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Prakash Chandran: When preparing for a new baby, it's not uncommon for a mother to have lots of questions and even feel a little anxious about breastfeeding. While many say it's a natural process that just happens, there are tips and education that will help make the experience as smooth as possible. We're going to talk about it today with Lorie Ochoa, a registered nurse, a certified childbirth educator, and an international board-certified lactation consultant at Ridgecrest Regional Hospital.

   This is the Ridgecrest Regional Hospital Podcast. My name is Prakash Chandran. So, Lorie, it is wonderful to have you here today. I wanted to start by asking a pretty basic question around the comparison between breast milk and formula. So specifically, if a baby under the age of one can have either breast milk or formula, what are the advantages of having breast milk? And is there really that big of a difference?

Lorie Ochoa: Yes. And thank you so much for having me here today, Prakash. I appreciate it. There is a big difference and I always encourage expecting mothers to make that decision before the baby is born, because breastfeeding is a lot of work. Back in 2012, the American Academy of Pediatrics decided in their feeding policy that breastfeeding should no longer be considered a lifestyle choice. Instead, breastfeeding is considered a major critical decision in infant welfare, meaning breast milk is so very healthy for a baby, nutritionally has what they need and, especially right now in these times, the mother is able to pass on immunities to that baby to things she's being exposed to. So breast milk is very different than formula. And although we live in a country that manufactures the formula and it's safe, it is not the healthiest choice for the newborn.

Prakash Chandran: Okay. That makes a lot of sense. And something that you alluded to earlier, you were saying that it used to be, I think, a lifestyle choice between the parent making the decision between breast milk and formula, maybe talk a little bit more about that. What is it that formula allowed parents to do that breast milk could not?

Lorie Ochoa: So formula is something that they could just simply go and purchase. They could mix it, they could feed their baby. Anyone could feed the baby because although it is the healthiest choice to breastfeed for the mother, as well as for the baby, it is physically demanding and it's definitely a commitment on that mother's part as well as the family being supportive and helping her to do that. It is a team effort for sure.

Prakash Chandran: Yes, absolutely. Okay. I want to maybe talk about, I guess, the life cycle or journey from when the mother first starts to breastfeed. I guess that would be from the first latch up until just developing and just getting more comfortable with breastfeeding. So, you know, as let's just say, an expected mother is listening to this, what are, I guess, some of the most common tips or things that they should be aware of when they first start breastfeeding?

Lorie Ochoa: Yes. So I do encourage again mothers when they're expecting to have this discussion with their partner, with their families because they will need support. We do offer a lot of support at the hospital as well. And I am reachable and our pediatricians are very supportive as well. So they need to have good support.

But what I would probably stress the most is that because they may not be able to see the milk, there is a missed assumption that moms don't have milk when they deliver. And that is not true. At about four months into the pregnancy, the body starts producing something called colostrum. And we refer to this as liquid gold. It is that valuable. And what they really feel that is, is very concentrated breast milk. So it's very thick, but there's not a lot of it. But the size of a newborn's stomach, a 7-pound newborn, which is the average size is the size of a marble.

So often we assume when we need to breastfeed that we're looking at that bottle is that image we see and women look at their breasts and there's like no milk there, but there is this colostrum, a teaspoon in each breast. So it is there. And as soon as they deliver and the placenta's delivered, that starts the mechanism to send the mother into making more milk as the progesterone levels drop. And as soon as that baby starts feeding at the breast, then the brain understands that and it is made on a demand and supply basis. So the more the baby demands, the more the mother makes. It's that simple and it's that complex all at the same time, Prakash.

Prakash Chandran: Yeah. No, that absolutely sounds fascinating. And I think it's an important point that you make that, number one, the mother produces that colostrum. And even though that feels like a much smaller size, the baby's stomach is the size of a marble, like you said. So the amount that they need is not necessarily how much we think that they need, right?

Lorie Ochoa: Exactly. And so often the perception of what we think and what is really needed is very different. And obesity has been tied to bottles. It can even be breast milk bottle-feeding because women pump and can give breast milk in a bottle as well as obviously formulas in the bottle. But when a baby drinks a bottle, you know, the milk flows so easily and so quickly, and whatever is prepared is usually what is drank by that baby. And really when the baby can tell us how much they want by suckling at the breast, then we are not going to give the baby more than the baby needs. Frankly, it's too much work for them. So they're not going to keep working for food if they're full.

Prakash Chandran: So, I guess this is a related question. How do you tell when a baby has gotten or is getting enough food to eat? Because I think probably one of the biggest points of anxiety for new parents when they're breastfeeding is like, "Did I feed my baby enough?" So maybe you can talk to us a little bit about that.

Lorie Ochoa: Yes. Yes. And that's absolutely correct. And that is the fear of parents. First of all, the mother doesn't know what's being given as the baby suckles. And then the support people, the family, they can't tell what the baby's getting. So how I instruct new parents is I tell them, "Look at how your baby looks after they're done eating." A baby that's full and has done some work to get full is going to be very relaxed and calm, and they're usually going to have their eyes closed and be ready to sleep. So looking at how the baby acts is a good way to know if they got enough. Also, if it's going in, it's got to come out. So I instruct parents to count diapers in the beginning. And the urine diapers, the pee diapers are going to get heavier and heavier in the next two, three, four days. Each day, the baby's tummy's getting bigger and the mom is going to make more, so there would be more output.

And interesting enough, if we can talk about poop, baby's poop is very dark in the beginning. It's called meconium. And as the milk starts to change, the colostrum changes into more mature milk, we call it. The color of the baby's poop or stool is going to change color. It's going to go to green and then it's going to go to yellow. So parents can really tell a lot by looking at the baby and looking at their diapers and counting those diapers.

Probably the hardest part is that until the mother's milk, mature milk, comes in, the baby is going to start to lose weight. And that is probably another huge obstacle that these mothers that are trying so hard to provide this perfect nutrition to their babies, it's discouraging to them and can be scary when they go back to the pediatrician and the baby's weighing less than they weighed at birth. It is completely normal for that to happen and the reason being because the baby takes more out or more goes out than goes in. So the output is much more than the input. So until the mom's milk comes in, that's the mature milk that I'm talking about, that's when that baby's going to start gaining weight and that mom can start to be reassured that she's doing all that she can do to feed her baby.

Prakash Chandran: Okay. So there's a couple things there that I want to expand on a little bit. So the first thing is around when the mature milk comes in, do you have a general rule of thumb or timeline that parents can expect that mature milk to come in?

Lorie Ochoa: Yes. You know, that's the magic question and I wish I could tell them exactly when that's going to happen, but our human bodies react differently. What I can tell you is that for first time moms, it does take a little bit longer because their body's not done this before. If a mom is breastfeeding that has had previous babies, that milk will come in a little sooner, usually around day two, day three. For first-time moms, it could be day four, day five, because the other factor into that is how hungry is their baby and how strong is their suck? How much stimulation is that baby giving that mother? Because that's another misconception, is that the mother needs to be making all this milk. Well, the mother's body is doing what her baby is telling the body it needs. Yes, we need mom and we need baby, but we need a baby to be very vigorous and hungry and want to eat and suckle at the breast. So the more the baby wants to suck, the faster the milk is going to come in.

Prakash Chandran: Yeah. Now there's kind of this fine line that, I guess, needs to be evaluated around maybe the baby isn't necessarily hungry enough. And also I think the worry that maybe the mom isn't producing enough and that needs to be supplemented with something else. So how do parents or mothers tell the difference between those two things?

Lorie Ochoa: Yes. That's a very good question. And when there is a concern that the mother is not producing enough, that's where we need to have the mother come in to the pediatrician's office. We can weigh that baby before that feeding, have the mother feed the baby and we can weigh the baby to see more accurately what that baby is getting. It is difficult because babies can be sleepy and parents can also be very tired. Having a new baby is exhausting. So I think there's also just the understanding that there are babies we need to wake up to feed. They need to be eating every one to three hours in a 24-hour time period. So we need to wake them, encourage them to eat and we do have some waking techniques. But we also need to give the mother that time to get her milk to come in and that can take some time and that's where the pediatricians are good about evaluating just how much weight that baby has lost.

And then there can come a point where there is a concern that the baby has lost more than the pediatricians are comfortable with, that they may recommend supplementing. And so how do we do that? There's two ways you can supplement a baby. The most important thing to remember is how you supplement. You really do not want to supplement with a bottle. So we can express the mother's milk out either with a pump or hand expression. Or if we aren't able to do that, we can give formula, but we want to make sure we don't give the formula in a bottle because babies can get what we call nipple confused. Eating from a bottle is very different than eating at the mother's breasts.

Prakash Chandran: So for example, my wife is due on July 30th, so very close time.

Lorie Ochoa: Congratulations.

Prakash Chandran: Thank you. Thank you. We're very excited. But I remember that with our daughter my wife, just breastfed what seemed like, I think for the entire time until my daughter weaned off. But because of that, she really didn't want to take the bottle. So my mother-in-law's concerned. She's saying, "You know, I want to be able to take care of her. You know, we want to be able to give you a break. So we want to introduce the bottle sooner." And so I was like, "You know, I'm not sure when the right time to do that is because of this nipple confusion." So do you have a best practice or rule of thumb around when parents start thinking about it?

Lorie Ochoa: Yes. And that's a wonderful question because there is that concern. The rule of thumb is to wait 30 days. After 30 days, offering a bottle should not interfere. A baby's always going to prefer the breast over a bottle after the 30 days, but certainly they're hungry, they will take from that bottle. And other babies, if you do wait too long to introduce a bottle, it can be a real battle because that baby is only used to eating one way and that's at the breast.

Prakash Chandran: Makes sense. So, you know, there's so much that we could cover here today. And I think this just basically gets to the point of, you know, if you are expecting, then please start getting this education sooner because there's a lot to learn and a lot to be aware of as you get into this beautiful breastfeeding journey. You know, we talked about some of the benefits of breast milk and why it's so important. We talked about colostrum and kind of the first couple of days and weeks as your baby is developing.

But before we close, Lori, I just wanted to ask from all of the mothers that you've seen in all of your experience, if there is one piece of advice that you could give to expectant mothers that are planning to get into this breastfeeding journey, what would that be?

Lorie Ochoa: I would tell them to have good support. You want people around you that understand what you're trying to do and can appreciate it because it is a lot of work. The mom is going to get exhausted and tired, and she's going to doubt herself at times. So she needs people to remind her and to encourage her and support her in this journey.

Prakash Chandran: Yes, exactly. Having that support system is so important because breastfeeding can be an exhausting, physically exerting thing to do for the mother. But I also hear that there are a lot of benefits for the mother for breastfeeding. So maybe you can talk about that.

Lorie Ochoa: Yes, definitely. There are advantages to mom, even though she may not experience those immediately, although she certainly will experience just a unique type of bonding with her baby. But she is also going to have this wonderful happy hormone we call it of prolactin that helps relax her and calm her. Now again, a first time mom may not experience that initially, but once breastfeeding starts on a smoother journey after the mature milk comes in, that mother is going to feel really good about what she's doing for her baby and her body is going to be more calm from having this prolactin.

Also, we are finding that it also helps with preventing certain types of cancers. Certainly, lowering her incidence of getting breast cancer, uterine cancer, cervical cancer. And it certainly helps her recovery as she's delivered a baby. And I think sometimes we forget that. A new mom, her body's recovering and when you're breastfeeding, it really helps your body recover more quickly and even have less bleeding. So those moms do recover faster than a mom that isn't breastfeeding.

Prakash Chandran: You know, Lorie, I really appreciate your time. Thank you so much. It was a super informative conversation.

Lorie Ochoa: Well, thank you for having me. And we do celebrate World Breastfeeding Day on August 1st and Breastfeeding Awareness Month in the month of August. So thank you very much for this time. I also would like to say if I could, Prakash, we certainly want to support all mothers that deliver at our hospital. And we also realize for some, breastfeeding is not their choice. And I just want to make that clear that we support all of our moms in their decision, whatever that decision may be.

Prakash Chandran: Well, that is a fantastic note to end on. Thank you so much for including that, Lorie.

Lorie Ochoa: You're very welcome. And congratulations to you and your wife.

Prakash Chandran: Thank you so much. That's Lorie Ochoa, a registered nurse, a certified childbirth educator, and an international board-certified lactation consultant at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To learn more, visit rrh.org. If you found this podcast to be helpful, please share it on your social channels, and be sure to check out the entire podcast library for topics of interest to you. Thanks so much again for listening. My name is Prakash Chandran, and we'll talk next time.