Jamie Lewis (Host): As a new mother, the amount of information and advice out there about breastfeeding can feel overwhelming. Should I breastfeed? Will I know how to do it? What if I can't? How will it affect my baby? Well, today we're talking with Associate Professor of Pediatrics in Neonatology, Dr. Misty Virmani of the University of Arkansas for Medical Sciences to learn about the importance of breastfeeding, how to make sure your baby gets enough, and how the first milk bank at the University of Arkansas for Medical Sciences can help. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.

I'm host Jamie Lewis. Welcome to the podcast, Dr. Virmani.

Misty Virmani, MD: Hi, thank you for having me.

Host: I want to start with the why behind breastfeeding. What are the benefits for mothers and infants?

Misty Virmani, MD: The benefits, or the importance, as I'd prefer to say to the health of both mothers and babies, is that breastfeeding is what your body is meant to do for both individuals. For babies, being breastfed or fed mother's own milk means that they digest it more easily, but more importantly, it helps boost their immune system and how their gut and other organ systems function in their body.

This means that it reduces their risk of certain infections like diarrheal illnesses or respiratory infections; some of which in very small infants or vulnerable babies can lead to a hospitalization or to increase medical care needs. It also helps reduce their risk of having some long term problems like asthma or severe asthma.

Some things like leukemia and lymphoma risk can be reduced by breastfeeding. One of the most important things that we like to emphasize about breastfeeding's importance to baby's health is that it reduces the risk of dying in the first year of life. Even in developed countries, being breastfed for longer periods of time can reduce the risk of death by as much as 20%.

But importantly, especially for states such as Arkansas, where the infant mortality rates are very high, breastfeeding can help reduce the risk of sudden infant death syndrome, or SIDS, by as much as over 50 percent for infants who are breastfed for six months or longer. The longer you breastfeed, the bigger and the more important the benefits to the baby's long term health can be.

One of the other things that we don't talk about quite often enough, although as a pediatrician I talk a lot about the reasons why bringing breastfed is important to a baby's health, is why breastfeeding and the act of breastfeeding is important to the mother's health. If you think about how pregnancy evolves, the state of being pregnant means that you are growing another human.

That means your body goes through a lot of changes to deliver fats and proteins and sugars to the growing fetus in your uterus. That means that there's a lot of metabolic changes that are not particularly healthy to mom's long term health if those changes are persistent after the pregnancy. So they're healthy while you're pregnant, but they're not so healthy if it keeps up after you're done.

And the thing that we kind of tend to forget is that the moment you're done being pregnant, the moment you deliver your baby, all of those things that changed in your body to give your baby more sugar and more fat and more protein, don't go back to being like they were before you became pregnant in the first place.

That reset button, if you will, resets mom's metabolism. It resets how her pancreas functions and her ability to metabolize and maintain normal blood sugars. It decreases her fat levels and increases her HDL fats, both of which are better for her heart, long term.

And the act of breastfeeding reduces her risk long term of going on to develop things like Type 2 diabetes, which is a high risk prevalent condition in our communities. And it also reduces her risk of things like stroke and heart attack, both of which are debilitating illnesses and cause a lot of maternal mortality and morbidity later on in life.

Host: You mentioned earlier that the longer a mother breastfeeds, the better, but about how long is that? How long should mothers breastfeed?

Misty Virmani, MD: What I encourage moms to do is to meet their own personal goals, and everybody has a different goal for themselves that they set. The American Academy of Pediatrics and the World Health Organization both recommend that infants are exclusively breastfed, meaning they only receive mother's milk for the first six months of life, and then continue to breastfeed along with the introduction of other foods and nutrients, up until they're two years of age or older.

But when you talk about breastfeeding for six months exclusively to a mother who is fatigued postpartum and has just had her baby and has just gone through the whirlwind of birth, that can seem entirely overwhelming. And for a brand new mom, I just talk to her about getting through the next feeding, getting through the next day.

And then the next week and having these small goals that eventually get you to that larger goal. But what I want for every mom is for her to accomplish what is to her, her own personal goal, whether that's two weeks of breastfeeding or it's two years of breastfeeding. Both are success stories if we accomplish mom's goals.

Host: That's the perfect way to say it and the perfect way to treat a new mom. What strategies can a woman learn to be successful in both starting and continuing breastfeeding?

Misty Virmani, MD: The first thing is to know that it's not easy, that while it's what your body is meant to do and it's quote unquote the natural path for your body, it doesn't feel entirely natural when you're doing it. It feels awkward and difficult to learn. It's like getting on a bike and somebody saying, this is natural and you should just be able to do it.

There's a lot to learn about it and going into it with clear expectations of I'm going to be tired. This is not necessarily going to be the easy thing that I'm going to do. And knowing where to look or ask for help and for support, is really, really important. So having that social construct of a supportive partner, supportive parents, supportive friends who are going to be your cheerleaders and who are going to be there to say you're doing a great job no matter what you're doing.

And if that means you are successful at exclusively breastfeeding, then fantastic. If it means you really just needed a break for a minute and you had expressed milk that you've had somebody else feed your baby, or you needed to use a bottle of formula, but it helps you be successful in the end at meeting your goals, then that's what it means.

So what I don't want a mom to go into it is expecting that her baby's only going to eat every three hours and it's only going to take 20 minutes to feed. And then you're going to have this other two hours and 40 minutes of your day given back to you. Because that's not the reality of breastfeeding a brand new baby. Going in expecting that, that small human is going to want to be cuddled up next to you for every minute, every day, for the first several weeks of its life and it's going to feed sometimes what feels like almost constantly. That is actually what that looks like. And I know I wasn't expecting that with my first.

I had this expectation as a Board Certified Pediatrician having my first child that every three hours, I'm going to feed my baby and it's going to take 20 minutes. And then I'm going to change his diaper. And then I'm going to go on about my merry way. And then there was this tiny human who just wanted to be like attached to me continuously day and night for days and weeks on end.

It felt scary and new and unexpected. And I think had I had a little bit different guidance going into that; I would have felt differently about it. In the end, it was a beautiful experience, but getting to that beautiful experience, was a bit of a rocky road. And I am eternally grateful that I had my mother and my husband as my cheerleaders and my support people, telling me I was doing a great job and to pick up not the slack, but to pick up on all of the other things in my life that were left going undone, dishes and clothes and brushing your hair.

Host: Yeah, when I had my first baby, I had this image in my mind of us both knowing exactly what to do, and that the whole breastfeeding process would go off without a hitch. But we did have our challenges getting started, my baby and I. So, share with us, what are some common breastfeeding problems or difficulties?

Misty Virmani, MD: Probably the first one we run into is moms having their baby, expecting their milk to be at two or three ounces every three hours, what they think their baby should be eating, right from, the second their baby's born and not realizing or not being prepared for the fact that when you have your baby, you're going to have a little bit of milk. But you're not going to have a lot. And that's actually what your baby's body is kind of made for. Their stomach is not stretched. It's not very big. It doesn't hold a large volume. So your body doesn't make a large volume. And as you feed more and they eat more, your body makes more and their stomach stretches and holds more.

But I think a lot of moms have their first child and expect to be able to breastfeed a two to three ounce bottle every three hours and when they feed or when they pump or they try to express their milk and they only get five mils or maybe if they're lucky ten mils; it's alarming and it's scary and it makes you think I'm not feeding my baby enough.

I'm not giving them what they need. The reality is exactly the reverse. That is precisely what their body needs. But that's also why they eat more frequently. Instead of every two to three hours, they eat every 30 minutes or every 45 minutes because they're taking in these tiny little volumes and that's what they can hold and they digest it and in the meantime your body makes more and then they eat that and it keeps signaling your body, hey, I need to make more milk. The baby keeps taking it out, your body keeps responding by making more and more and slowly over the first couple of weeks of life, you build up to that big volume that you wanted But I think that fear of not feeding your baby enough, can be enough to make some moms quit before they've even started.

Because they don't want to be in a situation where they feel like they're not feeding their baby. And, it's unfortunate that a lot of well meaning family members kind of reinforce that too sometimes, they're like, well, let's just give the baby formula and you get some rest, it'll be okay. Or, you clearly aren't making enough milk yet. Let's, do something else.

And that undermines mom's willpower and her confidence in her own body. And what I try to teach is to be confident that your body's going to do what it's supposed to do and what it needs to do, but here's how it looks. And it's not what you expected.

Host: What is the best way to assess for an insufficient milk supply?

Misty Virmani, MD: Well, then I give moms counseling about when I get worried about having an insufficient milk supply. So not having enough pees and poops, and honestly, poops are the biggest and most important part of that because as babies are stooling, that tells me that their intestines are being signaled that food is coming in.

And so the gut's response is to get fecal matter out. And so stooling is a really good sign that the baby is getting food into their tummy. Babies are supposed to lose weight in the first several days of life. And so weight loss, while it can be alarming to the mom, is what is normally supposed to happen and that doesn't alarm us as pediatricians.

Now too much weight loss can be something that can be concerning but that also depends on how much fluid mom got in her labor. So if she got a lot of extra fluids then the baby's going to get rid of all of those extra fluids because while she was pregnant the baby also got them. So you have to look at that kind of with a judicious eye, but if the baby's stooling and by day five or so those stools are transitioning from that kind of black sticky tarry meconium that comes out first to a brownish and then to a yellow seedy stool, then that baby has been getting a good amount of food into their belly and is getting what their body needs.

Host: Excellent. Will you share a little bit about the opening of the first milk bank in Arkansas and what resources it's going to provide?

Misty Virmani, MD: Absolutely. So I am an a neonatologist and as neonatologist, I treat mother's milk, as though it is a food, and as a medicine for the babies. I take it very seriously and we treat it with what we call medical necessity. So these fragile preterm infants, if their mothers, for various reasons, are unable to supply their milk in the first days of life or have a low milk supply, which sadly does sometimes happen with premature infants and premature delivery, then we have donor milk as that backup food source that's substantially safer than providing formula.

So I was approached by members of the legislature to discuss whether or not Arkansas would benefit from having a milk bank in Arkansas. And prior to the milk bank opening, many, many NICUs and nurseries around the state were using donor human milk, but they were getting it from outside of the state.

So from Texas, from Michigan, from Oklahoma, some from Indianapolis. And the problem with that is that when that state is running low for a variety of reasons, sometimes natural disaster or weather patterns or just the patterns in births and deliveries within the state, mean that their milk supply runs low, then they prioritize the needs of their state over the needs of any other hospital outside of their state.

So for instance, when Texas is supplying to Texas hospitals and supplying to other hospitals outside of their state, if they don't have enough to supply the hospitals inside of Texas, they're not going to send their milk outside of the state. And that leaves hospitals, that do not have a dedicated milk bank kind of scrambling to locate another source of that milk.

The other thing about that is that we have a lot of moms who are successfully breastfeeding in our state and are wanting, out of the goodness of their heart, to share that wealth of their own bodies with, babies who are in need, who don't have the benefits and parents who don't have the luxury of being able to provide their own milk.

So they send their milk to these milk banks that are outside of our state. Some in Texas, some in Oklahoma, some in other places. And that means that their milk may get to come back to Arkansas, but a lot of times doesn't. So there's a lot of reasons why, from a financial perspective, but also just from a supply and demand perspective, that we really wanted to be able to supply it from within our own state.

But the biggest reason is that we want to emphasize to the state that breastfeeding is important to the health of mothers and infants all around our state, whether they're in the NICU or at they're at home breastfeeding successfully. And we want to be able to build a platform of support that will help anybody be successful in breastfeeding, whether they're donating to the milk bank or they're just doing their own thing at home and being successful at it. My goal is that every mom who wants to breastfeed can and has the support to do that. And I hope that the milk bank, as we grow and as we develop more programs to help with education, both for the community, but also for the healthcare providers in the state about the importance of breastfeeding; and down the road is we hope to develop a lactation center where we can have outpatient support that is dedicated to breastfeeding women, and a resource and education center that we can be that bulwark or the platform that supports the efforts to support breastfeeding within our state.

Host: Well, I think I can speak for new parents out there by saying thank you so much for your time and expertise, Dr. Virmani, we really appreciate it.

Misty Virmani, MD: You're very welcome. It is my passion and it's one of the things I love best about my job.

Host: I'm Jamie Lewis, and this has been an episode of UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. For information about how to donate milk to the milk bank, please visit uamshealth.com/uams-milk-bank. Or to contact the milk bank, please call 501-686-5355, or you can email milkbank@uams.edu.