Dr. Jones: Breastfeeding, it should be easy. Mice do it, deer do it, cats do it. But if you have questions or problems as a new mom, who should you talk to? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and today we're talking to an expert on The Scope.
Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.
Dr. Jones: I was born in Germany and my mother, who was a good Boston girl, was told by the nuns at the hospital where she delivered, that she should drink beer, dark beer, to bring her milk in. Well, it worked and then on the trip back to the United States on a boat, supposedly I got sick and wouldn't nurse and she didn't have the nuns to help her to turn her milk off.
Well, when my son was born and I was worried about my milk supply, by the way, obstetricians are not very smart about breastfeeding, I actually brought my sister in to help me, cause she'd done it twice, and she brought me a beer. And 30 minutes later, it was a done deal. so a superstition and a tradition, were born in my family about breastfeeding and beer.
Around the world, there are customs and old wives' tales about breastfeeding do's and don'ts but there are actually some people and some science about it. New moms, here at the university hospital who have questions, can get help from a breastfeeding specialist. Today in Scope Studio, we're talking with Mary Erickson, a lactation specialist, on our postpartum floor.
Welcome, Mary. So you're a lactation consultant?
Mary: That's correct.
Dr. Jones: Did I say that correctly?
Mary: Mm-hmm.
Dr. Jones: And we have a couple of them here at the U?
Mary: Absolutely, we do.
Dr. Jones: Is there somebody during the weekday that's always available? Is there somebody always on-call?
Mary: There is always, seven days a week, there is always going to be a lactation consultant. Also, a lot of the nurses that don't actively work as the consultant but they have gone through the process, so there's typically someone who knows how to help.
Dr. Jones: Okay and they have a certificate and . . . so it's not your mother who is going to feed you a beer?
Mary: Right, that's right.
Dr. Jones: Oh good, oh good. So what are some of new moms' most common questions or concerns?
Mary: Probably the most common concerns are discomfort. There are some discomforts that are associated with the breastfeeding. And also her inability in her mind, that she cannot meet the demands of the baby and this might include baby's crying, won't sleep in his crib, baby's hungry, or wants to be held all the time, and all of those she usually internalizes and figures it's her own fault.
Dr. Jones: And it's her breast milk, rather than, who knows?
Mary: Right, yeah.
Dr. Jones: So that's some that the lactation specialist or consultant can help the mom interpret what's hunger and what's fussiness, and what's just, you know, "Wrap me up a little tighter," or, "I'd rather be with you, Mom, than by myself over there in the corner."
Mary: Right, so a lot of my job is educating what is normal newborn feeding behavior and just normal newborn behavior? When is the crying normal?
Dr. Jones: Yeah, right. Well, so how do you help moms who seem to be worried about not enough milk? Remember now, our patients who have a normal vaginal delivery, go home in 48 hours, even before their breastmilk has even come in. So how do you help those moms about their fears that they won't have enough, or help a mom who really maybe, her baby got sick and she didn't breastfeed for a while and now she's not got enough? What can you do for those moms?
Mary: So first of all, I think it's important that they understand what is normal behavior, as far as . . . a lot of them want very concrete, this is what's going to happen but . . .
Dr. Jones: Get ready for parenting.
Mary: Exactly. So Just talking to them about, the first 24 hours, this is what your baby is going to act like. And then when babies' 48 hours is going to be totally different. And then 72 hours, when your milk comes in, different again. And just preparing them, that every single day is going to be a little bit different, and trying to help them recognize when it's okay and when it's not okay. And then what to do when it's not okay.
Dr. Jones: Okay, so for moms who don't seem to have enough milk, it's hard. Moms may be going back to work. Now once again, they're heading to the hospital so can they still call? If they have delivered here, can they call, cause their problems may arise because their breast milk didn't even come in 'til they went home?
Mary: Right, right, and we're very fortunate, we do have a breastfeeding clinic, so moms do need support past the hospital period, so they do need someone to call. And it's very nice to be able to bring them in, have them a doctor, a pediatrician will look at their baby, make sure baby's okay, and then have them work one-on-one with a breastfeeding person that can help to troubleshoot and figure out what's going on and also hopefully, to give her a lot of reassurance.
So if she felt like she did not have enough milk, for me, it depends on where she's at on that timeline. If she's day five, six, seven, I would expect that she should've had breast changes and that she should be a little more reassured that she does have enough milk and if not, I would definitely want her to be seen.
Dr. Jones: Well, I remember, after that beer which was probably just given at the right time. I don't think it was the beer but it did relax me. My milk came in like a milk truck and then I thought, "Oh my gosh, I have way too much." And then I remembered that we were setup to maybe even nurse twins, so at the beginning, we have a lot. We probably have more than we need, so I figured that was just a chance to put it in my bank in my freezer. But some women actually let-down very quickly or have a lot of milk, and that doesn't settle down to a pattern. What do you do for those women?
Mary: Well, first of all, not enough milk is a lot more difficult to deal with than too much milk. But too much milk can also be a problem, especially for the baby. It is like trying to drink from a fire hose sometimes and that can be pretty challenging. So if that's the case, there are different things that she can do.
One thing that I like is I tell moms after the breast is empty, to do ice. Ice will decrease the blood flow and that should help her get on top of the volume a little bit better. Other things that they can try is breastfeed the baby on one breast per feeding, so they get a good milk mix of the hindmilk and the foremilk.
Dr. Jones: So you do ever suggest that the mom, with the milk comes out like a fire hose, just express some milk just so the pressure is down a little bit? So then maybe the baby can latch on a little easier, and not get flooded the first mouthful, and then get disrupted, and get upset. How do you deal with that?
Mary: Very good strategy would be to go ahead and get that first let-down over. That first let-down is going to be the most forceful so after that first let-down, the milk flow will be a little more gentle. So some moms do have to do a little bit of pumping or just a little hand expression and get that first let-down passed. Dr. Jones: It's great to have some professionals here helping us out. It's good news because in fact, I really didn't like beer.
So thanks for joining us on The Scope.
Mary: You're welcome, thank you.
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