Mamapalooza:: Breastfeeding Q&A with Board-Certified Lactation Consultant, Sunayana Weber, of It's More Than Milk

Kelsy: 00:00:00

Welcome back to Wellness Big Sis the Pod.

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We had so many questions surrounding our

episode with Sina, who is an international

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board certified lactation consultant,

and the owner of It's More Than Milk.

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So she kindly agreed

to do a bonus episode.

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Yay.

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Answering more specific questions

on feeding, because a lot of.

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Questions that I got from new moms were

a little bit more broad and the ones

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from, like I said, the veteran moms

veterans, it was, was more specific.

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So thank you so much

for, for coming on again.

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Of

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course.

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I'm happy to do this.

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Kelsy: Let's start with milk

production questions is kind of

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how I, how I phrased it, I guess.

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Supply level.

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Yeah.

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But one of the questions I got was

when will my supplies start to regulate

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and I guess part two and three.

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Is it true that my body will

start to make the milk more

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nutrient dense as the baby grows?

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So even if my supply stays the

same, it is okay because it is

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more calorie slash nutrient dense.

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Sunayana: Yes.

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So that is a great question.

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So we talked a little bit about

this on the longer episode, but.

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Typically your milk supply goes

from endocrine driven and hormonally

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driven to baby driven around the

four to six week mark When this

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happens, all of the engorgement and

the leaking and the breast fullness

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and heaviness, that eases up a bit.

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So that's, that's a good thing.

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Parents will feel like, oh, oh

my gosh, I'm not feeling like my

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breast is going to explode anymore.

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My supply must be down.

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But not necessarily.

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It's most likely just.

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The milk volume regulation.

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And so I would say about the four to

six week mark if you're a new mom, but

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if you're a subsequent mom, if you've

done this once or twice before, then

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it might happen a little bit sooner,

potentially even as early as three weeks.

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, And so it's important to remember that

just because you're noticing a difference

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with the way that things are feeling

with you physically, that doesn't

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necessarily mean there's a huge dip with

your milk supply or anything like that.

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, I'm gonna say this a million

times in this, this episode.

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That's okay.

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Reach out to a lactation consultant or

another breastfeeding support person

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just to make sure that that is what's

happening and not anything else,

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that could be affecting milk supply.

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Kelsy: What about the, the

nutrient density of it?

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Yeah.

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Oh,

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Sunayana: that's a great, okay, so

what is wild and fascinating is so

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the, the way that a parent's body

works in conjunction with their baby.

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Anytime that you put a baby to the breast

or for the exclusively pumping parents, if

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you kiss your baby's hands or their face

or any of that, that your body's going to

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ingest pathogens that are with your baby.

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And so when your baby is directly at

breast or chest and you're feeding

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them, their saliva gets absorbed by

our bodies and our bodies are able

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to custom make that milk for them.

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And it is ever changing

and it is ever evolving.

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And a great example of this is when.

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Somebody in the house is sick.

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So I've heard anecdotally and even

in my own home cases of entire

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families being wiped out by a cold

or the flu or something like that.

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Everybody except for the

exclusively breastfed baby.

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And that's because as the milk

making parent is healing, and as

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they're getting better, they're

going to continue to pass on.

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All of these antibodies and all of

these nutrients to their baby to

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help them either avoid the illness

altogether or if baby gets sick.

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It's a much milder version

than what the adults have.

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But I would say as far as the

nutrient density aspect of it, yes.

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So between one month and six months,

when you typically start solid

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foods, a breastfed baby takes about

24 to 32 ounces in a full 24 hours.

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It is the milk that changes in

consistency to meet the needs of the baby.

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It's very well established by

about a month, and then it kind

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of keeps settling in further.

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And so, yes, between one month

and six months, your baby

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needs a certain amount of milk.

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It's just your milk that changes

in caloric density in nutrients.

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And then during this time too, baby

gets more effective at feeding.

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So instead of taking 30 minutes or

45 minutes to feed, you might have

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a two month old or even a three

month old that is done nursing on

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both sides in 10 to 15 minutes.

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And at first you're like.

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There's no way that this baby is

getting what they need from me.

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But sometimes we'll do a weight feeding

or they'll monitor diapers, or they'll

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notice those, I guess, non-scale

victories as they call it, where all of

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a sudden baby's diapers are really snug.

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Or the clothes that fit

them fine last week mm-hmm.

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They've, you know, their little

feet are stretching them out.

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So, it's definitely one of those things

where yes, it's gonna sound real silly and

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woo woo, but it's like you have to trust

that your body is going to make the milk

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, that your baby needs, and that your baby

is going to tell your body about the milk

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that it needs specific for that instant.

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And so it definitely takes a

lot of trust in, in our bodies.

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But for the clients I work with that

have had trouble with fertility or if

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they had a long and difficult birth or,

you know, maybe a bumpy start, there's

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a lot of doubt and anxiety kind of

hanging out in the back of your head.

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So.

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We talk a, a good bit about

that in some of our visits too.

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Kelsy: So what I'm understanding,

I guess, is it's a little bit of

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a, top down, bottom up approach,

if that's a weird way to put it.

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But

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Sunayana: yes,

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Kelsy: The baby is.

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Stimulating the mom to

know what to produce.

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Mm-hmm.

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But then also the mom might be exposed

to certain things in the environment

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that feed back into the baby positively.

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Exactly.

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Okay.

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That's it.

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That I had.

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No, I'm learning so, so much.

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Yeah.

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So I had no idea for all of this.

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Sunayana: It is, it's so fascinating.

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Kelsy: So speaking of what

actually reaches baby, I've

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had a lot of questions on.

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The pump and dump theory,

of course, with alcohol.

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Mm-hmm.

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But there were also a lot of moms

who were struggling with UTIs or

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different things postpartum, and they

were wondering specifically about like

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medications or what actually, whether it's

alcohol, medication or something else.

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Yeah.

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What actually reaches the baby in the

breast milk and when do we have to be

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concerned about what we're consuming?

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Sunayana: That's a great question.

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So when it comes to alcohol, caffeine,

any food, it's important to remember that.

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All of whatever you're consuming,

even medication, it's gonna

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be broken down by your body.

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It has to get metabolized and

filtered especially the alcohol

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by your liver and your kidneys.

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And then it's gonna go into your blood

and then it's gonna go into your milk.

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So a good rule of thumb around alcohol

is . If you feel safe enough to

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drive, it's safe enough to breastfeed.

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Mm-hmm.

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And so I do have some clients that

are like, okay, well I'm gonna

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wait two hours after my drink,

before I nurse or pump for baby.

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And I think that's totally fine.

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You can do that.

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The best time to have a drink

would actually be while you're

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nursing or pumping because your

body hasn't started to metabolize

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it and break it down quite yet.

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But as far as alcohol, pumping and dumping

is a myth, it's not really gonna get.

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The alcohol out of your system any faster.

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But say you went to a friend's

bachelorette party and maybe you

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had a little bit too much to drink,

I would still recommend pumping

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just to keep that milk flowing.

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But I'm also a weird hippie mom,

so you don't have to dump the milk.

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You can mark it and you can

put it into a milk bath.

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I wouldn't give it to your baby

to consume, but you can use

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it for alternative reasons.

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Yeah, I

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Kelsy: love it.

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I didn't even think about alternate.

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'cause I feel like a lot of people Yeah.

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Pump and dump.

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Exactly.

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It's okay, but hang on.

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Yeah, there might be other things to use.

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You don't have to dump

it, use it for totally.

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Your body worked

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Sunayana: hard to make

that milk, you know?

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Totally.

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Yeah.

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Kelsy: What about medications

or different things like that?

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Yeah.

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Sunayana: In general, most medications

that you took during pregnancy

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are also safe for lactation.

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Now, there are definitely some medications

that are contraindicated for lactation.

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Some of them are for mental

health, some of them are for high

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blood pressure, and postpartum

hypertension and things like that.

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But in general, if you let your physician

know that you are breastfeeding, they

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should be able to offer you a medicine

that is compatible with breastfeeding.

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Yes, there is a little bit of whatever

medication you take that is going

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to pass through your milk to baby.

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And depending on what the medication

is, sometimes you have to do almost

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like a risk benefit analysis.

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Is it worth the risk of me taking.

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This medication to help me

function as a mom and as a

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human versus do I not take it.

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And then everything will be perfect

for baby, but I'll be a mess.

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So sometimes you have to sit down

with your care provider, even

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with a lactation consultant and

be like, I don't know what to do.

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And so also on that note, thankfully

there are great resources, which

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I'll make sure to send you.

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Mm-hmm.

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But there are, a couple

websites that you can check.

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One is called LactMed.

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And it is through the

National Institutes of Health.

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So you just put in the name

of the medication and it pops

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up all of this information.

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It's not gonna tell you take it or

don't take it, but it'll be like,

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this is the half-life, these are

the possible effects , on lactation.

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These are the possible effects on baby.

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And it'll also suggest some alternatives

if it's, you know, maybe not.

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Not so great for newborn

babies or something like that.

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And then at that point you will be an

empowered patient and you can go to

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your physician and say, Hey, I looked

up that antibiotic that you prescribed

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to me and it seems like it might do

a number on me, but also on my baby.

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Could we do this one instead?

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Mm-hmm.

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And so there are definitely resources.

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That's one of them.

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Elac.

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Tania is another one.

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And that also has resources

in Spanish, which is helpful.

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And then there's a place out at Texas

Tech called the Infant Risk Center, and I

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have that number programmed in my phone.

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'cause if I'm ever at a visit and I

can't find the answer, that's really

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nice because you can call them, I

think it's like eight to three, Monday

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through Friday, and a live human

will answer and they will go over all

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of that same information with you.

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But again, they won't tell you.

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Yes.

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To take it or no, not take it,

but they can at least help you

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make a more educated decision.

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Kelsy: I'm all about that.

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Just like trusted resources.

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Yes.

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That, for, for evidence-based,

trusted resources.

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Exactly.

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Exactly.

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Because like we mentioned in the

first one where comparison, you know,

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you're comparing all of these things

and all of these different journeys

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for different people and Exactly.

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Having someone like you to help

having these resources to go to

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is just like super duper helpful.

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So this is more of a personal question,

but how would you know if something like.

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Alcohol or medication or something

like that is affecting baby.

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What might the baby show either?

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Pee and poop or behaviorally that Yeah.

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Might indicate, oh, hang on, maybe

they're not, maybe I need to go get

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this looked at a little bit more.

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Sunayana: Exactly.

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So with alcohol, to be completely

honest with you, , the parent would

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be dealing with alcohol poisoning

long before we would see that.

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And really the risk of alcohol is not

through the milk to baby, but it's more

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that whoever's drinking is gonna be so

incapacitated that they fall asleep.

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Sleep on a couch or they fall asleep on a

glider, just in a really unsafe position.

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And that can have some

really dire outcomes.

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So , that's regarding alcohol.

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But with medications what you're

gonna wanna look for is things

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like, is your baby sleeping a

lot more than they normally are?

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Are they not sleeping as much?

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Are they more irritable and fussy?

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Or if they're having a lot of.

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Bowel movements, if they're having

a lot of poop diapers, is that

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poop looking really strange?

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Is it not the normal

consistency that it is?

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Do they seem like their belly

hurts or, they're bloated or just,

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you know, not feeling so great?

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So these are all definitely signs that

yes, something that you're consuming

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is passing through to to baby.

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Kelsy: So how do you know

if a baby has a good latch?

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And I guess along the same lines,

is nipple confusion a real thing?

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Sunayana: Yes.

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That, those are great questions.

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So when it comes to latching.

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Obviously we don't want to feel pain.

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Pain is a sign that something

is not going right with latch.

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Usually it's that maybe baby doesn't have

a big enough mouthful of breast tissue.

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But I would say ways to know

that your baby has a good latch

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is that one, it's not painful.

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Two, what you're feeling is a

gentle tugging from deep within

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your breast and it's very rhythmic.

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And the other way too is when

your baby comes off the breast,

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even if you're not feeling pain.

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Sometimes we can notice a change in

your nipple color or nipple shape.

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And so, it's one of those things where

if you notice that your nipple is pinched

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when it comes out of baby's mouth or

it's kind of lipstick shaped, or it

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has a compression stripe through it,

these are all signs that for whatever

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reason, baby didn't have a good latch.

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And then also if your nipple

is blanched, the areola looks

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bruised, any of those things, those

are signs of not a great latch.

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And really to make sure that your

baby is latching well I don't

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know if you've ever heard of the

sandwich or the burger analogy.

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Mm-hmm.

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Okay.

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So when we go to eat a tall burger or

a tall sandwich, we, I'm doing hand

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motions in case you can't see me.

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Yes.

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You're gonna compress the

sandwich in the direction of

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your lips and then you're gonna.

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Bring it to your chin

and your lower lip first.

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Yeah.

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And so that's what we wanna

do with breastfeeding as well.

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So we're gonna wanna shape our breast

tissue in the direction of baby's lips.

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Mm-hmm.

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So if baby's lips are, let's say,

vertical to your nipple, yeah.

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If they're in that cross cradle or

cradle position, you're gonna come in

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from underneath and make a U shape.

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Mm-hmm.

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But if you're feeding in a football

position where baby is kind of tucked

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under and their lips are coming at your.

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Nipple horizontally, you're gonna

come in from the side and make a

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C shape with your breast tissue.

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So that's probably the biggest one I've

seen parents in trying to feed their baby

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in cradle or cross cradle and instead

of coming in from underneath, they come

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in from the side and all that does is

just make the area a lot bigger for

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baby to have to get their mouth around.

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Mm-hmm.

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So usually it's a simple fix

when it comes to latches.

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Sometimes, of course it can be more

complicated, but I would say like seven

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times outta 10, that's what it is.

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Kelsy: So does baby ever give signs

that the latch is good or bad, or Yeah.

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What are those They can,

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Sunayana: So really, when.

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Latch is perfect.

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A baby is going to stick their

tongue out beyond their lower lips.

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They're going to cup the breast tissue

like a taco, and then they're gonna

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bring everything up to the juncture

of their hard and soft palate.

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Mm-hmm.

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So if you stretch your tongue

as far back as it goes in your

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mouth, it'll go from hard to soft.

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Mm-hmm.

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That's where they need to

bring everything, and that's

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pretty far back in our mouth.

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Mm-hmm.

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So let's talk about.

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Best case scenario.

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: 00:12:50

So when baby's doing that, yeah.

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: 00:12:51

And they're lifting the, the

tongue up to the root, to that

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: 00:12:54

hard and soft palate juncture,

they're actually creating a vacuum.

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: 00:12:57

So there is little to no

air that baby is taking in.

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: 00:13:01

So for a breastfed baby, not

to burp necessarily after every

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: 00:13:05

breast or after every feeding.

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: 00:13:06

That's not necessarily a bad thing.

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: 00:13:08

It's definitely one of those things where

I would watch that baby for discomfort.

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: 00:13:12

If you notice a lot of scrunching up

their legs or kicking their legs a lot,

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: 00:13:16

yes, it could be gas, but for the most

part , your baby may not burp a lot when

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: 00:13:21

they've been feeding it breast or chest.

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: 00:13:22

It's usually with bottle feeding that

they'll take in more air, and that's

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: 00:13:26

just unfortunately the nature of

bottles and the way that we use them.

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: 00:13:29

Kelsy: So with bottles,

you mentioned bottles.

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: 00:13:30

Is that nipple confusion

a real thing or, I like to

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: 00:13:33

Sunayana: call it nipple preference.

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: 00:13:34

Okay.

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: 00:13:35

Okay.

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: 00:13:35

I like that.

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: 00:13:36

Your, your baby is not confused.

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: 00:13:37

Mm-hmm.

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: 00:13:37

They know exactly what they want.

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: 00:13:39

And they are all about

working smarter, not harder.

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: 00:13:41

Yes.

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: 00:13:42

So, of course they're

gonna want the bottle.

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: 00:13:43

Mm-hmm.

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: 00:13:44

It's just gonna drip and kind

of flow into their mouth.

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: 00:13:46

So with.

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: 00:13:47

Bottle feeding.

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: 00:13:48

There is a way to feed a

breastfed baby a bottle.

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: 00:13:50

It's called paste, a bottle feeding,

and it mimics the start and stop

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: 00:13:54

of milk flow with the breast so a

person's milk isn't constantly flowing.

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: 00:13:58

Once it starts to flow, it starts

and it stops and it's up to baby to

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: 00:14:01

kind of change the way that they're

suckling in order to draw more milk out.

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: 00:14:05

So we're gonna mimic that with a bottle.

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: 00:14:07

And so there's some great videos online.

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: 00:14:09

This is definitely something that,

you know, your lactation consultant,

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: 00:14:13

lactation support person or even your

doula may be able to teach you before

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: 00:14:16

baby comes or after they've arrived.

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: 00:14:18

But it's definitely something I go over

if there's bottle feeding involved.

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: 00:14:21

Kelsy: Okay.

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: 00:14:22

Good to know.

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: 00:14:22

Yeah, I had no, I'm, again,

I'm learning so, so much.

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: 00:14:25

So, lastly.

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: 00:14:26

There was a question specifically, and

I'll read the question, but how early

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: 00:14:30

is it recommended to go past three

hours between feeds at night, especially

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: 00:14:33

for a baby who has already reached

her birth weight and is sleeping past

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: 00:14:36

the three, three and a half hour mark?

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: 00:14:38

And I guess in alignment with

that, I know you had mentioned some

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: 00:14:42

recommended ounces per day, like total.

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: 00:14:44

Mm-hmm.

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: 00:14:44

So what is that breakdown typically from,

you know, someone who is really early

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: 00:14:49

on newborn to someone who is maybe in

that like four or five, six month range?

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: 00:14:54

Sunayana: Yeah, that's, talk

through that a little bit.

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: 00:14:55

Good question.

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: 00:14:55

So I would say in the early

days probably for the first.

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: 00:14:59

At least two months of life, you can

expect eight to 10 feeds in 24 hours.

379

: 00:15:04

And so that might just break down

if we're going by the 24 ounce

380

: 00:15:07

number, just for simplicity's sake.

381

: 00:15:08

Mm-hmm.

382

: 00:15:08

It might be two to three ounces

per feeding, but as your baby gets

383

: 00:15:12

older, they're going to gradually

start to sleep in longer stretches.

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: 00:15:16

I usually.

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: 00:15:17

Don't recommend implementing any kind of

a schedule until baby is over four months.

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: 00:15:23

And the reason for that is, one,

they're gonna go through this huge

387

: 00:15:25

developmental milestone at four months.

388

: 00:15:27

And two, they're feeding changes so

frequently in those first four months of

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: 00:15:32

life, that it's one of those things where.

390

: 00:15:34

You can feel like, okay, well

we finally got a rhythm down.

391

: 00:15:37

We finally got this down, but then

the following week, your baby is

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: 00:15:40

going through a developmental leap.

393

: 00:15:41

And all of that hard work and scheduling

that you've done is out the window.

394

: 00:15:46

But to, to get to this parent's

question, I would recommend probably

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: 00:15:49

not going past three, three and

a half hours until your baby's.

396

: 00:15:54

I'd say maybe six weeks old.

397

: 00:15:55

And even then I would, I

give parents guidelines.

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: 00:15:58

I was like, we don't want you

to go more than five hours.

399

: 00:16:01

And this is more for the parent

and breast health really.

400

: 00:16:04

And so we don't wanna go longer than, say,

five hours between breast stimulations.

401

: 00:16:08

So even if your baby is sound

asleep and they're sleeping

402

: 00:16:11

great, six, seven hour chunks.

403

: 00:16:13

You may still wake up because

your breasts are feeling full

404

: 00:16:16

even though your baby's asleep.

405

: 00:16:18

And again, this is one of those situations

where you would use a hand pump or

406

: 00:16:21

even manually express milk to comfort.

407

: 00:16:23

We're not draining the breast fully,

but we're just taking away enough

408

: 00:16:26

so that you can fall back asleep.

409

: 00:16:28

Kelsy: So it has more to do

on parent comfort and the

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: 00:16:31

regulation versus the babies.

411

: 00:16:33

Sunayana: I, well, yes

and no sometimes too.

412

: 00:16:36

, I'll see parents read books about

sleep training and they'll put

413

: 00:16:39

their baby through sleep training

and their sleeping great stretches

414

: 00:16:41

by the time they hit the 12 weeks.

415

: 00:16:43

And it's like, okay, but biologically

babies are not supposed to do that.

416

: 00:16:47

Yeah, they're supposed

to wake up at night.

417

: 00:16:48

They're supposed to wake up.

418

: 00:16:49

At least once overnight.

419

: 00:16:51

And then also if that parent isn't getting

up to stimulate their breasts, they're

420

: 00:16:54

gonna notice that milk supply drops.

421

: 00:16:56

They're gonna notice that their baby

isn't quite as satisfied after nursing or

422

: 00:17:01

they're gonna want to eat more frequently.

423

: 00:17:03

And so I have definitely worked with

those moms who are like, we did.

424

: 00:17:07

This sleep training program, and now

we're seeing this and we brought the baby

425

: 00:17:11

to the pediatrician for the four month

visit, and their weight's gone down.

426

: 00:17:14

They've dropped their curve.

427

: 00:17:15

So it's like, okay, well let's talk

about how you're feeding the baby.

428

: 00:17:18

I hate to say this, but we

might have to add a night.

429

: 00:17:20

Pump or a night feed just to

bring your supply back up.

430

: 00:17:23

If that feels like too much, then if

you're okay with giving formula, I'm

431

: 00:17:27

okay with you giving your baby formula

too, just to make sure that they get fed.

432

: 00:17:30

And so I definitely have households

where they're like, no, parents

433

: 00:17:34

have very important high stress

jobs, and they need to sleep.

434

: 00:17:36

And so they will usually start to

introduce formula at that point.

435

: 00:17:40

And then unfortunately

without that stimulation.

436

: 00:17:43

Milk supply will go down.

437

: 00:17:45

It could drop significantly.

438

: 00:17:47

It could drop just a little bit.

439

: 00:17:48

It's just so subjective

based on the person.

440

: 00:17:50

, Kelsy: Totally.

441

: 00:17:51

And which is why working with someone like

you to help help with all of that Exactly.

442

: 00:17:54

Works out so well.

443

: 00:17:55

Well, thank you so much for answering

these more specific questions, and thank

444

: 00:17:58

you guys for submitting them, because

I feel like we're able to touch on

445

: 00:18:02

a lot more things than even we asked

about in the, in the longer episode.

446

: 00:18:06

Yeah.

447

: 00:18:06

So thank you so much for,

for joining us yet again.

448

: 00:18:08

Of course.

449

: 00:18:09

Thank you for

450

: 00:18:09

having me.

451

: 00:18:10

This was great.

452

: 00:18:10

Kelsy: I'll leave again if we.

453

: 00:18:12

I think we've set a few links and

she had mentioned a few different

454

: 00:18:15

resources and like trust-based,

evidence-based resources.

455

: 00:18:18

So I'll leave all of those links

below this one and probably the

456

: 00:18:21

long one just in case you guys

like look at one or the other.

457

: 00:18:24

So I'll leave all those below.

458

: 00:18:25

But thank you guys so much for

joining us for this episode of

459

: 00:18:29

Wellness Big Sis The Pod and we'll

see you guys again on the next one.