What You Need to Know About Breastfeeding

Breastfeeding brings with it important health benefits for both mother and baby, but it can also come with some challenges. Renae Green, IBCLC, lead lactation consultation at UPMC Magee-Women’s Hospital, discusses important information every new mom should know.

Read The Full Podcast Transcript

– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Breastfeeding can provide important health benefits for you and your baby, but it can also come with some challenges. So, what do you need to know? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Renae Green. She’s the lead lactation consultant at UPMC Magee-Womens Hospital. Thank you so much for joining us.

– Yeah, thank you for having me.

– Well, let’s first just talk about what a lactation consultant does, and how you help, and how you work in the hospital.

– As a lactation consultant, our job has many different facets. One of the biggest things that we do is that we empower these parents and families on their decision to breastfeed. And, so, that can be providing reassurance, helping them set goals, helping them to find out what lifestyle choices would be best for breastfeeding based on, you know, whether they’re returning to work, staying-at-home mom, if they have other children, things of that nature. What we also do is provide support to help find resolutions for different challenges that mothers can experience while breastfeeding. And, so, it’s very important that we are able and equipped to help them throughout all those challenges, as well as just providing support whenever they’re intending to stop breastfeeding. So, our job is throughout the entire breastfeeding experience – being there, supporting these families, encouraging them, motivating them, and also picking them up when things can get a little hectic.

– Let’s talk about the health benefits. First of all, the health benefits for babies.

– Yeah. So, babies do receive a lot more from breastfeeding than other methods of feeding. And what I mean by that is some of the components in breast milk cannot be replicated into any other supplementation that we use for babies, such as hormones that help to soothe them, such as oxytocin, as well as the way their bodies are able to digest breast milk. So, breast milk makes it easier for babies to digest their food. It helps to aid in the maturation of their digestive track. In addition to that, our bodies produce antibodies that we also give to our children through our breast milk. So, these things will help to fight infections, common colds, whatnot. And, as baby, or if baby is becoming ill or sick themselves, the breasts have a funny way of reading their saliva to determine how to change that milk to help them, and to help them heal from whatever is ailing them. So, breast milk does have a lot of benefits in that regard. It also increases child bonding with mother and baby, and there can be, you know, advantages as they grow because the milk is constantly changing to adapt to what baby needs.

– And, so, so much for baby. There are also health benefits for mom, too.

– Yes, yes. So, the act of breastfeeding helps to accelerate the recovery from birth. The breasts and the uterus are very, very connected, and what happens is the stimulation of baby suckling or pumping at the breast can help to contract the uterus muscles, which helps the body to heal from childbirth a lot faster. The other ways that breastfeeding can help mom is it can save a lot of money on the budget, as well as can reduce some chronic illnesses such as cardiovascular disease, diabetes, osteoporosis, as well as reducing the risk of cancers such as breast cancer and ovarian cancer.

– Wow. So, lots of reasons why. And it seems very natural. But yet, as we started to say already, there can be challenges.

– All of this is brand new for a baby. Breastfeeding is not something that babies innately know how to do. Babies are not feeding themselves in the womb. So, a lot of what they’re getting, a lot of the nutrition that they’re getting, is coming directly from the placenta and umbilical cord, and it’s being pumped into them, basically. So, when they’re coming out, they’re not really understanding what hunger is. They’ve never experienced that. This is something that they have to learn how to work for. And it’s not easy in the beginning. Colostrum is very concentrated. It’s thick; there’s no water in it. So, what happens is baby has to do a lot of work to extract it from the breast, and baby is the best one to get the colostrum from mom’s breast. With that being said, that means that they’re doing a lot more work. They’re exhausted, they’re overwhelmed. They’re really experiencing a lot of different things in those early days because everything is new to them. They’re overstimulated. There’s people coming in, poking, probing, touching them. You know, they’re having testing done. So, a lot of it is just overwhelming for babies to really wrap their head around, and that’s why we encourage moms to give themselves and babies some grace throughout that learning curve. Because in any situation that we’re learning anything in, there’s going to be peaks and valleys in that. There’s going to be times that are really great and we’re excelling, and then there’s going to be those low times where we can be a little frustrated and it can be a little bit more challenging for us. So, as we’re going through that up-and-down motion of learning, you know, giving grace throughout those first two weeks as you start to build that routine and habit of expectation around the breast, and teaching baby that efficiency.

– Right. So, in an ideal world, does it happen that from the first time? Are there cases where from the first time it works for mother and baby?

– It can. It most certainly can. I would say I wouldn’t expect that. I wouldn’t have that expectation going in. Every single baby has to learn something. So, a lot of what you should expect is at least if baby knows how to suckle, if baby can open their mouth, at least you may have to teach baby how to be efficient, how to be actively engaged, how to not treat you as a pacifier, so to speak, you know, can get in and get out pretty much.

– What are some of the most common challenges?

– Some of the most common challenges is keeping baby actively engaged at the breast. When we’re talking about early postpartum period, in a way, babies are, like we said, tired. They’re experiencing a lot of different things coming into the world. They’re finding their sea legs, so to speak, and so a lot of things are happening rapidly and all at once.

– So, how do you keep them engaged?

– Stimulating them through different means. That can be squeezing their hands while they’re feeding, blowing on their face, pushing up on their chin a little firmly. Like, gentle, but encouraging touches can help baby. Not stroking them in a very light way because that can also be very soothing, right? So, making sure that we’re gentle but also firm in our approach, because how babies are learning is by action, right? So, a lot of what they’re learning is in the moment, so being active and responsive to their movements and their lack of behavior at times at the breast in real time. And that practice is what’s going to make sure that baby is starting to become more efficient in being able to actively stay engaged at the breast. So that we can set that boundary, right, that when you’re on the breast, this is nourishment, this is not nurturing. They can be nurtured in other ways, but at the breast you want to make sure that their understanding there is this is for nourishment and this is not for pleasure. Latching on is one of the bigger challenges that moms can experience, definitely, because it can cause pain, and injury, and trauma to the nipple. We also have, you know, congenital abnormalities that can present their own challenges. I wouldn’t really call those common, but it is a possibility if baby has cleft palate or if baby is having issues with blood sugars or any other issues early on that can cause a need for medical intervention. Those things can arise, and that can happen. Typically, what we see is latch issues, milk supply issues, or congenital birth abnormalities causing issues with breastfeeding and challenges. And, just because those things happen doesn’t mean that breastfeeding has to stop because there are always solutions or ways that we can work around anything that’s happening so that parents are able to maybe exclusively breastfeed their children or provide supplementation and maintain some sort of breastfeeding relationship in that process.

– So, what happens, though, if it’s not working? How much time should a mother give? What do you say to someone who’s first trying it, and they’re saying, “This just isn’t working?”

– In the beginning, a lot of families feel that way, and that’s that colostrum. You know, we have this idea and this perception about breastfeeding based on what everyone talks about. And, the first thing I will say is, you are all on your own individual journeys with breastfeeding, and try to look more inward than outward, for other people’s experiences can really cloud what’s happening with you. But the other thing with that is whenever you’re dealing with a new baby and you’re dealing with new families, some of the challenges are going to arise from just the confidence overall and understanding what this is and trusting yourself that you’re producing enough milk, that you know how to determine that baby’s eating and getting enough milk. And that can be challenging because breastfeeding is a very ancient practice. In a modern world, where we can use a QR code to open up the nutrition facts on everything that we consume, breastfeeding is not something that you can get the nutritional facts on. You don’t even know how much baby’s transferring at the breast when they’re on there. So, we look at different ways to determine that, such as what is baby’s output? Are they having, you know, voids and stools regularly? Are they frequent? You know, that lets us know that what’s going in is coming out. How is baby’s hunger cues? Is baby hungry at the start and still hungry after coming off the breast, or does baby’s behavior change after feeding? Are they more relaxed? Are they content? So, we’re looking at other things to determine what baby is doing at the breast and if baby is successful at the breast. Those are early challenges. Now, postpartum a little bit down the road, things can look a lot differently. You can have breast infections, you can have latch issues, all of those type of things. When you run into issues that can be other challenges besides that immediate postpartum period, looking to lactation support should be your first course of action. Find a lactation professional, reach out to them, ask them for support, ask them to do an assessment, an observation. Even if it’s just a call, just to ask them a question, “This is something I’m experiencing, is this something that I can rectify with just a phone call?” You know, “Can I get some support for this?” Because what we are trained to do as lactation professionals is to provide support and help you with resolving any issues that are at hand.

– Is there a common solution or course of action if a baby isn’t latching on? What would you normally say to a mom?

– One thing about breastfeeding is nothing is cookie-cutter about this experience with any family. And I really have to explain the individualization of the level of support that we have to give as lactation professionals. Because what Mom A comes to me with today and Mom B comes to me with today may look the same, but there can be a difference in their overall breast anatomy, baby’s oral anatomy, there can be a difference in their lifestyle choices that can impact how I provide the support. And, so, I think that’s a very good question to ask because in the age where Google is our friend, and we can go online, and research, and answer, sometimes those answers may not fit exactly what someone needs to do, and that’s why it’s best to seek out a professional that will ask you those questions. And it seems like a lot because we ask you a lot. “How many stools is baby having?” You know, “How is baby sleeping? How is baby?” You know, we’re asking you so many questions to try to get to the problem, and sometimes, you’re just like, “Well, what’s the answer?” But I have to get to know you and your situation to determine that.

– How long of the period postpartum is the colostrum, what the baby is getting? And then when do you get to regular milk, per se?

– That’s a great question. So, typically anywhere from two to five days, it takes for your body to transition the composition of milk from colostrum. So, colostrum is what moms produce when they are pregnant, and they continue producing it throughout their pregnancy. And when we first have baby, it is the first milk that baby receives: very thick, like I said before, no water in it, so it doesn’t really flow out very well. As mom has given birth, what is happening is the hormones in mom’s body are starting to fluctuate, letting the body know that mom is no longer carrying a placenta and mom is no longer pregnant. And, so, when those hormone levels drop down to a certain amount, the body can then start to transition the composition of colostrum into breast milk. And, so, it can take some days. Some people can experience it a lot more immediate. There are some factors that can possibly have your milk come in sooner, like age. So, the younger you are, it’s possible that your milk can come in a lot sooner. Some people experience their milk coming in sooner if they’ve had multiple children. But, again, there’s that thing where nothing is really black and white in breastfeeding and lactation. So, you can be young and still, if you had a cesarean section, you may have a little delay in how quick your milk comes in. So, it’s pretty interesting, but it does take some days based on your hormones.

– Is there anything mothers can do ahead of birth to prepare to breastfeed?

– What they can do is take a prenatal breastfeeding class. Theory is going to be your best friend. Having an understanding of what the expectation is with breastfeeding will help you in those early days. If you are going into it very blind, you are not prepared for the amount of work and the level of discipline that you may have to put into it. I always try to explain to people that we don’t do enough of talking about how pregnancy is the phase leading up to baby being born. When babies are born, you’re immediately a parent. You’re immediately responsible, and this child, this infant, is immediately dependent upon you for everything that they need. It is hard to recover sometimes and also have such a demand to take on. And, then, when you’re unsure of the level of responsibility that is required from you for breastfeeding, it can definitely make the situation a little bit more stressful. And, so, it’s important to prepare yourselves with an understanding of what you’re getting into, what is expected of you as parents. You know, knowing how you and your partner can both support this process. Even talking to your family and friends about how they can support you with breastfeeding, these are things that you can learn in a prenatal breastfeeding class.

– So, that’s really important to attend and get information, and obviously talk with your doctor about that.

– Yes.

– I’m wondering then, once you get started, what does the ideal breastfeeding schedule look like?

– There’s no rhyme or reason to it. So, this, it’s really a beautiful thing. There are instances where people are more on a schedule, and I see that with families who do alternate forms of feeding babies, such as pumping exclusively, where you may have more of a set schedule. Ideally, when we’re talking about breastfeeding, you are feeding baby on demand, so you are feeding baby when they show that they’re hungry, right? And, what we say just to kind of keep families accountable is to make sure that you’re not allowing more than three hours between the start of one feeding to the start of the next. That makes sure that you can maintain an adequate supply of milk, because the way your body produces milk is the more you demand it, the more your body supplies it. But the less you demand it, the less your body produces it because what our bodies are doing is trying to inhibit the production of milk naturally. We have an inhibiting factor in our brains that stops us from producing milk once we hit puberty, right? So, we’re only producing milk to the point that it is necessary. But after that and beyond that, our bodies are going to stop. So, it’s very important to maintain that frequency and that consistency with how you’re expressing milk, whether it’s baby feeding at the breast or pumping, so that your body can maintain an adequate supply for baby. Otherwise, it will pretty much go away.

– And, do you find most mothers, it’s a combination of both? It’s definitely pumping along with breastfeeding.

– Yeah, I mean, in today’s world, a lot of parents, families rely on two-income households, and moms are going back to work a lot. And, with that, you know, that requires some mother-baby separation in which pumping would be essential while mom is separated from baby, and in place of baby being at the breast, the idea is that you would extract your milk through another means, and that would be pumping.

– And is that another thing the baby has to learn, then?

– Bottle feeding? Yes. I would say if you’re someone who’s planning on returning to work, it is important to establish a bottle feeding regimen with baby within the first six, four to six weeks of your postpartum period. So, that way, they are already used to another form of receiving milk, and it doesn’t have to be a breast, and also someone else feeding them in that process. Because there are instances, and it happens a lot, where babies will do what we call reverse cycle nursing and refuse to take any other method from feeding besides mom’s breast. And that makes it very challenging if you do need to go back to work, because you have to sit there and pump more or breastfeed more when baby is away, and baby is just pretty much not feeding until you come back. So, it makes them kind of cluster feed throughout the night, and parents usually decide, “I can’t go to work because this is too much on me.” So…

– And, so, then what does the decision look like to end breastfeeding?

– You know, it’s different for everyone. With the decision to breastfeed, hopefully, you know, you are able to meet or surpass your goal with breastfeeding and it’s not something you have to do prematurely due to issues or challenges that you’re experiencing. But when the need arises to end breastfeeding, what we expect moms to do is to expect it to be more of a slow weaning process. It’s not always something that you can do cold turkey, so to speak. You can’t just stop abruptly because that can have adverse effects on your breasts and it can cause other issues for moms in that regard. But it will be a slow trickle-down effect. You’re eliminating feedings one by one, you know, over a course of a few weeks until you get to a point where baby no longer needs it. And it’s also something where baby’s getting other forms of milk besides breast milk, or other complementary foods so that they’re sustaining the nutritional value that they need.

– What do you love most about your job?

– I love to empower families. I love to empower families. It is so beautiful to see anyone make a decision and get beyond the trying phase. And, also, just pouring into them love, and support, and kindness, and reassurance, and especially in that early period where everything’s in limbo and everything seems uncertain. Just being that backbone and being that motivational support for those families, I think that is the biggest reward for my day.

– Well, Renae Green, we thank you so much for coming in and spending time with us today. Some really good information. Thank you for your time.

– Yeah, thank you.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.