Jaime Lewis (Host): The national breastfeeding initiation rate is 84.1% and the state of Alabama breastfeeding initiation rate is 69.6% and the exclusive breastfeeding at six months is even lower at 21%. Dr. Francie Ruzic, an Obstetrician and Gynecologist with Mobile Bay OBGYN, works with our lactation consultants, nurses, and neonatologists to help support your initiation and continuation of breastfeeding. She joins us to discuss the importance of breastfeeding and how Infirmary Health supports breastfeeding moms.

 This is Life Cast, a podcast by Infirmary Health. I'm your host, Jamie Lewis. Hello, Dr. Ruzic. Thanks for being here.

Francie Ruzic, MD: Hi, thank you so much for having me on the podcast. August is Breastfeeding Awareness Month and as an OBGYN and a mother, I'm really passionate about the subject. So thanks for having me on.

Host: Of course. Okay. Well, to start with, how does breastfeeding my baby benefit me?

Francie Ruzic, MD: So breastfeeding has amazing benefits for both mom and baby, but first let's talk about how breastfeeding can benefit mom. Interestingly enough, studies have shown that women who breastfeed their baby are less likely to be diagnosed with both breast cancer and ovarian cancer. In general, a woman's risk of developing breast cancer is about 12 to 13 percent throughout her lifetime, and for ovarian cancer, that risk is much lower at one to two percent. Additionally, moms who breastfeed have a lower risk of developing Type 2 diabetes and high blood pressure. Breastfeeding can also help with postpartum weight loss. And in general, breastfeeding can help bonding with your baby, which is so important in the postpartum period.

Host: That is amazing. That's a huge change for having done something pretty simple.

Francie Ruzic, MD: Absolutely.

Host: And now how does breastfeeding benefit the baby?

Francie Ruzic, MD: So it's no surprise that breast milk is basically like a superfood for your baby. Breast milk contains the perfect combination of sugars, fats, proteins, minerals, and vitamins to help sustain your baby for the first six months of life. Also, antibodies, which help fight illnesses, are formed in the mom, and those can be passed to the baby through breast milk.

This helps your baby develop a strong immune system and protect them from childhood illnesses like ear infections and things like the stomach bug. Additionally, breastfed babies have a lower risk of developing asthma, diabetes. They have a lower risk of becoming obese, and also breastfed babies are less likely to suffer from Sudden Infant Death Syndrome, which is also known as SIDS.

Host: In terms of those benefits, how long should I breastfeed my baby?

Francie Ruzic, MD: So this is a really complicated question, Jamie. So, the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. At six months, foods can be slowly introduced into your baby's diet. However, the AAP recommends continuing to breastfeed until the child is 12 months, and actually last year in 2022, the AAP recommended continued breastfeeding for as long as you desire and really up until age two and beyond.

With this being said, and we'll touch again on this in a minute, but this new recommendation for up to age two can be really daunting. Two years is a really long time and me having had a baby in the last year and a half when I heard that new recommendation, I almost felt overwhelmed, like oh my gosh, you must be kidding me.

Two years. I was excited to get to six months. Breastfeeding does not come naturally to everybody. And therefore I want to encourage moms that while these recommendations exist, they're not the end all be all. So if breastfeeding works for a few months or a few weeks or not at all, that's okay. Your baby's getting fed and really that's all that matters.

Host: Absolutely. So as a new mother, when can I breastfeed?

Francie Ruzic, MD: Breastfeeding can really start as soon as you'd like. So right after birth, you know, provided that after delivery, baby is looking good and we can bring baby right up to you, right to your chest. You can also start pumping as soon as you'd like too. So some people actually will start pumping a little bit before delivery to help get some of that good colostrum for baby in this first few hours of life.

But, pumping can start really as soon as baby is born as, well. So in general, we recommend direct feeding, which just kind of means bringing the baby to your breast, or pumping every two to three hours in order to help get that milk supply established. That nipple stimulation every three hours signals to your brain to release hormones that in turn help increase the amount of milk that your body produces.

So nipple stimulation either with that direct feeding, bringing baby to the breast, or with the pump is really important in the first few days to help your milk come in.

Host: With regard to quantity, how would somebody know that their baby is getting enough milk?

Francie Ruzic, MD: This is actually, I found for me and other moms too, this can be really hard and really nerve wracking these first few days and weeks of life, especially with first babies. But in general, like we talked about, we want to make sure that your baby's getting breastfed, or a milk in some form, like with a bottle, eight to 12 times in 24 hours.

Yes, I said eight to 12 times in 24 hours. And that is why breastfeeding is quite literally a full time job. So if the baby though is making plenty of wet diapers and dirty diapers throughout the day and gaining weight, we feel like baby's staying hydrated. And that baby is getting enough milk. It can be really hard, because babies do lose some weight at the beginning. And this is really normal. However, after this, we should expect babies to gain weight. This is why we have you check in with your pediatrician, usually the day of discharge, in order to help set up an appointment. We weigh baby here and then baby also will have a weight done at the pediatrician's office to make sure that the baby's gaining enough weight.

You see your pediatrician actually a lot in those first few days and weeks in order to make sure that baby's getting enough breast milk. And so we generally feel like if your baby is, it appears to be content after feeding, and is gaining weight, that these are all good cues that your baby's actually getting enough breast milk.

Host: Let's say we're established, we're breastfeeding, but now it's time to go back to work or school. How can I still breastfeed when returning?

Francie Ruzic, MD: Right? And actually, breastfeeding is really hard. And I think that this was probably the toughest thing about it for me, was that, you know, when it's time to go back to school or work, what do you do? Especially when your baby's at home, we can start by feeding baby in the morning before you go to work or school.

Now, when you get to work or school, you'll be away from your baby. And so things that can help when you're gone, are pumping at work. And the reason that this is important is it helps to maintain your supply. So by still emptying the breast by pumping while you're away from your baby, helps you to still produce milk.

And so all this pumped milk is precious. It can be stored in a cooler or in the refrigerator. And then that milk can be fed to your baby for the next day, let's say when you're at work. That milk can be used to give the baby that milk through a bottle while you're not there. Really breast pumps have come such a long way in the last decade.

My sister in law saw mine and was like, oh man, I wish that we had that when I was having to go through this so they're actually even portable ones that are small, they fit into your bra. They're really quiet. They're wireless. So you can actually be pumping, like, for instance, in the patient room and patients don't usually hear it or at school, things like that. You can pump. These pumps are the couple of names are an LV, Mom Cozy or Willow. So that can make it a little bit easier. Also, it's not always covered by insurance, but in general, the other more traditional pumps that you plug into law still are a lot smaller. So you can bring one of those in a bag with you to work. In general, most places these days should be able to provide you with a private area for you to go to do this. And so you don't have to be, of course, in front of coworkers. So we should allow moms their privacy to go pump for their 15 and 20 minutes and have a quiet place for that. So that's kind of how we can tackle breastfeeding, but also being at work and at school when you're away from your baby. And like I said, all that breast milk that's pumped at work can then be brought home. And then for that following day, while you go back to work, all that great breast milk can be used to give to the baby. So, we also encourage when you get home from work, you can breastfeed your baby then, or breastfeed baby before bed or even throughout the night if baby is still waking up and things like that.

Host: Well, Dr. Ruzic, I sure wish I'd had you on speed dial when I had my babies 13 and 10 years ago, but I really appreciate all the information and thank you so much for sharing your expertise with us.

Francie Ruzic, MD: Yeah, absolutely. There's just one or two other things that I'll say briefly before we sign off. First, most hospitals, here at the Infirmary and all three locations actually, Wwe have really amazing lactation consultants that can help you in the first 24 hours, 48 hours of life, make sure that baby's getting that good latch and help identify a problem if there is a problem.

 And so we're not struggling with that later on. So definitely use those amazing resources to help, in those first few days of life. And then the other thing that I always think is so important is moms put, you know, including myself, I feel like we put so much pressure on ourselves to provide the best for our baby.

And we feel like breast milk's best. And so it can be a lot of stress. And so it's really important to know that for various reasons, breastfeeding doesn't always work. Babies might have a dairy allergy or mom's schedule may just not be one that can, where we can pump, or maybe just doesn't work for you and your baby.

And I just want to emphasize that that's okay. Formula really is an amazing alternative, and if that's how your baby needs to be fed, that's great. So all those moms out there who are struggling with that, you're doing an amazing job, no matter if your baby is breastfed or not.

Host: Great. Thank you for adding that.

Francie Ruzic, MD: Of course.

Host: As the first choice for healthcare for the Gulf Coast region, Infirmary Health Women's Health programs support women at all stages of life through a broad variety of care opportunities. I'm Jamie Lewis and this has been Life Cast, a podcast from Infirmary Health. Visit us at infirmaryhealth.org/women to learn more about our women's health services or to find a physician near you.