infant death syndrome, eczema, asthma. And that's just for the baby.

Host: What about for the mother, the benefits?

Disha Gehani: For the mother, we also see reduction of potential diabetes, breast and ovarian cancers, endometrial cancers, thyroid. And in general, it really aims for a better hormonal balance. and also helps with, some phases with menopause when it's really tough.

Host: So, why is there such a hype with breast milk?

Donna Rubin: We hear this kind of sentiment all the time. People want their partner, often it's the dad, to share in the feeding. And we know that instinctively, the baby will want to come to the breast and increase the mom's supply. Probably the biggest problem that we hear is mom's concern of low supply, but it is matched by what the baby comes to the breast for.

Host: So, feeding decisions can carry lifelong implications for both the baby and the family, yet today's parents face some unique pressures and obstacles that can make breastfeeding especially challenging. So, why is this decision so impactful? And how do modern day challenges in societal pressures shape a parent's ability to successfully breastfeed, Disha?

Disha Gehani: So, I'd like to start by giving some information here. According to the CDC in the United States, about 83% of women start breastfeeding. However, only 25% continue to exclusively breastfeed through the first six months of life. And just going by the recommended guidelines from the World Health Organization, the CDC, and the American Academy of Pediatrics, every baby should receive breast milk for the first six months of life, and then up to two years or beyond. And that really depends on the mother's choice, of course, the baby's preferences as well. But the first six months, the emphasis on exclusivity is so much more because of everything that we mentioned earlier on, you know, how dynamic and well put together breast milk is for the baby's nutrition and lifelong health.

However, we do live in the modern day world where there are a lot of stressors. Lifestyle is very different. We usually have both the mother and the father working. It's very difficult to provide for a lot of families. And not everyone is able to constantly juggle and manage and breastfeed and go to work. And it's just a lot of stressors is what I'm trying to say. And on top of that, the parental leave policies, the maternity policies aren't the best.

So these days things are changing, I think in some states versus everywhere, where we do see some more maternity leaves, and we also have paternity leave these days from a lot of corporates. But I think that still means a lot of work and advocacy to really make sure both the parents feel supported in this new phase of life.

Host: So, what are the key facts that parents should be aware of when weighing their feeding options and making an informed decision regarding formula?

Disha Gehani: So, formula is a big multi-billion-dollar industry. And just to give a number out there, it's approximately $55 billion annually in revenue. And they also spend a lot of money marketing their products. However, we really want to make sure we are taking an informed decision here. If you do check formula bottles, they don't usually have the ingredients listed. But if parents do their own research, they can really look up information and see that formula contains added sugars. It has some syrups. It has some seed oils, which aren't healthy for the baby's gut and nutrition and lifelong health.

There are also considerations to be made for baby's immune system. A lot of times, they can, tend to develop allergies sooner than later in life. And that's because formula is made from cow's milk protein. It changes the gut microbiome. When you introduce something which is made from cow's milk for a human baby, your baby is basically trying to break down those proteins in the gut, which is not easy to break down cow's milk protein for a human baby.

Donna Rubin: Often, the perception is giving formula will make parenting easier. And while that may seem that way on the surface, if the goal is really to breastfeed, we are not helping mom in that way. She is just starting to establish her supply. And so, if the partner wants to try to allow her to sleep in the beginning and give that formula, then we are interrupting that delicate balance of increasing supply that would happen normally.

I do want to add also a 2023 study from The Lancet that argues that formula milk companies exploit parents' emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women and children. We never say this when people are in the hospital, and this is what their choice is to do, but we do want people to be aware of it and informed before they make that choice.

Host: Let me ask you, does it count when a mother-- is she able to use her milk and put it in a bottle when she's not there? That also counts as breastfeeding if she pumps her milk.

Donna Rubin: Yes. It's her expressed milk.

Host: Okay. So, that's one way she can keep her child on breast milk for at least six months.

Disha Gehani: Absolutely

Host: Now, Disha, you mentioned microbiome. Can you talk more about what that is and how does human milk feeding impact an infant's microbiome?

Disha Gehani: Absolutely. So, gut microbiome simply put is basically, in our gut, we have a lot of intricate and extensive community of microbes including bacteria, viruses, fungus, rickettsia, and protozoa. And approximately, there are about a thousand bacterial species. When a baby is born, baby has a very clean gut, let's just say it as the baby's starting off on a clean slate. And what we put in really is helping and building a foundation for lifelong health.

As we already discussed about breast milk, because it's dynamic, it's ever-changing, when the baby's sucking, mom's getting all the signals, and the breast is producing breast milk, which is absolutely tailor made for the baby, sometimes if there are infections or bacteria, like as soon as the baby is born, your baby is exposed to several bacteria in the environment, so mother's breast milk is always producing what the baby needs to really resist and function and make sure the baby's thriving in the extrauterine environment. And that's what's helping and potentially forming a gut microbiome by the day. In fact, there's a lot of research on how babies who are exclusively breastfed or, you know, combo fed with breast milk and formula, how the gut microbiome is different. And then, there's a big difference with babies who are just exclusively formula fed.

The gut microbiome really contributes to everything, right, in terms of food breakdown, digestion, micronutrient production, protection from a lot of other bacteria that's in the environment. And it really helps to shape your immune system. So, it's really something that potentially can alter how healthy you live your life.

Host: Donna, why are lactating parents or women having such difficulty with following AAP recommendations to breastfeed for at least six months?

Donna Rubin: Yeah, this is a little complicated because, the influence of formula companies giving people the impression that that's easier. We don't have universal maternity leave long enough. And I think the last thing I read recently is that, if you have a longer period of time off, then many women will choose to breastfeed.

Host: And again, this is a recommendation from pediatricians?

Donna Rubin: The American Academy of Pediatrics. Yes.

Host: So, what are some of the common challenges-- you've covered this somewhat, but in more detail-- that new mothers face when starting to breastfeed, and how do you coach them through these challenges?

Donna Rubin: Yeah, the most common problem we see is the perceived versus the realistic expectations of milk supply. The baby's gut, their belly is only the size of a grape when they're first born, so they don't need a large volume. Often, I see the expectation is they expect the baby to drink as much as if they were a month old. And it takes mom's body some time to Get that supply revved up. Also, we see concerns with moms feeling like their nipples, their anatomy, their breast is not perfect. And most infants can figure out how to work with that. it takes a lot of practice. It's not just the mom's anatomy. We are also looking at the infant anatomy as well.

Host: So when you say it takes a while to rev up, how much time are you talking about for the breast milk to come?

Donna Rubin: So, it takes about four to six weeks from the time the baby starts to breastfeed at birth, before they have a full mature milk supply for what they need until they're six months old and starting food. And so, it's a slow progression. At day three, the size of the belly is the size of a cherry tomato; day seven, it's the size of an apricot; and at four weeks, it's the size of an egg.

Host: So, the mother shouldn't feel then that I'm not giving the baby enough food if enough is not coming out, or if she's expecting more?

Donna Rubin: We are always monitoring to make sure that the baby is getting an inadequate amount, and we know that by looking at their wet and poopy diapers, and frequency they're at the breast, their weight, and the color of the diaper.

Host: Anything else you're doing to make it easier for parents to breastfeed their infants if they face these challenges?

Donna Rubin: Yes. Sometimes, they need a little bit more physical guidance in how they hold the baby. Making sure the latch is deep enough. A lot of it is their expectation and being their cheerleader.

Disha Gehani: I wanted to add a couple points for helping mom with the common challenges, like Donna mentioned about perceived low milk supply and realistic low milk supply. It's usually a supply-demand process. When the mother is feeding, like we've discussed earlier, your body's constantly adapting to your baby's needs. So when the mother is feeding, your baby is regulating everything that the baby needs in terms of their belly size. So, for example, by the day as the belly size progresses and the mother continues to respond to her baby's needs, her milk production will keep increasing. And that's like a slow gradual progression that it takes place by the week, because baby's belly size is also growing slowly, like Donna mentioned already. But they're both kind of working hand in hand. It's like two pieces of the puzzle coming together to really make this work, which is why we really emphasize on the need of frequent cue-based feedings.

I think it's so very important to understand that the baby is really teaching us what the baby needs. And watching baby's cues is so important to make sure that we are feeding on demand, we are not following a schedule, because baby is growing by the day. And it's so hard to say one thing, and to have a schedule in place. And that is something that can really impact milk production as well. So as long as they understand it's a supply-demand process and we don't have unrealistic expectations of really producing a lot since day one, then I think that should be more manageable. And with all the support that we have at the hospital, we really try to make sure that we walk over all the techniques all the time. The nurses, the providers, everybody's really encouraging and supporting with breastfeeding as much as possible.

Host: Disha, I also want you to talk about medical conditions that might make it harder for some women to breastfeed than others. And if there are these kinds of medical conditions, how does your clinical team work together to try to find ways to help these women who may need additional support?

Disha Gehani: There can be some factors that impact, the breastfeeding journey for the mother-baby dyad. And that could start with pregnancy complications. It could probably be something during labor that didn't go well. A lot of times challenges could be with maternal existing pre-health conditions. It could be some hormonal factors, thyroid, diabetes, probably breast surgeries that the mother could have had earlier in terms of reduction or augmentation or anything else. There can be infection.

So, these are some conditions that can potentially impact breastfeeding. However, there is a way to, work with a lactation consultant and, of course, the relevant provider in that case to really work and support the mother with her respective feeding plans and choices. We always work cohesively with the providers that we have here in the hospital. And like we mentioned at the very beginning at the start, that we are a big lactation program, and it's a big team of about 15 lactation consultants. We really try our best to uniquely address everybody's needs.

And I also wanted to add about infants. Sometimes with infants they could also have challenges with oral anatomy. Maybe some genetic conditions, like Down syndrome, where breastfeeding support is vital. It could be a little challenging in the beginning, but we can definitely help and try to make it work as best as possible.

Donna Rubin: We can't really predict whether or not a mom is going to have difficulty with breastfeeding. And so, we always approach this as giving it a try. And of course, we intervene, because we are a baby-friendly hospital. So, we ensure that the hospital staff understands the importance of exclusive breastfeeding. But we make sure that the baby gets what the baby needs and we stimulate mom's breast, either with the baby or a pump if necessary.

Host: And how does your team work together to find ways to help parents who may need additional support?

Disha Gehani: We work uniquely with the mother-baby dyad, and we see how best we can support them. But most importantly, we also have something called as Team Birth that, in cases of any complications or, for example, if we have hyperbilirubin for the baby or we have blood sugar concerns for the baby, anything going on with the mother, we really try to make sure all the providers are on the same page and we are communicating the same thing to really as much as possible avoid conflicting information for the families. We really want to make sure it's a uniform messaging and a uniform education that we can put across to all families.

Host: That's great. Now, Donna, in addition to offering lactation consultants, what are some of the free programs that Capital Health offers to help new mothers with breastfeeding?

Donna Rubin: We have multiple parenting classes, both virtually and in-person. We have a support group for Black mamas. We have English and Spanish virtual and in-person groups. And we have a breastfeeding club. You can access all of these courses at capitalhealth.org/childbirth.

Host: This has been quite informative. I just want to say thank you for sharing such great information about breastfeeding for new mothers. Disha Gehani and Donna Rubin, thank you so much.

Donna Rubin: Thanks.

Disha Gehani: Thank you for having us, Cheryl.

Host: If you or someone you know is looking for more education on breastfeeding or would like to sign up for one of our free groups, again, visit capitalhealth.org/childbirth. If you found this podcast helpful, please tell others about it and share it on your social media. Be sure to check out our entire podcast library for other topics of interest to you. Thanks for listening to the Health Headlines podcast series from Capital Health.