Transcript: New Mom Breastfeeding Manual: First Week
The Boob Group
New Mom Breastfeeding Manual: First Week
Episode 88, January 17th, 2014
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription
ROBIN KAPLAN: So, you’re about to have a baby whether you were a first time mom or this is your second or third time around, what happens during that first week after your baby is born can make an impact on your breastfeeding relationship. What are some of the common challenges that breastfeeding mothers faced during the first week postpartum and what can you do to maximize your success?
Today we are featuring the second episode in our series – The New Breastfeeding Mom Manual. Our episode today focuses on Breastfeeding during the first week and I’m thrilled to introduce Ashley Treadwell a private practice Lactation Consultant in San Diego, California. This is The Boob Group Episode 88.
ROBIN KAPLAN: Welcome to The Boob Group broadcasting from the Birth Education Centre of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I’m your host Robin Kaplan. I’m also an International Board Certified Lactation Consultant and owner of the San Diego Breastfeeding Centre.
Did you now know that you can become more involved in our episodes even if you can’t make it into the studio? You can post a question on our Facebook page and we will have one of our experts answer it on an upcoming episode. Plus, you can become more involved on our recording days through our Virtual Panellists Program.
Our producer MJ will tell us a little bit more about this and the program in just a few minutes. I would love to introduce our panellists. Though first, before we get into the episode – so ladies, will you please introduce yourselves? Melissa?
MELISSA HOXSEY: Hi, my name is Melissa Hoxsey. I have almost six week old little boy and I’m a registered nurse and actually I’m a Lactation Consultant myself but I will not take the boards till July hopefully this year but prior next year.
ROBIN KAPLAN: Congratulations, that’s awesome.
MELISSA HOXSEY: Thank you. I have also a 23 month old daughter who is also breastfeeding.
ROBIN KAPLAN: Awesome. So, you’re a tandem.
MELISSA HOXSEY: She cannot make it here.
ROBIN KAPLAN: Good for you. All right, Julie?
JULIE SANDERS: My name’s Julie Sanders. I’m 31. I’m an engineer and I have my first child. She is just five weeks old today.
ROBIN KAPLAN: All right and Krystina?
KRYSTINA FEUCHT: I’m Krystina Feucht. I’m a marketing director and a business owner for Marketing Consulting. I’m 35, should I just had to remember?
ROBIN KAPLAN: Anything over 34, we don’t even remember it all.
KRYSTINA FEUCHT: I have my first child just over four weeks – Cyprus, a boy and I’m loving it.
ROBIN KAPLAN: Awesome. Well, welcome to the show ladies. MJ, you want to tell us about our Virtual Panellists Program?
MJ FISHER: Yes. So as Robin mentioned, our Virtual Panellist Program is a great way to join our online conversation when we record. If you’re not local or you just can’t be on the studio and you still want to share your story or your opinions on our topics, you can.
We post on our Social Medias – Facebook and Twitter the same questions that we asked our in-studio panellist while we are recording the show live. So, check out our website TheBoobGroup.com under the community tab, you’ll find more info on being a VP and possible perks for participation.
ROBIN KAPLAN: Awesome, thanks MJ. So before we get started, we’re going to talk about something that was in the news and headlines this past week. So, for those of you who did not see the Instagram photo going around about super model Gisele getting her hair done, all pampered up while she was breastfeeding. What she wrote was, “What would I do without this beauty squad after 15 hours of flying and only three hours of sleep and you see her getting her hair nicely done and she’s got this beautiful little baby just feeding while she’s getting all pampered.”
So, there’s a lot of controversy over this photo which I actually – the first I saw I was like, “My God, that’s so beautiful.” I wish that when I was breastfeeding that I would had someone doing my hair and my nails. I just thought how fantastic that she’s still breastfeeding while she’s getting ready for a shoot or whatever she was getting ready for.
But then, some other people came back and had really negative reactions around it. So, I just want to kind of toss it out to our panellists and also to our Ashley our expert. What was your initial response when you saw this? Ashley, do you want to go first?
ASHLEY TREADWELL: Sure, I thought it was fantastic as well. I love that the baby was a little bit older. Also, I think that’s a great encouragement for moms out there who are nursing older babies and it was great to see a woman doing her job and nursing while she was doing it and not for it to be a big deal.
ROBIN KAPLAN: Yeah, that’s kind of what I was thinking too. How about you Melissa? What was your reaction?
MELISSA HOXSEY: Again, awesome. I mean she’s got a one year old in her lap and we looked at celebrities every day for you know inspiration. Here someone is feeding their child, doing their job. It’s great. I loved it.
ROBIN KAPLAN: Yeah, how about you Julie?
JULIE SANDERS: She just looked so calm and laid back, just like, “I got this.”
ROBIN KAPLAN: Yeah, right. Very motivating especially for the moms who have three week, four week, five week, six week old babies and they’re like, “Man, a year from now you’d look like that.”
JULIE SANDERS: I’d look about 10 times more hairy than that I think.
ROBIN KAPLAN: How about you Krystina?
KRYSTINA FEUCHT: The same, just amazing. I mean it wasn’t really even a shock or a reaction that was extreme. It was just kind of like, “That’s really cool. Okay.” It just seems so normal now to see, “Okay, there is another mom breastfeeding, doing her thing, making it work whatever situation she’s in and it’s really nice to see that’s so comfortable.”
ROBIN KAPLAN: Yeah, absolutely.
MELISSA HOXSEY: It’s nice to see how they kind of incorporate breastfeeding, how other people incorporate it throughout their day in just in their day-to-day lives because it feels like I don’t know such a big thing right now.
ROBIN KAPLAN: Absolutely. How much easier it gets when your kiddo gets a little bit older? How about you MJ?
MJ FISHER: I love the little one reaching up too. She’s grabbing her necklace.
ROBIN KAPLAN: Holding onto her necklace.
MJ FISHER: Yeah. I mean it’s just an absolutely gorgeous photo. Just the breastfeeding itself but obviously, you know just looking like she is gorgeous but she’s just looking so gorgeous. So, it’s just so sad how our society can take something like this and turn it because – I mean obviously, she’s working and she’s taking care of her child. Awesome, cool
ROBIN KAPLAN: At the same time, how lucky is she.
MJ FISHER: Exactly.
ROBIN KAPLAN: Well, thanks ladies. Well, so today on The Boob Group we’re discussing Breastfeeding during the first week after your baby is born. Our expert, Ashley Treadwell is an International Board Certified Lactation Consultant with the San Diego Breastfeeding Centre. Thanks so much for joining us Ashley and welcome to the show.
ASHLEY TREADWELL: Thank you for having me.
ROBIN KAPLAN: Sure. So Ashley, we discuss breastfeeding during the first 24 hours in our last episode and how sleepy babies tend to be during that time. So, after those 24 hours, babies tend to wake up a little bit. How often is it or how often is normal for babies to eat per day during his first week and how long does a typical breastfeeding section take at this time?
ASHLEY TREADWELL: This is a great question. I think this is a very frustrating question for a lot of moms because they get a lot of different information.
So, some people are telling them:
• It should take 20 minutes, every 2 hours.
• Some people are saying, 10 times in a day.
So, short answer is – the baby should be eating eight or more times in 24 hours. Long answer is that, “We want moms to pay more attention to the baby than we do the clock.” So, while eight times in 24 hours works out to about every two or three hours. If a baby is showing hunger signs earlier than two hours then feed your baby. As far as the length of feedings similarly, we want moms to watch the baby as well.
We want to watch the baby when the baby seems done and satisfied. A breastfeeding session is over. However, a lot of moms want a concrete answer for hits. So, I will up and tell moms that during that first week, a normal breastfeeding session should take about 40 minutes possibly longer.
It’s also really important for moms to understand the difference between the feeding session and the sleeping at the breast session. So, you want to make sure that those 40 minutes or whatever it is the baby is actively feeding using lots of jaw movement, hearing lots of swallowing. With time that the baby is sleeping at the breast while if it’s okay with mom it’s fine, we shouldn’t count that as part of the feeding time.
ROBIN KAPLAN: Okay and is it helpful for parents to keep track of feedings like keep track of feedings and pees and poops during that first week?
ASHLEY TREADWELL: It absolutely is. Keeping track of those things is what tells parents whether or not breastfeeding is going well. When we say, “Keep track” we mean actually keep track by either writing down on a piece of paper on a log. There are also a ton of smart apps that are available right now for parents to use which I know a lot of parents really enjoyed because we use our phones for everything.
Those first days, you’re so tired. You’re so overwhelmed. You think you’re going to know how many times you fed your baby or how many times your baby peed. But often, you don’t and so, it’s really important to keep track of that. It lets you know that things are going well. Baby that’s breastfeeding well will be eating as I’ve said eight or more times in 24 hours.
Pees and poops, there should be one per day of life. So, first day they should have one of each. Second day, two of each – so on until they reach about day five and then it should be five of each. It also will let a parent know if things aren’t going well. If a baby isn’t pooping or peeing as much, if they’re not able to get those eight feedings and they know then that it’s time to probably call in some help. When help is needed, there’s a lactation consultant when parents have those logs, it’s really good information for us to know.
ROBIN KAPLAN: Okay, fantastic. Thanks Ashley. Ladies, how often did your baby feed in that first week or so? Was it always about those 30 to 40 minutes? Did you find that it varied? How about you Melissa?
MELISSA HOXSEY: If he varied, definitely varied. We went every two to three hours. I didn’t keep track as much as I should have.
ROBIN KAPLAN: Well, not necessarily it doesn’t mean that – I mean if things aren’t going well, you don’t necessarily have to keep track as much.
MELISSA HOXSEY: Yeah, I knew he was eating more than – once to get to the eight then I stop counting.
ROBIN KAPLAN: Yeah.
Melissa; But, he’s stools were less – so, that’s where my concern came in. But yeah, we kept track, like in our head – talk to my husband, that’s how we do it together.
ROBIN KAPLAN: Okay, cool how about you Julie?
JULIE SANDERS: It is about every hour I think I remember I was seizing a nap and that kind of totals up at the end of the day how many times he fed and it was always like 21, 22 – so, like every hour.
ROBIN KAPLAN: That’s a lot.
JULIE SANDERS: Yes.
ROBIN KAPLAN: How about you Krystina?
KRYSTINA FEUCHT: 8 to 12 was pretty common for the first week but they warned me about the cluster feeding. So, I would have time to where it was I felt like four hours straight with about 15 – 20 minute break. But, the hospital gave us say a tracking chart and my husband was, “There’s got to be an app for that.”
He kept telling me, “Log it in the app.” I’m like, “I can’t even see. I’m going to log-in in paper.” But, it was really helpful to log and see how many pees and poops where he couldn’t really think back how many consistent hours when everything kinds of run into each other. It was great to just track it.
ROBIN KAPLAN: Very cool. Ashley, when does a mom’s milk tend to change from Colostrum to mature milk and how much should a baby be taking in per feeding during that first week. It’s based on baby’s tummy size right?
ASHLEY TREADWELL: It is. It absolutely is. Babies’ tummies are tiny at the beginning. So, it’s really important for parents to understand this. As a lactation consultant, I love what I can visually show a parent – how much baby needs in that first feeding. First day, baby only needs about five millilitres per feeding which is a teaspoon which is a tiny amount.
As for your question about the milk transition, moms milk transitions from that Colostrum which is the first milk and very low in volume which is okay because the baby only needs a very small amount. Around day three to five is when the milk will transition from that to the more mature milk where there is a greater volume.
Second time moms may see this see this happen sooner than day three to five. As I’ve mentioned, the first day – it’s only about five millilitres. Second day that jumps up to 15 which is about a tablespoon – third and fourth day, we’re looking in about an ounce per feeding up to day 14 where they’re taking about 2 1/2.
As I’ve said, I think a lot of moms worry and the beginning because the Colostrum’s amount is so low that they don’t have enough to feed their babies. So, for them to understand how small the baby’s stomachs’ are helps them to feel more confident that they can provide everything their baby needs.
ROBIN KAPLAN: Okay. Some weight loss for baby is really normal during that first week too which a lot of parents maybe don’t know about. So, why do all babies lose weight and what is too much?
ASHLEY TREADWELL: Sure, it’s all babies lose weight. It’s very common that the normal range is anywhere from five to seven percent. The reason that babies lose weight – the first one is that babies are born full. They’re born full of that Meconium which is that really dark sticky first poop. They’re born full. So, when they’re weighed the first time – they’re weighed with that in their tummy. Over the next couple of days, they pooped on that stuff out. So, their weight’s going to drop.
Another reason that babies lose weight is that, ‘Moms often receive a large amount of IV fluids during labour.” The baby takes on those fluids and so, it sort of creates an unnatural weight amount. It’s higher than it would have been otherwise. So, over the next few days as the baby is shutting the success fluid, their weight will drop down. If a mom has had a very long labour with a lot of fluids – sometimes you’ll see a baby who’s breastfeeding well, who’s weight loss is higher than the seven percent.
You said what’s too much, anything over 10 percent is when you’d want to definitely seek help in when interventions maybe suggested. But, like I’ve said, “There are times for a very long labour when even a baby who’s breastfeeding well, their weight loss maybe a little bit higher.”
ROBIN KAPLAN: Okay and addition to the ones you have mentioned – what are some reasons why babies lose too much weight in that first week?
ASHLEY TREADWELL: Sure. When it’s too much, when there may be a problem. It’s mostly because the baby isn’t breastfeeding well and there are number of reasons why the baby isn’t breastfeeding well. One could be a sleepy baby. Premature babies are often very sleepy and may not be feeding very well.
If a baby is tongue-tied and not able to latch on well and efficiently transfer milk, they may be losing more weight. It can also be an issue on mom’s side with supply. If mom has a history of breast surgeries or something called, “Insufficient Glandular Tissue.” Her supply maybe a bit compromised which would cause the baby to lose weight as well.
ROBIN KAPLAN: Okay. Ladies, do you remember how much weight your baby lost in that first week and was it anything that your paediatrician was concerned about? How about you Melissa?
MELISSA HOXSEY: I was actually close to 10% and my baby had in his stool for almost 48 hours. So, that was concerning to my paediatrician and myself. But, he was eating enough and I know I was making enough milk. I can see it. It was squirting.
ROBIN KAPLAN: He’s your second baby; you had a toddler who was also
MELISSA HOXSEY: She was nursing so I wouldn’t – as much as he was concern, he want me to keep coming back and I just wasn’t going to sit there and worry about too much. I knew that he would catch up. He already had his three Meconium Stools in the hospital and we just kept just feeding him and letting him eat and eventually, he starts stooling again and he’s weight picked up with. He gained another four ounces, five ounces back in four days.
ROBIN KAPLAN: The doctor was a little bit more confident that things were going
MELISSA HOXSEY: He wanted me to come back again and I said, “No, I will be back for two months.”
ROBIN KAPLAN: Well, breastfeeding support groups are great places to do weight checks too. So, that way if you’re feeling like you don’t want to go into the doctor’s office, you still have these digital scales you can check in if moms are not as confident as sometimes second moms are feeling too. So, cool. How about you Julie?
JULIE SANDERS: When she left the hospital, she’d only last about two ounces. So, she didn’t lose very much but we had trouble with her gaining it back because we discovered later she had a tongue-tie and a lip-tie. She was kind of getting just enough milk for a while. So, she stayed seven pounds, eight ounces for a while.
Actually, my paediatrician wasn’t concern because I discovered they actually misrecorded her weight the first time we brought her in. It was seven pounds, seven ounces I think. They wrote seven zero. So, I brought her in the next week and she hadn’t gained anything. I think, “That looks fine to me.”
ROBIN KAPLAN: My goodness.
JULIE SANDERS: So, it was very helpful to record for myself what her weight has been.
ROBIN KAPLAN: Sure.
JULIE SANDERS: For you know because I was able to catch that.
ROBIN KAPLAN: You had mentioned that she was feeding 21, 22 times a day and so that tongue-tie and lip-tie probably were impeding her getting all of that milk out there you had.
JULIE SANDERS: Exactly.
ROBIN KAPLAN: How about you Krystina?
KRYSTINA FEUCHT: I had him at six ounces down at the hospital. You know, they do the two days afterwards. We came in for the check up and he’s still a little bit down. They were actually really reassuring saying, “As long as he’s feeding okay and he’s feeding often – you just not waiting until he cry and you’re seeing the signs that he’s hungry and he’s latching on well.” They said, “He’ll get there and we’ll see you at the couple of weeks and test him again” and everything worked out great.
So, it was actually nice that they were the opposite. They were very reassuring that don’t be worried about it. Everything looks like it’s going to be okay.
ROBIN KAPLAN: Cool. MJ, do we have any VPs joining in our conversation?
MJ FISHER: We do. We’ve got Pippa Harthridge. She said that her daughter DD Number One last 10% in the two days after a very traumatic hospital birth. We were readmitted 24 hours of supplementation with cup feeding help from breastfeeding counsellor and we were off on our breastfeeding journey.
DD Number Two; born calmly at home breastfeeding established easily gained weight steadily from birth and to very different experiences she says.
ROBIN KAPLAN: Absolutely! Well and I think she kind of reiterates the point too that, “Sometimes the birth can actually play in to why my baby’s lose a lot of weight in the beginning as well.” She did mention the supplementation which actually kind of our next question for Ashley. What are moms’ options for supplementation during that first week and does it always have to be given by a bottle?
ASHLEY TREADWELL: It doesn’t! This is a great question. I think many people when they hear the word supplementation, they automatically think it’s formula in a bottle and it’s not. Moms have lots of different options when it comes to supplementation. Mom can supplement with her own milk. She can use breast milk – I’m sorry, breast pump to express the milk and then feed it to her baby that way. If for some reason, the mom can’t express the milk that’s needed to supplement the baby. There was always donor milk as an option as well.
As far as methods, there are lots of different methods. Our favourite as lactation consultants is to actually supplement at the breast and that’s done with a small syringe of mom’s milk. You attach a little tube to the end and then when baby latches on to mom, you slide the tube into the baby’s mouth. Give the syringe a little push and then it pushes the milk into the baby’s mouth. So, baby thinks he’s getting his meal from mom. That’s the reason that we like it. It keeps the baby at the breast. It avoids any confusion at all. It also provides good stimulation for mom while baby is there which is good for building a supply.
If supplementing isn’t at the breast isn’t an option, moms can finger feed which is similar to supplementing at the breast but it’s using the tube on the finger rather than the breast. The slow flow bottle is always an option and a lactation consultant can teach parents how to feed a baby bottle in a way that’s breastfeeding friendly. I think that’s very important.
I think that a thing to remember for supplementation and something that we’re always reminding our clients is that, “We’re hoping it’s a temporary measure.” Its mom and baby have hid a speed bump of some sort. We’re getting over that speed bump but until we get over it. It’s needed. So, we’re hoping a few days maybe a week.
ROBIN KAPLAN: All right, fantastic. Well, when we come back Ashley will discuss: “Jaundice, Sore Nipples, Engorgement and Normal Infant Behaviour during the First Week.” We have a lot to talk about. We’ll be right back.
ROBIN KAPLAN: Welcome back to the show. We are here with Ashley Treadwell an International Board Certified Lactation Consultant in San Diego and we’re talking about: “What breastfeeding looks like during that first week after your kiddo is born.” So Ashley, we’ve talked about babies losing weight, how often baby should be feeding and one of the speed bumps that often actually facilitate babies’ losing weight too is Jaundice. So, what are the signs of Jaundice in the first week and what causes it?
ASHLEY TREADWELL: Sure, what causes Jaundice is an elevated amount of Bilirubin in a baby’s blood. Bilirubin is the by-product of the breakdown of old red blood cells. We all have Bilirubin in our blood. Our liver processes it and it comes in our stool. So, baby who has jaundice – their liver is in properly processing the Bilirubin so their levels are raised.
Signs of Jaundice are often a very sleepy baby – a baby who is hard to wake to feed. Baby that’s not pooping enough and also Jaundice is often associated with the yellow tinge to the baby’s skin or eyes.
ROBIN KAPLAN: So now if a mom has a Jaundice baby, what are some remedies to get rid of this Jaundice to kind of perk up the baby a little bit?
ASHLEY TREADWELL: Sure. The most important thing is to feed the baby frequently, breastfeed the baby frequently. Wake them up, get them naked, get them awake and feed them as much as possible. You want to move that stool through the body.
Supplementation maybe recommended if the baby isn’t feeding enough or pooping enough. Another, again the supplementation we want to remind moms that it doesn’t mean it has to be a formula. You can supplement with your own milk. Another option is and they will do this in the hospital sometimes when the levels are high enough as phototherapy. They put the babies under a special type of light that breaks up the Bilirubin in the blood.
ROBIN KAPLAN: Okay and I remember some paediatricians will recommend, just put your baby near a light and so, have that indirect sunlight coming through the window. I meant – that is what I meant to say, “The light from the window.” So, that can sometimes help because the skin.
ASHLEY TREADWELL: Yes.
ROBIN KAPLAN: If the Bilirubin goes to the skin and so, you can see it. Sometimes that indirect light can help in Bilirubin as well.
ASHLEY TREADWELL: Absolutely
ROBIN KAPLAN: Ladies, do any of your babies have Jaundice?
JULIE SANDERS: She was close to – she was right on the border line where they had to do the blood test instead.
ROBIN KAPLAN: Okay.
JULIE SANDERS: But, she came back as in a normal range.
ROBIN KAPLAN: That’s good and you know, one thing to mention to is that, “When they do the blood test, the amount that’s in the safe range like Julie is talking about changes as the baby gets older too. So, what might be on the cusp on day three if that levels the exact same thing on day four, it’s no longer. It often can be no longer concern.” So, we’re any methods recommended to you Julie or they said, “Just keep feeding the baby?”
JULIE SANDERS: Yeah, that was I was telling at the hospital. So, they were like, “We’re going to keep testing. In the meantime, keep feeding her and do as much else to do.”
ROBIN KAPLAN: Perfect. Ashley, how common are sore nipples in that first week? What’s normal and what are some indicators that there’s maybe a little bit of room for improvement?
ASHLEY TREADWELL: Nipples, the stuff of horror stories for breastfeeding. I’m sure everybody has or has heard of scary nipples story. It’s very common to have some nipple tenderness in the first week. It’s an amount of stimulation that’s most of us aren’t used to. So, it’s really common to be tender. Anything beyond mild tenderness indicates that there may be a problem. You know, and the problems could be the biggest problem is a latch.
If a baby isn’t latching well, they’re compressing the nipple. When a baby feeds, when they come off the nipple – the nipple should look like it did went into the baby’s mouth. It should be round. If the nipple is flat and under compressed that indicates that the baby isn’t latching well. There may be a problem. Anytime that there’s any sort of tissue breakdown. If the nipple is cracked or blistered or bleeding, something’s going on and some lactation help is probably necessary.
ROBIN KAPLAN: Okay and do most sore nipples – this kind of more of the tenderness, do they tend to resolve in that first week?
ASHLEY TREADWELL: Yes, if breastfeeding is going well, if the baby is latching well – after the first week or so, it should really fade. If you’re still sore after the first week and again if there’s any of the tissue breakdown then you might want to seek some help. That could indicate that there’s something going wrong. There are some physiological issues with moms that can cause pain sort of beyond that first week even if the baby is latching well.
It’s not super common but there are moms who experience something called Vasal Spasms. It has to do with poor circulation that will cause mom pain when baby comes off the breast. She’ll feel some kind of shooting pains and some things. There are lots of remedies for that.
ROBIN KAPLAN: Okay. The mention too the Vasal Spasms we’re usually looking for some whiteness to the tip of the nipple that then also turn to pink and you get that kind of those searing pains like you were describing. It usually doesn’t hurt while the baby is feeding.
ASHLEY TREADWELL: No.
ROBIN KAPLAN: Because it is just his mouth is nice and warm. Exactly and Ashley, what are some of your favourite remedies for sore tender nipples?
ASHLEY TREADWELL: Sure! So, favourite is, “Organic coconut oil and express breast milk.” Those are the two best things. Both are anti fungal, anti bacterial. It’s important to keep the nipples moist for a long time. When I had my first child, I was told to air them out all the time I’ve walked around with no shirt on for weeks. My husband was so happy. But, that’s actually not really what you should do. You want to keep them moist that will help them heal.
The best remedy for sore nipples is a good latch, a baby that is latching well. Beyond that, if you have still some soreness there I think it’s called the hydro gels. There are lots of different kinds of – lots of different companies make them. But there are small pads with a cooling gel that feel just amazing when your nipples are sore. So, that’s a good option as well.
ROBIN KAPLAN: Okay. Ladies did any of you deal with sore nipples in that first week and if so, how long did they last and what worked out best for you? Krystina, do you want to take that one since you’re nodding?
KRYSTINA FEUCHT: Yeah, I actually – I knew it was from the latching. He latched really well on the right but not on the left and it seems like no matter which way I tried to practice all the hold, he was just wasn’t latching well. I used the cream. I used, I didn’t know about the cooling pads. So, I used ice cubes and everything that I could.
Finally, somebody turned me on to a nipple shield and that helped at least to get the healing because it was like, “Once it was raw, I just couldn’t – it hurt every time I fed. So I just knew I needed to get past the rawness and let it to heal and because we got the latched down.” So, once I got past the few days of a little bit of rawness got it to heal with the nipple shield then it was – we got the hang of the latching and it worked out well.
ROBIN KAPLAN: How about you Julie?
JULIE SANDERS: Yeah, I’m still – I still have sore nipples. Again, because of the lip and the tongue-tie, she started chomping my nipples with her gums which I never heard the, your nipples suppose to come out the same shape as it went it.
ROBIN KAPLAN: It doesn’t.
JULIE SANDERS: No, it comes out very smooched.
ROBIN KAPLAN: Is anything helping your soreness at this point?
JULIE SANDERS: A lot of what helps is just when she goes longer between feedings and dig it kind of a break to recover that helps a lot. The hydro gel pads have a made a huge, huge difference. Mostly just getting help with her gumming them in the first place. That’s really what works the best. Yeah.
ROBIN KAPLAN: Yeah, how about you Melissa?
MELISSA HOXSEY: Not with him but with my daughter I did. I was really nervous that I was going to have it again. When he was born, I thought – well, during my last three months of pregnancy, when she nursed it was actually very uncomfortable. It was this ever going to go away.
It didn’t hurt like when she was first born but it’s just was annoying. But now, with hers as two weeks and my sister said, “If it still hurts after two weeks, you need to get help.” It went away after two weeks with him. I think that she paved the way. So, lucky me because it was like, “The pain went away.” I kind of caught lucky there. It’s gone. So, now she nurses. They both nurse. There’s no pain at all.
ROBIN KAPLAN: That’s fantastic. I just like you had mentioned Krystina, I actually used a nipple shield with both my boys for the first – like once we got home from the hospital – so, they were like four days old, three, four days old and then, I used it for about a week just to kind of repair the damage that had been done.
ASHLEY TREADWELL: Build up your courage.
ROBIN KAPLAN: Well, the great thing was – you kept them breastfeeding. It kept them at the breast to just provide a little bit of separation between bare nipple in their mouth. Once they healed, I was able to take it off and then their latch was fine.
ASHLEY TREADWELL: Every once in a while with a cluster feed, they get a little sore and it’s nice to just had it ready at the hand to say, “Okay. Well, this next feeding session we’re just going to put it on for a little bit until we’ve heal up in a few hours and then take it off again.”
ROBIN KAPLAN: Definitely and our next episode is actually about nipple shields. So, if you’re using nipple shields – you can tune it next week and you can hear about this as well. Ashley, to go from kind of sore nipples to now more engorgement – so how common is engorgement and what actually causes it?
ASHLEY TREADWELL: True engorgement is actually not that common but most moms feel some level of it. Engorgement happens when your milk makes that transition from the first milk which is very low in volume to the mature milk which is very high in volume. So, your breast fill up with milk and often times, the baby at that moment is not taking everything that’s in the breast. So, the baby’s feeding but not draining the breasts. The more the breasts aren’t drained, the more they become engorged.
ROBIN KAPLAN: Okay. What is normal fullness and then what indicates a possible problem?
ASHLEY TREADWELL: Normal fullness is just that, your breast feel full and heavy. They may feel a little bit firm before feeding but as you’re feeding the baby, they start to soften. Problem engorgement is when they’re so firm and so hard that the baby can’t latch on. If they’re extremely painful, sometimes moms can run a low grade fever. If the baby isn’t able to latch on and move the milk then a mom would want to seek some help.
First is to feed the baby often is to try and to move that milk as much as you can. Prior to feeding, it’s nice to get the milk moving. You can that with warm compresses or a warm shower is nice. Something else that moms can do is, “They can do some pumping to help relieved the pressure.” Sometimes moms can do a little bit of pumping and actually hand expression is even better than pumping because it’s easier. You don’t have to get off the pump and plug it in and attach it.
So, do a little bit of hand expression before feeding the baby that helps soften things up and get the milk moving. Baby is often able to latch on easier. Then, after feeding, if mom is still feeling incredibly full and uncomfortable, she can do a little bit of pumping or a little bit of hand expression. We really caution moms in that situation to just do a small amount, just to comfort because more pumping and more hand expression is sending that message to your body to make more milk which sort of increases this vicious cycle.
ROBIN KAPLAN: Okay and another thing that I love to – Jean Cotterman came up with it. She coin the term, “Reverse Pressure Softening.” So, what it is – and we’ll include a link to this on our website. But, if you put your fingers, all five of your fingers from one hand into a kind of like the shape of like a flower like almost like petals of a flower. You leave a little opening in the centre for where your nipple will go and you take your fingers and you press into the areola in these five different points where your fingers are.
What it does is – it pushes back the edema into the breast and makes your nipple pop out a little bit. So, what it can do actually – for moms who are finding that their entire breast is so full that baby’s slipping off kind of like they were trying to latch on to their knee. It pushes that edema back that swelling back just a little bit and so that way baby can get on, start swallowing hopefully some milk and then, we’ll help just kind of pop the cork on the champagne. I’d like to call it where it’s like all of the sudden the milk just starts to flow. It’s not really kind of stuck in there. So, that’s another little trick as well.
So, ladies did you find that your breasts were super uncomfortable during this first week and if so, how long did it last and what work best when you were kind of reducing that swelling? Julie, how are your breasts during that time?
JULIE SANDERS: They weren’t actually uncomfortably full. In fact, since she was feeding so often. I would sometimes get panicked that she’s sucked me dry and I’m out of milk. So, when they would have that full feeling, I actually really liked it because I felt like, “Okay, I have enough to feed her.” Good.
ROBIN KAPLAN: It’s a really good point to make too is that, “Moms that are feeding more frequently may not end up ever feeling that true fullness because babies constantly waking up and feeding. So, how about you Melissa?
MELISSA HOXSEY: I actually did. My first one I didn’t feel ever full the first week but the second time I did because I was trying to adjust with the two of them. I didn’t want her to get on and nurse everything out and leave him nothing. So, I really kept her and I let, feed him first and then feed her and then I would wake up the next morning and I actually almost had an infection because I had redness at my lower breast and I was very full.
So, at that point – I feel like, “You need to feed.” So, both of them and she was happy. I could just whenever yes feed, feed and feed. I feed her for as the same thing. I was nervous. So, don’t let her feed fully on eight because I don’t want to keep getting gores so to keep that, balance was a little bit difficult in the beginning. How much is she feed and when should he go on. So, I did the first time with her – nothing. No engorgement. With him, so it’s a little bit different.
ROBIN KAPLAN: Well, I think a lot of times – second time moms that they have more engorgement as well because if you think about it, when you first start breastfeeding, it’s like you have a three lane highway going on and then second time around, you get a five lane highway and you just keep adding on those lanes. So, it’s just more milk coming down.
So, I remember feeling much more engorge second time around than my first. They weren’t really feeding much differently. It was just that my body had already done this before.
MELISSA HOXSEY: So, I was just hoping that having two of them feeding all the time wouldn’t get me engorged because they’re feeding.
ROBIN KAPLAN: Yeah.
MELISSA HOXSEY: But, if she was feeding and she was emptying me so much at night, if they went through four hours of feeding. Then, I’ll get engorged.
ROBIN KAPLAN: That was so full. Absolutely, how about you Krystina? What was your engorgement like?
KRYSTINA FEUCHT: I definitely experienced it at when I first started trying to pump a little bit. Try to prep going back to work. If he slept a little bit longer with the increase pumping that definitely made it feel much more engorged than the first time he slept four hours. I woke up and it was just –they were rocks. They were so hard. But, the expressing in the shower was really nice. That would be the first thing I do as get in the shower and with that warm water, just expressing a little bit really helped.
ROBIN KAPLAN: I found that was helpful and also using ice in between feedings kind of trying to take the swelling down a little bit.
KRYSTINA FEUCHT: Even massaging while he was feeding will help just to kind of roll it out.
ROBIN KAPLAN: Really help move it out.
KRYSTINA FEUCHT: Yeah.
ROBIN KAPLAN: Absolutely. So, Ashley, mentioning all of these things – Jaundice, Sore Nipples, engorgement all that kind of stuff, we talked a lot about what was normal and you had also mentioned some other reasons that maybe someone a mom would actually want to call a lactation consultant. So, what would be these reasons that a mom would really benefit from meeting with an International Board Certified Lactation Consultant during that first week?
ASHLEY TREADWELL: Sure. I think anything beyond what we’ve talked about the mild sort of tenderness with the nipples, anything beyond that.
• Tissue breakdown
• Any cracking
• If the baby hasn’t started to regain weight by day five
• If mom’s milk hasn’t come in by day five
• She hasn’t felt that increase in volume by day five.
• If the baby isn’t peeing and pooping the amount that they should be depending on what day of life they are
• If the mom suspects that her baby may have a tongue-tie, extreme engorgement
• Anything that’s very painful
• A breast infection or a breast abscess
• An oversupply as well would be another reason to call an IBCLC.
ROBIN KAPLAN: Well, thank you so much Ashley for sharing this incredibly valuable information about breastfeeding during the first week post partum and thank you so much to our panellists as well. For our Boob Group Club members, our conversation will continue after the end of the show as Ashley will discuss: “What is the normal infant behaviour for baby’s first week.” For more information about the Boob Group club, please visit our website at www.TheBoobGroup.com .
ROBIN KAPLAN: So, here’s a question from one of our listeners. This is from Erin. She wrote, “I am writing because I’m interested in becoming a lactation consultant. First, I’d like to say that I love the show. It’s from having difficulty in the beginning and this show that I realized how much of an interest I have within the field.
I read about becoming a Certified Lactation Councillor and can actually attend the training seminar in October. What would be a good start since I can obtain practical hours to sit for the IBCLC exam? Would that certification be recognized by potential clients and/or in the health care setting? Thank you for your time and again, I really enjoy the show – sincerely, Erin.”
VERONICA TINGZON: Hi Boob Group Listeners. My name is Veronica Tingzon. I’m a Board Certified Lactation Consultant and owner of the Original Comfort Food Lactation Services. First of all, Erin, I want to say, “A great choice on career path.” You know, a lactation consultant has been the best thing I’ve done for myself ever. I love what I do.
One of the things that you can start investigating is what path you should take. There are different paths that you can take based on what kind of education level you have. Whether you are a lay person with no college background or you have some sort of degree but not in a medical field or whether you have a degree in a medical field, you would take a different pathway.
Really, the best way that you can find all of these out is you can go to www.IBLCE.org – once again that’s www.IBLCE.org that’s the International Board Lactation Consultant Examiners. Their website and it will give you which path will you need to take and then, you can go ahead and Google the different courses that there are in your area or online or tele-conferencing so that you can start getting your hours in.
You do need to become a Certified Lactation Educator Councillor first or you can also come throughout being a [unclear] leader and then, you can then tailor yourself into a lactation consultant course. Then, your hospital hours or your amounting hours with a Certified Lactation Consultant and then ultimately sitting for your board exam.
So, the very best first place to start is www.IBLCE.org and hopefully you can get all the information you need from there. Hopefully, you do become a lactation consultant and help many women. I commend you in your choice.
ROBIN KAPLAN: This wraps up our show for today. We appreciate you listening to The Boob Group. Don’t forget to check out our show, “Preggie Pals for expecting parents” our show, “Parent Savers for moms and dads with newborns, infants and toddlers” as well as our brand new show, “Twin Talks, talking about how to take care of your twins.” So, thanks for listening to The Boob Group, your judgement-free breastfeeding resource.”
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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