Liz Unruh: Welcome back to the Well Within Reach Podcast, brought to you by Riverside Healthcare. I'm your host, Liz Unruh. And today, I'm joined by Cathleen Currie, Riverside's lactation consultant, to talk about breastfeeding basics.

Thanks for joining me today, Cathy. We're glad to have you. Can we start off by you just talking a little bit about yourself and your background?

Cathleen Currie: Sure. It's so nice to be here today, Liz. Thank you for having me. So, I am a registered nurse, been a nurse for about 30 years. Initially, I did some cardiac nursing. And then, finally in like 2008, I had the opportunity to transition to mother-baby care. And from there, I moved on to lactation. I've been doing lactation as an internationally-certified lactation consultant or an IBCLC since 2016, is when I finished, but I have been doing full-time for two years.

Liz Unruh: Okay. That's exciting. Something kind of like close to my heart right now is I am expecting. So, something that came to mind, it's one of the first questions people seem to always ask you is like, "Are you breastfeeding or are you going to be formula feeding?" Can you tell us what the benefits of breastfeeding are?

Cathleen Currie: Absolutely. It's one of my favorite topics. So, breastfeeding benefits baby, particularly. But when we think benefits for baby, one of the top ones is it does reduce risk of SIDS. It also helps support their immune system. So that breastmilk prepares their GI tract and helps support. Also, helps reduce ear infections and childhood risk of obesity. So, as they get a little bit older, it helps reduce that incidence. Also, it lessens the risk of type 1 diabetes and the risk of childhood cancer.

Liz Unruh: So there are a lot of benefits, it sounds like, for the child. But are there benefits also for the mom as well?

Cathleen Currie: Yes. I'm so glad that you asked that. There are some great benefits for mom. It decreases the risk of breast cancer, uterine cancer, endometrial cancer, and also ovarian cancer. So kind of that whole system there. If mom is a diabetic mom, it helps decrease her use of insulin after having the baby. It decreases risk of bleeding because it helps that uterus go back down to size, so that improves that as well. And also, hand in hand with that, it decreases the risk of anemia due to blood loss and also it decreases their risk of infection.

Liz Unruh: Okay. So, there's obviously a lot of benefits for both sides of the group, you know, the mom and the baby. Something that I know, ever since I learned that I was expecting, I have gotten like bombarded on social media with all the recommended posts or like, "Hey, you should do this. You should do that." And one of the things talks about colostrum. Am I saying that right?

Cathleen Currie: Colostrum.

Liz Unruh: Colostrum. So what is that exactly?

Cathleen Currie: Well, colostrum is the first milk. Your body starts making that during the end of pregnancy or actually probably anyway part way through pregnancy there. So, you may even near the end of pregnancy be occasionally leaking or be aware that you have some colostrum. And that first milk is what we would call that. It's a small amount. It's thick. It's often gold in color, but it can be whitish. And you might sometimes hear us refer to it as liquid gold. And it is just the right amount for baby. It is particularly high in those antibodies that help protect baby and in the right amount for their small stomach. Because baby's stomach is the size of a marble or a grape that first day, and colostrum is just perfect for that. So, lot of times you won't feel, but it's that first milk that we can express for baby and give to baby.

Liz Unruh: Okay. That's what I was going to say, I've heard that liquid gold phrase before. I think that's an interesting concept because like baby's stomach is really so small those first couple of days. So, would they need any other things besides that while we wait for like the milk to come in? Because I understand that doesn't always happen right away.

Cathleen Currie: It typically takes three to five days for that volume increase or that milk to commit, as you would say. And knowing in most cases, breastfeeding with just the colostrum is going to be sufficient for baby. So, baby would feed frequently. And as long as baby is feeding as often as eight times a day, so it's about every two to three hours, we say, babies should be getting enough.

The other way, because we don't see what baby's getting when baby's at the breast is we count diapers. So in the first day of life, we actually only look for one pee and one poop diaper. Day two, we look for two. So the first four days of life, their pees minimally would match their day of life. And then, going forward, by the fifth day, when that volume increase has happened, that's when we would expect an increase in diapers to like six very wet diapers, and I usually say kind of wet squishy diapers at that point. The first few pees can be kind of small to see.

Liz Unruh: Okay. That's interesting. You know, you're all looking at the diapers. There's so many things like going on those first few days.

Cathleen Currie: Exactly. There is a lot going on. So, you would count the pees and poops. And then the other way we monitor so we know what babies getting, is we monitor a baby's weight. Most babies lose weight. Almost all babies lose weight after birth, even if you choose to do formula. We just want a monitor that it's not too much weight. And so, as long as baby falls into those guidelines, you count your pees, your poops, and your weights, then baby is getting a sufficient amount of breast.

And then, we'd also look to see if baby's satisfied, is baby acting satisfied after a feeding?

Liz Unruh: Okay. In part of this and part of the milk coming in, Riverside has added a breastfeeding support groups to its services. This free support group is open to all breastfeeding and breast milk feeding parents with the goal of connecting parents to peers and helping them reach their feeding goals. For more information on this lactation service, call 815-935-7342. Or visit riversidehealthcare.org.

So, the other side of this, there's some questions about, you know, so I have this new baby, are there cues that I should be looking for or watching for?

Cathleen Currie: Yes. So, babies will usually tell us when they're ready to eat. Early feeding cues are when baby is making sucking motions, if baby is kind of shifting around in their crib or in their bed. If they're putting their hands in their mouth or if they're turning their heads, like what we would call rooting if they're kind of seeking towards the breast or towards the bed, if they're laying in the bed or anything like that. So those would be cues.

Liz Unruh: Okay. So with those cues, should you feed every time baby gives a cue or is there like a regimented-- like you touched on, you know, "The first day, you feed this often or this much," but how often should you feed baby?

Well, babies should eat a minimum of eight times in 24 hours and that can look different based on feeding cues. Yeah, you would want to respond to what baby's showing you. So baby's acting hungry, you're going to put baby to the breast. And in the first few days, we especially recommend undressing baby, doing a lot of skin to skin. That's going to help baby latch and feed well. So, you would undress baby, put baby on your chest and see how baby's acting at that point and usually move on to latching baby and feeding at that time.

So, babies will have periods of time where they're sleepy and when they're more wakeful. The first day, they'd like to sleep a lot. So a lot of times, we'll have to undress them and do skin to skin and kind of wake them up. The second day, they tend to be more wakeful. Well, you may have heard terms where babies want to feed frequently. We may sometimes refer to it as cluster feeding, where they may feed hourly or they may feed almost constantly for a couple of hours. So, they do have a varied number of feedings that they do and you do want to respond. Babies at the breast cannot feed too often, but you want to make sure they're getting enough. So once again, you would kind of look to make sure the minimum is eight times a day, and that they're having their pees, their poops. And then, after they go home, you'd be looking for baby to start gaining weight. So, that's kind of how you would judge, if they're getting enough as the weight and the diapers. So say, like a baby's a week old, like how many diapers would you be looking for at that point?

Cathleen Currie: By the fifth day, babies diapers should be at least like six. So usually, by the time, they're a week-old, most times once they hit the mark of doing six wet diapers, they're doing it with almost every single feeding. So that could be depending on the baby, that could be anywhere from eight to 12 times in 24 hours.

Liz Unruh: Okay. I'm sitting here doing the math of how many diapers that's going to be, I'm like, "Okay."

Cathleen Currie: Yes, it can be a lot of diapers. But we like diapers when we're breastfeeding cause we know they're getting enough.

Liz Unruh: Yes, that is true. Is there anything else that you can think of that we missed or that we need to add?

Cathleen Currie: Well, there are some things we can do if baby's not acting satisfied at the breast, and you've fed baby and you've watched for a good latch, when you have listened for swallows. And early on, we're watching and listening for those swallows, which are much easier to see when babies at the breast. But also as our volume comes in, we're going to be looking for our breasts to soften after the feeding. So if we've done all these things and baby's not satisfied, we can do some hand expression or remove that milk, so we could pump to give that milk to baby.

Liz Unruh: Okay. You know, some people will have to pump. Some people, their baby latches and great. I hope to be one of those people have no issues.

Cathleen Currie: Absolutely.

Liz Unruh: Well, thank you for joining us today, Cathy. And thank you, listeners, for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. For more information about the lactation services and the family birthing center, visit riversidehealthcare.org.