lactation consultant

hey guys we are live! my name is smita aka drm. and and todayi'm joined with abha also known as dr. sharma and (please excuse my dog in thebackground! he saw something he doesn't like!) today we're going to be talking aboutsomething so many mother's struggle with and that is breastfeeding. i do want topreface this conversation to say that this is by no means a lecture to makeyou feel guilty if you're struggling to breastfeed or if you cannot breastfeedor you simply choose not to breastfeed this is simply just to help the mothersthat do want to breastfeed. and personally for me i had every intentionof breastfeeding my child but lactation

consultant after lactation consultantand my child would not latch and eventually i didn't make enough breastmilk so i had to stop and i only began to enjoy motherhood when i let go ofthat guilt. so what i want to tell you guys is how you choose to safely feedyour baby is no indication of how much you love your baby. so the most importantthing is a baby that is fed and a mother that is sane! you will have nojudgment from us it as to however you choose to feed your baby because what weall need is a little less judgment in parenting. amirite? yeah that's right! so with that being said today we'regoing to answer some commonly asked

questions about breastfeeding and breast milk. before we start i do have animportant to disclaimer to make. i am a physician with kaiser permanente howeverthe views and opinions expressed here do not represent those of kaiser permanente. they're simply her own! yeah they're just mine! soquestion number one feel free also if any of you are liveto send in your live questions as well we'll take those too. but questionnumber one-very common what are the best positions to help mybaby latch? so there's no one perfect or best position to get a baby to latch. everybaby is different and every

mother is different so it all depends onthe mom and the baby. there are about four or five differentpositions that are commonly used to help us demonstrate we have baby alive (doll). so cute! so when you first have your baby typically a lactation consultant or amedical professional trained in breastfeeding medicine should come by toevaluate you and the baby and they'll go over your breast anatomy, the baby's oral anatomy and help you to latch on. so just rememberwith any position that you use, the way you hold the baby is key! so you neverwant to put your hand right on top of

the baby's head like that because it willbe a reflex response for your baby to push back against your hand and then you maybe tired or exhausted and so then your wrist slowly start to do this and youdon't want to yank back on your baby's head and neck so instead you're going to put your palmhere and you're going to rest your fingers right here kind of at the baseof the baby's skull and that gives adequate support so that's the hold. sothe first common breastfeeding hold is the cradle positionso it's pretty explanatory-you're going to cradle your baby like this andso if you're cradling the baby in your right arm and right elbow and handyou're going to place them on your right

breast and you're going to use your freehand your other hand to support lift up and cup your breasts and help guide the nipple into the baby's mouth. depending on the lactation consultant or medical professional that sees you, they might either have you cup with a 'c' or with a 'u' to help hold up supportthe breasts and then do compressions of your breasts as you feed. so that's cradle--and then the second oneis cross-cradle--so you're cradling and you cross over to the opposite breast. so since you've crossed over you're still going to use that free handand in this situation probably a better way to keep your hand would be a 'u' hold--because if you think about it if you do

this you're kind of getting in thebaby's way of the food so you're going to do this instead. so that's the cross-cradle. and then thethird most common one is the football hold so you're going to hold your baby like afootball on the side. you may need to angle them a little bit like this. andthe free hand is still going to do the same thing as the other positions. one thing iforgot to mention with these first three that i reviewed is that you don't wantto leave a gap like this between you and the baby because then you're going tostart to lean over like that. you want to make sure the baby is at your breastlevel and their belly is turning towards

your belly and chest. so that's going to helpyou with those three positions. the fourth one is the laid-back positioning. sothat one is very laid-back you're not going to lay down flat on your back. you're actually going to recline back ina recliner chair or on in bed but propped up on pillows and with thisposition you can pretty much holding and supporting the baby this way justexplore and find the latch that works best for you. this position actually works really well when you're still in the hospital after the baby isborn.

if you have a premature baby a lot oftimes it's helpful and then if you have a larger breast size sometimes this iseasier. and most importantly if you have overactive milk flow this helpskind of take away the gravity. so that's the laid-back position. i think thatcovers all the common positions! perfect! so there's four position shewent over: cradle, cross-cradle football and side-lying (laid back). i know for me thefootball position like this... the football position like this workedbest because i wouldn't lean over and get get this gap between thebaby and i. so whatever works for you try all the positions and one of them willprobably be the most comfortable. so

here's another very common question--howdo i increase my milk supply? what can i eat? and what can i do? veryvery common question so the key to establishing and maintaining your milksupply is definitely making sure you extractor remove the breast milk at regular intervals. so that's going to be eitherputting the baby on the breast for breastfeeding every three hours as aminimum or removing it with a pump so that's going to be key. to establishthat course you need to make sure your latch is evaluated early on, and any issuesare corrected and then maintain that. if you go beyond those three hourintervals, you do risk minimizing your

supply or decreasingit rather. so that'sthe best way but your diet, hydration and some dietary supplements can helpsupport that. with your diet you want to make sureyou're consuming at least 500 calories above your pre-pregnancy intake. andthat's key to helping maintain breast milk production. if you're concernedabout losing weight post-partum then definitely make sure you're not goingbelow 1500 to 1800 calories a day. if you do go below that 1500 number, yourisk diminishing your breast milk supply. and one important thing to remember isif you're worried why you've been working out, you've been eating the rightnumber of calories to keep up your

breast milk supply but you just can't get rid of those last five pounds...remember that yourbody actually clings on to that amount of fat--about five pounds--to serve as astore for your body to produce breast milk so once that time period is overwhere you and baby decide to wean off nursing and you'redone, then your body will lose that weight. and how about herbal supplements ornutritional supplements? so you're going to see when you go to the store there's a lot oflactation teas, supplements, cookies granola bars and so there's gonna be alot of recommended ingredients but the two ingredients that definitely havescientific studies showing that they

increase breast milk production are brewer'syeast and fenugreek. (here i'm spelling the ingredients for those without subtitles:)) so fenugreek is available in teaform or you can buy it in capsules it's a common seasoning or spice used in indian/middle eastern food and the brewers yeast can be put in cookies asflakes or powder but the best way it can affect your breast milk production is intablet form. with both of these supplements they do decrease blood sugarso if you have a diabetes diagnosis or have issues with blood sugar levels, avoidthem until you talk to your doctor so one very important thingi know a lot of a lot of women want

to lose our pregnancy weight as soon aswe give birth and if you're trying to breastfeed you want to not go too fastwith that and one thing to not feel bad about is like abha said is we hold on to 5pounds of fat so there's nothing wrong if you're not losing the weight and ifyou're not losing it fast enough don't feel bad about it. how beautiful is it that your body cando this for somebody else or even go through the whole pregnancy process. lordknows it's not easy! so just just really be in that appreciativestate you will eventually lose the weight, it may just take a little

time. so another question--does giving mybaby a bottle of pumped breast milk or formula affect your breast milk supply?because sometimes we're just tired! we just want to sleep! so you want to have your spouse or your partner or afamily member feed the baby so will giving the baby a bottle or formulaaffect your milk supply? so definitely you know we've both been through this, we bothhave toddlers we so we know it's exhausting and you need that nap oryou need to just break away for an hour two-- but if you go beyond that threehour interval that i mentioned earlier

without removing the breast milk, you sendthe signal to your body that you don't need to produce more breast milk becausethere's no demand so we don't need to produce the supply of milk. so if you needto take that break and give the bottle of your pumped breast milk or if you'rechoosing to supplement with a little bit of formula then youneed to make sure that while your spouse, or your partner or your family member isfeeding the baby, you put the pump on and if you have another adult in thehouse that's there to help you, have them feed you or bring you a snack so that way youpump, you eat and then you go to sleep. and then three hours will pass and you need to get up and feed the baby again!

so give the bottle, get your rest, pump and go to sleep! key! yes very important. ask for help, it's key! so another question--i just pumped my breast milk and saw how thinit is! should i give the baby a bottle or formula so they don't go to sleep hungry? all of my family membershave been telling me that breast milk doesn't have enough fat and won't keepthe baby full. so this is a very common question i get. so when you'renursing your baby obviously you don't see the appearance of your breast milkand so your breast milk composition is going to vary throughout the day and itchanges to meet your baby's needs. when

you pump it and you put thecap on and put in the fridge and look a few hours later, the fat floats tothe top and then the rest of the components of the breast milk are at thebottom so it looks thin or watery. so a lot of times that leads you to think maybeyour baby is not getting enough but your baby's going to get all the rightnutrition with your breast milk that you pumped. it's a common myth that theformula is more nutritious or maybe has more fat andkeeps the baby full, but actually the only reason that the formula helps thebaby to sleep a little bit longer than the breast milk is because the emptyingtime from the stomach is a lot longer

than your breast milk. so that's why! you know when i first looked at mybreast milk in a bottle i was like 'this looks really weird!'yeah it can look watery and sometimes it can even take on different colors. yes!. sodon't be worried, that's what it's supposed to look like.and they love it! this is so common i thinkalmost every mother that has come to my clinic has asked me this question. does giving my baby a pacifier mean he or she won't latch onto the breast anymore? so the issue with giving the pacifier in the first three to four weeks

after the baby is born is that's whenyour baby is showing you their hunger cues and you're learning what they are.so if you use the password to soothe your baby, you may actually miss that they arehungry. so by the time they're really hungry the late hunger cue which is that they are justscreaming her head off you know you have to actually calm down your baby and thenget them on the breast or get that pumped breast milk in the bottle andmore because you missed them smacking theirlips turning their head suckling on the

fingers and sticking their tongue out. sothat being said if you need to use a pacifier to soothe your baby, you definitely want to use this type ofpacifier. so if you look at it it's shaped much like your nipple and thisthis may look familiar to you if you already have kids or if you work in thehospital setting. this is what is used in hospitals during procedures or if the babyneeds to be soothed you definitely in the first month wantto use this and not use this type of pacifier. so do you see the difference? round and this is flattened. so if you use this type-then your baby will definitely getconfused because this is not shaped like

a nipple so definitely this one. so definitely the rounder nipple is what you want, not the otherone. and where can you get the round nipple? so this particular one was the avent brand. i picked it up a target so you can find it at target you don't have to go to target butthat's where you can get it from or babies r us so yeah the avent brand. and if it's been more than 90 minutes after feeding? so if it'sbeen more than 90 minutes since your baby's fed you may actually need to feed the baby. and definitely don't use the pacifier to--another question i get alot from parents is--

well maybe we should stretch out the feeds a little bit by giving the pacifier. no if they'reshowing you that they're hungry then go ahead and feed them. yes. and the next question kind of goesfrom this question--so i'm going back to work and i have to pump my breast milkso the baby is going to have to drink from the bottle does this mean that mybaby will get confused have 'nipple confusion' and refuse to latch onto thebreast? so what happens when we go back to work and we have to pump? so with bottle feeding the breast fed baby, the

confusion or refusal of your baby tolatch after taking bottle is really not so much related to the size of nipplebut it's how you feed your baby so if you think about it when the baby latchesonto your breast, they have to work and you know suck and swallow and you haveto do compressions on your breasts to get the milk to come out--but with abottle and here comes baby alive again-- she comes with a bottle! so if you think about it, not every parent does this butyou just put the bottle in the mouth the milk flows out and you're lookingaround and you know within a minute you're like oh it's all gone she'sreally hungry maybe she needs more

formula! and really not much work was putinto gulping this down because it all was just flowing out. so the key thing is howyou bottle feed the baby so let me actually position her a little bit better. so what you wantto do is instead of having her flat like this, prop her up like this (or him). and thebottle you're actually going to imitate what you do with your breast and nipple right before feeding starts so you're gonna tickle the nose with thenipple and tickle the lower lip in the upper lip and go back up to the nose andthen drop a drop of the breast milk on the upper lip but by that point the babywill open their mouths big and then you

guide the nipple in. and you're going to keep it kind ofslanted like this or angled like this and baby's gonna suck and swallow the breastmilk three or four times and after that fourth time you want to not remove thebottle but just make it more horizontal so that the flow isn't there and whenyour baby starts sucking again then you guide it back to angle, count to fouragain and then make it more horizontal again you can count to four so this willgo back and forth. if your baby when you make it more horizontal after youcount to four seems like they're falling asleep you know stimulate them. i'm going to move my hand back a little bit. so you'regoing to stimulate right above the elbow-

if someone else is sitting with you havethem kind of rub the back of the baby's head and that will wake them up alittle bit and then they'll start sucking again and you can angle the bottle again. so what this method is called is pacedbottle-feeding and that helps mimic what your breast does. so how interesting! so the key to avoiding nipple confusionis the way in which you feed your baby to have them work for it! yes, exactly! and the same way that theywork to get the milk out of the nipples

so it's not exactly the nipple confusion,it's the process. so you don't have to buy 20different nipples and experiment with them if you do this method, it definitelyworks and i did this with my daughter when i went back to work. ok so now that you got the hang of nursing your baby and all of a suddenyou find out that your baby wants to feed all the time allevening, day/night does that mean i'm not making enough milk? so your baby in thefirst 3-4 months after birth their nervous system is immature, they undergogrowth spurts at different intervals. different books are going totell you at two weeks, at two months and

four months those are some of the common times theyundergo a spurt in their growth. so of course with thespurt in weight and height they're gonna want more calories and more breast milkand because their nervous system is immature, they are of course going to getreally fussy in the evening between six to 10pm up and then they're going tocluster so that you're going to feel like your baby wants to feed every houron the hour and then they go to sleep for longer than that three hour stretch andwhat your body does is because of that repeated stimulus from the breastfeedingback-to-back it is going to respond by

giving more supply of breast milk. soyou're definitely not under feeding your baby. this is a time period that can be a littlefrustrating for most parents because they're exhausted but it's very normaland provided your baby's gaining weight and on track with developmentalmilestones, you don't need to add a bottle of formula especially if yourgoal is exclusive breastfeeding. so basically you're telling me that's life and deal with it! yeah sorry! okay this question...super important :) so i had a glass of wine how long do i wait before i canbreastfeed again? should i pump-and-dump?

ok so definitely go ahead and have thatglass of wine you don't have to pump your breast milkand dump it out so most of our medical literature statesin a day breastfeeding mom can have either an 8 ounce glass or two beers and that's safe. it won't decrease your breastmilk supply and it won't inhibit your let down you don't have to wait a specified timeinterval to nurse your baby or pump just wait until the effects of alcohol wear off-- inother words until you're sober-- and then you can pump and store the milk orsafely nurse your baby

so with one glass of wine just waittill the effects are over and then and then you can go ahead. yeah and don't throw out the breast milk. butif you've had more than that then yeah if you have more than that then ofcourse it's going to take a little bit longer to go back to sober state. so just make sure just that you're pumping and letting the milk out but if you're stillnot sober don't give that milk to your baby. and what do you think aboutthose alcohol strips? i have personally never used them i've heard a lot of people do and so i don't have experience

with the strips. so you canbuy the alcohol tester strips. yeah, i've seen them before. so that's another way to check if there's alcohol in your breast milk. but the mainthing is that you're not feeling the effects and when you're not feeling theeffects it's safe to breastfeed. so go ahead ladies! have your glass of wine! sometimes we need it! okay so our last question.. i'm nursing my infant and found out thati am pregnant i need to wean off immediately and if i keep breastfeedingwill this affect the development of the

baby on the way? ok so definitely an excellent question. so pretty common scenarioyou definitely do not if you want to continue nursing your current infant ortoddler you don't have to wean off and stop you your body will produce the right amountof nutrients in breast milk for your baby or toddler and your body will alsouse it stores to help you're developing baby grow--the one in your uterus--theperson that you really need to look after is yourself if you're in thisscenario. so if you are pregnant and

you're nursing at the same time, talk toyour ob/gyn or your regular physician about what your nutritional needs arebecause you'll definitely need to go up on your calorie intake and the vitaminsand minerals as well. so it's a beautiful thing! how amazing our bodies can do this right? even though sometimes we go insane. but how amazing! so that's that's our episode for today.the key thing is to take care of yourself, ask for help, get your rest. happy mom isa happy baby. let go of the guilt if you've doneeverything, it's not working

just let go of that guilt. enjoy being amother because it can be quite awesome...sometimes (just kidding!) so until next time remember if you have any questions if you have any further questions leave acomment on our video we'll answer them join our newsletter for more informationjust like this i'll post the link soon and we'll see you next time have a greatday! bye!