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Growing Healthy Podcast

Dec 4, 2017


AP:  Welcome to Growing Healthy, today we are speaking with Di, a lactation consultant about what are the common issues that come up in the beginning of the breastfeeding journey, and how can you manage them.  We will get to them right after this little reminder.

The Growing Healthy Podcast and website is meant for general medical information only.  this does not apply to every situation.  If you have questions, or if you have received different advice please contact your health care provider.  The views expressed by growing healthy and our guests are not representative of any institution with which we are affiliated.

Di, welcome!  Tell us a little bit about yourself….
AP: So lets talk about engoregment…what is it? and why does it happen?
Di: Engorgement sure can be a surprise, the breasts can become quite a bit larger, firmer and feel uncomfortably swollen. The body is preparing for feeding the newborn throughout pregnancy and breast changes are usually noted as birth nears. Colostrum (the early milk) is present at time of baby's birth, but full milk production is waiting for the signal that babe is born. This is a hormonal signal to the brain. The placenta releases progesterone, which tells the brain that the baby is still in utero - "not born yet, don't start the full milk production yet". 
So the body is all set, but waiting for the delivery of the baby and the placenta and the drop in progesterone.The best analogy that I've heard from a recent course, is thinking of the placenta like the e-brake on a car...the car can be revving up, but it's not until the e-brake is released that the car can then drive on. 
So, baby is born, the placenta is delivered and it's a GO - the body now starts the full-on milk production. Over the next few days the volume starts to increase, the milk ducts fill and the breasts become full. This is also combined with extra fluid and therefore some swelling can happen. Thus, engorgement! 
Moms can help this process and try to reduce the extent of breast engorgement by feeding their babies "early and often". If we can keep up with the production of milk and the emptying of the breasts with shorter intervals in the early days, then the milk ducts hopefully won't become painfully full. 
AP: Are there any tips and tricks you can offer to women and their partners to help manage engoregement? 
If engorgement occurs, continuing to feed baby every 2 hours, cold cloths following feeds to reduce swelling and expressing the milk can be helpful. We need to be cautious with pumping or manual expression, however, that it is just to move the milk for mom's comfort and not to signal to the body to make even MORE milk.
Interestingly, cabbage leaves can help alleviate engorgement. So, you peel off the leaves of a green cabbage, crush it a bit with a rolling pin and place in your bra a couple of times a day. As the cabbage wilts the components help to reduce engorgement. Use with a bit of caution, however, as it can also reduce milk supply if used more than twice a day. 
As with any challenges with breastfeeding, please seek help early if you're having trouble latching your baby. Sometimes, when the breasts are very full and firm, the baby may have difficulty staying latched or may slide down on the the nipple and cause pain.
AP: Yes! So important to get help when you need it!  and you are right about the nipple pain.  Lets chat a bit more about that!
For sure there is some adjustment to having a babe (or two or three) at your breast feeding frequently! Likely the number one reason that we see moms for BF help is nipple pain, and thankfully is usually is the BF challenge that we can most quickly resolve with a latch assessment. I once overheard a conversation between two women that it was advised to 'toughen up' the nipples by scrubbing them with a toothbrush ahead of time! Please do not think that there is any need to toughen up your nipples. Yes, to a certain extent it takes some 'getting use to', having your baby nurse for many hours in the day, but your nipples should not be bearing the brunt of this. Remember: babies Breastfeed, not "Nipplefeed" as they might with a bottle. Maybe we can talk more about achieving a deep latch in a moment.
If you have pain with latching your baby, please seek a latch assessment by a skilled breastfeeding support person- whether that's your Doctor, Public Health Nurse or Lactation Consultant. We are all more than happy to help alleviate that pain on latching. You do not need to 'just push through and get used to it', generally if there's pain there's an issue we can help resolve.
AP: Now it’s not just a latch issue that can cause nipple pain…what are some of the other reasons that this can happen?
There also might be other causes for nipple pain: if it's not just a latch correction, it might be something else going on with the nipple. For instance, there might be an overgrowth in yeast. We all have yeast, or candida, on our bodies and given the right environment it can have rapid overgrowth and cause discomfort. Symptoms of yeast overgrowth, or thrush, can include a burning discomfort on the nipples and areola, shiny, red skin on the areola and even some shooting pain following feeds. Anyone who has baked bread would know that yeast loves warmth, moisture, sugar and darkness-- all of these are present with soaked nipple pads, so change them out frequently and seek treatment options from your medical care provider. Thrush is generally easy to treat in the early stages.
I have often heard that yeast pain described as like someone is stabbing you with a knife through your nipple into your back….not a pleasant experience!  Definitely ask for help early!  
Sometimes, vasospasm may occur with the nipple either by the nipple being compressed during a feed and coming out looking blanched or occurring immediately after the feed. When vasospasm occurs after the feed it is generally a result of a latching challenge or a damaged nipple. 
Sometimes there are other conditions present like Reynaud's phenomenon. A woman may be aware that they have Reynaud's that shows up as vasoconstriction on fingers and toes and then it is exacerbated by breastfeeding.  Keeping the nipples warm following a feed is key, either by immediate covering with a warm cloth or with your baby held to the breast. If this is not enough, speak to your doctor for other treatment options. 
AP: Raynaud’s of the nipple is often worse in the colder months, and you are right ….warmth is very helpful.  sometimes I even suggested hand warmers behind the nipple pads to provide some extra warmth!  

AP: Can we talk a little more about latch? Especially in those first few days it is soooooooo important to really focus on getting the best latch you can with your baby…..
Absolutely, I agree that often we meet moms who have been so excited that their baby has latched on that they will endure any pain they might feel just to keep their precious babe feeding. 
As we've talked about, latch is key to successful breastfeeding. Over the last couple of decades we have realized that culturally we have been trying to breastfeed babies in a bottle-feeding position (as in, cradled in our arms on their back) and often we imagine that a mom's nipple should look like a bottle nipple. But, in fact, nipples can look very different and babies are born seeking to feed in a way that doesn't look like the classic 'bundled in your arms bottling position'. Babies are instinctively driven to seek out the breast by way of using all of their senses and all of their body. 
It's pretty cool to watch the videos on babes crawling up to latch onto the breast themselves, and although we might not have this exact experience, it is also very cool to watch your own baby seek out the breast by bobbing their heads around at the breast and batting their little hands around to initiate the letdown reflex. 
AP: It is great watching these videos!  Lets post some in our show notes!
What we know is that babies are 'ventral feeders' meaning that they are sort of 'hard-wired' to have their chests touching mom, ideally skin to skin. They tend to feel calmer, more regulated and focused on feeding when they are 'belly to belly, skin to skin' especially with the early feeds. We also know that the depth of the latch is important for both the comfort of mom's nipples and for the best transfer of milk. So, using gravity to babe's advantage, lying back and allowing baby to fall onto the breast during a feed is more productive than sitting straight up and having babe fall AWAY from the breast and onto the nipple during a feed. 
This is a little hard to describe without visuals, but we encourage moms to go with their intuitive, right-brain thinking when feeding their babies. One of the most impressionable talks I've attended over the last few years was from Nancy Mohrbacher (who has written several great breastfeeding books). She says something along the lines of, "just get comfortable and feed your baby, like in a TV watching position"  to her breastfeeding patients. It is both mom and baby who need to 'learn' to acheive the best latch. Mom's can go with the comfort piece: if it hurts, is pinching or they're uncomfortable, then take babe off and try again. Babies learn by the best transfer of milk: the deeper on the breast they are, the more of a reward of milk they will get. 
Sometimes there can be difficulties with the latch due to baby's tongue shape, mom's breast shape (particularly with engorgement) or other barriers to achieving a deep and comfortable latch- again, please seek help, ideally in person. 

AP: Great! Some great tips…now we talked earlier about feeding often, especially in those first few days….Part of the reason babies need to do that is to help mom’s milk come in and to signal to mom how much milk they need!  
One of the most common concerns  that moms have is that they won't know exactly how much milk their baby is getting when breastfeeding. They may feel anxious about not feeding their baby enough, particularly when babies want to feed VERY often in the early weeks. It is completely normal for newborns to feed every 2hours, and sometimes clusterfeed in a way that feels like 'non-stop' for a few hours in a row. This does not mean that you don't have enough milk, it's just how newborns behave. We can determine if babies are getting enough milk at the breast by both their diaper output and weight gain. So, you will be given guidelines on what to watch for with both of these. For instance, we want to see that babies are peeing frequently (6-8 times/day by the time they are a week old) and that they are gaining appropriately. Your care provider will go over what healthy weight gain should look like for your baby. If your baby is sleepy, because of jaundice, for instance, you may need to wake your baby to feed.
Human milk is designed for frequent feeds, and human babies are born needing to feed on cue. Another point that Nancy Mohrbacher makes is,  remember that we are CARRY Mammals. Like chimpanzees and gorillas we are meant to carry our newborns and feed them often. We are not Follow Mammals like horses where the newborn needs to walk straight away and catch-up to their mom for a feed a few times a day, or Den Mammals that leave their newborns and return a few times to offer feeds in the den. We sometimes, collectively, like to think of ourselves as den mammals with creating lovely nurseries and cribs thinking that our newborns will politely sleep there and feed by the clock every 4 hours, (LOL) but our milk and our babies are not designed this, know that it is completely normal when your newborn wakes up after an hour and a half to feed again.
AP: Really glad you mentioned this….I think we all want to have a predictable schedule, including feeding times, and sometimes it gets there…but certainly not at the beginning….I asked a group of women once what they wish they knew in the first few days after giving birth…and one said…that if your baby seems hungry…feed it! don’t try to stick to a 3 hour schedule!  So for those parents who are struggling..what can we do to support them? 
Di: So glad you mention the importance of support! In regard to breastfeeding, specifically, moms can check-in with their care providers for BF assessment, book an appointment with a community professional for a BF consult (with public health or a lactation consultant). You can also connect with your local La Leche League group. Having adequate support in the early weeks is so important in general for new parents. It means, perhaps, the difference of a mom being able to spend quiet skin-skin time with their newborn, instead of needing to shop or cook. Or, being able to catch up on a bit of sleep to allow them recovery time from birth. Or, even just to be able to talk about how you are feeling and feel heard and not alone in your new parent struggles can make moms feel validated and supported.  We encourage you to reach out to who you would identify as a support person. There are many community baby groups that you can attend to meet other moms, whether through Public Health, the rec centres, libraries or the monthly groups here at Grow Health. Connecting with your doctor or nurse about how you are coping is often the best way to start identifying your best supports. We are not meant to do this alone!
AP: Great advice Di!  It is hard to ask for help sometimes….but trust me you will not regret that you did!  A little help early on in the journey can make a huge difference in your infant feeding experience, and our hope is that it makes it more enjoyable for both you and your wee one….We will put some links to resources in and around Victoria BC, so check them out….and in the meantime…..Keep on growing healthy! 
Victoria Public Health Units
La Leche League Victoria
Nursing pads
Milkies milk savers  
Haakaa Milk saver