Child: Welcome to my Mommy’s podcast.
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Katie: Hello and welcome to the Wellness Mama Podcast. I’m Katie from WellnessMama.com and this episode is all about breastfeeding and postpartum. I get a lot of questions about these topics and with some very specific ones especially, and I was excited to get to go deep on these with Erin Appleton, who is very much an expert in this. She is an MD and also an International Board Certified Lactation consultant and is one of only a few hundred MDS in the world with a fellowship in the Academy of Breastfeeding Medicine. And she also has a practice where she helps thousands of families who are having breastfeeding issues and provides a lot of advice on this topic as well. She has a lot of extensive resources online.
So this is a very specific episode for breastfeeding moms or moms who will be breastfeeding at some point soon. We talk about how she got into breastfeeding medicine. We talk about the differences in microbiome with vaginal and Cesarean birth and how to optimize each, an important bacteria that’s missing for many people’s microbiome and that is very important for baby and that can be missing even from vaginal birth. How breastfeeding is a source of important pre and probiotics. Why latching is a big issue in many breastfeeding relationships, including how lip and tongue ties can affect breastfeeding for mom and baby. How lip ties are often over diagnosed. But tongue ties can be under diagnosed.
The golden hour after birth for getting milk production started and how to do this even if you are separated from your baby, all the factors that affect supply and what to do about low supply or high supply. The fascinating science of how moms and babies bodies interact and the mom’s milk supply adapts in real time to exactly what the baby needs. What Triple Feeding is and if she ever recommends this, how mom can protect her own mental health during breastfeeding and how partners and family members can be supportive. Why mastitis is often misunderstood and poorly treated, and what to do instead. And then we talk about specifics of helpful supplements for postpartum, supplements to avoid and answer questions like can breastfeeding moms use the sauna? And so much more. So let’s join Dr. Erin Appleton. Erin. Welcome and thanks for being here.
Erin: Hi, thank you so much for having me. It’s such an honor to be here.
Katie: I’m excited to chat with you. I get a lot of questions about the breastfeeding and postpartum phase and I think that there’s going to be some really relevant answers in this episode and a lot of directions that we can go before we jump in. Specifically to that topic, though, in researching for this, I have a note that you also have, I think, a similar interest to I do, a fascination with the microbiome. And for me, even like the oral microbiome became a research topic and I feel like this absolutely does also relate to birth and breastfeeding and so many other elements. But I would love to hear what sparked your interest in that.
Erin: Initially, it was actually getting into breastfeeding medicine about a decade ago, a lot of things were starting to get kind of published and breastfeeding is actually kind of where a lot of that kind of interest was sparked because the difference between vaginal and C-sections and the microbiome based on that. So, yeah, it really started because of my interest in breastfeeding medicine, actually. And it kind of grew from there to be an interest in everything about human microbiome from birth to death, actually. So it’s a fascinating topic. It’s pretty big. We could be talking about that for an hour.
Katie: Yeah, well, just to jump in, I’d love to just touch a little bit on this because I think this is an important topic and it’s one I’ve also researched quite a bit, both as a mom when I was pregnant and also as a doula. I’ve actually facilitated helping a lot of gentle Caesareans and doing the seeding process right after birth for moms who weren’t able to deliver vaginally for whatever reason. And I know this is now talked about more, but I feel like it’s still a little bit kind of unknown in a lot of the birthing world even. And that certainly from doctors. I have gotten pushback with that process in the OR where they’re like, oh my gosh, what are you doing? That’s not sanitary. And I’m like, you literally witness birth all day long and you know how this process happens. But can you explain for people who aren’t familiar, what the microbiome difference that happens with a typical vaginal birth versus a typical Caesarean and maybe some of the factors that can influence either one in a more positive direction.
Erin: So essentially, if we had ideal microbiomes, which I think there’s pretty good evidence that we don’t necessarily have ideal microbiomes as adults in our Western world, but if we had ideal microbiomes, and we passed on every bit of our vaginal microbiome through the birth canal into the oral cavity of the baby who’s being born vaginally. They would have a really big preponderance of good bacteria. So Bifidobacterium species particularly, that help them to develop a healthy microbiome through their lifespan. And one particular Bifidobacterium was found to be essential for breast milk digestion. So human milk oligosaccharides are a big part of breast milk calories that are not necessarily digested by baby. They’re digested by this particular bacteria called B. infantis. And in a lot of people, that B. infantis is actually missing. So through C-section, you don’t get exposed to it at all. So virtually every baby that’s born by C section is not exposed to this very important bacteria to help colonize their gut.
So even vaginal deliveries will sometimes not be exposed to this particular important bacteria, and it’s missing in between eight and nine out of ten people, even vaginally. So that piece of seeding, that little bit of bacteria into the really healthy guts of a vaginally birthed baby, is really important, and C-section babies don’t get that at all. So that’s where this practice of vaginal smear being placed in the mouth of a baby is. Where the practice came from, is just knowing that those microbiome are so different from vaginal to C-section, with C-section babies having more of a lean towards more pathologic bacteria than vaginally birth babies.
Katie: And just briefly, is there anything parents can do if they had no idea about this when they had their babies and now are concerned about it? Like, for instance, as my own example, my third baby was a C-section. The rest were natural. I had placenta previa with him, so he was necessarily a C-section. And I didn’t know all of this back then, and he’s my only one that had eczema or had gut issues, and we were able to resolve all of that. But it’s easy to look back and be like, oh, I wish I hadn’t known. Is there anything parents can do? Obviously, the optimal is to figure that out beforehand and optimize your birth scenario. If you’re already past that point, are there things parents can do to help kind of nourish their babies or their child or their teenagers gut bacteria at these different phases?
Erin: Absolutely. If you can breastfeed, that’s the best pre and probiotic on the planet for a baby. And if you’re formula feeding and breastfeeding, you can do both together. I love inclusive feeding. Exclusive breastfeeding is not absolutely necessary in order to optimize the bacteria, and you can do probiotic replacements. It took me a long time to be really convinced that probiotics were going to necessarily make a difference. And I think there’s still lots that we need to know and lots of science that needs to be really established before it’s something that I recommend for everybody.
But if you think that that might be a scenario for you, there are definite probiotic companies that have good science behind what they’re making. And you can get strains that have been shown to actually develop a colony, because a lot of probiotics will actually not make it right. They kind of act like tourists in your gut, they go from your mouth and don’t necessarily set up shop. But there are actually companies that have developed a technique that is actually able to get the bacteria to the right spot, set up a colony and help with digestion.
Katie: It makes sense. And really I think this conversation goes all the way through our adult lives as well, understanding it’s not just what we eat and the nutrients we need, but what our gut bacteria needs that we may not, as humans, directly benefit from, but our gut bacteria benefits from. So therefore we also benefit in a tremendous way. So I love that this is entering the conversation in a much bigger way and that there are, to your point now, resources to actually help in a targeted way for all these different scenarios that play out.
I’d love to also touch on some of the other many things that are issues for new parents, especially with breastfeeding, starting broadly with I know you do work with this every single day you’re in your clinic right now. What are the most common issues that you see in new parents coming into your clinic that they’re facing with their babies?
Erin: The vast majority of parents are struggling, usually with basic latch. Latching is something that we don’t necessarily have mirror neurons appropriately triggered from the time that we’re toddlers and little children growing up. We see a lot of bottle feeding in our society, so we tend to mimic bottle feeding type movements and positioning. And when you’re trying to bottle feed your breast to your baby, you’re often ending up with like a crunched position. Your shoulders are hunched, you get super bad spinal and neck and back pain because you’re leaning towards your baby, bringing your breast to your baby. And that’s the most common thing that I’m correcting because parents don’t necessarily have the coaching along the way to make breastfeeding as logical as possible.
And so what I generally tend to teach is a lot of just really good optimal latching position, making sure baby has the ear, shoulder and hip in a straight line, has their chin slightly up and that they’re not turning their head from side to side. And mostly putting baby into a parasympathetic nervous system state because if they are in fight or flight all the time and they’re not touching mom from chin to toes, they feel unstable. And when babies feel unstable, they can’t feed as well. So even without there being potentially something like an oral tie or something that’s causing them to struggle, even just simply putting them into a tummy completely to mom and leaning back, mom reclining and getting her shoulders down and putting baby on her to latch properly. That helps baby get into the right state so that they’re able to attach better. Even if there’s an oral tie.
That’s probably the most common in my common problem in my clinic is I see a lot of oral ties. So lip tie, tongue tie, because I have a selection bias of people who are having breastfeeding and infant feeding problems so it can also affect bottle feeding. So in my particular case, I’m seeing all feeding problems so I have that selection bias and that I tend to see a whole lot more oral ties. But the vast majority of people, if 70% of people are having troubles with breast, chest or bottle feeding, it’s usually their latch technique, not an oral tie.
Katie: That’s fascinating and I think you’re the first one I’ve heard really discuss that the nervous system state and getting baby in parasympathetic. And it seems like I’ve encountered this more in the adult realm and in my own therapy and the importance of parasympathetic and realizing in hindsight, I think I went through at least a whole decade having never really engaged my parasympathetic side and now seeing just how drastic of a difference that made for my own nervous system. But it seems like there also is some co regulation between mom and baby when it comes to this.
So what are the factors that come into play here? You mentioned that alignment and the baby’s physical positioning being very important. I would guess also mom being able to downshift and be parasympathetic also helps baby to do that as well. Is that true? And if so, what are some ways that mom can also because of course, new motherhood also can be stressful and make it a little more difficult to shift into parasympathetic.
Erin: Absolutely. So we’ve seen definitely that even just the five deep breaths, listening to a calming meditation, listening to even binaural sounds or waterfall, something that can give you that sense of internal peace and calm. It doesn’t have to be perfect. Also partners can be really helpful in getting baby out of that fight or flight state and getting mom more into that parasympathetic rest and digest while dad’s calming or partner is calming the baby.
Because babies won’t always become for the feeding parent because all they smell is milk. So they’ll often just be cantankerous and not able to settle for the primary feeding parent, but they will be for the non primary feeding parent. So what partners can do is actually do skin to skin and hum. They actually often men have really deep vibrating voices and they can get babies into parasympathetic just by humming in skin to skin. And once you get baby out of their fight or flight, it’s a whole lot easier for mom to get out of fight or flight so she’s not panicking and doing the ram and jam and pushing the baby to the breast and both of them are just having complete and utter dysregulation. Getting both into more of that parasympathetic state and then starting the latching process is just so profoundly helpful for so many people.
Katie: I really love that you mentioned humming because I feel like this is another area that’s not talked about. But instinctively with each of my kids, it was like I developed a different hum that seemed to be like I would describe it, it sounds super woo, but almost as like their resonant hum that was specific to them. And I would just sort of instinctively do that and then their dad picked it up and would kind of do the same thing and it just seemed like it somehow helped regulate them. I had no idea that that was actually a thing, but I found it fascinating in learning. I used to have thyroid issues and that humming is actually also beneficial to us as adults to do because it stimulates the vagus nerve and the thyroid function.
And ironically, I think humming plus when I started taking voice lessons, I started seeing my thyroid improve and I always wondered, is it some actual stimulation happening from the movement of my vocal cords? That’s beneficial to me as the mom as well and also seem to very much calm the baby, but that’s a great tip for dads.
You also mentioned oral ties and I think lip and tongue ties are a huge topic and another one that’s not talked about much. I know there are amazing lactation consultants that are now checking for this day one with babies, but it doesn’t seem like fully part of the wider conversation yet. So can you explain why we’re seeing lip and tongue ties, what they are and what to do about them?
Erin: So we are seeing probably not necessarily more. Maybe we are we don’t have really good data about that, but we are definitely diagnosing them more and they are getting diagnosed more in specialty feeding clinics like mine. And they’re being recognized as a contributing factor to feeding issues because we’ve definitely seen good data about the problems with creating vacuum. And when you can’t lift your tongue with a wide open mouth, you can’t create vacuum. So babies are meant to have big, broad, wide open mouth at the breast on bottles and they are meant to open their mouth and drop their jaw. And their tongue needs to be able to lift with that jaw wide open. And if you think about it, if your tongue is tied and tethered to the gum line and as soon as you drop that jaw, the gum line goes with it, the tongue goes down with the gum line. If you can’t maintain suction, you’re going to have to close your mouth and you’re going to use your lips. So I find lip ties are really over-diagnosed. Like everybody looks like they have a lip tie when they’re born. Almost 93, 94% of us look like we have a piece of skin that goes down to and attaches on the gum line or wraps around and under. But we can’t all be lip tied. That would make no sense, right?
The function of the lip is what makes it tied or not tied. Can it lift enough to touch the nostrils if it can, even if that little piece of tissue is there, it is not tied. It functions just fine, but with the tongue, oftentimes the baby will be looked at, maybe in the hospital, and somebody will say, oh, that looks fine. But they haven’t actually stressed the upward lift of the tongue, so they might look at it. And unless there’s actually a piece of tissue tied to the tip of the tongue, they’re often dismissed as not tongue tied because they have not actually done a full functional assessment of the tongue. So the tongue needs to be able to lift upwards with stress of the downward movement of the jaw, and if it can’t, then it is functionally tied.
You’ll often hear clicking, losing suction, not being able to manage flow, mums often think they have a lot of milk, and sometimes they do, but they’ll sometimes lose their supply over time. Like, if a baby is gaining weight really well and moms may be having a lot of milk, baby is clicking, but everybody’s like, well, baby is thriving. Don’t worry about it. Those types of ties often go undiagnosed for a really long time. And then they’ll show up at three or four months with this feeling of babies never happy, or they slow down their growth, or they’re pulling and bucking at the breast all the time because they were living on the letdown and the letdown has slowed and the extraction control is what’s taking over and the baby is not a great extractor. So the milk supply starts to dwindle, and they’re the kids that end up showing up in my clinic at three or four months with an undiagnosed tongue tie.
So there’s definitely lots of ways they can show up. The really obvious ones are sometimes clipped right at birth, but they don’t usually show up to me right away unless they’re still struggling with feeding after the clip, and maybe the clip wasn’t entirely complete, like they didn’t get the posterior portion of the tongue tie. There’s other factors that can also cause issues that are also part of the baby’s anatomy. The way that they maybe had some birth trauma, like a vacuum or forceps or C-section. They were maybe wedged down into the pelvis and they’ve got a little bit of tightness through their head and neck and they’re not opening their mouth well. They usually struggle going more to one breast than the other. So they have torticollis or even some flathead developing, and that can be treatable with some body work, some physio, and getting them to mobilize better, and that will help their jaw and their cheeks to work better, and sometimes their tongue and function gets better, even just with a little bit of time and patience. But, yeah, it definitely is a multifactorial issue.
And there’s factors on mom’s side and factors on baby side. And there’s no other area of medicine, actually, where two people have to intimately work together so much, where there’s variables on both sides that could be affecting feeding, and that includes breast anatomy and nipple anatomy and how long and stretchy the nipple is versus maybe short and flat. So there’s factors on mom’s side too that will affect the way that baby can attach. And sometimes we have to just work with a little bit of nuance around how mom’s reclining and how mom’s bringing baby to the breast. And the depth of the latch improves immensely, just with a little bit of a tweak and off they go. So it definitely isn’t always something really medical that needs intervention. But for sure in my clinic, especially these days with a long wait, it tends to be more tongue and lip.
Katie: Well, and you brought up an interesting point and I love clarification on it. You mentioned like often mom will have nipple pain or discomfort, and I certainly experienced this especially with my first, but with every new baby there was like an adjustment period where I felt really sore for a few days. And I’m now curious, looking back, knowing that several of them had tongue ties we didn’t resolve till later. Is some amount of discomfort kind of normal with the adjustment to breastfeeding? Or is that often a sign that something needs to be tweaked or adjusted?
Erin: Generally some degree of discomfort, as long as it’s not damaged, is normal for the first few days of breastfeeding. It’s not going to be perfect and painless right away. It tends to be within three or four days. You’re getting used to it, it’s getting better. Something sucking on you twelve times a day is going to be a little bit uncomfortable, but if there’s any damage, if there’s any nipple compression, and blistering, if there’s bleeding, gosh, no, that is never normal and it needs to be paid attention to right away. And not every nipple that’s damaged just going to have a baby on the other end that’s tongue tied or lip tied. Oftentimes it is just simple tweaking of the ear, shoulder, hip alignment, maybe the two cheeks being more symmetrically applied to the breast so that there’s no kink of the nipple. Maybe the baby is just not in a state where they feel safe to nurse. Or maybe they’ve got their head and neck turned to one side and they’ve kinked their esophagus and they can’t swallow well. So there’s definite things that don’t require surgical intervention and that’s probably the vast majority of the time. But for sure there are times we need to do something.
Katie: And this might dovetail directly with what we’re already talking about, but I would guess there’s also other factors involved. I hear from a lot of moms who deal with low supply and I don’t think that I ever struggled with that. However, I never really had to pump to be able to measure my supply. But my babies always grew really well. But they only wanted to breastfeed exclusively, like they would never take a binky or a bottle or any of that.
But I hear from a lot of moms who do struggle with low supply. And so I would love to hear, is this also often a positioning issue? Could this also be a tongue tie issue? Or are there other factors on mom’s side that can come into play? Or how does someone figure out what’s going on if they’re having low supply?
Erin: That’s a big question that has a lot of potential answers. But in general, with starting really well, if you start breastfeeding within the first hour and you get optimal positioning and you get the baby latched really well and the baby feeds on queue and they don’t have anything head and neck going on. If there’s nothing else metabolically going on with mom, meaning insulin resistance or some other hormonal thing that might have occurred during pregnancy, maybe even preexisting pregnancy, there’s definite things that we, I think, need a lot more research on, including insulin resistance, metabolic disorders that need more data when it comes to the ability to make breast milk.
In my clinic, I definitely see lots of insulin resistance. I use medications to help increase milk supply. Often though, it’s more that they have gotten off to a rough start. So the data that we do have about breast milk production is if you can get that first hour and turn on the factory, that is the optimal way to start breast milk production. It’s just like in evolutionary terms, I often refer to it as turning the factory on because the baby made it right in the wild. Did you get skin to skin right away and protect your baby from any predators? And did that baby get to the breast and start the factory up? That is what optimal breast milk production will happen. And getting that first hour. Even if you are separated from your baby for medical reasons and C-section is a necessity, you can start that nipple simulation just with hand expression. So anybody that’s worried about that first hour in the pregnancy period, you can start production right away. Just get your hands, use your hands in even pregnancy to learn how to hand express so that you know your body, you know your breasts and you know how to turn on that optimal production in that first hour.
And then if you have been separated from your baby, pumping and hand expression every two to three hours in those first three or four days is going to turn that production on optimally if your baby can’t do it. So there are ways to optimize things optimal obviously is baby is doing this and you guys are not separated. You’re doing as much skin to skin, keeping yourselves in that parasympathetic nervous system state as much as possible and keeping baby close at all times. So easy access to the breast all the time in those first three to four days, that will absolutely be by far and away the most important way to prevent low supply. The most common things I see are definitely in terms of low supply, usually tongue and lip high in my practice and then probably other metabolic things that might be happening with milk production that we’re kind of guessing physiologically what might be happening, but that’s tools that I use all the time.
Katie: And purely anecdotally. But I’ve gotten to work with a company called LMNT that does minerals and there is a large group of breastfeeding moms who have noticed an increase in milk production from optimizing their hydration and especially minerals. And I’m curious if there’s any data that you know, that supports this. It certainly seems like there’s plenty of anecdotal evidence from a lot of breastfeeding moms, but it makes me wonder. I know we get told the importance of hydration during breastfeeding and often people just assume water, but it seems like electrolytes and minerals also are important and it kind of makes sense because a baby would be getting a lot of these resources from you. So your body might need more, but do you see that in your clinic as well?
Erin: So there’s lots of anecdota about using things even like gatorade for pumping. People will swear that the blue gatorade or whatever makes them make more. You have an objective measure, are you making more? Are you when you’re using? Right? So I certainly don’t argue with people who have that personal experience.
But in terms of the physiology of breast milk making, lots of people, even dehydrated will make plenty of milk for their baby. We are pretty well designed for this and a lot of times baby will take. I mean, the breast is a really good organ and it really highly regulates things within fractions that you can’t really control a whole lot of, it will take from you what it needs. And you can do some probably supplementation of fat soluble vitamins to increase them in breast milk, but the others are all pretty tightly regulated.
But again, I can’t argue with moms who have this anecdotal experience where they just have tons more milk when they feel more hydrated or they’re eating good fats and proteins and they’re really protecting their own self care and they’re going for walks and getting sunshine and vitamin D. Right. It definitely is something we need more good science on. But I definitely recommend vitamin D supplementation for women in breastfeeding because you can take enough in your own supplementation to increase the breast milk vitamin D level, so that, say, those days, maybe you forget the D drops. It’s not as big of a deal. Definitely it’s important to still supplement baby with vitamin D if you’re exclusively breastfeeding, but you can take 6400 international units and your breast milk will have more vitamin D that way.
Katie: And I love that because it touches on the importance of at the end of the day, yes, consult practitioners who are your partners in your health, but also listen to your own body. If one lesson I’ve learned over and over in the health world in the last 15 years, it’s that we are each so individual and we’re also each responsible for figuring out what works for us. So take the best of all the data and the approaches and then figure out your own answers.
This podcast is sponsored by LMNT, which is a tasty electrolyte drink mix with everything you need and nothing you don’t. It is a science-backed electrolyte ratio, with none of the junk found in electrolyte drinks. No sugar. No coloring. No artificial ingredients. No gluten. No fillers. No BS. I love this company so much that I invested in them and am a daily user of their electrolyte mix. Many of us are not hydrated enough, and this doesn’t just mean we need more water… electrolytes are an important part of this balance as well, which is why LMNT is so helpful. Electrolytes in this particular ratio can help prevent and eliminate headaches, muscle cramps, fatigue, sleeplessness, and other common symptoms of electrolyte deficiency. They can also boost performance and recovery. Electrolytes facilitate hundreds of functions in the body, including the conduction of nerve impulses, hormonal regulation, nutrient absorption, and fluid balance. Many people find that these electrolytes support a low-carb lifestyle by preventing, mitigating, and eliminating the “low carb/keto flu” and they can also support healthy fasting. LMNT replaces electrolytes without breaking a fast.
As a listener of this podcast, you can get a free sample pack with any order. The LMNT Sample Pack includes 1 packet of every flavor. This is the perfect offer for anyone who is interested in trying all of our flavors or who wants to introduce a friend to LMNT. This offer is exclusively available through VIP LMNT Partners – you won’t find this offer publicly available and is available for new and returning customers. They always offer no questions asked refunds on all orders if you aren’t completely happy. Grab the deal at drinklmnt.com/wellnessmama.
This podcast is brought to you by BonCharge and specifically their Sauna Blanket. I know you’ve heard me talk about the benefits of sauna before, and I’ve said that if this was a pill, I think everyone would take it because of the really well-researched benefits of sauna on everything from reduction of all-cause mortality, increased longevity, better cardiovascular markers. Sauna is in general considered an exercise mimetic, meaning that you get many of the same benefits like sweating, like cardiovascular function, and even lymphatic movement from using sauna regularly. But I know that often it’s hard to fit a sauna in a house and saunas can be really, really pricey. And that’s why I’m so excited to see things like this sauna blanket entering the market. This can really heat up your wellness routine because you get all the benefits of sauna from detoxifying to better sleep, to better skin. This is something I try to make a part of my regular routine at least several times a week. And the blanket makes it even easy to do, even if you don’t have a lot of space for a regular sauna, because you can simply pull out this sauna blanket and roll it out, turn up the heat, slip inside and enjoy the benefits. Easy clean up with a damp cloth. And then you can just roll it up and store it under a bed or in a closet. I’m a big fan of putting on a podcast or an audiobook and spending 30 to 45 minutes in the sauna. And it feels like a total brain reset and body reset. So I love making this a regular part of my routine. You can check it out by going to boncharge.com/wellnessmama and using the code WellnessMama to save 20% on a sauna blanket.
I’m also curious if you can confirm or deny this, because I heard this explained one time and I thought it was so cool that basically we assume when we’re nursing that our milk is going to baby. And that’s of course true, but it sounds like there’s actually an interface between mom and baby’s bodies and immune systems. And so the mom’s body is like rapidly adapting in real time to exactly what the baby needs if the baby’s sick, if the baby needs more nutrients. And you mentioned that the body very tightly regulates what comes in the breast milk, but do we have any actual data to confirm that that the mom and the body’s babies are actually in a dance of knowing exactly what the baby needs?
Erin: Yes, absolutely. So the breast has an entire network of lymphatic vessels, just like the rest of the body does. And when babies are actually vacuum attached to the nipples, it’s kind of gross, you’ll never forget this, but like swapping spit and that vacuum into the skin of the nipple, into the lymphatic, so that whatever baby has been exposed to mom is making direct antibodies because of the direct antigens from the baby’s mouth to the nipple. Oftentimes moms are worried when they’re pumping them, of course, oh, I don’t have baby direct, that somehow that’s not going to be as relevant. But actually you’re in the same environment most of the time as baby is. And if you’ve been exposed to what and you’re kissing baby, right? Like often we can’t help ourselves. We’re smooshing them and they’re in our faces and it’s a beautiful immunological dance that doesn’t just have to be direct at the breast. The breast is going to make antibodies to whatever you’re exposed to in your environment.
Katie: That’s so fascinating to me and so cool, even if it does feel a little weird the first time you hear it. Can you also explain what triple feeding is? And if you ever recommend that?
Erin: So, triple feeding is what I call breastfeeding purgatory. So it is not a fun place to be. It means you are trying to increase your breast milk supply because your baby is probably not gaining weight and it’s a very traumatizing experience if it’s longer than probably three to five days. In my experience, if you have no plan to stop it. So what it means is you’re feeding your baby at the breast, then you’re feeding your pump by pumping and then you’re feeding back your pumped milk to your baby. And then I call adding formula quadruple feeding so it’s even more hellish. So it’s really not something that’s sustainable. Triple feeding is something that’s recommended to increase breast milk supply. And oftentimes in the lactation world if you’re seeing lactation consultant, it should be something you are very quickly turning around and reevaluating. Because mom’s mental health is very likely to deteriorate very quickly with all of that extra work.
Katie: And that brings up another important part of the conversation, which is mom’s mental health during breastfeeding. And I know there’s a whole spectrum here in many cases that can happen, but I feel like it brings up some important questions of how can mom support her own mental health while she’s breastfeeding? How can a partner or any support structure support that? I know I hear from women who had the most glorious experience of breastfeeding and they felt so bonded and in love with their babies. And I felt bonded and in love with my babies and also didn’t ever love the experience of breastfeeding. I get touched out very easy. So for me it was like a patient’s learning exercise pretty much the whole twelve years that I did it. But let’s talk about the mental health aspect and how we can help ourselves and also how we can have our support people and partners help us.
Erin: Absolutely. So my motto is “fed is first”, the baby needs to be fed. You can’t move beyond that, ever. That’s the first initial most important thing. So if you are worried about low milk supply and you don’t have enough, you need to feed your baby. Right. The second one is actually mental health, which is why the triple feeding is not something I recommend for more than a few days without reevaluation. It’s important if your baby is not emptying your breast well, that you actually prioritize getting the milk out some other way because maybe your baby has a tie or something that’s causing them to be a poor extractor and by poor extractor I mean maybe the pump is even better, right? So not every baby is better than a pump. Despite the old adage that a baby is better than a pump, that is not always the case and it definitely requires pumping after feeds or even pumping in place of feeds if your milk supply is really deteriorating because your baby is not moving the milk out of the breast.
So sometimes we actually have to do, instead of an ABC approach, we do a CBA approach, we actually prioritize pumping, not latching. Because if you’re really wanting your milk supply to go up, you may need to actually pump instead of latching and that’s heresy in some cases where there’s definitely cases where people have been told that no, you have to get that baby to the breast. But if that baby is actually just spending 45 minutes to an hour and getting ten mils and your pump can get 50, that 20 minutes might be better spent pumping so that you and your partner can get the baby well fed and mom’s mental health is better taken care of. Maybe the milk supply starts going up because she’s not as overwhelmed and stressed about this baby that’s not gaining, she’s going to get maybe even more milk because she’s not quadrupled eating. So all of those pieces need to be really like baby is fed first in mom’s mental health and we can’t go beyond that equation if we’re not kind of checking those two boxes.
Katie: That makes sense and important in that order especially. Another common thing I get questions about and I experienced first hand a few times, was mastitis. So I’m curious, what are some good first line of defense? What does a mom do if she feels like she’s getting mastitis? What does she do if she knows she has full blown mastitis and is there anything preventative that can help avoid it?
Erin: So generally mastitis is misunderstood and poorly treated. The breast of the glands, just like your thyroid glands. And women are often under the impression that plugged milk stuff they somehow have to pound out of breast by massaging it and putting heat on it. And the traditional ways of treating plugs and mastitis is actually not physiologic. So you wouldn’t put a hot compress on your swollen knee, you shouldn’t put a hot compress on a swollen breast either. A gland that’s swollen is going to get more swollen with heat. And vigorous massage is also quite dangerous in terms of increasing what’s basically a traffic jam of milk that can’t get down, it needs to go up. So the milk itself is not necessarily the problem, it’s the swelling and edema around the ducts where the milk is coming out.
So if you can get the edema and swelling up into your armpit, which is where your lymphatic drainage is gentle therapeutic breast massage like gentle, gentle touch, like barely wrinkling your fingers over the breast and massaging your breast. Upwards towards your armpit is going to help to get that traffic jam relieved so that the milk can actually leave and not necessarily overfeeding. On that side, where the quote unquote bug is, it increases milk supply if you’re doing that. And you actually probably have a little bit of oversupply and it’s counterintuitive from everything Google tells you to put cool compresses on and maybe rest that side a little bit more. Take some Ibuprofen for a fever if you feel unwell.
There are definite signs that mastitis is getting worse. If you’ve got a really red wedge shaped area that’s just not getting better, you have a fever that’s lasting more than 24 hours, and if you’re really miserable, you need to seek emergent attention. You probably do need antibiotics, but there’s a spectrum from a mild plug with a little bit of systemic symptoms like a mild fever that can be easily treated with just gentle breast massage, cool compresses, normal feeding, not excessive feeding on that side, and definitely not putting hot salt water or anything like that on the breast. And heat is not bad for something like nipple vasospasm, which is when the blood vessels are going into spasm. So heat is not always bad for the breast, but certainly for plugging a mastitis, it can be.
Katie: That’s helpful. So there is something to my midwife’s advice of cool cabbage leaves and just normal feeding and rest for mom. Turns out I’m convinced midwives have so much wisdom often gets overlooked. Well, I think there’s so many other parts to this as well. I want to make sure we also touch on some of the most common questions I get from postpartum moms because it feels like there’s not a lot of guidance necessarily. There’s tons of functional health advice for women and for men for all categories except for postpartum often feels a little left out.
And I hear from so many breastfeeding moms very specific questions about whether they can do certain activities, certain supplements, all these things while in that postpartum and breastfeeding phase. So I’d love to touch on some of those if possible, starting with are there any supplements that are generally helpful for the breastfeeding phase that are often just beneficial to women across the board in that phase, and or are there any that should absolutely be avoided during breastfeeding?
Erin: I think in general, again, we don’t have enough data really. It would be nice to have an amazing database of supplements and herbs that we can refer to. That’s amazing. It gives us lots of really good science around us. We don’t have that.
But in terms of clinical experience, I’ve definitely found things that can be helpful are things like vitamin D, which I had mentioned earlier. Magnesium. Also, supplementation with magnesium is safe. It can help sometimes with sleep just like it can in any other time of life. Magnesium, just like glycinate or three and eight is often something that I will suggest for new parents who are struggling with sleep and maybe a little bit of anxiety postpartum. It’s definitely not to replace something like therapy and medication, if that’s what you need. It’s certainly not something to do alone and you need to reach out for help if you do have postpartum anxiety and depression. That’s not a journey you take alone and try to supplement yourself out of. But magnesium can be helpful.
Omega-3s again, like anything fatty, can be influenced. It’s not going to increase the fat content of the breast milk, but it can influence what omega 3 to omega 6 ratios. There are again, not super great data on that but makes physiologic sense. And in terms of things to avoid, probably sage because that can decrease milk supply. Peppermint oil, unless you’re looking to decrease your oversupply, maybe peppermint oil is something I will sometimes recommend just to kind of take the edge off of oversupply. And yeah, there’s definitely some decreased milk supply with sage extract. And if you don’t want to have that little drop in supply after your turkey dinner at Thanksgiving, maybe avoid the stiff stuffing.
Katie: That makes sense. And then beyond that, it would seem like everything gets into the realm of personalized and consult with your actual provider. If you have a specific question on something you specifically want to take but you’re not sure of safety for baby, it seems like that’s a very nuanced. Consult someone who has direct knowledge of you and your medical situation type scenario.
Erin: Absolutely. And most I think supplement companies are definitely putting the contact your doctor and speak with them and that would apply for anything for sure. Don’t take medical advice on podcasts, that’s an individual decision for sure. But for things that might be helpful, this is probably not a bad way to start.
Katie: Okay, the other one I get a lot is if sauna use is okay in postpartum and breastfeeding. And this one, the more I’ve talked about sauna, the more I get this question. And I’m curious. Obviously baby doesn’t ever need to go in the sauna, but can mom sauna in any amount postpartum? I know this often can be a helpful for stress relieving in other populations and we talked about the mental health side. So I’m curious is there a safe dose of amount of sauna that postpartum moms can do?
Erin: Probably not a safe dose or upper limit other than just dehydration, there’s no reason why you couldn’t do sauna other than making sure you’re really hydrated and taking care of yourself, otherwise.
Katie: Well that’ll be encouraging for a lot of moms listing. My only direct experience with that was visiting Finland and seeing definitely moms who had babies getting in the sauna, not with their babies and even pregnant moms and not as intense of saunas and I know that’s not recommended in the US. But it made me curious like what the actual recommendations were when it comes to sauna use.
Erin: Yeah.
Katie: Is there any other universally beneficial advice that you think postpartum moms and breastfeeding moms can benefit from and or any other universal things to avoid in that time period?
Erin: I would say again like protecting your mental health, getting sleep, surrounding yourself as much as you can with a village of people who can help and a partner that is invested in not necessarily trying to beat the baby to bond with them. If breastfeeding exclusively at the breast is your goal, but learning how to support you through other means like the humming, skin to skin, like baby wearing partners are good at that and it’s their superpower actually. So it doesn’t have to include beating that you are bonding with your baby that way. Right, so it definitely is something I think more people need to learn is those skills of regulating a baby in some other way.
Katie: That’s a great point. It seems like it’s easy to fall in the trap of just regulating through nursing. And I know having a partner who could hold the baby even for a little while and just as a new mom, getting to take a shower or go for a walk or just have a little bit of a mental health break also was tremendously helpful. Much more than it would have necessarily been helpful for him to just bottle feed the baby. So I think that’s an excellent point and one that touches on that mom’s mental health side and certainly a way that a partner can be very involved and support both mom and baby in that process.
Erin: Yeah, absolutely. What I meant by the partner feeding the baby would be by bottle because that’s often what the default is, right? So yes, don’t keep the baby from the breast when they’re hungry, obviously. But oftentimes partners feel that the only way they can bond is by giving that baby a bottle and that’s not necessarily the truth. Right.
So finding ways that work for you and again, nothing that I say, I always say, nothing I say is written in stone. This is platters of options. You need to find what works for you and pick off the platter that works? When you’re looking at things like feeding, it’s going to be all permutations and combinations that work differently for different families and it doesn’t mean that you have to exclusively breastfeed to have a really amazing feeding journey. I like to call inclusive feeding out because I think inclusive feeding is what is important. Exclusive anything is not necessarily the way to happiness and bonding. You can do this in other ways that don’t have to look, quote unquote, perfect. You can actually have an amazing feeding journey and just pump and bottle or just formula feed or have whatever combination of the above makes the fed and mental health work, right? Because if we’re not prioritizing those two things, we really are in a spiral of downward getting worse mental health. And we need definitely I can’t fix the societal issues that come from not having childcare, not having mental health support, but making it so that families feel that they can be empowered to feed their baby and protect their mental health and still have the bonding and the love and the connection with their family that doesn’t have to look perfect. I think there’s a lot of misunderstanding and trying to look perfect and do things perfectly that is just so much extra stress on an already stressed society that’s trying their very best to just be good parents.
Katie: That’s true. So important and very much a both/and situation. To your point, this is not an either/or and often it seems like the best options are a hybrid or a combination of whatever is going to support both people and that like you explained, very symbiotic two-way relationship that’s very unique in medicine. And on that note, I know there’s so much more than we can cover in 1 hour related to this topic and that you have a tremendous amount of resources, even free content available online. And that you’re one of the few MDs who’s also certified by the Fellowship of I believe is it breastfeeding medicine and that you have a tremendous amount of resource available here. So where can people find you online especially to get answers to more specific questions?
Erin: Absolutely. So I’m at breastfeeding.MD on Instagram and I have a website that’s breastfeedingmd.com because of the situation with my clinic where my wait time is huge, I have about eight weeks and that’s if anybody has had feeding problems with their kiddo way too long. So in order to help people who are on my waitlist, I actually made a course of 15 minutes or less videos that’s available for purchase on that website that goes through the things that I talk about all the time. Like the very simple, repetitive things that I’m telling people in the clinic. How to improve their latch, how to increase their milk supply, how to decrease their milk supply, how to latch a baby with a bottle if you’re pacing and wanting to do breast and bottle. Both.
So it goes into a lot of how to that I talk about all the time in my clinic so that people at least have the resources of good evidence based breastfeeding and infant feeding care before they get to me. So that inspired me just this past little bit to create a course of people to have that information. So it’s available @breastfeedingmd.com but you can also there’s like a free and lift high information PDF, there’s lots of other things on that website.
I also have my clinic website that has a ton of other people’s resources that are linked for free and that’s nurturefeeding.com. So that’s another free resource for parents.
Katie: Awesome. And those will all be linked for you guys listening on the go at wellnessmama.fm, along with show notes from this episode and a couple of last questions I love to ask at the end of interviews. The first being if there is a book or number of books that have had a profound impact on you personally and if so, what they are and why.
Erin: So I went on a bit of a journey of self-discovery and self-care over the last few years and that’s where my interest in functional medicine kind of came from. I actually really loved The Surfer and the CEO. It spoke to me as a story of how to really live life to the fullest. And I just found those stories spoke to me more than even somebody saying this is how you need to prioritize things. So it really helped me on my journey, along with multiple other self-care and self-help books, for sure, but that was one that really stuck out to me because it was a story that really rang true for me.
Katie: Awesome.And lastly, any parting advice for the listeners that could be related to breastfeeding or any of the topics we’ve covered or entirely unrelated life advice that you found helpful.
Erin: So I thought long and hard, I think, about self-compassion over the last number of years and I think to me, self-compassion is something that I think particularly moms need to keep in mind. We’re very hard on ourselves. We tend to be our own worst critic and sometimes our own worst bully in our head. And learning to love yourself no matter what, not being a perfect person, not being a perfect parent, realizing that we need to have that self-compassion to move forward is so important. So I think self-compassion is probably one of the most superpower skills you can develop and I’m definitely still working on mine.
Katie: I love that. I think that’s a perfect place to wrap up for today. Thank you so much for the time and for all the work you’re doing for new mom and for families. I’m very grateful to have you here and thank you.
Erin: Thank you. Same to you, Katie.
Katie: And thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy and your attention with us today. We’re both so grateful that you did and I hope that you will join me again on the next episode of The Wellness Mama podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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