Helen Dandurand (Host): Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host Helen Dandurand, and joining me today is Bonnie Occhiuzzo, lactation consultant, who is here to talk about breastfeeding basics. Welcome, Bonnie.

Bonnie Occhiuzzo, RN, BSN, CLC: Thank you. I'm glad to be here.

Host: So can you start by telling us a little about yourself and your background?

Bonnie Occhiuzzo, RN, BSN, CLC: Sure, yeah. I'm Bonnie Occiuzzo, like you said. I've been a nurse for 16 years. I started in pediatrics and then I cross trained to OB and worked in postpartum and nursery.

And then I was doing that for a little while and then I did stay home for a little bit with my kids and then I went back to work and I started working more postpartum and nursery, and I would help moms with breastfeeding before I became a lactation consultant. I was really, enjoyed that, trying to help them as much as I could.

So I've been a lactation consultant for four years now. I have four children of my own. I have a 10-year-old, a 9-year-old, a seven-year old, and a five-year old. And I did breastfeed all of them for a year. And it wasn't easy. There was obstacles along the way. So, I'm very passionate about it.

Host: That's awesome to be able to help others, make sure things go smoothly. That's really cool. So let's start, get into it breastfeeding basics. For someone who's brand new to breastfeeding, what are the absolute ground level, basic things they need to know before baby arrives?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah, no, definitely. So one thing I like to tell moms is, because there's so much out there and everything, I like to tell them, your baby's unique and you can't compare to everybody else. Your friends, you can't compare how their journeys were. You have to go into this knowing that it's your baby and your baby's going to be unique and you can't play the comparable game.

Because that really makes it harder when you go into thinking it that way. And I also, feel like moms should get some education. If they take a class that's great. Being careful where they get their sources. You want to have a legit source, a lactation consultant or somebody that is in that education field that you're listening to, not just other people's opinions. It's great to hear their journeys, but that's their journey. So it's good to try to do some research, just so you have an understanding on what kind of to expect.

Host: Okay. And I know like a lot of parents worry that they won't do it right or that kind of thing. What are the most common concerns and questions that you hear in those first few days?Or even just, you know, beforehand when you're doing a class or something like that?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah, definitely. One of the most common questions I do hear when I see moms is that I don't have any milk. They can't see it, so it's very hard for them to believe it's there. And I get that because it's hard to see because the first milk is the colostrum and it's thick and it's concentrated, so it's not just going to come out easily.

So, I usually try to remind moms there's milk there. Baby does the best at getting it or hand expressing and sometimes if they are concerned, and they don't feel like they have milk, I'll show them how to kind of hand express to see the colostrum, and let them know it is there. It just takes time and baby needs to latch and nurse and the more they start moving the milk, the more it's going to help the mature milk to come in.

But I also like to remind them that babies' bellies aren't really big when they first come in. They're just like a size of a marble, so they're not requiring a lot. They just have to learn how to latch and stimulate the breast to get the milk to come out. But it's okay. It's not a lot at the time because their tummy only can handle so much as it is. So that's one of the huge questions I feel like I hear all the time.

Host: Yeah. How long does it typically take for that mature milk then to come in after the colostrum?

Bonnie Occhiuzzo, RN, BSN, CLC: It takes about three to five days for the mature milk to come in. The more baby's coming to the breast, the more it's going to keep telling the body to make more milk. The best way to do it is right in the beginning if you can, right after birth. I get it. Sometimes things happen and mom can't bring baby to breast right after birth. But as soon as they can, that's the best time to do it to help that milk start moving and telling the body to keep producing milk.

Host: Gotcha. And taking a step back does like the colostrum. When does that start to come in before?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah. No, definitely, so the colostrum around the third trimester there is colostrum in the breast already. And some moms will say, Hey, I expressed some milk, or I hand expressed, or I did pump before around 37 weeks or so.

Not all moms do and that's okay, but some moms do. But it's not really going to come out the best until after the placenta's delivered. Then you're going to see the colostrum, coming out when baby latches and everything. And that first feeding, usually they get like a little bolus of colostrum and that's why the babies usually stay on there for a long time.

Host: Hmm. Awesome. Were there any other kind of common questions, concerns that you hear? Was that kind of the big thing?

Bonnie Occhiuzzo, RN, BSN, CLC: I feel like that's one of the biggest questions I hear is they're worried that they don't have milk.

Host: Got it. And then how can someone tell, you did mention that the baby's stomach is only the size of a marble, but how can you tell, if you want a sign or something that the baby is getting enough milk?

Bonnie Occhiuzzo, RN, BSN, CLC: That's another thing. How do I know if baby's getting milk? So usually I tell moms once baby's latching, if baby is eating, you're going to see that jaw kind of rocking back and forth. You're not just going to see like a sucking motion by the lips, but you're going to see the jaw moving.

And you may hear little swallows here and there. And usually when a baby's eating, sometimes in the beginning their hands are like they're fists. They're just closed together. And as they start eating, their hands start to relax. So their behavior starts to relax a little bit. They're starting to fill their bellies, they're starting to feel a little fuller.

So it's kind of like their behavior, how they're looking. I'll have mom sometimes compress their breasts to see, you know, just the little drops come out. And if baby's still hungry, baby will start moving that jaw again and eating, when they're compressing their breast and rubbing the baby's chin to stimulate baby to keep eating.

When baby's starting to slow down and not really moving their jaw as much and starting to get sleepy or whatever after they've been feeding, that usually means that they're getting their belly full.

Host: Awesome. Great. I know that latch also in doing some research can be a big challenge, and you did mention that too. Can you explain, maybe it might be hard on podcasts, but like what good latch feels like and what are signs that it might need adjusting?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah, sure. The latch is the hugest thing, honestly. One of the hugest parts with breastfeeding. And usually when moms are latching babies, I say the key things to do are, when you first bring baby to breast, no matter what position you want to try to bring baby, tummy to tummy, you want that baby facing you basically. And you want to try to bring baby, nose to nipple level when you bring baby to breast. And one key thing to remember, that's an easy habit to get into, is always making sure bring baby up to breast, not breast down to baby. Not good for people's backs and not good for positioning for baby.

 So making sure you bringing baby up to breast, nose to nipple level, then you kind of tickle their upper lip with your nipple to get them to open nice and wide and kind of tilt their head back a little bit. And it's key to try to get that bottom lip in first and then the top lip.

Because what happens when, babies just kind of latch on without getting their bottom lip in first, is the nipple goes more in where their hard palate is in their mouth. So when they start sucking, it starts to feel like a pinching feeling and the baby's not getting as much milk as if the nipple was further in their mouth, and it's in the soft palate and expands and gives them better milk. One way to know, that I heard one time, which I thought was really cool, is if you want to know how it feels, if you suck your finger to your first knuckle, you're going to feel your tongue pushing on your finger.

But if you suck your finger to your second knuckle, you're going to feel a gentle pull. And that's what you want to feel when your baby's latching.

Host: Awesome. That was all really great info. We are going to take a quick break to talk about primary care at Riverside.

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To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew. And we are back.

So breastfeeding can maybe be uncomfortable at first, but obviously pain is not the goal and is not necessary. What is normal early on? And then when should someone reach out for help?

Bonnie Occhiuzzo, RN, BSN, CLC: Our goal is definitely not pain. For sure. I don't know why I would do it if it was supposed to be painful all the time. Sure. I do tell moms in the beginning, you may have a little bit of soreness and tenderness. Baby's still learning. Baby may not know how to latch correctly, and that's common.

So you might have some soreness, but that pain should subside as baby is learning to latch better. So you don't want your nipples to be bleeding and cracking and being in a lot of pain. You definitely want to reach out if your nipples are starting to bleed or crack. You want to reach out before that.

If you're feeling more pain, you definitely want to reach out. I do tell mom sometimes if baby wasn't latching in the beginning correctly, you may have a little bit of soreness as the baby continues to latch, but the soreness shouldn't get worse. Like if the pain's getting worse, definitely reach out because we want to see what's going on.

Sometimes it's just a matter of the latch or just adjusting baby a little bit.

Host: So then feeding schedules, I feel like that seems a little bit overwhelming. How often should newborns eat? And what cues should parents be watching for from baby?

Bonnie Occhiuzzo, RN, BSN, CLC: So with feeding schedules, babies that are breastfeeding are a little different than formula fed babies. We do want them to be eating every three hours if they haven't shown any signs before then. But sometimes babies will eat before then. I usually tell moms, go by the baby, not the clock, but if it's been three hours, you definitely want to bring that baby to breast because they are sleepy the first couple days of life.

So they're not always showing those feeding cues when they're all swaddled up in their blankets and stuff.

Host: Yeah.

Bonnie Occhiuzzo, RN, BSN, CLC: So it's important to, make sure you watch babies feeding cues though. If they want to eat before three hours, definitely feed them. They know when they want to eat. It's just harder to determine when they're sleepy in the beginning of life. So, feeding cues are usually babies bringing the fingers to mouth, sticking their tongue out, starting to get a little antsy. If they're on someone's chest, even if they're not on mom's chest, they might try to start sucking on the chest looking for it.

So those are usually feeding cues I tell them to look for. The late feeding cue is usually crying, which we find out at night because we're sleeping.

Host: Sure.

Bonnie Occhiuzzo, RN, BSN, CLC: But trying to get to them before, if you can is great to get them when they're starting to show those feeding cues, but if it's been three hours, I definitely tell moms, you know, get that baby skin to skin and to the breast.

Host: Yeah. Do you have any kind of like tracking apps or ways that you track kind of the length of time and the cues and things of that nature that you recommend?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah. There's so many apps out there. It's called Baby Tracker. You can track when baby starts, when they finish. You can track what side they're on. You can track their diapers, their feedings, their shots when they go to the doctor. You can their weight, everything. So I like the Baby Tracker, but I know there's probably many apps out there.

Host: But definitely good. I'm sure writing it down in some way versus trying to remember in your mind is probably a good thing, at least for a little bit.

Bonnie Occhiuzzo, RN, BSN, CLC: Yes, for sure.

Host: Yeah. Cool. So then there's many families that use a mix of maybe breastfeeding and pumping and things of that nature. What should parents know about finding a rhythm that works best for them?

Bonnie Occhiuzzo, RN, BSN, CLC: Yes, definitely. Usually when I go into mom's room, my goal is to tell them, do what works best for you. You don't want to stress yourself out, or, I mean, you need to worry about your mental health too. So whatever's working best for you and baby, that's what you need to do. There's no right answer. It's what works best for you and your family. So, I usually see what their goal is. I usually ask them, what's your goal or your plan, or because I'm here to help you reach that however I can. And then depending on their goal or plan, I'll tell them what I usually suggest. I usually do suggest though, in the beginning, for the first three to four weeks, if they are bringing baby to breast, to try to primarily bring baby to breast for those first three to four weeks to get breastfeeding well-established.

If baby's latching correctly, they're going to get more milk out of them than the pump anyways. So that first three to four weeks to get that milk established is good to bring baby skin to skin to the breast, get established, but then they do want to start introducing a bottle, even if they're not planning on giving bottles too much. I usually recommend around three to four weeks. Because if they wait too long, that baby will reject that bottle completely.

Host: Sure, sure. That's awesome. I feel like that's really great info. If there is a new parent listening and they're struggling or maybe feeling discouraged, what reassurance or advice would you want them to hear?

Bonnie Occhiuzzo, RN, BSN, CLC: It's not an easy journey and that's why I just like parents to know that I'm here to help support them and it's important to have support. That's a huge thing. One thing I would tell them is when you're going into breastfeeding, try to calm your nerves and give yourself grace.

It's a learning process for you and baby. Doesn't matter how many babies you have. Every baby's different. Every pregnancy is different. So it's really important to go into it, you know, with trying to take a deep breath. And one of the simplest things they could do right after birth is just bring baby skin to skin.

Babies go so much better to the breast when they've been skin to skin. So as soon as they can, if they can, in that first hour, that's the greatest time to bring them skin to skin. Now if things happen, I understand they could still bring them skin to skin after, as soon as they can. That's the most important thing with babies that breastfeeding.

And the most simple thing they could do without freaking out is just take a deep breath and hold your baby skin to skin and work on breastfeeding. It takes time, but you're not alone and there's people to help. And it's very important to have that support and remember that your baby's unique and your baby will show you, and you'll learn together with your baby.

But the most important thing to do when you're freaking out, just bring baby skin to skin.

Host: That's reassuring advice. You mentioned that you're here to help. What kind of breastfeeding resources does Riverside offer for new parents?

Bonnie Occhiuzzo, RN, BSN, CLC: Yeah, we have a couple different resources. I do teach a breastfeeding class. And I'm also the lactation consultant of Riverside. I see outpatients if needed and I'll see the patient's on the unit. I'm part of a breastfeeding coalition in Kankakee County Breastfeeding Coalition. We have a Facebook group and we're there to help. It's a bunch of us lactation professionals there to help with any resources, questions, concerns.

Like I said before, it's great to get the resources, but you want to make sure you're getting them from the right places. So we have this group in order to give the moms the right information. We're not just giving our journeys or opinions, which is wonderful, but we're giving evidence-based research and factual information when they come to ask a question on the Facebook group.

Host: That's great. So, you know, like first things first, if you're able to go to one of the classes, that's a great way to get a lot of good information, I'm sure some hands-on or like, you know, visual experience, which can be really helpful, learning something new. And then if you have additional questions, you can reach out.

And so you said you take outpatients too, so afterward they can give you a call and just say, Hey, I need help, and that kind of thing?

Bonnie Occhiuzzo, RN, BSN, CLC: Definitely. I usually give them my business card.

Host: Okay.

Bonnie Occhiuzzo, RN, BSN, CLC: That has my phone number and my email. I do let them know I only get my calls when I'm at the hospital, so I do check my emails at home because I want to make sure things are going well. So if a mom needs to reach out to me and email me, they can definitely do that too.

Host: That's great. And then the Facebook group, that just sounds, like another really great extra resource. So yeah, you've got a lot of good info here for everyone. We really appreciate it.

Bonnie Occhiuzzo, RN, BSN, CLC: Definitely. It's my pleasure. And I really am passionate about this and I love supporting, moms and families in their journeys, so I'm always here to help however I can.

Host: Well, thank you again for being here today, Bonnie and thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.