How Breastfeeding Actually Works: Milk Supply, Tongue Ties & the Mother-Baby Dyad with Dr. Linda Dahl


Transcript

Speaker: Hello and welcome back to Since I Became a Mother, the podcast about the things that motherhood changes, the things no one warns you about, and where we figure out who we are becoming together. I'm your host, Taylor Rae Roman.

Speaker: Welcome back Since I Became a Mother, the podcast about the way motherhood changes you, the things no one warns you about, and the way that we are figuring it out together. I'm your host, Taylor Rae Roman, and I'm so excited because I was just telling you, I read your book, Better Breastfeeding, when I was pregnant. I'm 16 months into breastfeeding my son, I'm And honestly, I was like fangirling when you said that you would that you would talk to me because I recommended your book to so many people. I referenced it like throughout my entire early breastfeeding journey. And I'm just so excited to have you. so we have Dr. Linda Dahl with us today. Welcome to the show. you. Thank you so much. and I'm so flattered and humbled. Thank you for having me. I'm so excited to get into this because i feel like there's so much...

Speaker: misinformation, confusion about breastfeeding. And you word this and talk about this perfectly in your book, but like for something that's supposed to be natural, that people make you feel like, oh, you're just going to know how to do it. Like you have a body, you have a boob, you have a baby, like it's going to be great. It's not that way. There's so much that goes into breastfeeding. um It's physical.

Speaker: It's yourself. It's the baby. It's the combo of like you and the baby together. It's There just so many details go into breastfeeding. And I'm so excited to be able to share this with the audience today, especially new moms, which we were just saying are so vulnerable and just going through it. So a little bit of background on Dr. Linda Dahl before we dive into this conversation. She is a board-certified ENT and a leading physician in infant feeding and breastfeeding medicine, bringing an anatomy and physiology-based medical approach to breastfeeding problems, which we love. Author of Better Breastfeeding, like I said, which is one of my faves, and also The Clinician's Guide to Breastfeeding. And a physician who's worked with tens of thousands of mother-baby pairs. And I'm sure you're going to share even more. So the first thing i want to get into is that your path into breastfeeding started with your own breastfeeding experience. So what happened? Let's get into it.

Speaker: Yeah. So I was in my fourth year of residency when I became pregnant and it was, i was married at the time. I wasn't planning to get pregnant. So it was, it was a surprise, but um as a woman, especially in medicine and I was doing a surgical residency, there's never a good time to be pregnant. So It's not like you can find a good time. So um I delivered my daughter when I had about six months left of my residency training. And um and it it was hard anyway. We only had six weeks off of our... wow Six weeks off for for maternity leave. But that was the amount of time we could take off for all of any year in residency. So if i I needed more time or took more time, I would have had to repeat an extra year. So it was pretty brutal. um And so i I gave birth and then I tried breastfeeding and I thought, you know, how hard can this be? It's so natural, just like the childbirth, which was another story.

Speaker: So natural. They're both natural. yeah um And I found out very quickly, breastfeeding is one of the most complex things yeah two people can do together. And i I was breastfeeding all the time. It was in the winter. i was in agony. You know, I was feeding her all the time. And then about a month in because a lot of pediatricians and OB-GYNs don't really see you until four to six weeks yeah postpartum. So that first four to six weeks, you're really left on your own.

Speaker: I'm asking your friends and whoever you have to reach out to. So I thought everything was fine. i went to a breastfeeding class on the Upper West Side and I was absolutely shocked at what the breastfeeding experience is like for everybody else compared to mine. And we weighed my baby. She hadn't been gaining weight. And the lactation consultant said, you need to start breastfeeding.

Speaker: pumping and formula feeding go see a lactation consultant at the class. And I was shocked. I thought, well, this is what it's supposed to be like feeding on demand and it hurts at first. You know, I was listening to everything that was being told to me. So went to a lactation consultant and it turned out I was making two ounces of milk if I pumped on my own because for that first four weeks, she wasn't really transferring milk. So my supply went down to very, very little. I was in agony for nothing. She nursed all time because she was starving. And then as soon as I started pumping and saw the reality of it, for me at that point, it was just too late to do anything. And I mean, I had no money. I, you know, was at the time $250 was like food money. And so to go through that and then follow all the recommendations I was given and still end up failing, of course, I blamed myself and Maybe I was working too hard or everything. It completely felt like it was my fault.

Speaker: And then i've i graduated, actually, no, for four and a half months. in I had to go back to work in the hospital where there was no place to pump. I was pumping, you know whatever, six times a day.

Speaker: because we had to do overnights, ah collecting with a hospital-grade pump that I would carry with me into the call rooms or the bathrooms or wherever I could find private space. And I would make about two ounces a day. did that for four and a half months just to give her some. Yeah. breast milk and then I... And you were doing a combo of that with formula? Of course. yeah Yeah. Because she had to... And then she was gaining weight with the formula. And then after that, I stopped and I just felt like a complete failure, but I didn't have an explanation for why it failed. Nobody could explain that to me, except that I was stressed and it was my fault. And then fast forward into ah practicing. I started, I joined a practice and they just happened to see a lot of children

Speaker: and ear, nose, and throat practice. And I started getting these referrals for babies with tongue-tied. I'd never heard of tongue-tie, but immediately I was emotionally connected to the the they you know the mothers and the babies, and I wanted to help them. So I had assumed that treating these babies was just something I didn't learn in residency and that it was obviously... you know, common because when I would perform the procedures, which I had been trained to do, but just not for this um reason, the babies immediately nursed. It was amazing. yeah And so i I just assumed I wasn't trained appropriately. And so I kind of figured it out myself and I started treating all these babies. And then it really quickly, my practice was flooded with babies that couldn't breastfeed and my bosses were

Speaker: questioning everything else. What are you doing? This isn't what you're supposed to do. like But it's working. and and And everything just kind of carried on from there. yeah Yeah. I mean, it's amazing that it kind of all started with your own personal experience. And as a mom...

Speaker: myself, a new mom and a mom that breastfeeds, I feel like breastfeeding is such a huge part of new motherhood. It's such a personal part. It's something that like I remember even my husband being like next to me while I was nursing overnight and he would wake up with me every night and eventually I was like,

Speaker: you can't really do anything to help. Like, I'm so sleep deprived and tired, but like only I can do this part. And that weight that's also put on you, whether it's going well, which like even for me that it went well, but the mental toll and like how how hard it was, even though physically it was all working. You know, there's just like so much pressure that's put on moms, whether it's going well or not well, because you feel like it's all, you know, all the weights on your shoulders. um So I want to get into a little bit more that you were talking about. um

Speaker: the way that breastfeeding is seen as natural, how does breastfeeding actually work? Because I don't feel like anyone is told what is actually happening happening. You're just like, put the baby on your boob. They have to open their mouth super wide, shove the boob in, and that's it. Like, then they're gonna breastfeed. But I feel like most moms don't even know, like, what are the mechanics that are actually happening when you're nursing your baby?

Speaker: Yeah, this excellent question. And this was what I was most interested in, actually what I've ended up focusing the most on, because you're right, there are little snippets that you hear here and there, but really putting together the whole mechanism, I think I find it really fascinating as well.

Speaker: um And it's fun when i have when parents come in together um ah and the moms are really emotionally exhausted, because usually I see um but babies that are having a hard time breastfeeding, And as I explain the mechanics, the dads are usually like, yeah, I totally get it. And then they get in there and they help. It's really, yeah i think dads, and well-trained dads would make the best lactation consultants. I love that. um So the mechanics of how it works. So there are a bunch of reflexes. There's a bunch of hormones. There are lot of hormones. um And then there's the mechanics, like the physics of how the whole thing works. So when the baby is first born, they're actually hardwired to smell this sort of oily substance that's secreted around the areola.

Speaker: So they are hardwired to find your breast through smell. um And then when they get to the breast, they start rooting, which means that they're kind of moving towards it. um And then the next step should be that they gape, which I'll get into detail, which is not just a wide, wide open. It's actually an unhinging of the jaw like a snake. So they have to unhinge and then they have to latch.

Speaker: So to get as much of the areola nipple in their mouth as possible so that the areola nipple has to actually touch the hard palate, the roof of their mouth. And once that happens, that contact is made, then their suck reflex is triggered. So ideally they're sealed around the areola with the areola all the way back into the back of their, they sorry, the nipple in the back of their throat with the areola touching the palate. And then the tongue lifts up and compresses.

Speaker: the areola and then pulls back. And there's this theory that there are these little valves, one-way valves in the milk ducts um and in the nipple that when the tongue lifts up and pulls back that they kind of open, so it goes in one direction, it's a theory. um And then the the tongue drops and creates a vacuum and then the baby swallows.

Speaker: That's wow one part of it. The other part of it, of the mechanics, is that that pleasant feeling um with the warmth and the um um from the baby's mouth, and it has to feel pleasant, triggers a hormone in the mom's brain called oxytocin.

Speaker: And the part of the breasts where the milk is made, is called they're called alveola. And these alveolar, these little, like I think of them as like clusters of grapes, and they have these little muscle cells around them. So usually in the rest of the human body, if there's um a muscle, for a muscle to be triggered, it has to be stimulated by a nerve. So a nerve goes to it, stimulates it, its but it contracts. But in the breasts, it's oxytocin. It's that hormone that actually triggers the squeezing of those muscles. so So the hormonal component from the mom actually squeezes out the milk that's in the breast. Oh, wow. And that's why pumping alone only does part of the work. Wow, yeah. This is when you were explaining all of the mechanics about the gape and the drawn hinging. I so vividly remember taking a picture of that part of your book and explaining this to my husband and being like, but when I was pregnant and being like, so this is how it's going to work. And the jaw unhinges. And then, and I remember, this is like blowing my mind because I remember when my son was first born, the pediatrician came and she goes, this is like, I just gave birth. Like he's two seconds old. And she's like, okay, smell the milk. And she brings him to my breast and is like, smell. And then he like latches. And so for me, reading your book, plus that, I was like, okay, cool. He has to smell every single time. So I would like stick my boob in his nose every time.

Speaker: It's great. And then lactation consultant a few months later was like, no, girl, you don't have to do that every time. I was like, no, don't have to like stick my nipple in his nose. She was like, no, like he's good. like He knows where the boob is. But this was, i forgot about all of that. But you're like bringing it back because i I really did, though. I felt like a scientist. I felt like a genius knowing this information. And I wish that for all moms because so many moms, like,

Speaker: As we'll get into more, there's obviously so many factors that impact having a breastfeed journey that leads to being able to exclusively breastfeed your baby and having enough supply and all that stuff. And like their anatomy and your anatomy working together for that to be successful. But I think having the foundation of that knowledge was an awesome like step for me. Obviously, the other things worked out, too. But like knowing that.

Speaker: Yeah, I love that. I love that. It really brought all back for me. um So getting a little bit more into the physical things that you spoke about, the latch, the gape and tongue ties, like I want to talk a little bit more about oral mechanics and what issues we should be thinking about as new moms or not even issues, but like.

Speaker: Obviously, issues can arise, but just talk more about the oral mechanics of like what's happening for the baby. And then especially tongue ties, which I know it's such a hot topic on social media, but also between moms and the mom groups. The moms are talking about it. So just get into the oral mechanics a little bit more.

Speaker: Sure, um I think that there, a lot of the oral mechanics of newborn feeding, whether it's on the breast or on a bottle, um is there there are parts and bits of this research that have been done through the years, um but most of the research has been done on normal nursing or normal latching and suck and swallow. And because there's always been this, up until recently, an assumption that every baby can nurse and every mom has perfect amount of milk, um Just like so much of women's medicine, there's just these assumptions made without really getting into the details. That's what I was most drawn to because we learn all about, you know, why breast milk is good and why you should breastfeed. And if you don't, how bad it is for your baby. I mean, all of this sort of, um ah not all, but most of the information that you get about breastfeeding is about how great breast milk is and why you should do it. Mm-hmm. with very little attention paid to the mechanics of it, which end up being becoming the most complex when they don't work.

Speaker: um So the baby really has to be able to gape. And I think that that first step of latching is the most important part. It's the part that's overlooked the most. And it's really where where it can fail the most. So when... babies have a hard time nursing, it's usually that first step in the gape. And so everyone describes it as just opening their mouth really wide, but we can open our mouth really wide by hinging at the jaw.

Speaker: But babies, are so they're the way they're shaped anatomically when they're born, they're supposed to be able to unhinge. And it's very hard to tell from the outside what's happening. So if you latch a baby on and you look at it from the outside and and lactation consultants will look at it, everybody, people will look at it and say, oh, that looks great, but you feel terrible hurt or the baby is like falling off and smacking and having all these problems. It just proves my point that you can't really tell what's going on the inside from the outside. um And so it's really important for moms to understand what it's supposed to feel like and know that most of the cues to let you know whether or not it's working efficiently or not um are are indirect. So the baby has to be able to unhinge. And that is a relaxed position. So if you or I tried to open our mouth and put our mouth around something large and round, like an orange, for example, it would hurt after a while because we have to hold our jaw open. That's what happens sometimes.

Speaker: to babies when they can't unhinge. They open their mouth as wide as they can and they get on and then it starts they start getting exhausted. So they're using then they start sliding down and then you're using most of their oral muscles just to hold on. yeah They can't really use their tongue to lift and pull the milk out.

Speaker: And that's how a lot of the that's why a lot of the other symptoms kind of turn out, you know, end up happening. um but And when babies can't um gape, that moms, or not just moms, pediatricians, everyone will say, oh, the baby has a small mouth.

Speaker: That's not a real thing. Babies don't have small mouths or big mouths or, oh they're going to get bigger and it'll get their mouth will get bigger and stronger. It's really about the biomechanics, not about the strength or the size. And even preemies, like preemies have different issues with their reflexes kind of waking up and then your milk coming in. right So there's there are more issues with premature babies. But so many times they're just labeled as having small mouths because they're not big enough when the problem is that they actually can't do that first step of latching, which is gaping. They can't really unhinge.

Speaker: And then as babies get older, they don't develop the ability to gape. They're supposed to be able to do it when they're born. And as they grow, taught it's absolutely can't be taught because they have to physically be able to do it. And as they get older, their anatomy moves away from being able to unhinge. So if you have 16 month old baby who hasn't nursed, they don't, they can't then develop the ability to gape. Toddlers can't gape. We can't gape. yeah um So it's really important I think for mothers to understand that that gape is an inherent, um, reflex that they have when they're born. And if they can't biomechanically unhinge their jaw, they won't develop the ability to do it later.

Speaker: If they can't, if a baby can't gape, can they not successfully breastfeed at all? No. And that's an important point too. So it's really a spectrum. And I think everybody simplifies the latching issues to tongue tie and tongue tie is a very specific diagnosis that we can talk about in a second. yeah But if you put aside that term and the use and misuse of it, and the use and treatment and over-treatment of it, just put that aside, um if you understand the baby has to unhinge and gape, then they have to be able to latch onto the breast and form a seal with their lips around the breast, and then their tongue has to be able to lift up and pull back.

Speaker: um There are far more... um there are there's a much more common reason that happens, and it has to do with the entire shape of the baby's head and jaw.

Speaker: um And it can be treated like tongue-tied, but it's a spectrum. So sometimes babies have a more narrow gape, or they can't gape as wide as they ought to be able to, um and mom has a low amount, like a low milk supply, and then they're going to have a hard time. But if a baby has some difficulty with gape, and the mom has a huge supply, then they can kind of overcome it. So it really is, it's It's both. It's the baby's ability to latch and it's the mom's supply and it's the dynamics of the two and it's also the brush shape. So, you know, like I mentioned, it's one of the most complex things that two people do together. right And it's, you know, made, moms are made to believe that it's the simplest, most automatic thing. yeah Because when it does happen, this even proves how many details are into it, like how many different factors there are. And you're actually reminding me of a part that was in your book that talked about you were saying the shape of the baby's like palate and their mouth. And

Speaker: I feel like there's a part where you talk about like, yeah, the shape of the baby's mouth based on how they are inside of the womb. And I remember being like, how's my baby in the womb? What's the shape of his mouth going to be? Is he going to be able to breastfeed? So it's so funny. um i just thought about that.

Speaker: Okay, let's I do want to hear what you have to say about tongue ties, because I know that's like such a huge thing. I remember even meeting with the lactation consultants in the hospital. They were like, your son might have a slight tongue tie.

Speaker: It was like the second day of his life or something. And I was like, okay, I'm going to see. And if he does, I'm visiting Dr. Dahl because i I know a little bit about this. So I want to know, yeah, just anything you can share about what a tongue tie is, and then i know there's treatment options like the ones that you perform, but also there's dentists that perform some of these treatments with lasers and just your thoughts on tongue ties.

Speaker: Great. I love this topic. I love it because I feel as an ear, nose and throat doctor, ah it is the diagnosis and treatment that really falls in my specialty the most. And because I, um again, as an ENT doctor, understand the biomechanics of the head and neck anatomy. um I love this topic. um And so I'm gonna describe the way I classify and diagnose tongue tie and the way I treat babies, which is very specific to me. And I know people get very emotionally ah charged, triggered by these discussions, but um I like to really keep it medical and anatomic. So tongue tie is, I go by the very strict definition of tongue tie. when there's Um, so the tongue in the first four weeks of gestation, like when the, when you're early pregnancy, we need most women don't even know they're pregnant.

Speaker: Um, when the head and neck develops, it kind of forms just to simplify it and into two, in two pieces. And it, they kind of seal together by the fourth to six week. And then if you think about a mold, when you, when you create a mold of something, if there's extra, say you're pouring, you know, um, ceramics clay into a mold, and then there can be sort of a ridge of extra ah clay and then you cut it off. Like, If there's that extra ridge of tissue, um when the tongue seals together, it's called a frenulum. And there's always a frenulum. Frenulum is just the connective tissue that covers over the undersurface of the tongue. But if that frenulum doesn't dissolve that extra tissue, then it can...

Speaker: tether the tongue down to the floor of the mouth. And the tongue is a muscle, the floor of the mouth are muscles. The tongue is connected to the floor of mouth by muscles, but then there can be this extra piece of connective tissue. um It doesn't have a function. if it's 75 to 100% still there, then it can restrict the movement of the tongue, which can impact all kinds of things in the future.

Speaker: You have to be careful too. have parents that have tongue tie and they bring their babies in and you start listing off all the horrible things that can happen with tongue tie and the parents will stick out their tongue and say, well, I have it and I'm fine. um But what happens with tongue tie is that the tongue, like I said, is a muscle and if its movement is tethered, then it doesn't develop the the correct size and shape to fit the mouth. And it also, so people will have a hard time lifting the tongue to flatten out the palate.

Speaker: And the hard palate, the roof of the mouth, is also the floor of the nose. So the more arched and high it is, the smaller the nasal cavity. So there are a lot of implications um that can happen if you leave a tongue tie. um And there can be things like not lisping, by the way. um but um having a hard time articulating, especially quickly, speaking loudly, licking food, you know, intimacy. So there's a lot of issues that can happen with tongue ties. So I recommend, regardless of breastfeeding, that if a baby has a tongue tie, which is 75 to 100% tethered, that it be released as soon as possible in the gentlest possible way. There's no matter how you do it, whether you do it with a laser or scissors,

Speaker: from newborns to however old you are, there's always regrowth because that's just the nature of how the oral tissues heal. um So the follow-up and there's all kinds of recommendations for stretching and redoing and was it done enough? Like that's a whole other discussion, but There's always regrowth, it's important to release early, and then and if you can release it early in a newborn, the nursing, and their nursing, um the lifting of the tongue alone is so powerful that it'll actually flatten out the palate as they get older too. So there are all these benefits.

Speaker: um But ironically, especially in the babies I see, the vast majority of babies that have a hard time breastfeeding do not have tongue tie, and there are many babies who have tongue tie who who breastfeed just fine.

Speaker: And so the recommendations get flipped. yeah mean Pediatricians will often say, oh, if the baby's breastfeeding, fine, just ignore the tongue tie, which is the opposite of really act not just the way I practice, the opposite of the urnasium throat recommendations. um But conversely, it's those babies that don't have tongue tie um that have a really hard time breastfeeding. Those are the ones that are getting confused the most. yeah ah they get labeled as tongue tie or mild tongue tie or lip tie or cheek ties. i mean, there's everything's tied in the mouth. yeah All these structures that don't exist are sort of suddenly becoming named and tied and tied and cut and lasered. and its um but the way i um And this is actually what I've, I guess, kind of discovered in my practice.

Speaker: Because when I started seeing babies, I realized that when i when it got to this type of issue that babies had with nursing, there was no literature that really kind of put the whole thing together. So when I was asked, I was actually asked by Springer Publishing to write the first book, well, to edit the first book. So I called on a bunch of colleagues to help write certain chapters and nobody would help me. And I realize now,

Speaker: Probably because nobody knew how to yeah answer these things. So i I had already signed the contract. So then I had to write the whole book, which was not planned. But it was great because just like you, this is Clinician's Guide um to Breastfeeding. And I went through all the research, just like you, just really.

Speaker: just every bit of research, not just in medicine, but also in osteopathy and Chinese medicine. i learned what the lactation consultants were were um learning and teaching and really kind of put the whole thing together, the whole... um per I guess the whole paradigm of the way I practice now, unknowingly I was doing it. um and what i what I realized or what I gleaned, and this is just a first step in understanding the biomechanics, is that when babies have a certain architecture to their head and neck anatomy, they have a really hard time doing that unhinging. And it's almost like those transformer toys. Like in order for them to turn into a certain shape, they have to be lined up a certain way. So with babies, um when, um so if this is the palate, the roof of the mouth, and this is the jaw, and this is the tongue, they have to be able to unhinge. But what happens, and this is the cool part, is that often babies, their entire head and neck anatomy is vertically rotated like this.

Speaker: So if you can see, palate ends up becoming really arched, the jaw set back, and the tongue, weirdly, stays in the same place. But because the tongue is connected to this jaw by those muscles, those floor of mouth muscles, it's the floor of mouth muscles that are pulling the tongue back. It's that entire vertical rotation of the architecture. that creates the restriction. And so there are ties all over the mouth. So if you don't understand that global issue and you're just looking for where the parts you know where there is tethering, it can get very confusing. And I think there are, um it's mostly dentists, I'm sure there's some ENTs or pediatricians maybe, that look for those, where is it tied, where is it tethered, I feel these bands and they just start to cut, they just start cutting, yeah which I don't agree with and I've treated enough babies, um

Speaker: who've had it, not had it, and you know I talk tell them they don't need a procedure, and then later down the road, the baby's just fine. you know So i I have a lot of experience, not just with the initial diagnosis, but with the long-term outcomes and seeing repeated babies from, sorry, but repeated babies, other babies from parents who've had older children and what they were told and what they did. So it's kind of its own informal experience.

Speaker: Study of what happens when you treat certain babies in certain ways and and the outcomes. Yeah, so I have two thoughts that came up as you were sharing the first is that I was super blown away that there's no doctor of breastfeeding like that isn't that doesn't exist and I was looking for that and I learned from your book and also just like other resources like that isn't a thing there is doctor of breastfeeding your ob b might have some input your pd your child's pediatrician i'm super lucky that my son's pediatrician was so supportive of my breastfeeding because my son had jaundice when he was born and i was like he needs more like liquid to pass through him he needs formula because there's no way he's going to pass this jaundice and she was like no you're okay like you're doing it and she was so supportive and like she love her so much because easily I could have been like, oh, my breastfeeding, like, it's not going to work. I have to give him formula if another pediatrician had recommended that. And so you have the OB, you have the pediatrician, you have a lactation consultant. You might have an ENT if you feel like you're running into some issues. Like, there's all these different people that have different parts to add, but there's no

Speaker: Is that wild that there's no like one place to go for breastfeeding? Because I guess, because a lactation consultant isn't necessarily a doctor, even though a doctor can become a lactation consultant. Yeah, lactation consultants aren't aren't even licensed healthcare professionals right in most states. I think there's four, there may be a few more. But anybody can do the training regardless of their background. yeah um And then when they when they finish the training, depending on what they do, they can take a board certification. But um the board certification isn't, it's it's confusing, right Because they have this established boards, but they don't have a licensing body. So um there's no consistency in their messaging and there's really no oversight information.

Speaker: for what they're saying or if they're doing it right or doing it wrong. um And that's um that makes it challenging both for the lactation consultants and for the parents and the clients and for the doctors because a lot of parents think that that lactation consultants are healthcare professionals. You can be a healthcare professional and then do that extra training, but But ironically, the the foundation of lactation consulting training comes from La Leche League. yeah And La Leche League, I think, is a fascinating organization because the foundation of it is actually kind of the opposite of what it became. It was very conservative religious mothers in the 50s who really wanted to conserve breastfeeding because um in the 50s, women were pregnant.

Speaker: you know sort of moving away from breastfeeding and child birthing was becoming very much more medicalized. So instead of midwives and women helping women give birth and teach them to breastfeed, it was taken over in the hospitals, mostly by men, and it was all becoming medicalized. So it's kind of beautiful, the foundation of it. um But because there was no doctor, you know, part of it, and and the doctors really didn't care about that,

Speaker: part of it, um it just they kind of pulled together what worked for them. So La Leche and lactation consulting, the kind of underlying perspective is breastfeed at all costs. this And if it's not working, this is how to make it work. wow um So it's suppose it's a really practical guide for trying to figure it out yourself or through trial and error. And these are all the things that worked for us and maybe it can work for you. um And there's a little bit of medicine and science sort of woven in there. And and as time has gone on, there's more of it. um But if the perspective is breastfeed at all costs, it's kind of the opposite of what we're trained in medicine, which is like diagnose the problem, yeah you know, decide on the treatment with informed consent and then and then deliver the prognosis. And then if you're going to perform a procedure or or even if you don't, there's follow up and you can continue to make decisions as you go. So they come from kind of opposite perspectives. yeah So I've always found it interesting when doctors doctors

Speaker: nurses will go train as lactation consultants and I watch it in them how it's like there's so many things that are like at odds. So even when I was writing clinician's guide, there's so much of the research that is completely the opposite of what is recommended in La Leche and it's not about being right or wrong, it's really about the perspective.

Speaker: And this is bringing me to the second thought I was having, which is breastfeeding. it sounds like you tell me it just might not work for some mothers and babies like that is that's a thing like it just might not be.

Speaker: doable. Is that true? Absolutely. I mean, I think of breastfeeding is like everything else in the human body. It's just that so much of women's medicine has just never been part of medicine. I mean, with the exception, I mean, even child birthing is a good example. It's like you, it became very medicalized and women are really trying to have, you know, sort of go back to what midwives already knew And But with menopause, you're seeing it, you know, lactating breasts, nobody is trained in that in medicine. Like OB-GYNs are the least trained. um But right, there is no, there is actually a University of Rochester, I believe, now just started a breastfeeding medicine program. oh wow And there is an Academy of Breastfeeding Medicine. So it's what what we're seeing now with all these different specialists or people coming in with different perspectives is the development of a new field of medicine. And everybody has their own perspective and they're all, you know, coming in very excitedly about, you know, trying to contribute what they know. um But I think that it's, ah yeah, it is. And that's why so much of the information that moms get is so varied and confusing because nobody's really agreed on what normal is yet. Right. But because people have specific experiences and they have success in some ways and failures in others, um it's kind of like the Wild West. Yeah.

Speaker: The last question that I definitely want your thoughts on, because I know so many, there's so much conversation about this, especially I see this on social media, is around supply.

Speaker: i don't feel like... I don't feel like people use the word correctly. I feel like it's a lot based off of vibes. I see like eat Oreo cookies and like eat oatmeal and I'm like, what girl? Like, I feel like that's not gonna, that's not gonna do it.

Speaker: um And I know it's a lot about the transfer of breast milk. It's a lot about the frequency of breastfeeding. Obviously I wanna all of your thoughts about what impacts supply and what can actually help your supply? Because i don't think it's Oreo cookies. Definitely not. Definitely not Oreo cookies. I love Oreos, don't get me wrong, but I like don't think that's what's going to do it.

Speaker: Not so much. I mean, I think it's, well, milk supply on its own is a massive topic. um And again, like, you know, the more moms I see, every mom, every a patient I see teaches me something new. And the spectrum of milk supply can go from you can't produce any milk to there's so much milk, your baby is getting waterboarded and it's like spraying across the room and like 100 ounces a day. sam mean it's unreal. yeah And because there's so much um variation in that, there's variation in the the dynamics of how quickly your breasts make milk, how much they make at a time, um what will increase it, what will decrease it, if anything, um it's impossible to make a general statement about this increases supply, this doesn't. So I tell moms, I try to classify them into low supply, like normal or

Speaker: I don't ily like the word oversupply, but an abundance of milk. But they're both, you know, but but if you're on either end of, and it's a spectrum. So if you're on either end of the spectrum, um then there are some adjustments that need to be made. And sometimes there's just so little milk, no matter what you do, that's hormonal and dependent on the amount of breast tissue you form during puberty.

Speaker: So there's really nothing you can do about it. yeah um Some women just will not make enough milk. um And I was in that category. So regardless of what I had done, i was never going to make enough milk. But even in those situations, if you know that about yourself or if you're, you know, there's some hints that can tell you early on if you're going to make enough milk, then you can adjust your feeding experience around that. Like you could nurse what you have or you know or take supplements to try to increase it early or try to um remove as much as you can for what you have so that you can at least, even if you can't hold a certain volume at a time, you can do it more frequently. so Or if it's just too much, you can just bond with your baby through skin to skin, which is really how it works. And then you can feel comfortable and loving feeding your baby with formula because you're never gonna make enough milk. So it really is, yeah, every woman's different. If there's sort of a normal,

Speaker: supply, I'll describe the mechanics of um emptying that works for kind of that middle ground. And if you have a huge supply, it's almost, i mean, there are different problems that come up and because especially in the beginning, if you make so much milk that the baby can't handle it, they'll choke on it and they'll fall off. They'll get Very very gassy they cry every time they press feed which seems crazy because there's so much milk Because milk separates into this lighter sugary milk in the front and the breast and then heavier in the back So if your volume is so huge that your baby's only ever getting that sugary milk, they will get very fat very fast They will cry all the time throw up all the time And you'll be miserable. The baby's miserable. You get engorged. You get mastitis. I mean, yeah, it's like it's not like too little is bad and too much is good. It's really you have to balance each other out. But so for average milk supply, women with an average milk supply, which is the which is the most common, right? The way breastnet dynamics work ideally is that for the first four to six weeks after you give birth, your breasts are trying to figure out how much milk to make. So during the end of pregnancy, in the beginning of, I'm sorry, like the end of your pregnancy and right after you give birth, the breast tissue is turning into milk making tissue and it will,

Speaker: turn into more milk making tissue if you show it that you need it. So I usually say an average of, in the beginning for the first couple of weeks, 10 to 15 minutes of nursing on each side or or emptying your breasts, followed by two hours of waiting and then doing the whole thing again.

Speaker: um And it's best if you fully emptying your empty your breasts in the shortest amount of time and then give them time to fill up. That's a way to maximize your supply. um And the specifics of why that why that is how the breasts work I can get into. But it's not just a made up thing. It really is based on the kind of... um I believe you. It's not what It's what is produced in the breast milk as your' you produce um a protein called, the it's called FIL. It's an inhibitor of lactation. So the more full your breasts are, the more of that protein there is. So the more full they are, the less milk you'll

Speaker: purdue So if you're nursing for an hour just at a slow leak, then your breasts don't really get triggered to make more milk. So sometimes moms will say, oh, I nurse for three hours in a row and then it's an hour and then they're hungry again. But but I'm emptying my breasts, I'm going to have more milk. That's not how breast dynamics traditionally work. um But if you have ah let down every you know one to three minutes, an average of 10 to 15 minutes of nursing, active nursing and emptying the breast will empty the breast.

Speaker: So I tell parents, moms, as a general rule, um tend it should take a total of 20 to 30 minutes to empty your breasts and then give yourself another two hours to fill them up again. um And so you're that it's not perfect and every there's a huge variation, but I think it's good to start you know having have a starting point. um And then as the baby gets older, their needs change from day one until four weeks. And then at four weeks and up, they keep the same volume of milk. Isn't that interesting? Yeah. But the amount they can take from you and the frequency, the amount of times they need to nurse changes. So as they get older, they just take out more in a quicker amount of time and they need to nurse less frequently.

Speaker: So, but the same volume, it's the same volume, which I thought was fascinating. But if you're not emptying your breasts or you're in a lot of pain or the baby is just like nursing all the time, cluster feeding, which is another favorite. So is cluster feeding not real? It's very real. Oh, okay. I was like, wait, what do you mean? Cluster feeding is is is sort of scooped into the, this is a natural thing that happens when babies have a growth spurt. It's very, very common, but it usually means there's a mismatch between what they're getting from you and what they need.

Speaker: And if it happens every once in a while, it's like, yeah, there's, you know, they're going to need more and maybe you're not producing as much that day. But if it's happening for like a week or two weeks, ok your baby's starving. Okay. I was like, wait, what are you telling me right now? But okay, that makes sense. Yeah. And it varies, right? But if the norm is cluster feeding with your baby, that's not normal. Right. god Got it. Got it. They'll go through periods of that. And I think so much of breastfeeding advice is that way. Like they'll say, oh, it hurts a little at first. It's fine. It hurts. Breastfeeding hurts.

Speaker: but without any qualification, right right? It's like it hurts a little bit in the beginning when you're engorged and then it's not supposed to hurt anymore. But if you're in week four or six and you're in agony, you're like, no they said it's normal. I'm like, that's not normal. Yeah. And even what you were saying about like the anatomy with, I mean, I'm not going to say it as eloquently as you, but like the your nipple isn't just like chafing on the roof of the baby's mouth. And I remember I would imagine like my nipple hanging in the back of his throat and be like, that's why this doesn't hurt. That's crazy. But the the way that it is supposed to be in an ideal world prevents that pain from just like nonstop. So, yeah, completely. oh my God. I love this. I feel like everything that you're saying, I keep being like, why do I know this? But it's literally just because I read your book. And I'm like, am I a genius of breastfeeding? But you are i i feel like...

Speaker: There's you know, honestly, I just have to get out soapbox for one moment about like the state of our society and the I feel like people don't read books anymore and You retain so much more information if you actually read a whole book than if you just get a quick snippet or like quickly Google something because I Am i mean, I told you I'm a huge fangirl of you. I already told you this I started the episode saying that but this is really just solidifying my my title as the president of your fan club because I actually have so much breastfeeding knowledge up here because I actually read a book. Like, reading... Guys, nothing's gonna beat reading a book. Like, you retain so much more knowledge, so I just have to say that. um I am thinking...

Speaker: I just want to make sure I kind of touch on, I know so many new moms are like going to listen to this and going to be wondering like, okay, but what do I do? Like, what steps do I take? So I guess the question I really just want to ask on their behalf is like, okay, you're a new mom, you're home from the hospital. Maybe you met with a lactation consultant in the hospital. Cause I feel like most of them offer that now, which is amazing.

Speaker: And it's not going well. Either you have pain, your your baby is constantly nursing, or you have an oversupply, undersupply. you don't know how to use your pumps, which I feel like we didn't even get into pumping. um You're just having issues. Like you're having pain or you feel like your baby's not getting enough. Like, what is your first step? Who do you even call? Like, where do you go?

Speaker: What do you, what step one? Yeah. That is the hardest question because it really depends on where you are in access and who you can turn to. But i I like to empower moms with as much information as they can have so that they can kind of, that will help them choose what to listen to and which healthcare providers to ask.

Speaker: do not go to someone who's gonna immediately diagnose your baby with tongue tie. um But I think for, it like the first thing to look at as as a mom is whether or not the baby is unhinging and opening wide.

Speaker: Feel the palate, the hard palate and see like if it seems like it's more horizontal or if it's more, it's higher. Look at the chin position um and um see if when the baby opens they're able to stay on, if they keep sliding off, then it's really the baby's gape and latch issue. Now, what you wanna do about it is that's up to discussion. And um like I said, if you have if you see a lactation consultant and have access to one, there is not very much consistency with the kind of advice you'll be offered. And often they will diagnose, even though that's not really um they lane. um And then if you see the pediatrician, it really depends on their perspective. If they say, you know oh, just stop breastfeeding, it's not working. Or if they will um at least validate, yes, this isn't working well, I may not know what's causing it, but you're right, the baby isn't latching. Because I think it really gets it gets minimized, the issues with nursing get minimized to is this tongue tie or not, or is this lip tie or not, which is not how it works.

Speaker: um And if you are able to empty your breasts and the baby, I'm sorry, if the baby's able to empty the breasts where you feel like you're full in the beginning and then it's you know softer in the end, then those are good signs. But but I do think it's important that if you really wanna breastfeed and you don't really know what your milk supply is, that instead of just pushing through agony and pain,

Speaker: and I'm following all the rules and it's not working so it must be my fault. Like it's usually not your fault. It's usually the baby's anatomy. um And it's if you really want to breastfeed, focus first on maintaining your supply and then and feeding the baby because that separation um isn't going to make the baby forget you.

Speaker: Because like I said, they're hardwired to smell the oil around your nipples and latch on. if you're constantly trying to get them to latch and they can't get milk out and then they start losing weight and then you have to give them formula and if you keep doing that you're actually training in nipple confusion and you're suffering yourself and then your milk if supply can can drop but i think if you know that one piece of advice which many will disagree with me but i have actually practice this way for 23 years and I see so many positive um outcomes from this. If in the first couple of weeks, if you're really struggling and it's hurting and the baby's crying and they're not feeding, minimize the variables, like focus on bringing your supply in focus on feeding the baby and then bring the two together. And if it really isn't working, it's often the baby's latch and there's adjustments you can do. um I mean, there are interventions depending on the situation, but even if there is an intervention, there's a lot of follow-up

Speaker: And there's a lot of biomechanics that you still need support with. So who do you go to? i wish I could generalize it. And I think there are more, there are definitely more breastfeeding friendly healthcare practitioners. um But often it depends on their perspective. They may want to sort of push one direction or the other, but just know that there are so many options, yeah just like in the rest of medicine. I mean, you're exactly proving a point though that I think so many new moms feel, which is Breastfeeding is so hard. Who do I turn to Who do I believe? What information is right for me? And especially what you were even talking about, the gape and the latch and the the way that like some of these things you can't even see. it And especially if you're a new mom and you've never breastfed and you're like, I don't know if this feels right. Like I remember...

Speaker: physically, i was like, okay, I'm not experiencing pain, but I would have some moments where it would make like almost my skin crawl because I was like, this is so weird. Like now I say I have nipples of steel. Honestly, I'm like, I don't feel nothing when when I breastfeed. But in the beginning i was like, oh, this like, actually I hate this. But it was like, also my hormones were insane. I was a new mom. I wasn't sleeping. I was losing my mind. Like there were so many factors, but this This is just to say any mom that's listening to this that is like breastfeeding is just really hard. It is really hard. Really hard. It's really hard. Even in the best of circumstances, it's one of the hardest things you'll ever do. It is so hard. It has completely impacted and colored my entire motherhood journey. It is one of the main things because I do it every single day and I was doing it day and night for months. And like the...

Speaker: the way that it I did not know was going to be such a huge part of being a new mom, it's humongous. So I'm so, so happy that you were able to share so much knowledge because really just like knowing anything about something that seems amazing.

Speaker: I mean, you think you just think it's magic. Like you can't see it. You can't see it happening. You're like, this is magic. I should be good at it. So having information I think is going to really help so many moms. I want to close us out with some recurring questions that I ask every guest. You're my first official guest, so you're setting the tone. um But since you became a mother, what do you understand about motherhood now that you didn't before?

Speaker: Everything's your fault. Yeah. no matter what you do, and you will feel like it's your fault. ah There's no such thing as perfection. um And I think that it feels like, you know, your children are um an extension of you and a reflection of you, but they really just come through you.

Speaker: And your job is to provide, you know, space and safety and love for them in their journey, which may be very different from yours. yeah um And you can't really predict what's going to come.

Speaker: I love that. They just come through you. I love that. um What is something that mothers worry about that you wish they would give themselves permission to stop worrying about? Their intuition.

Speaker: i love that. Their intuition. And when your intuition is suppressed or you're told that you're wrong, then it turns into panic and then you get blamed as being stressed out and panicked. And that's a huge pet peeve of mine. It makes me angry. But Mothers, I'm telling you, there are always their intuition is always on point. They may not be able to articulate why, and they may not have the answer to you know what to do about it, but always trust your intuition, no matter what anybody tells you. yeah Yeah. Okay, I'm obsessed with that also. um And i so i so relate to that. I feel like I have superhuman powers to my baby. I'm like, no, I know. like I know what's going on. Or even if I don't know the answer, I'm like, something is tingling. like Something's happening.

Speaker: And lastly, what would you say to the mother listening right now who feels like she's the only one struggling with this? So especially for today's topic that feels like she's the only one struggling with breastfeeding. I run a clinic um in Brooklyn and it's so fun. It's in this very busy clinic. It's like underserved population. And they rearranged all the rooms to have a waiting room just for the moms and babies ah aside, you know away from all the regular patients. And one of my favorite parts of that um setup is that the moms talk to each other and they and they just vent. and They see how everyone is struggling and they see the number of people coming in there with issues that it's more common to have issues than it isn't. yeah Even when things are going perfectly, there's the struggle with like timing and refrigeration and where do you do it? So there's there's no such thing as like, oh, it was just super easy and I never thought about and it didn't impact my life at all. it's

Speaker: Motherhood, and especially if breastfeeding is part of it, whether it's nursing or pumping, has a massive impact on your life and it's really important to have a support network that's going to help you and not judge you and and also that you don't judge yourself because you know maybe you can't nurse your first one but you could nurse your second one or maybe you can never nurse and that's just part of motherhood for you and and bonding you can get you can bond in so many different ways Yeah.

Speaker: Thank you so much. I loved this conversation. i this was guys, this is not to like support her book, this book. When did you write Better Breastfeeding? um when It came out in 2022. Yeah. So this is not. During the pandemic. yeah This isn't me promoting this book as like a new release. I just actually love this book. And I'm so happy that I was able to talk to you and get All of the info in person, in real life, um you have helped me to breastfeed my son. So I'm so grateful for all the knowledge you shared in your book. and thanks so much, guys, for listening.

Speaker: This was Since I Became a Mother. I'm Taylor Rae. Thank you. See in the next one. Thanks so much for listening. if you loved this episode, if something resonated with you, if you learned something that you think is interesting or amazing, make sure you share this with another mom that you know.

Speaker: All of the links for today's episode will be in the show notes, my social channels, any info about our guests, any links, products, or resources that we mentioned will all be there for you. I hope to see you in the next one released every Tuesday.

Speaker: Before I was a mother, i barely noticed mothers and now they're all I see. i see you.