Ep. 30 - Top 8 Early Breastfeeding Mistakes - We’re here to help! You got this!

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November 20, 2020

Early breastfeeding mistakes?! What are they and how can I avoid making them?!

This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. An inclusive evidence-based podcast hosted by midwives and lactation professionals. That’s us. Here to talk to you about all things lactation, and boobs, body positivity, mental health, all the Milky topics. Join us for another episode.

Hey there. Are you a noob with a boob? Yeah. Are you newly lactating? Newly lactating people, we’re talking to you. Yes. Or soon to be lactating, if you’ve still got your bun in the oven. Today’s episode on The Milk Minute it is about the difficulty that we face in the first month or two of breastfeeding and some of the biggest mistakes that we see.

Yeah. And you know, the good news for you is that yes, you’re going to screw up, but we already know what you’re going to screw up. So we’re just going to tell you in advance because it’s always the same. Because we know how we screwed up. We know how we screwed up and also we’ve seen, I don’t know, thousands of people at this point, and it’s always the same mistakes, right.

So we got together and we made this quick list for you. Let’s talk about it.

Let’s take a minute to thank our sponsor, Happi Tummi. Wait, what’s Happi Tummi? Maureen, I’ve told you about this. Well, I forgot. So tell me again. Okay. So Happi Tummi is a heating element combined with aromatic and therapeutic herbs. Okay. Okay. I’m listening. And you slip it into a fabric waistband with a separate pouch insert and you put it directly against your baby’s tummy and it provides nearly immediate relief of most common symptoms of fussiness and gas.

 Sounds really nice. Well, it is really nice because I mean, I used to get really bad cramps myself and I had a lavender heat pack that I would put on. And it just makes sense that you would have one for babies. Yeah. I was kind of just thinking like, hmm, I could use this for my own self. Yeah.

I mean, it’s got a mixture of lavender, chamomile, lemongrass, peppermint, and spearmint. Oh, I love that. Yeah. I mean, how great is that? Yeah. If I had gas and you came over and just tied that around me, I would love you. You would be one happy baby. I would be one, I’d have one happy tummy.

Yeah. We have an exclusive offer for you, our listeners. If you go to Happi Tummi’s website, you can enter a promotional code MILKMINUTE10 for 10% off. Yeah. And they have way more products than just that. That just happens to be my favorite one. Yeah. So we’ll put the link in our show notes. Yes. And don’t use gas drops and just get Happi Tummi.

Yeah. Again, it’s promo code MILKMINUTE10 for 10% off.

Okay. So I wanted to start by talking about feeding on a schedule. Ugh! Sorry, go ahead. No, just have your outrage moment. Well, that’s not okay. I’m totally cutting ahead of you. I’m so sorry, but I spend a lot of time as a lactation consultant undoing a lot of the pressure that is put on parents that have chosen to deliver in a hospital setting where the charting is punitive.

You know, if you don’t chart the exact amount of minutes of feeding that a baby had, then you are going to get a nasty gram. The pediatricians are going to be mad at you. And you know, here’s the thing, time does not equal volume, right? So it doesn’t actually matter how many minutes, hear me now.

They just want to make sure you’re feeding your baby at all. And they want to have legal proof of it. So if the nurses are charting that you’re feeding your baby every two to three hours for 30 minutes at a time, it’s like, it makes them so happy. The T’s are crossed. The I’s are dotted, but it actually doesn’t mean anything about volume, right?

So they’re going to tell you to feed every two to three hours, right? Or you might hear your nurse or doctor or midwife say, okay, when you go home, make sure to feed at least every two to three hours, which some people hear as, “OK I’m feeding every two hours, I’ll set an alarm.” And they set an alarm for the next four months because nobody tells them when to stop.

So the reality is that feeding on a schedule is outdated advice. And we have a lot of good data that tells us that that actually leads to decreased duration of breastfeeding and decreased milk supply and weight loss in infants. So the most up to date advice for healthy term babies, right? This does not necessarily apply to your NICU baby.

Nope. Is that you should feed on cue or on demand. So that is essentially whenever baby shows you the signs that they would like a feed. Right? And so obviously for this to apply, your baby has to be cuing you, right? So if your baby has neurological stuff going on and they’re not cuing you, this is not about you.

And, and I just want to say your baby can’t feed too much or too often. No, they are not going to fill up on breast milk like it’s a bag full of peppermint patties. Right. Breast milk is digested very easily and it digests very quickly in like 90 minutes. So if your baby is feeding for 30 minutes at a time, and it just keeps going after that, it’s like half-digested the stuff that it ate 30 minutes ago. It’s just moving through.

Every baby has a different pattern of feeding, just like every adult does. Like Heather, how many meals do you eat a day? Three. How many snacks? Sometimes mostly zero. Right. Heather eats three meals. I eat like 20 snacks and one meal and that’s fine. Both of those are fine. And babies are like that too.

You get the babies that just kind of want like a little bit of milk all the time. And then you get the babies that wait until their tummy is completely empty and they freak out and then they completely fill up their tummy. And they’re fine for two hours. Then they eat with rage and they slap your boob like they’re just so pissed off.

Right. And, both of those are fine. So that’s why we talk about looking for cues, feeding cues, like rooting, lip-smacking, bringing the hand to the mouth. Those early feeding cues are really good. Crying is a late feeding cue. Yep. It’s late. And it’s also really, really difficult to latch a pissed off baby.

So if that happens, just put them skin to skin for five minutes or however long it takes them to calm down, reposition and try again. Right. And like we’ve said a zillion times, and I will say again, breast milk is created with a demand and supply relationship. So by letting your baby feed, whenever they want, that tells your body how much milk to make.

Okay. So I think that covers feeding on a schedule. Yeah, don’t do it unless you are ordered to do it for a real medical reason by a provider, not the nursing staff. The nursing staff is going to tell you to do this because they will get in trouble if they don’t have it in the chart during their shift.

So just tell them they can chart an attempt. So if your baby is in the first 24 hours and they go to latch and then they decide they’d rather sleep, just tell your nurse. Oh, we had an attempt. Yep. This segues really nicely into the next topic I have. The next kind of mistake I see really often is supplementing too soon, because pretty much in a normal, healthy baby, we don’t have to supplement in the first 24 hours.

No. We do not recommend supplementing in the first 24 hours. Unless there is like a glucose issue, which would mean that your baby is not medically well, so no, we don’t care. We don’t care as providers. It’s okay if your baby just attempts a couple of feeds in those first 24 hours and doesn’t really transfer claustrum yet.

Yeah. Being born is hard sometimes, you know, they have to go through it too. And we really need to allow them to transition to this extrauterine life. Give them a break. And luckily they’re born with enough brown fat on their body, if they’re medically well, to survive the first 24 hours without food.

Right. And it’s rare that healthy babies even need supplementation any time before your milk comes in. Yeah, because colostrum is not calorically significant, right. Colostrum has all of these other components that are important for baby, but calories it does not really have. Right. So why do we need to supplement baby with something that has x amount of calories per ounce, but no immunological factors, no STEM cells, things like that?

Right. And here’s the thing. Our bodies make such a small amount of colostrum for a reason. If baby needed a large amount of colostrum to survive, we would have it. So we need it to be a small amount because babies tummies are the size of a marble when they’re first born.

And then when you’re giving these small amounts of colostrum your body keeps replacing that colostrum and you get a little bit more every time until your milk comes in. But your baby needs to be a little bit hungry, so it will latch and it will suck, suck, suck, suck, suck to get your body to make the milk.

So when your milk comes in, that mature milk, it comes in with vigor. Cause it knows there’s a baby there. If you give that baby two full ounces of milk, it’s not going to suck for anything. Cause it’s really full. We want a hungryish baby. Yeah. And then we see a lot of parents get stuck in what we call the top-off cycle right from birth.

And then that leads to a chronically low milk supply. And it’s actually really hard to break the top off cycle. Right. Can you just describe the top-off cycle for me? So people will breastfeed and then baby will cry after and they will take that as a sign that baby is still hungry. And grandma or the nursing staff, or somebody will suggest that they’re hungry.

And that you don’t have enough milk because your milk hasn’t come in, so just go ahead and top them off with a bottle. And of course, baby sucks it down because they have this crazy sucking reflex and they’re just going to drink it because what else are they going to do? They’re primal. So they suck down this milk and then guess what?

They aren’t as hungry soon enough. So then they delay feeding for longer than they normally would. And when your breasts hold milk for longer than they typically do, that tells your body to make less. Yep. So then you have less milk the next time, they feed later, they don’t get enough milk again, they cry.

Then you give more milk. And you top them off again. And then the cycle is a slippery slope until before you know it, your breasts barely have anything in them at all. And this happens pretty quickly when it happens soon. So like in that first six weeks of life, when your breasts are really trying to get that demand and supply relationship under control, if you’re doing this consistent top off cycle, you are never going to get to that regulated place where it’s just, yep I have enough. And we just do it.

Right. And when we see that exclusive breastfeeding is essentially never initiated, right. When we supplement in those first few days, then the overall duration of lactation is very low. Yeah. And they know this, and that’s why they’re not allowed to give you formula supplements in like gift bags anymore at the hospital. Yeah, because it has a negative association with breastfeeding. Even just sending somebody home with formula does that.

Right. So just, you know, only supplement if it is ordered by a pediatrician and it is medically indicated, right. If your baby is hungry, put them back on the breast. So if you feed on one breast and they’re still crying, first of all, burp them, change their diaper, walk them around, get a change of scenery.

And if in 10 minutes they’re still rooting around, put them on the other breast. That’s fine. And you know what? That’s going to tell your body to make more milk and it will. So, yeah, just have faith in yourself that you got this and a crying baby is a baby that’s breathing. Is a baby that’s neurologically well.

Yeah. It’s a baby that is trying to communicate with your body. So just let it happen. Crying is not all bad. No. And as a midwife, I would much rather like, honestly, to hear from a parent that the baby cries all the time versus the baby sleeps all the time. Yeah, yeah, absolutely. Absolutely. I mean, I’m like good.

They’re telling you something, they’re cueing you. They’re alert, they’re awake. They might be uncomfortable. Maybe something else is going on, but you know, that is much more comforting to me that we have a healthy baby versus well, we have a baby that sleeps all the time. Like let’s check their jaundice levels. Like, do you really have to wake them up to feed every time?

I don’t like that. I don’t like it either. And if you are the person that is like, but when I feed the baby pops on and off, like they’re still hungry. Like they’re not getting anything. Okay. Here’s what I want you to do. I want you to do breast compressions, where you do a compression behind your breasts, like almost all. How do you explain this?

So I, for breast compression, I usually say, lay your hand flat at the top of your chest, so like just below your collarbone. And then apply a really even, pretty firm pressure and kind of slide your hand down about halfway down the breast, you don’t really want to compress your areola because you don’t want to unlatch baby. Right.

But you want to do a nice even pressure pushing down the breast. It’s like trying to get icing out of an icing tube. Oh, one of those little baggy things like, yeah, you’re coming from the top and you’re kind of pushing it down to increase the flow because you might just have a baby that has one of those personalities that’s like, I want it. I want it now. And that’s fine. There’s nothing wrong with that. Just give it to them.

 You know, and it is like a flow. So, I mean, if you increase that pressure back there, it’ll increase the flow and you’ll start to notice your baby sucks a little bit more and again, same thing. Burp change a diaper, change the scenery, switch boobs, breast compression.

And Oh, I want to mention, okay. Sometimes that popping on and off is also, really early, it’s reflex integration. Where baby is, you know, we see babies repeat reflexes, like the startle reflex. Popping on and off the breast, repeating that latch over and over and over, because they’re literally integrating that reflex into their brains as a learned behavior.

Oh. Tell me more about that. I’ve listened to a really cool lecture on it and just, you know, all of the infant reflexes that we check in the newborn exam, they have a purpose. So when we see them repeating them over and over, like a lot of babies will startle over and over at the breast and unlatch, you know. That’s part of this healthy, neurological process, and it’s frustrating as hell as a parent when you’re like, stop throwing your arms around.

What are you doing? Yeah. And that’s your classic late preterm behavior, right? So maybe your baby was like, 35, 36 weeks? Classic popper onner offers. Yeah. And that’s okay. They didn’t have as much time in the womb then to develop those reflexes neurologically. They have to do it outside of it. That’s really interesting. Yeah. That’s pretty cool. Yeah.

So just take a deep breath and talk to your baby and tell them that they’re doing a good job. You know, because they’re learning how to do this. Also tell yourself. Yeah. I’m doing a good job, baby. I’m doing a good job and you’re doing a good job, too. Keep up the good work. Yup. Okay.

My next big one is when people just think, you know, they’re experiencing nipple pain, right? Early on and they think, you know what, that’s normal. I’m going to tough it out. And then three weeks later, we have somebody in the office sobbing with bleeding nipples. Yeah. Well, it could be because they have a pediatrician that says, don’t worry, your nipples will toughen up. Right. Or their mother-in-law. Right. And it’s not false. I mean, they will. I still have, I still, to this day on my nipples have like bruising scars on the tips of my nipples from where they were damaged.

Like, yeah. That was not necessary. And that’s exactly what I’m thinking. So yes, sometimes some nipple pain is normal and sometimes we see nipple pain that we just, no matter what we do, we can’t help it. But most of the time when I see it, there’s a reason for it.

So addressing that as early as possible is going to be beneficial for you. Because if you didn’t have to have your babies suckling on bleeding nipples for three weeks, you shouldn’t, you shouldn’t have to go through that. So what I want you to do is to find a lactation professional to talk to you about this, because your pediatrician probably doesn’t know. Your OB probably doesn’t know.

Nope, but maybe a nurse is also a CLC. If you are a lucky as hell, one of your doctors might be an IBCLC. You might have independently practicing IBCLCs or CLCs nearby, seek out a consultation with one of them. You can usually find one at WIC also. Because usually nipple pain is due to a bad latch and it’s a pretty easy fix, especially early.

Right? So sometimes what I’ve seen, especially with the late pretermers, again, they have really small mouths. They tend to compensate for the larger nipple that they’re having a hard time shoving in their tiny mouth by tucking their bottom lip. So I think a lot of that chomping and the actual, like bruising and the blistering that happens is because a tucked bottom lip makes it real pinchy.

And then it inhibits that nipple from getting all the way back to the soft palate and they just continuously compress it against the hard palate of their mouth. And it’s really painful. Yeah. So that one is not cool, but it’s easily fixable. So you don’t have to break the entire latch to fix this. You just stick your finger between the baby’s chin and your breast and pull the chin down and it’ll pop that bottom lip out without breaking the latch.

It’s really cool. And your partner can do that for you too, if you’re using all eight of your hands already to breastfeed. Yeah. And we actually have some larger studies from Australia where they have a really great breastfeeding rate about nipple pain and the most common causes were incorrect positioning of baby.

So maybe holding baby too high, too low, twisting their body a little bit, incorrect attachment of baby. So like Heather said, their mouth isn’t on there right. And one of the big ones too, was mothers holding their breast or holding the back of baby’s head and not letting them readjust. Right.

And so all of those instances can have really quick, easy fixes. Super quick and easy fix. And also just one tiny little one. Sometimes babies have, what’s called a little Epstein Pearl on their gum line. And they’re like little white calcifications on the gum line that are completely normal and they will go away. Some people are like, my baby has a tooth and probably not.

It’s like an Epstein Pearl. So if the latch it feels okay and looks okay, but like in one particular spot on the nipple, it just feels a little scrapey or, it’s not pinchy, it’s like pin prickly. Check the baby’s mouth and see if they have an Epstein Pearl. And if that’s the case, that might be a scenario where you tough it out.

Yeah. You know, because you can’t get rid of that Epstein Pearl other than time. Right. And again, you know, the worst case scenario here is you see your lactation consultant and they’re like, actually this is normal pain. Yeah. You know, and then they can give you some advice for how to cope with that.

Yeah. And you know, what is normal pain? So normal pain, and pain is relative, but normal discomfort of nursing feels more like pulling. So your nipple is getting sucked on with like 120 PSI. And that’s a lot, but we’re built for it. And it’s just never happened before. And we do have some fibers that do need to stretch in our nipple.

Right. Especially with your first, yes, feeding experience, you typically experience more pain. It can feel weird. It can feel pulley, but it should not feel pinchy. Yeah, right. Yeah. And those, those sharp pinchy pains usually tell me that we’ve got some positioning attachment issue. Right. So try those little minor fixes first before you completely unlatch or muscle through and lose a nipple.

Yeah. Don’t lose a nipple. So the next one on my list is having high postpartum expectations. Oh my gosh. Is this one fixable? Yes and no. I mean, here’s the thing, your postpartum experience, there’s a lot that you don’t get to control about it. You don’t necessarily have control over what condition your body is going to be in after labor.

You don’t necessarily have control over whether you have a baby that wants to feed all the time or that cries all the time. But what you do control is your expectations. Say the word new normal, I dare you. I will not. So a lot of people expect that after having a baby things can kind of go back to normal and you know, maybe their partner gets a week off work and then they’re like, cool back to dishes and laundry and whatever.

And for some people that’s fine. And for some parents that is fucking impossible. Yeah, it is. And every relationship is different. And we really, in both of our individual teachings with patients, we try to include partners as much as possible and set their expectations straight because yeah, they might have to take on a lot more duties and they’re not getting laid in return.

Yeah. It’s not a tit for tat scenario here. No, it’s not. Yeah. You might have to ask for help from friends or from family. You might have to hire help. You might need a postpartum doula. And I really like to conceptualize the first month or two after having a baby as the fourth trimester. And you know, there’s a whole book about this and this is kind of a whole postpartum philosophy.

And if you haven’t heard of it, essentially, it’s considering the early postpartum with the same mindset that you consider pregnancy. Where the birthing parent and the baby are still essentially one being. They can’t exist without each other really. Right. And sometimes that combined being needs extra rest and extra care. Sometimes? I think all the time.

Sorry. You’re right. I mean, but can we muscle through it? Yeah. Yeah we can. And it sucks. Should we? I mean, think about all the hormonal changes that are going on. You’re not going back to normal. You’re going back to a now different version of it. You’re being recreated. You’re now a lactating version. So if you were a person and then you were a pregnant person, then you were a postpartum person. Now you’re a milk making person.

All of those have different hormones and different things going on. And you’re expected to do all of that in one year. Great, you know, regulate that. And so, you know what? Don’t fucking do the laundry on top of it. Don’t vacuum. No, don’t do the dishes. Take those expectations and just, eat off plates for the next month, drop them down.

Yeah. Paper plates. Yeah, I did that. Can we have some paper plates that are merch that just say, don’t do the dishes, Milk Minute. I definitely want to do that. We are now going to create a line of paper products for your postpartum. And, you know, in general, I am all about being very environmentally friendly and reusable products, but seriously, in the immediate postpartum, no, no, I’m not doing the dishes.

No. Mental health guys. Yeah. Mental health is important. Don’t do the dishes. I’m actually currently on a dish strike in my own house right now. I was wondering if you were going to say that, right. Just guys. I just, I can’t do the dishes right now. You can just do whatever you want and it’s fine. Nobody died because you didn’t do the dishes. They got done.

And we have more dishes than we need, anyway. Don’t you think about that? I remember being postpartum and being like, all right, fuck it. I’m getting rid of all the dishes except one designated plate and bowl per person, because I can’t do that the shit anymore. You know, a lot of larger families that I serve do that. Each of their kids gets their own set and they’re their own color, or they have their names on them and they have to do their own dishes. And if they don’t do them, then their dishes are dirty and they know it because it has their name on it.

Yeah. Especially like these rocking home birth families with like six or seven kids that I serve. I always wondered how they did that. That’s how they fucking do it. Wow. That’s actually. Brilliant. Really good idea. You can do it with two kids too. Hashtag accountability. Yeah, right? Yeah. My son would be like, are you kidding me?

Like, Oh, I’m sorry. Is there dried ketchup from lunch on your plate? Oh, have fun eating off of that again. Yeah. That being said, there are creative solutions to some of these problems. There are, there are. Just do whatever you want and don’t apologize for it.

Let’s take a minute to thank our sponsor, Aeroflow. Oh, tell me more about that. You know, do you ever wake up in the morning, and you’re like, I would love to call my insurance company today? Literally never once have I thought that, okay. So people at Aeroflow knew this and they decided that it would be in everybody’s best interest if they developed a business where they contacted your insurance company to order your breast pump for you. This sounds good. So you literally never have to call your insurance company to work out getting a breast pump, which is fantastic because no one ever wants to do that crap when they’re postpartum.

And the other cool part is they will text you and let you know when it’s time for you to replace your pumping parts and when your insurance will pay for new ones. So maybe, you know, your pump parts are fine for now, but if insurance is going to cover a new set, great. I mean, I don’t know about you, but I’m not really combing through my insurance benefits information postpartum to see when I qualify for replacement parts? No, not at all. Right.

So we’re going to go ahead and put a link in the show notes for Aeroflow. And when you click that link, it’s super easy. You just put in all of your insurance information and then somebody from Aeroflow contacts you directly, and you have like a real person that you talk with and then they do all the dirty work for you.

It’s fantastic. I couldn’t recommend it enough. Please. Just do yourself a favor and get your pump through Aeroflow. It’s going to save you so much time and trouble, right? And they have all the top brand name pumps, replacement parts, and accessories. You know, they’ve got cooling gel pads. They’ve got those pumping bras, all the stuff you need, one place. Yep. One place. So, um, I guess the only thing left to say about that is you’re welcome. Yeah, you’re welcome.

All right. The next one on my list is forcing baby to feed right after it’s born. This is a really tough one to combat in a lot of hospitalized birth settings. However, I’m just going to contextualize a little bit. Your baby for two hours, 10 hours, 48 hours, experienced labor in your body. And before that they lived in a uterus for maybe 41 weeks, ideally.

And then out of nowhere, they’re in labor. And they’re being squeezed over and over and over. And then they are ejected from their environment and then their plumbing gets completely rerouted. They breathe. Their circulation changes rapidly. I mean, this is a big transition. And then sometimes they are just dropped onto mom’s chest and expected to breastfeed.

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Yeah. And the mom or parent is laying on her back, still getting her vagina sewed up. What the fuck just happened? It’s a slippery baby. Maybe she’s getting pooped and peed on, but it’s also the sweetest moment ever. But you’re slouched down in the bed. You’re makeup is running down your face. You might be just like in this super, like where even at home births sometimes, sometimes we were like laying on the bathroom floor. Or you’re tied up in your epidural catheter line and like, and it’s all around your hair and your arm and your hospital gown, and your IV is also tangled in there and they’re going hold your baby, hold your baby. And you’re like, I am literally hanging by my epidural catheter.

I feel like when I doula at hospital births rearranging these cords it’s like actually most of what I do because you flip-flop in labor and then you get tied up and all this crap. And yeah. So if you are literally bound, like in a four-point restraint, all of the stuff that they have you hooked to just wait a minute, you don’t need to rush this.

And the reality is that when babies are allowed, you know, healthy term babies, right, they’ve got all the reflexes and the energy. When they’re allowed to perform what we think of as the breast crawl, that takes about an hour, sometimes two. And that is okay. Like we mentioned before, there’s no reason that baby has to immediately feed. What’s happening during that immediate postpartum period is stabilization of vital signs.

We are getting sutured up sometimes. Yeah, babies, literally learning how to breathe, babies, learning how to breathe, stats have just skyrocketed. Right. They live in this like totally hypoxic environment. And now like they have oxygenated blood. Yeah. And they were practice breathing with fluid just a second ago and now there’s air in there.

You still might be cleaning/ clearing fluid from their lungs slowly. That’s okay. You know, and they’re experiencing their body motions in air for the first time and their reflexes in air, which, you know, it feels different to move in water versus air. It’s like being on the moon.

Right. And so babies have to have this period of.] Understanding where they are, you know, kind of climatizing to this whole new freaking planet they live on. Yeah. One of the ways they orient is by being given the opportunity to find the smell, right, that is on your nipple that actually smells like amniotic fluid.

Right. And to see these really dark areolas that you might have developed in your pregnancy and to move their feet on your stomach and to move their arms around on your chest and to bob their head up and down, to maybe taste where they are, tastes their hands, taste your nipple again. That’s okay. Because guess what? Their environment is you.

You’re all that that baby really needs to know right now. And it needs to know everything. Where to get the food, what she smells like, what she sounds like. And luckily they’ve been hearing you in utero for a long time now, and now when you’re talking to them, it sounds more clear and they’re going to go to that.

They’re going to go straight up and they’re going to find the breast on the way. And they’re going to hear your heart rate from the outside. And it’s so nice to give them that opportunity. And when you said kicking the feet on the stomach, they are massaging your uterus from the outside by kicking your stomach.

And that is helping you not have a postpartum hemorrhage. It’s so cool. And they’re a little fists on your chest. That’s helping stimulate your breasts. Yep. Stimulate a letdown. Yep. And you know, what we really want to avoid in this situation is taking baby’s head and grabbing your boob and just shoving them together.

Because one, obviously if a newborn, immediately newborn baby gets something shoved in their mouth that they’re trying to use to breathe, they’re going to reject that. Yep. Which usually doesn’t cause like long-term aversion, but what it does do is cause you to feel like your baby doesn’t like your nipple and I’ve heard this over and over and over from parents where this happens and they’re, you know, and they’re just saying, baby doesn’t want my breast.

And that is so incredibly sad. Yeah. It’s sad. And then the other thing that happens is they latch on and while you’re busy, you’re like, Oh great. They’re latched. And, but you’re in a weird position. You’re slouched down in the bed; you’re still delivering the placenta or whatever the heck is going on. And your birth might not be done.

Yeah. Your birth might not even be done if you’re having twins. Who knows? Who the heck knows? So baby’s latched on and you’ve got all of these natural anesthetic hormones flowing through your body and you don’t recognize that it’s actually a painful latch. But you don’t have any concept that it is painful at that moment because of all those hormones.

And then an hour later, you look down and you’ve got a wicked nipple hickey with a blister already. And you’re like, Ooh, whoops, it’s worth it to just let baby do skin to skin until you can reposition and get in a much better situation. And then try again. Yep. And it’s okay. You know, if you guys have waited an hour or whatever, and baby’s still not fully latched, but they’ve done all that orienting.

It’s okay then to kind of move maybe into a better position, maybe adjust your breast and facilitate that process. But we really just don’t want to like shove a nipple in a mouth and hold them until they work, which I see. Anyway, I’m just not going to start on that rant. Okay. Heather. Cluster feeding. Yeah, it’s going to happen.

Yes. Cluster feeding is not bad. However many people feel like it is because it does not always feel good. Well, it doesn’t come with a warning sign. Right? You don’t get a memo on your email in the morning. It’s like, Oh FYI, you might want to cancel your plans today. Little, Oliver is going to be cluster feeding today.

It’d be like, nice to get that email, but typically it just shows up as a fussy baby that just wants to be on your boob all day long. And you look at your partner and you’re like, what in the actual fuck! Like I have not even been able to take a dump today without taking the baby with me, like what is happening?

I don’t have enough milk. I think I’m starving him. We should give him a bottle. Top off cycle begins in that phase. Yeah. So, you know, I’m going to say, try to have the confidence that cluster feeds are normal. That feeding constantly can also be normal. You know, we talk in other episodes about tracking how much milk babies getting with poops and pees.

This is a good time to think about that and to use that to reassure yourself. And the good news is cluster feeding usually only lasts a few days. Yeah. It’s usually 24 to 72 hours. Sometimes longer, but usually when it lasts longer, we start to think, Oh, maybe this is something else. And not cluster feeding.

Maybe this is your baby you know, struggling with some other discomforts and just needing comfort or needing you know, so, so we kind of talk through it at that point. Right. And especially if it’s correlated with other symptoms in baby, or something else is if it’s a specific time that it happens every day.

You know, cluster feeding, it’s like all day. All day. But if you’re like, Oh, 7PM hits, baby will not stop feeding until midnight or they cry. And we’re like, yeah, we’re going to talk about colic and witching hour and all of that in another episode. Yes.

Okay. So segwaying into one of the biggest, saddest mistakes I see is that parents assume that there’s something wrong with their body first, right? That they assume that it’s their inadequacy that’s causing whatever problems they have. Of course. We’ve been trained, right? We are trained from birth to think this way. And interestingly enough, we’ve actually had some studies on this because perceived low milk supply is the number one reported reason for the cessation of lactation, for stopping breastfeeding.

Yeah. So there have been studies on this and it is the number one reported difficulty for lactating parents. It is associated with shorter duration of breastfeeding and less exclusive breastfeeding. Now this is perceived low supply. This is when parents self-diagnosed with low supply with absolutely no medical indication.

Yup. And then it’s like, wait, why’d you quit breastfeeding? And it’s like, Oh, I just didn’t have enough milk. Right. It’s like, Oh, did you go see a lactation consultant? No, I just knew that I didn’t have enough. And it’s like, fuck. Yeah, it sucks. And interestingly in some of these studies when they charted, like which parents had this perceived low supply, versus which didn’t, they saw a lower incidence of this when they had behaviors like rooming in with baby and skin to skin.

And they had higher incidences of parents doubting their milk supply when they slept separately from baby, when they didn’t do immediate skin to skin after birth, when they didn’t continue to do skin to skin at home. And also the partners. So if the partners are continually affirming the awesomeness, that is you and the fact that you’re able to feed your baby, then you are much more likely to feel adequate and continue breastfeeding.

The minute your partner says something like, I think he’s starving. You just go in this downward spiral of fucking awful thoughts. Yeah. And then, I mean, that’s our worst fear, right? Yeah. It’s like, what if I’m not enough? Right. What if I’m not enough for my baby? What if I’m not enough for my partner? Yeah.

I mean, why am I even a mother?  Those are like the worst? Like what good am I at all? And we just want you to know that you are adequate. Yeah. You’re more than adequate. You are enough. And even if you truly do have low supply, you’re still adequate. Right?

Your milk volume does not equal your value. Volume does not equal value.

Remember us saying that, please. If you do have to supplement, okay. Any breast milk that your baby is getting is awesome. It’s awesome. Celebrate your wins every day. Every Sunday, I want you and your partner to get together and talk about your breastfeeding wins. And yeah, your partner gets to participate.

I win this week because I freaking wash the pumping parts every day before you asked me to. Is that a win? Hell yeah, that’s a win. So why don’t you guys practice getting together once a week and going over your breastfeeding wins. You might think it’s stupid, but I don’t. No I don’t think it’s stupid. I think it’s great.

Oh, and tell us about it. Yes. Write us an email. Leave us a message on Facebook. Okay. So I got one more for you, which is an interesting one that I might not actually have a clear recommendation for at the end, but okay. I want to end talking about pacifiers. Ooh, I love pacifiers. Yeah. I love talking about them.

I love hate them. So let me just start by saying that pacifiers are modeled after a nipple, so your baby can never use your body as a pacifier because pacifiers mimic your body. So, so, so hold on, but wait, stop what you’re doing everyone. And, and hear her one more time. Okay. I’m gonna say it again. This is really important.

Your baby can never use your nipple as a pacifier because pacifiers were created to mimic your body. Oh, right, right. So the baby’s using the pacifier as a breast? Yes. Okay. Okay. Everyone got that. You got it. Okay. Just, just so we’re clear. So sometimes, and so the recommendation with pacifiers, let me just start here.

Is that you wait until your milk supply is kind of fully established before you introduce them, which is usually between four to six weeks, six to eight weeks, somewhere around there. And the reason for that is that if you are giving baby a pacifier when they want to say, cluster feed, that interferes with baby sending your body a signal to produce more milk.

That’s true, but can I expand on that? So actually in the very early days, like the first two weeks after birth, every time baby sucks on anything, a hormone called CCK is released in their body that tells their brain that they’re full after a certain amount of time. Yeah. I’m glad you brought that up. And what happens is the baby eats and then maybe falls asleep.

But then wakes up and starts crying and grandma, or whoever says, Oh, this baby’s just really oral. Like what the hell does that shit even me? They’re all oral. Yes. They’re all oral. That’s all they have. And you’re anal, grandma!

We really love grandmothers here. Well, there’s a lot of problems. I know. But anyways, so then you give this hungry baby, a pacifier and CCK is released in their body and it tells their brain they’re full and they go back to sleep and then grandma looks at you and goes, see, I told you. Right, they’re just using you as a pacifier.

Right. And what happened is their brain thinks they’re full, but they’re not. Their brain thinks they ate, but they didn’t. And so when they do wake up 30 minutes later or less, they are pissed. They’re so hungry that they can’t even coordinate themselves neurologically to eat. Right. That’s when you have the screaming baby that won’t latch.

Yup. So that lasts about two weeks. That’s a really primitive hormone that’s released and it doesn’t last long. I mean, God, if we still had CCK, I’d stuck on something just to control a diet. I’d get myself a little ring pop, and I’d be good to go. So after two weeks, the American Academy of Pediatrics says yes. And that’s a new recommendation, right?

So the recommendations around this are changing a little bit. Because it used to be thought basically like any pacifier use in the beginning is going to damage your milk supply, but then they did some studies and found out that wasn’t exactly true. It was interesting the way these were worded. So I found a couple of studies and then I found the Cochrane review.

So that was nice. If you don’t know the Cochrane, I don’t know, is it Cochran or Chochran? I say Cotran. Cause it’s a C H . I’m pretty sure it’s Cochran. Oh fuck. You know, it’s one of those words that I’ve only read and not had to say out loud before. Okay. It’s okay. I’m usually in your seat. This organization, basically they do these like metadata analysis and then they kind of come out  with how good the evidence is for whatever protocols.

So they actually have something on pacifier use, which I was really interested to see because there have been a lot of studies and how it affects breastfeeding. And their summary was really interesting. And I’m going to just try to emphasize a couple of words here. So I’m just going to read it.

It says in motivated mothers, there is moderate quality evidence that pacifier use in healthy term breastfeeding infants before and after lactation is established, does not reduce the duration of breastfeeding up to four months of age. However, there’s insufficient information on the potential harms of pacifiers on infants and mothers. Until further information becomes available on the effects of pacifiers on the infants, mothers who are well motivated to breastfeed should be encouraged to make a decision on the use of pacifier based on personal preference.

So the biggest, the thing that stands out to me is that they specifically say motivated mothers. So basically they’re saying, in people who are super determined to lactate and feed their baby their own milk, pacifier use doesn’t particularly affect their lactation. How did they assess their level of motivation?

I don’t know. I’m sure they had like a survey? Or was it the amount of times a day they breastfed? Probably surveys. But that’s interesting to me and that kind of tells me that introducing a pacifier for somebody who maybe has very low self-esteem when it comes to breastfeeding or maybe doesn’t have a supportive enough environment that that could be damaging.

Yeah, for sure. Right. But you know, in somebody who’s very comfortable with their feeding plan, maybe they’ve done it before. That maybe that’ll be fine. And you know, let’s think about what a pacifier is for. It’s for comfort. Right? So immediately after birth, what do we typically see? You know, when, after they get their bath, they get put in these little Swaddlers where they can’t access their hands anymore.

They used to have their hands next to their face for the past, however long they’ve had hands in utero. A couple months, at least. At least a couple months that they’ve had hands and they, they suck their thumbs in utero. They rub their hands over their face. They suck on their umbilical cord. They do. And then all of a sudden they’re born and now they have mittens on and they’re like, what the hell is this?

So they literally can’t self-soothe like, none of that is familiar to them. And so I always encourage people to get the swaddlers that have the hands out, so the babies can get to their hands. And, you know, because the problem is, if you wait until six weeks to introduce a pacifier, a lot of times they won’t take it right.

They don’t want it. But then if you’ve also been swaddling without hands, they have no self-soothing ways to go back to sleep or anything. So, you know, one or the other. You know, if you’re going to do a pacifier, at least wait two weeks, is my usual recommendation for my practice and leave the hands out so they have an option.

Yeah. So, sorry to end on a wishy-washy note. So, yeah, pacifier? Maybe? Who knows? Maybe?

Please. Always making it weird. Heather. I can’t help it. It’s like I have. Your brain is like, I’m going to make it weird. No, no, no. Weirder.

You know, believe it or not, this happens in person. Like I’m really bad at goodbye. Like when it’s like, do I hug? And then sometimes I’ll just like throw up a double wave, just like a two handed, like BYE! I’ll say it too loud. Oh no. I’m like, Oh God. And then now that there’s a pandemic, I’m just like elbow. And I give him like the wiggle elbow, like, Hey, this is what we do now. Which like actually hard to aim for.

You’re like, wait, just stay still. Sometimes I just go, okay. And then I bow like goodbye. Did I just do that? And then I’m like, I’m so sorry. I’m so sorry. I don’t know. Goodbye. It’s over. We’re done.

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