Breastfeeding and Lactation Support
Dr. Amy Thompson
Good afternoon. I'm Dr. Amy Thompson. And I'm so glad that you've
joined us today on this topic of breastfeeding and lactation support.
So as a reminder, the information provided during this event is for educational
purposes only. It is not intended nor is it implied to be a substitute
for professional medical advice. Talk to your healthcare provider to determine
the appropriateness of the information for your own situation. If you
have any questions regarding medical conditions or treatments, please
consult your physician. Participating in this discussion does not create
a doctor-patient relationship. So, I'm so excited to have today joining
me in an interview on this matter; I call her Becky. I am privileged that
she works here with me at Covenant Children's Hospital. She is a nurse
and she's a lactation specialist who works here at my hospital. I'm
telling you, this woman knows more about all of this topic than anyone
I've ever met. So you guys are in for a treat. So Becky, I always
love this question since I already know you but tell us a little bit about
your role at Covenant. What is it that you do on a daily basis and then
talk a little bit about what inspired you to do what you do with your life?
Okay. I coordinate the lactation portion of the parent education service.
So here, we have a group of about eight women, there's five positions,
several are on call and several of us are full time as well. And we coordinate
and do the parent education classes, which includes the infant CPR, the
breastfeeding, labor and delivery. You know, the classes that way, and
also sibling tours and adult tours as well, which you know, are a little
bit on hold right now. But we're starting to get back into things.
And we do daily rounds on all of our patients every day. And we are here
to assist the mom with baby, labor and delivery, and a part of nurses
with all of the lactation services. So we see patients every day. As far
as my background and why I ended up in this position; I was a pediatric
nurse straight out of nursing school. And when I got pregnant with my
first child, I was aware of all of the different things that go on in
pediatric floors and things, and I really looked at what I was going to
do as far as my breastfeeding, my voice and choice on that. I read everything
I could on breastfeeding, formula feeding, all of that. And that was when
I realized I have a family history of allergies. I got really interested
in breastfeeding and learned as much as I could, and then went to work
for pediatricians for the corporate public. And then ended up on the pediatric
floor here, and then ended up doing the classes here, and then just was
thrown into the coordinator position.
That's awesome. You've done a great job for us. So my understanding
is this August is National breastfeeding month. And so it’s kind
of a month to bring a highlight to breastfeeding and lactation, and services.
So I was a breastfeeding mom and like you, had a mom who did not breastfeed.
And so she was very supportive of me. But really, I didn't have a
lot of, you know, knowledge. So for moms that are breastfeeding or thinking
about breastfeeding, what are things that you would consider normal? What
are things that they're going to run into that are just part of this?
You know, it's a learning curve, just like everything else and I think
probably, if you can, get a good baseline education before you start because
a lot of people come in and they're like, Oh, yeah, I'm gonna
breastfeed, but they really haven't done any kind of educational research
on it to have a baseline of what to expect. So the first thing that I
would say is they need to do is to get that baseline going. And it requires
a whole lot of patience, usually, and a whole lot of persistence. And
it's one of those things that you just have to say, yes, this is what
I want to do. And if you have a desire, you need to really give it a couple
of weeks. So don't anticipate that it's always going to be easier,
or it's always going to be hard. For some people, it's the easiest
thing in the world. And for others, it's probably the hardest thing.
In the end, there's a lot of normal in between. So just anticipate
that it is a learning curve and that you just have to be really patient
be able to be successful and give it a couple of weeks.
Yeah, that's great advice. I have two sons and I breastfed both of
my sons, the first of whom latched on the first time. It didn't hurt.
Everything was beautiful. But I always say if I had had JJ first, because
JJ was very difficult to breastfeed, we might not have. We did it successfully
eventually, but I think to your point, if I’d had JJ first I hope
I would have had someone like you to say it’s going to be alright.
You know, that’s exactly right. And I tell moms all the time, I wish
I had “me” when I had my first child. I really had it fairly
easy compared to most moms, but, some of the typical things that we see
would be, lik a first time mom that had it really easy the first time.
Then the second time or third time, all of a sudden, it’s really
hard. And it's very discouraging, because you think you've already
done it, so naturally with two babies it's going to be easy like that.
And that's not always the case. Every mom and every baby is different.
And that’s why every day is different for us, as lactation specialists.
Different problems, different dyads. So you just have to be real patient
and go with it, with whatever you get, and do the best you can.
So what are some of the challenges that you often encounter with moms that
Probably one of the biggest ones is the, “Is there enough milk?”
There're so many people who, first of all, don't understand the
natural phases of when the milk comes in and the volume issue with it,
and they really don't understand that breast milk is not just nutrition.
It's like medicine, you know, it's a combination of nutrition
in very small amounts. The baby's tummy is small. But that's one
of the hurdles that we have to get over with the moms is for them to understand,
you know, and trust their bodies and trust the babies and then have us
there to guide them if they need that. If the baby's really not getting
enough milk, then we troubleshoot for them. The second is probably the
latching. If it's not comfortable in the very beginning, you have
to kind of teach that. And a lot of people are afraid to ask for help.
So you know they might say, Oh, it's kind of a private thing. It's
not something that you feel real comfortable with a lot of times, but
it sure is worth it because it can be a very simple fix that we can help
with, that piece. And then I would say probably the third thing, the engorgement
part. When the milk comes in, it can catch you off guard, and it can be
a really very, very difficult hard thing to get over. But I think if you
ask for help, then we can give you the suggestions and hopefully remedy
that you know, for you pretty quick.
So if you have a mom who is struggling with some of these things, when
is it that you suggest that they start to reach out for help? And then
talk a little bit about, you know, what happens after you go home. Because
I think a lot of folks are very comfortable reaching out while they're
in the hospital. So talk about the timing of when you think that should
happen. How do you do that when you're out?
Well, I feel like we're very fortunate here because we are able to
check on our moms every day. So it builds that rapport which makes it
a little bit easier to reach out. There are people that don't need
help. And you know, I respect that totally. I think that in the very beginning,
if you have questions, you need to reach out at the hospital. If you are
uncomfortable, or you are concerned that feeding is not doing well, don't
be afraid to reach out to have somebody just do a quick evaluation. And
then absolutely when you get home if things are not falling in place,
and you have that baby that isn't satisfied or you’re not having
adequate output. Weight gain is one issue definitely. If your baby is
not gaining weight, we'll give you some guidelines on that. We definitely
need you to reach out and get help. And right now we're doing a whole
lot of phone calls, you know, since we're not doing outpatient, that
is typically follow up phone calls. Make sure that they have a phone number
where they can call. And besides reaching out to the hospital to us, there
are other services that are in the community. I mean, there's WIC
clinics, there's La Leche League, there's people that actually
have doulas that can help them and then private consultants as well. So
there are many opportunities to reach out, and it's worth their time
and their trouble. It can really make it easier than trying to, you know,
tough through it.
Yes, I agree. And, talking about how I breastfed my first son, and my mother
had not breastfed, one of the things that someone encouraged me to do
was to get perspective of how hard it was, you know? Or how easy it was
to just get your lactation specialist to come by and watch a feeding so
see what you're doing, and it was invaluable to me. You know, like
I said Rowan was easy. But it was invaluable when they came by and said,
He's latching well, and to show me what to look for. So, I would encourage
you while you're in the hospital, take advantage of the personnel
that you have. And then I would echo your sentiment that once you get
home, man, there's so many resources that you can help. So what about
things like support groups for these moms? How do you think they help,
and how do they get in touch with one of those?
The advantages of having that support afterwards is that you learn so much
from other mothers. It's just, it's amazing. We've had a support
group for a long time. And we used to have a whole lot more people but
now, with social media the way that it is, and people can get the information
online… But sitting and talking to a mom that is going through
the same things that you are, it's invaluable, and you can learn so
much. And especially in a support group where you have different ages,
like you've got babies that are nine months old, and then you have
a newborn baby. Those mothers, they learn all the tricks and trades from
each other. Plus you've got the support and you realize, Oh, no, she
had the same issue that I did. Or, you know, I'm really fortunate
because this is easy for me. I'm one of those ones that got that easy
baby that latched on and you know, it was not a problem. So you learn
to appreciate but also build bonds. We've actually had some of the
support groups start groups that they have developed later on on their
own, and I think they are especially committed. If you are in a new community
and you don't know anybody, it's a perfect place to meet somebody
and to support each other, you know, in your endeavors with it.
I agree, I think that that's great. My son just went to college this
year, but we actually did have some ability to get on the internet and
social media even back in those days. And so I know that we were part
of a group and even some of the things that we were able to find online.
So if you're at home and you're struggling with, you know, some
of those issues, make sure to try to get on and look for either a support
group or some of those things.
And the other piece of that is if you're fortunate enough that wherever
you live, that you have access to outpatient services, then that - especially
people that are having trouble with the latch, after they get home, it's
worse or if it's not improving, or a weight gain issue - those are
perfect opportunities for that hands on help to get. And it's really
hard to do if it's not in person to kind of show you. So if your community
has outpatient services I would highly urge you to go. Not everybody needs
an outpatient appointment or a visit. But if you're struggling mentally,
that's something to see if it's available.
And it was crazy to me with my second son that I kind of struggled with
breastfeeding. I did get in person support. They just changed the way
that I was holding JJ and like, everything changed. You know, it was amazing
to me that I never would have thought of what it is that they have and
how they told me to position him and then he was doing great.
I tell a lot of moms, I'm going to show you my tricks. It's just
that I need to tweak it a little bit. And they're like, Oh my gosh,
even the way you sit, the way you position the pillows, it could make
all the difference in the world and a lot of very simple, easy techniques,
and you just need somebody to show you.
Yeah, I agree. So you know, the topic that we can’t get around Becky,
on anything that I'm doing on Facebook these days is COVID. So talk
to me about what has changed, like with your recommendations or like what
you're doing with new moms with COVID.
I mean, with the COVID piece of it. I think what we've noticed more
than anything is the anxiety, you know? Everybody's experiencing it
but then if you're pregnant and you have a new baby, we've gotten
multiple calls asking about that. Continue to breastfeed, you're giving
your baby that extra protection for everything and hopefully COVID too.
So it's just like everything else, wash your hands. You know, with
the COVID positive mom, originally the recommendation was to separate
the mom and the baby but for the mom to still continue to pump and give
the milk. Now the recommendation has changed. We can actually keep the
moms and the babies together. When the mom is at home with COVID, then
you're just going to make sure to remind her and instruct her that
she needs to do particulars. Hand washing, she needs to wear a mask and
feed her baby or she can pump and use meticulous technique with her pumping
equipment so that her baby is safe. And then do the distance thing and
have a caregiver, a healthy caregiver, family member, friends, that can
take care of the baby. At this point, that's what's happening,
that’s what we're recommending, and we're getting good results
with it so far. Now you know, Amy, I mean, everything changes from day
to day. We do our best to keep up with what's going on in the world
and all of the different recommendations and everything and we just have
to go with the best evidence that we have available at this time. But
we try really hard to encourage the moms. We are seeing anxiety with all
of these moms, and I can understand it. And we get phone calls from moms
before they deliver, they're concerned about COVID, wanting to know
what to do. We just want you to be as careful as you can, do your social
distancing especially that last month before you're coming to the
hospital, and hopefully that's going to help to decrease the amount
of moms that are positive at their delivery time if they follow those
I agree and here at the Children's Hospital, we have seen a lot of
asymptomatic pregnant women, testing when they come in that are positive
for COVID. We've got great techniques and staff that all focus on
labor and delivery and mom, baby or lactation, exactly how to take care
of the patients. And like Becky said, we used to have an American Academy
of Pediatrics who suggested separating [mom and baby]. I think we've
only had one in the early days when we thought that's what the recommendation
required. Everybody else, we've been able to keep those moms and babies
together. And I think the moms have done really great.
Yeah. And they just need a little extra TLC. I think that when you think
you're fine, you feel fine, and then you find out you're positive,
it's really hard for those moms to do that. And I admire all of them
in you know? I encourage them all to breastfeed. If that was their plan
and that's what they wanted to do, then don't let that get in
I agree. And I would encourage you, if you're a mom out there that's
watching, make sure you're talking to your OB/Gyn. Recommendations
are changing. Last week I talked to a group of folks in Lubbock talking
about going back to school. And everything that we were reading is that
younger kids are really not active in transmission. And then literally
today, this article came out in the pediatrics journal that is like, Hey,
just kidding, we actually think kids have these viral loads, and can transmit.
And part of the thing that comes with anxiety is the fact that data is
changing all the time and we learn new stuff about COVID. And the very
best thing for you to do is to keep talking to your physicians. I read
every day to make sure that nothing has changed. To think about treating
my patients so just make sure you continue to touch base with your physician.
We’ve had lots of questions about breastfeeding, can a COVID positive
mom actually transfer the virus to the infant in breastfeeding?
Remember nothing is 100% because we don't have all of the information
in, but everything that has come across my desk that we've been looking
at, and that we've read is that we haven’t seen any positive
case of that, no. There's been a few things, maybe one article about
the possibility, but it wasn't anything that was definitive. So really
we haven't seen any of that so far.
I agree. And what I've looked at shows moms are not transmitting across
the placenta, so if you get COVID and you're pregnant, there's
been no transmission to the baby before birth. And then certainly, in
the transmission that has happened after birth, those numbers have been
very low, and they think it's what you and I were discussing that
it's actually probably, if mom is holding the baby, and potentially
maybe not masking. My understanding as a pediatrician, and the thing I'm
always encouraging moms to do, is the very best thing that they can do
which is breastfeed, especially when they're sick. Because then they're
making antibodies and giving those to the baby.
Yeah, it just makes sense, because that's how our bodies work. You
know, the active mechanisms. So I agree, we'll just keep following
the data, until they tell us to do something different. If there's
something else we need to do better, we’ll do it.
So, you know, let's talk about the part of the population that, even
with lactation support, and even with things like this, who find themselves
unable to breastfeed. Or they have other things that preclude them from
breastfeeding. We are huge encouragers of breastfeeding. But if you're
out there and you're watching and you just have not been able to make
this work.. You know, my mother did not breastfeed me. She said, I did
what the pediatrician said, and we were formula feeding. And I always
joke with them that, You can decide if you think I turned out okay. But,
you know, this really is a concern. And so while we're talking about
breastfeeding, talk a little bit about formula. If someone finds themselves
in that situation, what do you suggest?
I don't think any moms should feel guilty, first of all, whatever their
decision is, I think it's a real personal decision. I always encourage
them to do their education and make an educated decision. But there are
definitely situations where it's not the safest thing to do. And we
always try very hard to respect that mom's decision and support her
in whatever she needs to do. As far as which formula, I get asked that
a lot. I always defer that to the pediatrician. There's basic formulas,
and then there's the specialty formulas. And so that's something
that the pediatrician should guide them on. But definitely, that is a
situation that is there and we do encourage moms to try to get educated
and make the right decision. Because there are reasons like medications,
or they've done everything they can possibly do to get their baby
to breastfeed, but they don't, you know? There's some sort of
anatomy with you, that's really preventing it and I would never want
them to ever feel really bad. And that's one reason why with the mothers,
we just try to get them to give it a couple of weeks, because at a couple
of weeks, it's kind of like, okay, I can do this, or no, this is really
not working for me. Because I don't want them to feel guilty about
their decision. Because everybody's doing the best they can for their babies.
I agree. And I would echo, talk to your pediatrician about this specific
type of formula. All the formulas that we have available to us, you can
buy in the supermarket that are available to you. They're all different.
Some of the additives, like, if you added rice and these different things,
let your pediatrician talk with you about which one of these formulas
is the best for you. Some of those formulas have more or less calories,
different for premium rice. And that's really a decision that you
need to make with your pediatrician. But Becky, I echo the thing that
you say that if you're out there and you have just not been able to
breastfeed or if your condition is the reason that you can't breastfeed,
we’re very, very blessed to live in the year 2020 where the formulas
are very good. And when they figure out some more of the things that breast
milk provides, you'll see that they’ll be able to make those
and add those into formulas. They've been able to really improve infant
formulas. And one thing I'm going to add to the formula piece, it's
important that a lot of people don't realize they really need to know
how to mix their formulas correctly. Because I can remember from my days
as a pediatric nurse, babies coming into the hospital because it was not
mixed correctly. It's very important to follow the directions, read
the directions and know all of the big stuff. And you should get information
on that in the hospital before you leave. You can always call and ask
questions, that's really important. Also, nobody wants to leave out
the dads. So if we have dads that are watching, what are some ways that
new dads can get involved? Sometimes there are dads that actually like
the idea of feeding because they can help the baby or they can do these
things. So what suggestions would you give for dads whose wife is breastfeeding?
The moms that are probably the most successful have dads that are supportive,
and it really is important just for them to be on board, you know, for
them to value what the moms are doing and realize the health benefits
for the baby. And I think dads burp a whole lot better than moms for some
reason. I don't know why, but it works that way. But dads can do skin
to skin with babies for comfort and give moms a break with that piece
of it. I mean, anything they can do as far as the diapering, the nurturing
and all that, and the bottle of course, will help with everything. I mean,
the pumps are so good. Now, in a few weeks, Mom's gonna have plenty
of milk pumped, so typically Dads can help with those feedings and maybe
Mom gets to go to sleep a little bit earlier. There's ways that you
can coordinate that. But dads or, or even grandmas or whoever that support
person is, they need to realize how important it is that they keep, you
know, telling them how good a job they're doing, Asking what they
can do to help. I mean, I have the dads here getting the mom situated,
getting the baby over there, and they've got it all set up before
they even walk in the room. So they are very, very important. This is
a family. It's the three people it doesn't take just one it takes
the mom, the dad and the baby.
I agree with that. And if you're out there and you are the dad, the
significant other, the grandma, anybody who is that support person, there
is a role that you play, and you can bond with that baby, even without
being the one who's breastfeeding. And my favorite thing with my husband
was that 2am feeding, when he was with our babies and I would get myself
set up and he was able to participate. So I love that advice. So if you
wanted to give one final piece of advice to new moms on breastfeeding,
what would be the thing that you would say to them?
It's really hard to just have one. You need to get your baseline education.
I think that you need to make up your mind that this is what you want
to do, and not expect it to be perfect. And, again, you have to have patience,
and you have to be persistent and you know, give it that couple of weeks.
And then I feel like you're going to feel really good about your decision.
I agree. And I'm really thankful that I was able to be able to breastfeed
both my boys. They make all kinds of stuff we have a breastfeeding store
here, and it helps breastfeeding to work. They helped me figure out how
to pump on my way to work, which my husband thought was the funniest thing
ever. But, man, I loved it because it helped. On my way to work, and,
I knew that the clock was, that I needed to get started then. And so much
good advice from folks who were even in the store. And so there's
so much out there, there's so much written, there's so much support.
We want to encourage you, and we do think breastfeeding is best. As a
pediatrician, I certainly encourage it. But know that if you can't,
there are good alternatives with formula feeding and we're raising
healthy kids. Thank you. Thank you so much for joining us and sharing
some of your knowledge about breastfeeding. It's been a pleasure to
have you on the show and let these folks know you. Keep up the good work
with what you're doing with our patients.
Okay, thank you.
Thank you guys.