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Evidence-Based Breastfeeding Tips for New Moms

Maggie McKay (Host): It's not easy being a new mom. There's so much to learn. Being a new mom can be overwhelming, especially when it comes to breastfeeding. Breastfeeding can be stressful, but it's not something moms have to tackle alone. Seeking help from a lactation consultant can improve the experience for both mom and baby. Here to talk with us today is La Bonheur, nurse and international board certified lactation consultant, Helen Scott, to share evidence based breastfeeding information for new moms. This is the Peds Pod by La Bonheur Children's Hospital. I'm Maggie McKay, Helen. It's a pleasure to meet you. Thank you for joining us today to help take some of the anxiety and mystery out of breastfeeding for new moms.

Helen Scott: Good to talk to you, Maggie, thank you for this opportunity.

Maggie McKay (Host): Absolutely. We're happy to have you here to start. Why is breastfeeding a good choice to make for your baby?

Helen Scott: Well, the immediate and long term benefits for both mom and baby, I would say makes it a good choice and it's the best nutrition for baby with all the right ingredients and everything that baby needs. And the breast milk is species specific and provides health, social and environmental benefits. The examples for health are for the mom, protect mom against breast cancer, ovarian cancer, diabetes, and heart disease. And for baby, it protects baby against respiratory infections like COVID, ear infections, stomach bugs, or diarrhea and vomiting.

So, those are beneficial and also social benefits are, they reduce ACEs which are adverse childhood experiences. And actually, I think they feel like COVID has exacerbated ACEs in our population. So that's a benefit. And of course it has environmental benefits as well.

Maggie McKay (Host): As a lactation consultant, what help do you provide for mom and baby?

Helen Scott: We provide the support that mother needs. Most new moms, it's their first time to breastfeed haven't, experienced it. So we are there to support them, give them the techniques, to support with, the breastfeeding and ensure that they get a good start to the breastfeeding journey.

Maggie McKay (Host): Helen, what are some tips that you give new moms so that they can be successful at breastfeeding? Because sometimes you think you're doing everything they told you to, and it's just a matter of a small tweak that you need someone like you to help with?

Helen Scott: Well, first off I would recommend, that they attend a prenatal and a postnatal breastfeeding class and learn about breastfeeding. It's like anything new, you have to learn about it. And it doesn't just come naturally. It's a learned art and not just instinctual, it's more instinctual for baby, who can actually do the baby call if they allow to do this and call up to the breast and find the breast. But, Not all babies have that opportunity. So, the mothers just need to learn how to support the babies at the breast and to ensure that they're getting a good latch and, providing the milk that the baby needs.

A lot of moms are concerned because. Not sure how much they're producing. Not sure if they're producing enough for their baby. So we can share information. They can learn about it through the classes. And we share that information with them, that, baby starts off just with a teaspoon of colostrum from mother The first day of each feeding and that doubles the second day. And by the third day baby's getting half an ounce at each feeding by a week, they're getting an ounce to an ounce and a half. And by a month, up to two to three ounces, and then up to six months, they can take in as much as four ounces.

So it's not a lot of volume and a lot of aren't aware of that. And then the other thing that's important is to know that they only gain an ounce a day, which doesn't seem like very much, but that's going in and coming out. So, they regain their birth weight. They do lose weight initially because of the amniotic fluid they've been swallowing in utero. And then, by two weeks they've regained their birth weight. And if they do need to introduce a bottle for any reason, we recommend a slow flow nipple, which is more like the flow from the mother's breast. And that's better for the baby.

Maggie McKay (Host): What are some of the common barriers to breastfeeding that you try to help with?

Helen Scott: The barriers to breastfeeding. Well, the starts off actually, in the hospital, there are a lot of medical procedures that are done that can interfere with. They're starting an IV and giving medications and the medications can pass through to the baby and, make baby more sleepy. So baby's not as alert, after delivery. It can sometimes give too much fluid that can affect the weight and cause edema for mother. and that has an effect when her milk comes in. And she can get more engorged as a result. then there, barriers when they return home families wanting to help feed the baby rather than letting mother feed the baby and get the breast feeding established.

Or sometimes even the dads want to be involved, which they are either ways dads can be involved by just supporting mom, taking over after the feedings and getting baby into a deeper sleep because they're usually in a light sleep after breastfeeding. So, trying to lay baby down right away will often just cause babies to wake up. Then mothers are confused or the parents are confused and think baby's still hungry. So they try to put baby back to the breast and it's just a matter of getting baby into a deeper sleep for about 30 minutes and then laying baby back to sleep. Then there are barriers when they go out into the community.

They don't always receive the support to have a private place or just to be able to feed in public. They, as long as they're doing it discreetly. And when mothers return to work, this can create a barrier to if they're not supported, to have a private place to pump. It's difficult for moms to be separated from their babies. because that's part of the reflex that allows the milk to leak down. So they need to be relaxed and calm and not interrupted. they don't need to be in a bathroom or toilet store where that is unhygenic. They need to have a clean place to pump and feel comfortable and secure. So they can relax and allow the milk to leak down so that they can produce the milk that their baby needs.

Maggie McKay (Host): And I believe it's now the law that workplaces have to have a private place for women to breastfeed. Is that right?

Helen Scott: That's correct. And the Tennessee Department of Health have laws in place. Employers must accommodate breastfeeding mothers at work by permitting them to express their milk in a private room other than a toilet store. So that's the law and, there is another law as well. A mother has the right to breastfeed in any location, public or private where she and her child are otherwise authorized to be present.

Maggie McKay (Host): And when it comes to diet that can affect the success of breastfeeding. What are the best foods for breastfeeding moms and what foods might cause some issues?

Helen Scott: Just a normal, diet is what we recommend now. Some, mothers have allergies or the allergies in the family, which could pass it's usually in the mother that's passes through to the baby. But the father could have allergies too, that are passed through to the baby, of course. And so, we just recommend, if they know what the allergy is, if they have a food allergy, like a dairy allergy, which is the most common. Of course, they want to avoid dairy products. and that is seen in the baby by, diarrhea or changing stool color and, blood in the stool.

So, usually their pediatrician will help them with that and recommend eliminating dairy from the diet, but now studies have shown that they don't have to eliminate it forever. usually by about four months, they can start introducing the dairy again. But things like peanut allergies that cause anaphylactic reactions, definitely you want to avoid foods like that.

Maggie McKay (Host): And how long do you encourage moms to breastfeed? Because sometimes that can be a hot topic when you're in the throes of it. I remember some very opinionated people weighing in on how long, but shouldn't it be different for every person?

Helen Scott: It is unique to each mom. because not every mom is able to breastfeed. Sometimes, it could be medical. Issues, problems that they have, they may be on medication, mothers with cancer who have to receive treatment, chemotherapy can't breastfeed. So they are, and then they just mothers who emotionally, it stresses them out to breastfeed, because they don't know how much they're producing and stress decreases the milk supply. So The lactation consultant needs to be aware of that and just work with the mother to support her. If she's not able to continue to help her with weaning and, not, make her feel guilty, that she can breast feed her baby.

Maggie McKay (Host): But do you see a lactation consultant? Have the baby, like after you've gone home, because I don't remember that?

Helen Scott: There are lactation consultants in some communities, I guess, not, everywhere, but, there is a great resource available, online, Tennessee Breastfeeding Hotline. and, if you want that number, it's 855-423-6667. I was the breastfeeding coordinator. they Got that, program started with lLa Bonheur in 2013. It's a great support and, it's still available. So mothers can call 24/7 day or night, you know, whenever they have a concern or question and speak with the board certified lactation consultant.

If they can see lactation consultants, it's now becoming more common and we have actually at La Bonheur have, lactation services in the La Bonheur pediatric clinics and there are other pediatric clinics in the community who have lactation consultants in the office. So when a mother comes to see the pediatrician and has a breastfeeding problem, then the pediatrician can refer to the lactation consultant, because they really don't. Have the time to work with the mother and maybe the expertise. So they, have that service available so that the mothers can receive the breastfeeding help they need.

Maggie McKay (Host): That's wonderful. It sounds like La Bonheur really has it covered on all angles. What are some of the things that you do not want moms to do while they're breastfeeding?

Helen Scott: I would say you don't want the baby crying, when the baby comes to the breast, because then of course, especially for a new mom, that's upsetting and, her milk won't leak down. So, good to get the baby ready, maybe 30 minutes before the feeding, making sure baby's got a dry diaper.

and then putting baby skin to skin, to allow baby to connect with mom. And there are benefits to that. We don't want baby crying, otherwise it can make it difficult to get baby to feed. And if they are ravenous because, crying is a late feeding cue, then they normally can't latch well and get what they need.

Maggie McKay (Host): stay on schedule.

Helen Scott: Yes, we don't, necessarily recommend a schedule in a watch in the clock, but that they should be feeding every two to three hours. And so you want to watch for babies feeding cues, usually, seeing the baby's rapid eye movement, when babies arousing and then wanting to suck on their hands and, showing those feeding cues.

So getting them ready then is good. Some babies will even cry after changing the diaper that we normally, when you lay baby over mom's heart, baby's used to hearing that heartbeat. And so that calms baby down. Another thing I would say not to do, don't think breastfeeding pain is normal. Ask for assistance. A lot of moms think they'll well, they just need to toughen up and it'll get better, but it can actually cause more damage if they're in pain. And baby sliding onto the nipple and damaging the nipple. and then baby's not getting enough milk.

So baby needs to have a good latch and then not to separate from baby in the hospital unless medically indicated. And I know this is a challenging one, because moms are exhausted and sleep deprived from delivering most often. And so they want a break and would like, the baby to go to the nursery, but then they miss the feeding cues and often then the baby gets a bottle in the nursery, and that can interfere with their breastfeeding process.

And then another reason would be, not to pump unless medically indicated. Pumping takes more time. There are things involved with pumping, like having the right size breast shield and, that could affect mom supply. So it's best not to introduce pumping, unless it's, medically indicated like if they have a premature baby and they separated from their baby. And then not to introduce formula, of course, that's, doesn't have the nutrients that the baby needs, the best nutrients I should say, it does have nutrients.

Or the bottle and pacifier, because that's a different suck normally, so that can interfere with breastfeeding. So we try to avoid those unless medically indicated.

Maggie McKay (Host): And then at home practical things like I assume, smoking and drinking. And there's a few things you don't want them doing while they're still breastfeeding?

Helen Scott: Right. Things not to do at home. smoking is a concern, especially with a newborn. and if there is a smoker, they need to smoke outside the house or apartment wherever. Any secondhand smoke is inhaled by the baby and can affect, baby's breathing. Of course, they've got really small lungs and so, it's even more detrimental.

And then the other thing that's important is to make sure they change clothes, the smokes in their hair, in their clothes. And if they holding baby against their clothes, the baby's inhaling that, secondhand smoke. But as far as alcohol, you know, that's a common question from moms. they've been trying to avoid alcohol through their pregnancy and they want to celebrate.

And, as long as they do it in moderation, you know, and if they overdo it as long as they're not intoxicated or they wait till they're back to, they can hold a baby safely and breastfead without feeling intoxicated, then It's safe to go ahead and feed baby. Or if they're concerned, there is information, on infant risk website, infantrisk.com on, alcohol and, smoking marijuana and other, social practices.

So, yes, those are things they can go to that website. There's a number they can call. They can actually talk to a nurse. The Tennessee, Breastfeeding Hotline has information on, medications and drugs so they can get the information they need that way.

Maggie McKay (Host): How has COVID affected breastfeeding counseling?

Helen Scott: COVID has created, anxiety in breastfeeding mothers and their partners and families. So, I personally have found, I needed more time to communicate with mothers to talk to them about their feelings and relieve some anxiety, hopefully. Or refer them to resources in our community. Sometimes a little bit of medication may help, get them through because as you mentioned, breastfeeding can be very overwhelming.

And then this COVID was followed by the formula crisis and that affects the majority of the mothers who I see who triple feed, which is breastfeeding pumping and giving formula supplement. And so if they don't have that backup, that results in stress and anxiety, that decreases their supply that they do have. And in addition to the stress created that is the returning to work and that leads to similar outcome if they're stressed and not supported.

The United States Breastfeeding Committee works on a national level, well, they've been working on the Pump Act, which is to improve maternity leave for mothers and, making sure that they are allowed to pump at work, so they can continue their breastfeeding, their baby. So those are things we're working on to improve. But Rarely breastfeeding mothers need support from the entire community. And I just wanted to share that for mothers who have an abundance supply, we now have, the mother's Milk Bank of Tennessee, in Murphy's Burrow.

And, they can donate their milk to allow premature babies to survive and thrive. So that's a great service. And hopefully if we can get enough milk from mothers, donating their milk, we can provide an outpatient service for those who. just struggling with their supply. So there's more information on milkbanktn.org for those mothers. And just one last thought is breastfeeding is key to sustainable developmental strategies, post pandemic. As it improves nutrition, ensures food security, and reduces inequalities between and within countries.

Maggie McKay (Host): Just to wrap up, when should a new mom seek the help of a lactation consultant?

We assist with the breastfeeding technique, which is really important if they don't have a good technique, then that can be a problem, right from the start. So, getting that help in the hospital is really important, making sure that they're not experiencing pain. And then, making sure that they have an adequate milk supply, by the number of wet and dirties, that babies producing between the number of feedings.

The baby should be feeding every two to three hours, at least eight feedings in 24 hours. And the diapers. Increase as the days increase. And by five to six days, maybe should be having at least one weight diaper, every feeding, at least three dirty diapers and the color changes. So we want to monitor that and make sure that the parents are aware of that as well. And then make sure there's no breast or nipple pain, assist with the nursing rejection as the babies get older around three to four months, they get more interested in the environment and start to breastfeed less or more distracted.

So we have, encouraged them to find a quiet place to breastfeed, and then we, get them information on medications and breastfeeding and that the resource I gave you, Dr. Thomas Hales, infantrisk.com. and then there's also another, Pharmacist Dr. Frank Nees who he focuses more on herbs and breastfeeding, and then working on breastfeeding supporting mothers and, helping them build up their supply for when they return to work.

So there are a lot of resources that new mom could reach out to. That's a good thing.

Helen Scott: Let me give you, a few resources? So, , Shelby county breast feeding coalition, has a free breastfeeding class that's offered online, virtually. So anybody can Google that and join, either going to the website or Facebook page, there is a link. And it's on the third Saturday at 10 o'clock and Dr. Alison Stars is a local pediatrician and lactation consultant.

So she offers a really good class. And then as far as breast pumps and rentals, most insurance has covered the breast pumps now. And airflow has been one company, outside of Tennessee, but in Tennessee, we now have a new company, Mommy Express, and you can go to the website and, call and get a free breast come through the insurance, that way. Their local support groups. we have, breastfeeding moms name for online. We have, B stars, which is breastfeeding sisters that are receiving support for the African American community on Facebook live, And the last, Wednesday of the month. So the support is so important for moms.

Maggie McKay (Host): That's so true. This has been so helpful and educational Helen. Thank you so much for sharing the facts and your experience to help make it easier for moms who are breastfeeding or will be in the future. Again, that's Helen Scott, La Bonheur nurse and international board certified lactation consultant.

Visit www. LaBonheur.Org to learn more about La Bonheur Children's Hospital, and be sure to subscribe to the Peds Pod on apple podcast, Google podcasts, or wherever you listen to your podcasts. You can also check out labonheur.org/podcast to view the entire podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by La Bonheur Children's Hospital. Thanks for listening.