Transcription:
Breastfeeding

Melanie Cole (Host):  Welcome. There’s no handbook for your child’s health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. Our topic today is breastfeeding and joining me is Carolyn Migliore. She’s an internationally recognized and certified childbirth educator, lactation consultant and infant massage instructor. She is also a Clinical Nurse Specialist and is currently a Clinical Instructor on staff at New York Presbyterian Hospital Weill Cornell Medical Center. Carolyn, it’s such a pleasure to have you join us today. Can you tell us about the primary health benefits that breastfeeding provides to babies?

Carolyn Migliore, RN, MSN, LCCE, IBCLC, CIMI (Guest):  Well it’s well documented in the American Academy of Pediatric literature that six months of exclusive breastmilk whether it’s straight from the breast or via a bottle, increases a baby’s immune system, diminishes the risk of asthma, allergies, upper respiratory, ear infections. It’s much more easily digested so it’s easier on their tummies. It cuts the risk of SIDS, childhood obesity, juvenile onset diabetes and we now know it also cuts the childhood malignancies like leukemia, lymphoma and Hodgkin’s not to mention, higher IQs by fir to seven points.

Host:  Wow, that certainly is so beneficial for baby. So how does breast feeding compare to formula feeding Carolyn?

Carolyn:  Breast milk is a complete nutrition source specifically designed for each individual baby so there is nothing that can compare to that. There is no artificial ingredients. It is completely natural. And you cannot duplicate that.

Host:  Well what if someone is having trouble breastfeeding. What do you tell them about trying, about sticking with it or when they might have to resort to formula?

Carolyn:  Well that’s an issue that we deal with almost on a daily basis because moms do have issues and that’s why we are out there in the world to assist moms and try all different maneuvers to either get the baby to latch directly to the breast and if that is not possible; she always has the option to just pump and serve her breastmilk from a bottle.

Host:  So, then how can a mother tell if baby is getting enough milk? How do we know?

Carolyn:  That’s the number one question we get all the time. How do I know if my baby is getting enough milk? Well the first thing we look at are elimination patterns. Is the baby urinating and stooling enough? Does the baby seem content after a feeding? Is the baby lasting an hour to two hours? And then is the baby gaining weight? Those are the parameters that are looked at to tell whether or not a baby is getting enough food from its mom.

Host:  So, then let’s talk about mom for a minute. What health benefits does breastfeeding provide for the mother and what are some of those?

Carolyn:  So, initially after delivery, breastfeeding helps the mom’s uterus contract and go back to it’s prepregnant state faster. Moms get extra to eat and lose weight. So, it’s a great weightloss diet. As I always tell my clients, I wish I could breastfeed all the babies, maybe for once I would be skinny. But that’s not what the main purpose is. It also cuts her risk of breast cancer, ovarian cancer, osteoporosis, and adult onset diabetes. And it’s cost efficient.

Host:  it certainly is. Now as mom is breastfeeding some women, they were on folic acid when they were pregnant or maybe they take vitamins or supplements. What’s recommended while they are breastfeeding as far as vitamins, supplements and even medications Carolyn?

Carolyn:  So, as far as supplements go, we do recommend that she continue taking a good multivitamin. If she has more prenatal vitamins, she can finish those off. But any good over the counter multivitamin is highly recommended. Folic acid is no longer required during breastfeeding because that’s for neural tubular development in utero. Now that the baby is here, she does not need that unless her own folic acid levels are low. Any other supplements that she was on prior to delivery, then her practitioner can decide whether she would continue to need those afterwards. As far as medications go, there are way too many medications out there. We do use resource books to look things up for a mom should she call and ask questions, or should a physician contact us to find out if something is compatible with breastfeeding. And there is quite a number of medications that are compatible with breastfeeding.

Host:  Well thank you for that very clear answer. So, let’s talk about pumping for a minute. What are some of the best ways to pump? You mentioned it a little bit before. Should they wait before using a pump and how do they maintain or even increase their supply while they are pumping?

Carolyn:  Ideally, we try to have her hold off for at least two weeks after delivery to let the baby establish a supply to meet their demands. And because this mom is so exhausted and overwhelmed, we don’t want to add anything else to her plate so to speak to topple it over. At the two week mark, things tend to start going a little bit easier and then we gradually introduce pumping immediately after several feeds a day for about ten minutes. What that does, it really drains the breast adequately, it helps increase supply so that she could start storing her breastmilk. And then if she does choose to give one bottle a day, she has breastmilk to utilize and then she can pump at that feeding for that to go into the freezer for storage for later on down the road.

Host:  Well expand on that then. How do women properly store breastmilk for the short and longer term?

Carolyn:  If the breastmilk is going to be used right away it can sit out at room temperature for four hours. If she is going to refrigerate it, it is good in the refrigerator for four days. And frozen in a standard freezer for four months. And it’s highly recommended that she always rotates her breast milk and utilizes the oldest breastmilk first because breastmilk composition changes over time to meet the growing needs of a baby. So, the expression is first in, is first out. Meaning what she puts in the freezer first, is the first she uses.

Host:  What a great tip Carolyn. So, women experience many barriers when they are nursing. Can you tell us some ways and some common things that women come to you with whether it’s soreness, or redness, speak about some of those and what you tell them about that.

Carolyn:  So, we do encourage using an appropriate nipple cream whether it’s a lanolin based product or an organic nipple balm. They will tend to soothe the nipples. Manually expressing a few drops of her own breastmilk and allowing that to air dry on the nipple is one of the best protectors. There are gel pads out there which are these little silicon disks that are refrigerated that can be very comforting. Another old fashioned remedy which is not evidence-based but does work plain old fashioned tea bags, steeping black tea in tepid water. The tannic acid in regular tea will also help take the sting out of sore nipples.

Host:  Another great tip. So, do you have some advice for women about eating healthy while they are breastfeeding? Things they might – should avoid, things that you want them to try and get more of?

Carolyn:  Absolutely. But when it comes to I hate to even say this, quality of food, that is irrelevant because no matter what moms eat, she’ll still make good quality breastmilk but clearly, for the mom’s benefit, eating well is always better. We do know things like almonds and oatmeal can help increase milk supply. She does have to increase her calories from a normal woman’s diet of 2000 calories a day to about 2500 calories a day. And it’s kind of hard for a new mom to be counting calories so she breaks it down into three good meals and four to five snacks a day, she will get the additional calories that she needs.

But on top of that, we do tell them to eliminate things like parsley, sage and anything mint. Those are three things that we know that can diminish milk supplies. And more importantly, is water. A minimum of three liters of water per day.

Host:  Wow, that is really, really great information. What do women do if they have an excess supply of breastmilk? We’ve heard about milk depots. What are these?

Carolyn:  So, there are breast milk storage banks throughout the country. There’s one here in New York City. There’s one up in West Chester. So, if a mom has an over supply and she’s running out of freezer space; one of the greatest things that she can do is to donate her breast milk. There is very rigid screening criteria for them to accept breast milk. And then the milk is pulled and homogenized and stored and can be purchased for others to use.

Host:  So, as we conclude, how can the whole family, especially the partner, get involved in the feeding process when a woman is breastfeeding and give us your best advice on planning, getting ready for baby and getting ready for breastfeeding and such an exciting time.

Carolyn:  Well making sure that they are very supportive of this mom who is going to be going through a lot initially. Making sure the cupboards are stocked, the fridge is full, the freezer has food readily available. Trying to minimize the number of people that are around initially because they are both going to be very exhausted and then as a routine gets settled in, giving mommy periods of breaks, having mom get out, having a bottle prepared so that the partner can then use a relief bottle while this mom either gets a little extra sleep, maybe an extra nap or time away from baby.

Host:  Do you have any final thoughts that you’d like for women to know about breastfeeding?

Carolyn:  I think it’s very important to women to know that there’s lots of help out there. That they should avail themselves to help that most insurance companies will cover lactation visits. To reach out to their pediatricians or their primary healthcare provider for referrals for lactation consultants. Or to utilize the internet because if you go online, and you put in search for a lactation consultant; we’re out there. We’re easy to find.

Host:  Thank you so much Carolyn. What a great segment and such important information. Thank you again for joining us Carolyn Migliore and to our listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, please follow us on your social channels. I’m Melanie Cole.