Natalie: 0:49

On today's podcast. We talk with Carrie Harris and Sarah Stephens, both internationally board certified lactation consultants who are passionate about educating people and empowering them to be successful in their breastfeeding journey. For those of you who choose to use formula to feed your baby, please know that we are all advocates of feeding your baby in whatever way works for you and your family. Hello and welcome. I'm Natalie. And I'm so excited to have both Kerry Harris and Sarah Stephens on today to talk about breastfeeding. These lactation ladies really know their stuff. So Sarah Stevens is an internationally board certified lactation consultant in Anchorage, Alaska. She is currently starting a private practice, just call Sarah that specializes in home lactation care education for families and for businesses and clinical men mentorships for aspiring IBCLCs. She has worked in clinics and birth centers. At WIC and in several hospitals providing lactation care, she has presented at several conferences most recently, the midwives association of Alaska conference in 2020 and the American public health association conference in 2019, Sarah enjoys all of the plane outdoors that Alaska has to offer and loves to make messes in the kitchen and in her garden. So welcome Sarah, Carrie, Carrie Harris is also an internationally board certified lactation consultant who has been working with breastfeeding families for 12 years. First as a let J league leader and founder of Lecce league of Anchorage. And then as an IVC at midwifery and women's health, for the last three. She is a mother to three wild boys, all breastfed with great difficulty to add. She sits on the board of the Alaska chapter of postpartum support international. And does advocacy work with the maternal mental health leadership Alliance? She thinks she has the best job in the universe. I carry like baking boobs, big earrings, and hanging out with our girlfriends. So welcome ladies. I'm so excited to have both of you today.

Carrie: 2:57

for having.

Sarah: 2:58

Yeah, thanks for that.

Natalie: 3:00

So let's just start with, what led you to decide to pursue a career in women's health and specifically lactation.

Carrie: 3:13

go

Sarah: 3:13

is,

Natalie: 3:13

wants to go first.

Sarah: 3:16

this is Sarah. Um, so when I had my first baby, I knew I planned to breastfeed. Um, I had seen breastfeeding with my family, um, with my mom, um, and my younger brother. And I just kind of had grown up with the attitude that like, this is normal and this is what babies eat and like not a big deal. But we were living really far away from family and we didn't really have access to very much prenatal education, like no breastfeeding education at all, and really minimal like birthing classes. So I, you know, I read as much as I could and I knew a lot about why to do it, but most of the books back then didn't really tell you how to do it. And this is really before the internet was a reliable source of information. So I ended up having a preterm baby. She was born at 34 weeks and she went to NICU and the hospital. Extremely like, not even just not supportive of breastfeeding, but they were actively undermining my breastfeeding. My baby was getting formula bottles, um, without my consent. And they weren't, you know, they weren't supporting me to breastfeed, but they also weren't calling me when it was time for her to feed. And so we, you know, we made as biggest and cause we could as parents because we knew that we had the accurate information, but we were really being opposed in the hospital. So they discharged us early with the baby on oxygen, um, who had never successfully breastfed. And I was home with this baby that like, didn't know how to eat and I didn't know how to feed her aside from preparing her a bottle. And um, we eventually figured. And it was really hard and we figured it out and we had a long and happy and very successful breastfeeding relationship, but kind of the upshot of my experience was that like, even though everything was going great, I didn't really feel like her mom. I didn't really feel like I was empowered to make any kind of decisions about her. Um, because we just spent so disconnected from each other at the very beginning. And I really like, I never wanted another parent to have to feel that way. So even though the breastfeeding was going well, the parenting wasn't going super well. And that's why I do what I do. I don't want families to have to experience that disconnection and that disempowerment that I felt. And so that led to me also becoming a validated lean leader a very long time ago. And eventually after we moved to Alaska, I found a great mentor and was able to become a lactation consultant.

Natalie: 5:41

That's an amazing story. Wow.

Carrie: 5:43

Yeah.

Natalie: 5:45

It's a lot of history that goes into it. So Carrie, go ahead and share.

Carrie: 5:52

Um, what made me want to become a lactation consultant? Um, so when I was pregnant with my first west, um, you know, I, I wanted to breastfeed, I was going to give it a try, but I was not married to this idea of breastfeeding at all. I liked the idea of kind of like the earth mama goddess, like feeding my baby with my own boobs and not something that I buy it is like, I kind of liked that vibe. I was like, that would be super cool if that worked out, but, um, pretty much everybody I knew in my family really had a very difficult time with breastfeeding, of course, because they had no support and no information. Um, and it was a very unpleasant, difficult, um, heartbreaking experience for them. And. So I was very ambivalent about it. Um, and then of course he was born and then the minute I saw him, I was like, oh no, I I'm definitely going to breastfeed this baby. This is incredibly important. And so we started out and, um, you know, within hours my nipples were turned into ground beef and just, it was the most painful thing I'd ever done. Um, and I had a really hard time finding support a really hard time. There was one lactation consultant at our hospital, like as far as I knew, kind of in the whole area. Um, and she did her very best, but, um, Being a lactation consultant was not her main job. And she just didn't really have a lot of time. I eventually got hooked up with and they helped me out a great deal. So I became really involved with them. And the more I learned about lactation, um, the more fascinated I was, I had no idea that breasts were this magical and that, I mean, they're literally miraculous, right, Sarah. Um, and I just found it fascinating. Um, and then again, like Sarah, it was such a fraught. My first couple of months was such a fraught experience and I didn't have enough milk. And I didn't know that I had a certain type of breasts that, um, don't just don't produce tons. Um, yeah, I mean, there was all kinds of stuff that I didn't know, and I really didn't have any guidance other than Lala to, and they really encouraged me. Um, I found some support online in the community. I set a goal for myself that similar to Sarah, I wanted to, uh, make a career out of helping people navigate breastfeeding, whatever that looked like for them. It's different for everybody and every family and situation. Um, but I wanted to provide a timely and informed and evidence-based help to people who needed it. Um, because that was so difficult for me to find. And, um, we could have had a much easier go of it, know, if, if I had had that, um, and then I went on to breastfeed my second and my third child as well, um, a whole new set of problems with each one of them. Um, and yeah, I also, at that time with my second one, Sarah Stevens was actually my lactation consultant. And she was magical. And so flipping smart. And I was like, well, I would like to be her when I grow up. And so she really encouraged me. And, uh, and then, yeah, after I, you know, my kids were a little bit more grown and I had some bandwidth and Headspace to pursue and I BCLC that's, that's what I did.

Natalie: 9:30

Awesome. Awesome. Thank you both for sharing. And you actually answered my next question. I was going to ask how you met and how you became boob friends, because that's how I know you both. I feel like, and whenever a client asks me a breastfeeding question like here, these are, these are my blueprints. You need to talk to them.

Sarah: 9:52

So the practice that I used to work for, um, was really mixed in their rules about being like friends with patients. And there were some of the providers who were like, I would never allow a patient to be friends with me on social media. I would never like hang out with a patient outside of, you know, the professional practice. But for me it was, I was like, we have rad patients. These are people that I would want to be friends with in my real life. And so Carrie and I were friends on social media, even though we didn't really hang out together. And at one point when she was pregnant with her second one, she said she was really craving donuts. And so I made like my grandma's recipe and I knew she had an appointment the next day and I brought her donuts and she took a donut. She put it in her mouth and we were like, kind of like, you know, really enjoying each other's company. And then she was like, oh crap. I actually have my glucose tolerance test today.

Natalie: 10:52

Oh, that's the best story. Oh my gosh.

Carrie: 10:56

was a highlight for me. Yes. You know, Sarah was working there at the clinic and, you know, I would see her before I was before I had my second and thought she was very cool and then breastfeeding issues with my second, she was so knowledgeable and funny and smart. And I was like, I, I got to find a way to be this girl's friend and then, you know, donuts and just lots of talk about boobs and a friendship grew. And, and I just love her to bits and bits and bits.

Natalie: 11:31

I love it. I love it. That's awesome.

Sarah: 11:34

She called me once and said, Hey, I'm going to be on this charity spelling bee team. And I think you should join. And Carrie is so enthusiastic about everything that was kind of like, Hey, you're a good smell, speller. You're really smart. Um, I'm going to do this spelling bee and I think you should do it with me. I think it would be really fun. And I got caught up in the energy of the moment and I was like, yeah. Okay. That sounds amazing. Sure. I'll do that. And then I was like, what did I just agree to? I'm not sure. I actually want to do that fun.

Natalie: 12:01

And did you win? Did you win the spelling? Wow.

Carrie: 12:06

Yeah,

Natalie: 12:08

gets you a long ways. I think. Um, so both of you mentioned in your own breastfeeding journeys that you had lack of support and, um, found support along the way and, and made a career out of it. But do you feel like that is really common nowadays? Is that part of the reason that breastfeeding is so challenging? Would you say.

Carrie: 12:35

You know, I mean, so I have a little bit of a roundabout. Yes. And no answer. We are really lucky to be here in Anchorage, Alaska, because we have some absolutely top-notch lactation people around here. It's not just Sarah and I, it's all of Providence lactation, um, other lactation consultants at other midwifery clinics. So many lactation consultants that are so good at different pediatric clinics. We have a lot of lactation help around here. And so if you want to breastfeed and you're having issues and it's not going well, there is always somebody that you can call. I feel like we're lucky in that respect. Um, a lot of people, I think don't, don't utilize them very much. Um, don't know exactly when to call a lactation consultant. Um, so we have the support around here. Uh, A lot of the support that's available is of course only available during nine to five office hours and feeding your know breastfeeding. Your child is a very time sensitive thing. You can't just have a baby that stops latching at 7:00 PM and be like, oh, well, I guess we'll just put off feeding until I can get ahold

of somebody at 9: 13:59

00 AM tomorrow. It doesn't work that way. Um, so yes, we have a lot of help around here. Um, I've wished that more people knew about it and I wish there was more round the clock help available. Um, I also think that the onus should never be on the person who's struggling to actually reach out and get the help, um, and have, then have to, you know, state with a newborn that isn't feeding well, get themselves all dressed and clean and ready and in the car and out in the snow to a clinic appointment. I feel like if you're endeavoring to breastfeed, the whole world should just drop everything and come to you.

Natalie: 14:45

agreed

Sarah: 14:46

Yeah,

Natalie: 14:46

as with anything in postpartum. I think.

Carrie: 14:49

exactly.

Sarah: 14:52

I would add that. I think a lot of people are maybe just culturally, we don't realize how much breastfeeding is a community endeavor. I get very frustrated even like when at that public health conference that I spoke at, um, the whole audience and the whole panel speakers on breastfeeding was all women. I mean, this had public health experts from the entire country working on all kinds of really important topics, but breastfeeding was kind of a lady thing and it's not just a lady thing. It takes so much community and so much to support to be able to breastfeed. And I think that most people aren't prepared for that before they have a baby. Um, I think most partners and families aren't prepared for the amount of support that they're going to need to provide, but it also comes from employers and it comes from hospital and it comes from policy and it comes from so many other places that. Trying to breastfeed. They're often kind of fighting against some of these tides of like, well, am I informed my employer? Doesn't value this and doesn't think it's important. And I'm having to advocate for myself to get time to pump or to have a longer maternity leave or whatever it is, or, you know, my partner doesn't understand why I don't look like I'm doing anything all day because I'm stuck in this chair on this couch for eight hours and I'm asking for snacks and water to be brought to me and things like that. Um, so I think that really, it, it can be really challenging to find those people that support you and sort of pave the way and facilitate that.

Natalie: 16:21

that makes a lot of sense.

Carrie: 16:22

Bingo. And I think that the thing that you're getting at this Sarah is that it's not just technical. Know-how like, okay, we're going to hold the baby in this way with this arm. It's not just the technical aspects of breastfeeding that the mother needs support for oftentimes, um, to an even degrader, an even greater degree. It's the, it's the emotional support. It's the logistical support. Um, yeah,

Sarah: 16:49

Yeah.

Carrie: 16:50

That's a lot harder to come by than it should be.

Natalie: 16:52

yeah. Yeah. Agreed. So there's definitely a lack of support awareness, I would say. So people don't know that there's a support available, but then there's also like a deeper vein of the community aspect of this is a family endeavor. This is a, a community endeavor where friends and family and employers have to be supportive to make this thing happen.

Sarah: 17:17

Absolutely. And I think we spend a lot of time trying to educate women on like they should breastfeed and why they should breastfeed and how important it is to breastfeed. But we spend a lot less time and resources on educating other parts of the community about how important this is for a healthy entire community and sort of what their role would be in and facilitating.

Natalie: 17:37

So then I guess my next question is how can we do that? Or how should someone approach that, like someone who's pregnant for the first time wishing to breastfeed, what should they, what should they do? How, how can they educate themselves? How can they educate their family, their partner, and everybody around them to make it the smoothest path possible.

Sarah: 17:59

That is such a good question. And I wish I had a perfect answer for you. I think. Um, so I think a really helpful exercise is to sit, you know, sometime before the baby arrives and think about. What you're going to need. And, you know, usually it's concrete things that you come up with first, right? I'm going to need somebody to provide X amount of meals for me, or I am going to need, you know, to talk to my employer about having this much maternity leave or being able to pump this many times during the Workday or things like that. Um, but I think sitting with somebody, especially, you know, somebody who is either a lactation professional or somebody who's experienced this before, maybe recently helps to get at some of those, those deeper things about like, oh, you know what, your baby can't tell you that you're doing a good job. So your partner might not have been socialized to verbalize what a good job you're doing, or thank you for all of those efforts. So somebody is going to need to tell that person like, Hey, you need to tell her multiple times a day. I am so proud. You're doing such a good job. Thank you for doing this for our baby or things like that. Um, you know, families might. Extended families might see their role as coming into like, you know, hold the baby or play with the baby and what they really might need to be doing instead is mothering the mom. Um, and I think that, unfortunately it's been so long that people have been sort of isolated in their breastfeeding journeys and not really had extended family or social or community support, that it's hard to be the trailblazer. And it's hard to be the one to ask for that. But I think once we start getting comfortable with being messy and imperfect as moms, if people come over and they see that we're in our jammies still at four o'clock and they see that we maybe haven't had a shower in a couple of days and we're crying that, um, there needs to be a little bit more of that, you know, deeper. Uh, I don't know what I'm trying to sit here. There needs to be a little bit more. Sharing of the responsibility of getting a baby fed it can't all fall on the birthing parent.

Carrie: 20:13

Absolutely. I mean, I think the prenatal education is a big part of that. And I think that the type of prenatal education that You choose is important. I, I love and, and embarrassingly addicted to social media. And at the same time, a lot of what you see on social media in regards to a baby's first week or breastfeeding, your newborn is so unrealistic and it's, um, you know, person with makeup on. Sitting there in their clean house, like staring lovingly at their baby. And like their shirt is white, whatever. No, we don't wear white in the postpartum period. Um, you know, and it just, it looks social media. Perfect. D um, and it seems to be going well, and it's like three tips to help make breastfeeding go better. And then they're like, I mean, yeah, those are kind of helpful things, but I don't know. I mean, I think that one of the things that I, that I try to make a point of in my class is not scaring people, but being a little bit honest with them and letting them know that for the vast majority of women out there, the first week of breastfeeding your newborn immediately after you give birth, it's a total shit show. Yeah. I mean, it's really hard. It's it's not just, you're not just using your boobs to feed your baby and you don't just put the baby at the boob and they latch on magically. I mean, some of them do, but those are, those are definitely outliers. Um, it's, you know, you're, we're asking you to start breastfeeding immediately after you go through one of the most. Profoundly exhausting, um, laborious periods of your whole entire life, right after you've given birth your body and your whole life. And everything has just changed in the most profound way it may ever. Um, and then we're like, okay, great. Now you just keep this baby alive with only your nipples. Yay. Have fun bikes. And, uh, and if you don't know what to expect, if you think it's just going to be, you know, putting your baby there and then you guys sit and you watch Netflix while your baby feeds peacefully, um, That's that's typically not how it goes. And so for someone who is endeavoring to breastfeed, something that can help them, uh, uh, definitely prenatal education, take a breastfeeding class. Um, and then talk with, you know, either a lactation consultant or your other friends who have breastfed or anybody else and find out what it's really like. There are oftentimes a lot of tears in that first week, particularly around the time when your milk comes in. Um, yeah, you're not going to be able to just sit on your couch and do it all is going to need to be bringing you water and snacks because you'll be more thirsty than you've ever been in your whole entire life. And, yeah, it's like a 60 hour a week job breastfeeding kind of in that first week. It's a very steep learning curve right. Upfront. Um, but it definitely gets easier,

Sarah: 23:28

carrie, I think it's so like, one of the points that you made is that just managing those expectations. And I think people are so shocked that newborns don't just eat and sleep, right? I mean, I think that's what everyone expects is that I'm going to feed. And then my baby is going to be asleep and they're not going to need anything from me until the next time they need to feed, which, you know, everything tells me is three to four hours later. And so these babies that need intensive holding and, you know, consoling and bonding and things like that that is stuff that we weren't expecting to do. Or we weren't led to expect to do when we had a baby.

Carrie: 24:03

Yeah. You think it's going to be like you in your cute post-partum robe that you got off at Etsy or wherever and your baby And all their cute newborn clothes that everybody is bought. And it's just going to be this thing and know you're leaking out of every orifice possible and your baby wants nothing, but to be naked and on your chest, you're sweating like a hog and your

Sarah: 24:26

And people are asking you to come over and you're like, oh my God, my bathroom's got blood in it. And nothing's clean dishes and my boobs are out 24 7. Like, no, please don't come over.

Carrie: 24:39

Totally.

Sarah: 24:40

come over and do my dishes and clean my bathroom.

Carrie: 24:44

Yeah.

Natalie: 24:44

Yes. So tip number one, hire a postpartum doula who doesn't care if your boobs are out and will take care of the house for you and bring you snacks and cook you. Good nourishing soup and all of that.

Sarah: 24:58

Postpartum doulas are

Carrie: 24:59

Yes.

Sarah: 25:00

heroes. Everyone deserves, it was partum doula. And I know birth doulas get, you know, like they have the glamorous job, right? They're there and they're supporting you through the labor and it culminates in this beautiful experience and everyone's in tears and there's photos and postpartum is not like that. Postpartum doulas are the real heroes in my book.

Carrie: 25:21

Yeah,

Natalie: 25:22

I agree. Yeah. So another thing too, that I always tell my clients is, is tell people to just leave, uh, uh, you know, a cooler on the porch and people can put food in that don't ring the doorbell and just, you will tell them if you want them in the house and.

Carrie: 25:43

absolutely.

Natalie: 25:44

A, uh, a sink full of dishes. If you can complete that, then you can earn maybe 10 minutes of baby snuggles. So it's, it's, you know, a chore, that's your reward for doing chores around the house. So what you're signing up for. Yeah. Yeah. I think too, something that I've kind of noticed, um, with my own clients who have, have breastfeeding struggles or just in our society today, unless you're in the birthing world or lactation world, you don't see nursing infants. And a lot of times people maybe didn't see that growing up. They had no exposure to it. They had, you know, no aunties or sisters who are, who are breastfeeding in their presence uncovered even right. Covered as another thing, but uncovered too, so you can see what's happening. Um, and so I think maybe just lack of exposure. Leaves people more isolated as well in their journey. Is that you guys have seen as well?

Sarah: 26:48

Yeah, absolutely. And even, you know, I said that I watched my mother breastfeed my brother, but really what I saw was that every few hours she would disappear into her dark bedroom. And she had put a blanket over her shoulder, even in her bedroom where the lights were off. And my brother would be somewhere under the blanket doing like whatever he was doing under there until I understood that he was feeding. And I understood that this is what babies do, but I didn't really have. Breastfeeding knowledge, even as an adult and intending to breastfeed my own kid, I thought, oh, you just go in a dark bedroom every three hours or so, and put a blanket over yourself. And something magical happens in there.

Natalie: 27:25

so we really need to be educating older siblings as well. Like breastfeeding education needs to start there with toddlers and kids who are in the house.

Sarah: 27:34

And you know, a lot of studies show that the decision to breastfeed your infant is at least partially made by the time you reach adolescents. So if you have seen babies being breastfed as a child, you're much more likely to incorporate that into your own scheme, out of sort of how we treat babies and what we do. Whereas if you've only seen bottle fed babies, you're not very likely to consider that breastfeeding is an option, or even be aware that that's something that's, you know, more common than most people think it is.

Natalie: 28:03

Interesting. Interesting. Wow. Adolescents that's

Sarah: 28:08

So everybody please public the breastfeed. So all our kids see that breastfed babies.

Natalie: 28:15

it. I love it. Um, okay. Let's talk about another, another big concern that I hear. And I see social media talking about is, is low production or low supply. Um, and parents are worried about this. So, and Carrie, you mentioned. A certain type of boob that doesn't produce as much. How would one know that they have that type of boob and how do they determine how much is enough for their baby? Right. How do you, how do you know you're filling your baby up? So let's talk about that.

Carrie: 28:45

yeah. Good question. Okay. So first, I mean, it would be so wonderful if babies had like little hash marks on their, you know, on their abdomens and we could see, oh, Okay. well now we're up to the four rounds line. Yay. We're good. but they don't. And so the only way that we can tell if they're, if baby is actually getting enough, is by counting poops, because if we've got, you know, if we've got an adequate amount of output coming out of the baby, then we know that the input is also adequate. And then also we want to keep track of baby. And so they're all born at whatever their birth weight is. They'll lose weight for the first couple of days. Um, and then from the point that the mom's milk comes in somewhere day, 2, 3, 4, or five, after that, then we want to watch baby's weight climb by roughly one ounce or 30 grams per day. And if we're seeing that and we're getting the requisite amount of poops, then congratulations, breastfeeding is going well, you are making enough milk. Your baby is able to extract that from your breasts and go, you, you get a plus. Um, so I have a type of breasts they're called hypoplastic breasts. Um, basically that just means underdeveloped to some degree and there's different. Uh, you know, you can have. Wildly underdeveloped breasts. Um, or you can have sort of mildly underdeveloped ones. Mine were kind of somewhere there in the middle. Um, I always knew that my breasts seemed way more further spread out. They were like more towards the sides of my body then kind of up front and center. Like most of my friends were, um, and that my nipples looked a little different too, but I'm not going to describe my nipples to you, but there is a particular way that, um, oftentimes the hypoplastic breasts, the nipples on them end up looking. Um, but nobody had ever mentioned anything about this to me. So I started off breastfeeding, you know, a lot of breasts will oftentimes make more than what's necessary in the very beginning. Uh, and then regulate them their production downwards. Um, I started out with plenty of milk and then it just kind of disappeared and he wasn't gaining weight like he was supposed to, and he wasn't pooping. Adequately per day. Um, and so that is how I knew that I didn't have enough milk. It's something that definitely happens. I mean, the type of breasts that I had, hypoplastic breasts or another name for it would be insufficient, glandular tissue or IGT. Um, that's just one reason out of actually quite a few that women, um, just for whatever reason through no fault of their own are not able to make sufficient amounts of breast milk for their babies themselves.

Natalie: 31:36

Okay. Interesting. Interesting. I learned something new.

Carrie: 31:40

Yeah.

Natalie: 31:40

knew I would, I knew I would learn a lot of new things.

Sarah: 31:45

I would like to add to that though, while like having a low milk supply in actuality is a very real thing. And it can be really traumatic when people do experience it when they were expecting to fully breastfeed or where they were expecting to breastfeed easily. And it's just not as easy or as straightforward as they were expecting. Everyone thinks that there is this epidemic of insufficient milk supply going on. And I would say more than 90% of the clients that I work with are just convinced that their bodies are failing them and that they're not making enough milk and their baby's not gaining. And people bring me sometimes a perfectly fat, very well fed baby, put that baby to the breast. The baby is like, you know, trying to keep up with this massive flow of milk and people are still terrified that they're not making enough. And so I liked the, put it out there that like, this is a normal biological process. You birth a placenta, your progesterone levels fall. And the next thing that happens is lactation commences. And for almost everyone, this goes the way it's supposed to almost every time, just like every other biological process, there can be interruptions, right. And things can go wrong. But the vast majority of the time it does what it's supposed to do. And so I like to point out to people who, you know, all the evidence says that they have a completely adequate milk supply and a very well fed baby, um, that, like, we don't worry about like our other bodily processes that much about whether they're failing or whether they're doing what they're supposed to do. Right. We don't breathe. Oh my God, are my lungs going to fail me now? Like, are they just going to crap out? And then they're going to bring it again or like, oh my gosh, what's going on? Where's my digestion has my stomach forgotten how to digest my food, but the minute that's externalized, right. And we have a baby and we can see what's going on. We are just convinced that that process is going to fail. And I think, I don't know where it comes from exactly, but I can kind of pinpoint two things. One of them is just this kind of internalized, like distrust of women's bodies. Like we've been told that like, doctors are going to tell us what to do, or somebody else is going to tell us what to do or all of this needs to be managed by somebody else. And we kind of trust ourselves. Um, but in addition, I think we've all grown up in the us seeing massive portions of food and thinking that babies can't possibly survive on this tiny little puddle of milk that we managed to produce. Um, and it's really pretty miraculous, like what babies can do with the volume of breast milk that they get. Um, I have a friend who was never able to pump more than about two ounces at a time. And a lot of times people take their pumping output as like a stand in for their actual production, which isn't necessarily like a one-to-one correspondence. Um, she was never able to pump more than like two ounces at a time. And at work, you'd see these, like, we need teeny little bottles of milk that she had expressed. Her babies were the fattest babies that I have ever seen. So whatever was coming out in the pump and they were exclusively breastfed. Was enough to grow that baby. And so it's really, really important to not get too hung up on the quantity unless there is like really distinctive evidence that the quantity is a problem.

Carrie: 35:02

Yeah. And this really like he was, I mean, this is a planetary problem. One of our mentors for both Sarah and I, Jennifer , she does a lot of work in Nicaragua and Honduras. I think it's just Nicaragua. Um, but goes down there and the, the women who are, you know, they're not hanging out on social media all day. They also are just convinced that they don't have enough milk. We have, we have managed to convince the entire planet that women's breasts are just probably going to fail them and not have enough milk. And it's um, Yeah. like they were saying, it's something that we deal with everyday. We see a client.

Natalie: 35:41

And I've also heard too, um, not even the low supply, but prior to milk coming in, right at that whatever day it is postpartum, what sustains babies from birth to the point where the milk comes in, because I've heard people have concerns over that and they automatically start formula. Um, because they're worried about that.

Sarah: 36:05

I think a lot of people expect that the, somehow the minute they deliver their bodies are miraculously going to be overflowing with milk. Right. And it's a process that takes a few days again. Um, but the colostrum is pretty amazing stuff. Um, there's kind of babies have kind of a metabolic shift where they burn some of the fat that they were born with in order to make the glucose that they need to survive. Because the colostrum that first milk is like super concentrated milk and it has the protein component and the antibodies component and a ton of vitamin a in there to keep baby safe from infection. But it doesn't have a lot of. And it doesn't have a lot of lactose in it for babies to fuel their brains and things like that. So this is a transition that's supposed to happen. And babies build up a lot of fat in the last few weeks of pregnancy, because they need to be able to liquidate some of that fat to fuel their brains while we're waiting for the milk to come in. But it is again, I think people can't wrap their minds around the, like the amount of colostrum that would fit on your pinky. Fingernail is actually enough to sustain your baby until the next feeding. And it's just, mind-blowingly like small and mind-blowingly difficult to accept that that is enough to sustain a baby.

Natalie: 37:20

Wow. Wow.

Carrie: 37:22

And just, I mean, I mean, wouldn't it be so helpful if everybody out there knew exactly what you had just described, Sarah, that, that, that burning of fat in those first few days that they've both dealt with in the last weeks of pregnancy, if they knew that, you know, I think that a lot of it is just, uh, uh, a lack of information and let people know, you know, Again, remembering that your baby has been passively very well fed via the placenta for all these nine months. And they're born a little bit of water law. They are not, they, they are not hung. They're not born hungry. They are not born hungry at all. They are born with a strong need for immune protection, and that is what the classroom, uh, provides them. It's their immune system in, in liquid form out of your boobs. Um, but yeah, it's, uh, we do see a lot of panicking about the amounts of classroom that people know they have or things that they have in those early days. And how am I God? How could that possibly be enough? We have to start supplementing and for a lot of people, that's a slippery slope.

Natalie: 38:28

Right, right.

Sarah: 38:30

So I have started if I get to see clients prenatally, which is not always the case, but when I get to see clients prenatally, I have started teaching hand expression, even prenatally, because I think people feel so validated when they can make a little bit of colostrum come out of themselves. And I think they go into the feeding much more reassured that what's supposed to be. There is actually there versus if somebody hasn't seen it and you know, your breasts don't feel full and you don't feel it coming out, it's a lot harder to actually believe that the process is working the way it's supposed to.

Natalie: 39:07

That's a really cool tip. That's that's not something I would have thought about.

Sarah: 39:11

So prenatal milk expression has been, you know, Thing that people do, especially when women have gestational diabetes or something, um, that would make their babies at higher risk for being supplemented after delivery. If they really want to avoid the supplementation, sometimes prenatal, uh, claustrum expression is a way to come in with a little bit of colostrum. Hey, if my baby needs to be supplemented, please use this. Um, but there have been a lot of studies recently that have shown that women who have had like previous lactation difficulties or women who have gestational hypertension and might be induced instead of going into labor naturally. Um, and these are some times scenarios that set you up for a little bit more difficult, initial breastfeeding experience, um, that when we teach those parents to hand express prenatally, um, that. of them continue breastfeeding or breastfeeding, exclusively after delivery. And they just have a higher degree of kind of confidence and self-efficacy of like, okay, yeah, I know how to manage this process. I understand what's going on here. And my part in it. So prenatal, breastfeeding or prenatal hand expression is kind of amazing. And it is very safe unless people are at really high risk for early delivery. Um, but people who are likely to carry to term and not having any like threatened to miscarriage or threatened, uh, early delivery are very safe to express some cholesterol prenatally.

Natalie: 40:37

That's so cool. So at what week would you recommend people maybe meet with you or try doing hand express?

Sarah: 40:45

I typically tell people around 37 weeks, assuming that everything is well with the pregnancy and. And this is not necessarily supported by evidence. This is sort of my comfort level from working with midwives, um, but had the babies in a good position because prenatal expression is gonna cause some contractions. Um, and when it causes some contractions, I don't want the baby to get stuffed down into the pelvis in a position that's not very favorable for delivery. So it's not, baby is in a funny position. Then I say, you know what? Let's hold off until we get the blessing from the midwife for the OB or whoever it is. Um, but 37 weeks ish in my experience is a good time to start expressing providing all the other conditions are right.

Natalie: 41:23

okay. Cool. That's very exciting. Um, okay. So I think. I think this kind of segues really well into the pump discussion. So let's talk about pumping. Let's talk about what types of pumps are best or maybe not helpful. How do you even figure out what is good. Talk all about it.

Sarah: 41:49

Don't carry.

Carrie: 41:49

gosh. That's oh, goodness. Yeah, the whole pumping thing. know, it was a lot easier a few years back when it was just Mudela They were kind of the only pumps that were, uh, you know, commonly available to moms and spectra came on the market. And that was great. And now like the whole breast pump market has just blown up and there are so many different types of pumps out there in different insurances, cover different ones in different stores, sell different ones. Um, and I think. Well, one of the things that I like to talk with moms about is the fact that not all pumps are made equal. There are some really great pumps out there, and there are some pumps that are super stink and will not help you out at all. Um, and there's a lot of pumps out there, uh, that are very specialized they're for specific situations. Um, one of the types of pumps that are really popular right now are the hands-free ones, the wearable ones. So they're wireless instead of, you know, holding either with your hands or a bra holding two flanges, you know, one on each breast and then a tube running from. Controls the section in the little motor in your bag off to your side. Um, instead of that, just the I'm sure like the Willow and the LV, those are the ones that tend to be the most common now, but they're kind of shaped like a boob and it's just something the motor, the, the bag that you express the milk into and everything is just right there in this little apparatus that kind of looks like a boob and you stick it inside your bra, and then you go to the store or you go driving or you clean your house, or you go for a walk with your friend, um, and you're breast pumping. So hands free, you don't even really have to do anything. Obviously that idea appeals to a lot of people because we are a very independent multitasking, or you're not an actual productive person focused society now. So a lot of people really like that option. The majority of those wearable wireless pumps out there are, um, uh, just simply do not have the motor strength to be effective any more than maybe once or twice a day. Um, they're just, they don't have reservoirs large enough to really pump the milk out of a breast that has a larger storage capacity. The motor itself is just not strong enough. Cycle and provide the right type of suction so that the breast becomes adequately stimulated such that it will continue making milk for the long run. And so a lot of times we'll get a mom who maybe has a little bit of a supply problem, and we really want to be sending her breasts, the repeated consistent message that, Hey, we would like you to step up your production. And they've spent $500 on one of these fancy wearable pumps, and it's just not going to get the job done for them. Um, and that's always really disheartening for a mom to learn that. she just, you know, broke the bank, this type of pump because it looked really cool and seemed really convenient and it's just not gonna meet her needs. Um, and so that. One of the things that I like to talk with parents about prenatally is the type of pump that would be best for your situation. If you're going to be exclusively pumping, um, then definitely not one of those wearable type pumps. Um, are you going to be exclusively pumping or are you going to be pumping, um, for your long shifts at work? Like, are you, do you have 12 hour shifts? So you're separated from your baby for maybe like 14 hours out of the day and you'll need your breast pump working for you that entire time. Well, then we're definitely gonna look at or want to look at some one type of pump and not at others. There's just, there's a whole bunch of them out there. And, uh, yeah, I'm still working on ways to get the message out there that not all of them are, are built equally and not all of them work super well. They all say they do. So of course, when you're choosing one prenatal.

Sarah: 46:03

I like to give people the rule, um, try not to buy a pump that's made by a formula manufacturer. A bottle manufacturer or a toy manufacturer, because those amounts are not gonna, like, they're just not vested in your breastfeeding success. And so those pumps aren't going to be adequate to meet your breastfeeding needs. So there are a lot of pumps out there that are made by especially bottle manufacturers. And they're kind of like drugstore quality pumps. Right? You could go to Walmart and pick one of those off the shelf. And a lot of people end up with those because they have the name recognition of like, oh, you know, I've seen people use these bottles, so I'm going to buy this pump that's associated with these bottles or, oh, you know what? This color scheme, this kind of purple and lavender color scheme is associated with lots of stuff that got handed out in the hospital. So this must be. Good pump and that's not necessarily the case. And so it's really important to be aware of like, is this made by somebody who specializes in doing other stuff or is this made by an actual, like company that exists to create breast pumps or a company that exists to create durable medical equipment?

Natalie: 47:15

What about hand pumps? Non electronic pumps.

Carrie: 47:23

With a hand pump, you're like, if the hand pump is your only pump that you have, and you're trying to, uh, increase your supply with just a hand pump. Um, it's probably not going to be adequate, but I feel. Everybody should have one. They're great to just throw in your diaper bag for a time. Like maybe you're stuck in traffic on the way home and your breasts are about to explode. Well, then you've got that there. Um, yeah, I think I think they're wonderful.

Sarah: 47:52

I think hand counts are really great tool for learning how to pump and learning how to respond to a pump. Because I think we sort of had the attitude that our breasts are somehow like taps and you can turn them on when you want milk and you can turn them off when you don't want milk some on people, they work that way and you throw the pump on and they flow. And there's no like middle process in between, but for a lot of people, they actually have to learn how to respond to a pump. And I think that sometimes the electric pump. Removes a little bit of that, like tactile element to the process because you just bumped the dials up and down until you get the result that you want. But with a hand pump, you couldn't really concentrate on like one breast at a time. You can concentrate on co okay, how much suction, how much speed? Like what do I need to do to make my body respond well to this? And so I think sometimes those are good first learning pump before people transitioned to relying more on an electric pump. If they've returned to work and need a pump multiple times a day,

Carrie: 48:51

Yeah. And when we, as just as a clarification, when we're talking about hand pumps, we're talking about the kind, you know, that you, you press the lever down, not about the passive collection devices, like the haka, those silicone type.

Natalie: 49:07

GAM. So definitely something to add to the baby registry, um, when you're thinking about breastfeeding. We can definitely do a two-parter to this, but, um, is there anything that you guys want to talk about specifically before we go into like resources for people who want to do more research? You said the second night that was something I had written down.

Sarah: 49:34

Yeah. So I think this is a very real thing that happens with almost all babies and parents are often caught unaware and that the first night baby has just been born is taking in a whole lot of new information. And the way that they cope with that is often. To sleep. They're just trying to figure out what just happened to them, trying to figure out how to survive in this new environment. And they tend to sleep quite a bit. Um, the second night of life isn't like that at all. Now baby's been around for awhile. They're starting to recognize that their body has needs and that their psyche has needs and that where they were in this very controlled environment before where it was dark and they have like a predictable level of noise. And they felt like they were being held 24 7 because the muscles of the uterus were pressing all around them. Now mom's tired. And she's trying to put this baby in a bassinet so that she can sleep. And babies are like, no, no, no, no. I've been held 24 7. And by the way, my body clock is also messed up because when women are pregnant, when they walk around during the day, they're kind of rocking babies to sleep. And then when they settled for the evening is when babies often wake up and get really active. So the baby still has that circadian rhythm. They want to wake up and be active in the evening and they perceive that they're getting like 90% less holding than they got when they were in utero. And they have all of these, like I'm cold. I'm seeing light for the first time. And I don't like it. Whereas my uterus. And so the second night of life is predictably really fussy and challenging night, and babies need a whole lot of holding and they need a whole lot of feeding and some of that's about food and some of that's about comfort. Um, but it really comes at a time when people have often just been discharged from the hospital. So they had this very peaceful first night at home in the hospital, and then they go home and everything falls apart. And it's really easy to be convinced that you're failing when you go home and everything falls apart because you did not know to expect this would have happened. If you were in the hospital, this would have happened if you had, you know, whatever is going on. This is what babies do. Um, and I think it's really, really important for families to be aware of that because I did just work with a family who, you know, had this experience the first night in the hospital was great. The second night at home was a nightmare and they called their pediatrician because the baby was crying and they couldn't figure out how to make baby stop crying. And the pediatrician said, oh, well, they're probably just hungry, feed them an ounce of formula after every breastfeed. And so now this family is not only convinced that they were failing at breastfeeding, which they weren't, but now they've actively undermined that milk production because the baby's getting a lot of the food needs met with the bottle and not so motivated to work at the breast anymore. So, yeah, I think a lot of supplementation happens on that second night because parents just don't know what to do. And they do feel like they're failing, but they're not failing. It's just what babies do. And we just kind of have to walk through it with them.

Natalie: 52:36

important. That's a really important information to know really important.

Carrie: 52:43

that. And Yeah. it's interesting how the F when, when we get to that second night and things start to unravel and it's not, not the peaceful, lovely, wonderful thing that we thought it might be like the first night. Um, the first place our minds go is it must be the breastfeeding. It must be that my body is not working, and I do not have enough food to feed this child and I'm starving them and, oh my God. And then,

Natalie: 53:11

It's If a spiral.

Carrie: 53:13

that follows that it's a total spiral And that's related to.

Natalie: 53:18

And I know one of the things that is being talked about more and more is tethered oral tissues. So lip tie, tongue tie, all of that, which can, can cause problems with baby being able to extract milk from the breast. So, um, if you guys would briefly talk about that, I am going to have an SLP who, um, is very involved with, with tethered oral tissues on the podcast. So don't feel like you have to cover everything. Um, but maybe just talk about a little bit of maybe some of the signs that, that parents should look out.

Sarah: 53:53

So when we talk about tethered oral tissues, we talk about typically tongues and upper lips. And what that means is there's just a piece of tissue that is restricting the function of that tongue or that upper lip, or it's functioning differently from how a baby without a tether would function. So the. Kind of only a problem when it's a problem. And I would say like, there's a lot of attention paid to lip ties and I have definitely seen some upper lip ties that are a problem, but not all upper lip ties are a problem. And if they're not a problem in that family, in that mom doesn't have like intractable nipple damage or baby is not like falling off the growth chart and struggling to make a seal with their lips are struggling to feed. There's probably not a compelling reason to address that upper lip type in my experience, tongue ties are there's often a more compelling reason to. Address a tongue tie early in infancy. And that a lot of times babies who can't extend their tongues past their lower lips, they can't wrap their tongues around the nipple, or they can't elevate the nipple to the roof of their mouth because babies hold it with their tongues. Um, while they drop their jaws up and down to extract milk. And, um, sometimes babies who have those can really free ride on a mom's good milk supply when the milk first comes in and the milk supply is generous, but as time goes on and they're not really emptying the breast really effectively because they're compensating a lot for how their tongues work, um, they tend to either fall off the growth chart themselves, or mom's supply tends to decrease over time because they're not getting. The amount of stimulation and the amount of emptying that the breast would get and relies on. Um, if the baby didn't have a tether. And so it's really, really important. I think if you ask on, you know, on Facebook or on Instagram, everyone will tell you that your baby has a tie, right? It doesn't matter what you say. Like my baby is gassy or my baby pooped 12 times yesterday, or my baby hasn't pooped in three days, somebody's going to say, look, have you checked for tongue ties? And this even actually happens in like lactation consultant, discussion groups and wild ties. Yes. A hundred percent can be contributors to lots of different types of breastfeeding difficulties. They're not the only thing out there and not every baby and not every tie is a problem.

Natalie: 56:10

Awesome.

Carrie: 56:10

Okay. So Sarah, jump in anytime with this. Um, so a couple of things that, um, that a parent might see that might warrant them, you know, contacting a breastfeeding professional, or somebody that knows about this type of thing, um, and saying, Hey, you know, I'd like to have a, a solid evaluation to see if this is in fact what we're dealing with. Some type of tethered oral tissue. Things, you know, like, uh, typically we would want the tip of the tongue, the apex of the tongue to be rounded off, you know, um, oftentimes when we have, uh, a link, uh, frenulum underneath the tongue, that's, that's restrictive in some manner, the tip of the tongue will look almost notched, or it will look kind of flat with like a little, just a little divot there in the center. looking like, kind of like the top part of a heart, uh, that can be an indicator. I would, you know, if you saw that in your baby said, oh, okay, well let's maybe let's call, uh, an IB CLC or let's call a pediatric dentist and see what they think. Um, Um, when you see your baby nursing at the breasts, if they are really working their lips at the breast, um, and you know, there's a lot of lip action going on there at the breast. And then when they finish feeding, if you look kind of at their lips, um, you know, there's the outside of your lips that we see when you're just staring at somebody. And then there's kind of the mucosal part on the inside where it's soft and kind of wet. Um, oftentimes those babies who are having, who may have a tongue tie will have, um, look like little sucking blisters, all along the mucosa part of the lip there. Um, and that's just because those lips are trying really hard since the tongue isn't doing exactly what we want it to there at the breast. The lips are having to grip the breasts repeatedly to keep the breast to their, at their mouth. And so we'll get little sucking, blisters, um, you know, uh, The ex not being able to extend if you're kinda touch the baby's nose down to their lips, to their chin, trying to get them to try to elicit that tongue extension. If they're not able to stick their tongue out to their lips or pass their lips, or, you know, certainly pass that lower gumline, then that would, that would be something that would tell me that, you know, maybe a good evaluation would be in, in, order.

Natalie: 58:34

Okay. Yeah, those are really helpful tips. So, um, I know I have a lot of listeners who are nerds like me about research and want all of the resources. So what are your guys's favorite resources for someone who, who wants to do more of the researcher have these, these things on hand in case they do face some challenges with.

Sarah: 59:01

So hands down, my number one, favorite like breastfeeding preparation or breastfeeding troubleshooting. Site is called the global health media project. And it's a series of videos that were made for health visitors and the developing world to help them support women, having babies breastfeeding and to solve common breastfeeding issues. The videos are beautifully made. The explanations are so straightforward and simple, and often I will just give that website to people to get them through until I can see them and see what kind of problem we're dealing with. Um, I think those are my absolute favorite thing. Global health media.

Natalie: 59:45

Okay.

Carrie: 59:46

minus. Well, the videos are beautiful. They are the clearest most succinct, um, easy to follow videos ever. They're short. I mean, I think most of the videos are like nine minutes long. Yeah, they just give very clear descriptions and pictures of what we want. that's a wonderful, wonderful resource. Um, for a mom who was planning to breastfeed or would like to learn more about breastfeeding. Um, another site that is really great is Kelly mom.com. Um, it's, I think it. ends up being more of a site for moms than for, you know, like researchers. Um, but Kelly Banjara runs the site. She's an IB CLC, um, super squared away, nice gal, uh, everything on there. It is a very comprehensive site. Everything on there is evidence-based it's up-to-date and one of the things that I really like about it is that the end of each one of her little articles, she lists links to all of the studies that she's used to inform that article. Um, it's a wonderful, wonderful site. It's very large. It can feel overwhelming, but spend a little time there And it's a great place to go. Yeah. Kelly, mom dot.

Natalie: 1:00:58

And I will link all of these in the in the description of the podcast too. So for easy access.

Sarah: 1:01:03

I'd like to add one more, and this is a little bit more for professionals, but for people who really want to do sort of a deeper dive into the evidence, and maybe also, if they need to have a conversation with a healthcare provider about breastfeeding and you know, either how to solve a problem or what kind of support they need. Um, the academy of breastfeeding medicine is a site that's for healthcare providers. Um, but they have a list of. Protocols that they've published for many different things. So there's like newborn hypoglycemia on there. And, um, you know, how to create a breastfeeding friendly pediatrician's office and all kinds of things. Um, and they also list all of their references. So if you really want to know, like, okay, where did this recommendation actually come from? You can look at their protocols and then find the reference and actually tastes down that reference as well. So it's really, really helpful in providing evidence-based stuff, especially to physicians who really kind of only want to listen to other physicians. is so way to get physician evidence in front of a physician. And this

Carrie: 1:02:07

Yeah. It's just a wonderful compendium of best practices. It's it's an invaluable resource.

Natalie: 1:02:14

Nice. I'll have to check that one out. That's a, that's a new one to me. Um, what about books? What about books on breasts?

Sarah: 1:02:22

Books are hard. I feel like most people who are having children right now are much more likely to go to the internet than they are to a book for a reference. But I will say the one that I use in my own practice almost every day is a book called the breastfeeding Atlas. And it's for lactation consultants to prepare, to take the exam. And it shows photos of so many different things like a breast abscess or like terribly damaged nipples, or like what thrush looks like in a baby mouth and what thresh looks like on a baby bottom and, you know, normal newborn diapers and like just an amazing resource. And I keep it in my office because I like to be able to show parents like, oh, okay, you were concerned that you had maybe a yeast infection. So if you had one, you know, I can turn to the page and say, this is what you would probably be looking at. Or, you know, if somebody is wondering, like, do I have mastitis or do I have a breast abscess what's going on? I can turn to the photos of a breast abscess and say, if it looks like this, or if it feels like this, this is when we're concerned for an abscess. And the visual really helps the words saying. support that

Natalie: 1:03:33

as a parent, definitely to see photos of something, compare yourself to it. Because a lot of times we, we tend to over-exaggerate the negative in our own brains

Sarah: 1:03:43

Absolutely. And if we just send someone out to Google or Instagram they're as likely to get misinformation as they are to get correct information. So it's nice to resource at hand.

Natalie: 1:03:54

I Love it.

Sarah: 1:03:55

really have that

Carrie: 1:03:57

Um, one other thing that I, I'm just looking at the information on that I I'm embarrassed that I didn't think about earlier. Um, but I want to mention the melanated memory Atlas,

Sarah: 1:04:07

Yes.

Carrie: 1:04:08

because not all breasts are white, not all breastfeeding women are white gals. It's a mobile friendly web application, but it is a, it is a, a web app basically it's called a melody, did memory Atlas and he does pictures and case studies and all kinds of information about breasts of color and what they look like. Thrush looks a little bit different on a dark nipple as it does to just a light pink one. A lot of stuff looks a lot different based on the color of skin of the breast. And so just because of how the world is so much of the medical research and stuff that has been done, as far as breastfeeding goes, has been done. And we have pictures of it on white breasts, um, which is not fair and not cool. And, uh, so I'm really happy that this one exists, but yeah, the melanated memory Atlas,

Natalie: 1:05:04

That, um, that sounds like a really valuable resource, um, just to have, and, and be able to show clients as well.

Carrie: 1:05:12

Um, as far as books go, another one that I really like is the womanly art of breastfeeding, which has gotten a bad rap in the past. It's put out by Lala to league. Um, the first 12 additions, 12 or 13, I think, um, we're very stay at home. Mom focused, you know, just assuming that everybody has somebody else who's paying the bills for them and they don't need to work. And they just get to sit home and hang out with their babies all day long. Um, and they had some good information in there, but it really was aimed at just what is a very small subset of what American culture looks like today. Uh, the most recent edition is a different story and recognizes that a lot of breastfeeding women are exclusive pumpers. That that is in fact, a form of breastfeeding, not every person who chooses to breastfeed identifies as female. Um, And so it's, it's, uh, it's written in a very conversational style and I think it does a really good job of, um, helping set expectations that are a little more reasonable than what we might find, uh, especially, you know, in social media. So I think that's a good one.

Natalie: 1:06:26

Yeah, it sounds time, but I have no excuse. Okay. So of my favorite questions to ask my guests is what is your number one piece of advice for our listeners? What do you want everyone to know?

Sarah: 1:06:49

So I think pertaining to this topic, I want everyone to know that healthcare providers don't necessarily get breastfeeding education just because you're pediatrician or just because you're an OB does not mean that you have had even one hour of breastfeeding management education in med school and residency. And so often. When people get advice from providers who haven't had breastfeeding education, um, they get advice that might solve an immediate problem. Like is there a baby who's hungry and needs to be fed or is there a nipple that's damaged that needs a little bit of care, but it may not be the advice that supports the overall breastfeeding goals of that family. And so it's really, really important for families to seek out a breastfeeding professional, if they can, whether that's a lactation consultant and they can access a lactation consultant or even somebody like a leader or a WIC peer counselor, or, you know, a midwife or a postpartum doula or somebody who has actually gotten some specialized breastfeeding education. Um, just because we tend to put the fates of a lot of this stuff into the hands of sort of doctors and, um, while doctors are really important for a lot of parts of life, they may not have the education in this specific person.

Natalie: 1:08:13

I love that. I love that. I think the more we educate parents. The more empowered they are, right? Education is power. The more, you know, the more options you have, the better you can, you can choose what's right for you and your family. So

Sarah: 1:08:26

Absolutely. And I feel like even if we took breastfeeding out of that and just said that whatever physician healthcare provider you might be talking to might not have the most amount of education and the specific thing that you're experiencing. And it really is okay to sort of check around and it really is okay to like, get other opinions and use of other resources.

Natalie: 1:08:49

I love it. Love it.

Carrie: 1:08:51

I think one of the things that I've maybe most like to talk with moms about, um, is that not for everybody, but for the majority of moms that I work with, uh, learning curve for breastfeeding is incredibly. Breastfeeding, uh, 1, 2, 3 day old is pretty challenging. Um, for a lot of different reasons, some of them don't even have to do anything with your boobs or your baby. Like it's just, it's a very, it can be a very fraught experience. You've never breastfed before your baby's never breastfed before your partner and the people around you may not have ever supported anybody endeavoring to breastfeed before. It's just new. And it's something that most people do, and they don't really have any type of precedent for in their life. So there is a really steep learning curve up front. Most people are shocked by the amount of time that it takes, um, by just the, the emotional component that comes with it. You think you're just feeding and you are just feeding, but. For a lot of women is a tremendous emotional component to this. I mean, breastfeeding causes all kinds of hormones to come into play and start flowing. Um, but there's a large emotional component with it too. And so you put all that together and, and it's just a real challenge, even though it is the biological norm, like being pregnant for nine ish months is the biological norm you using your breast to feed your baby is also the biological norm. Um, all that said it's incredibly challenging. So nursing a three-day old is really, really hard nursing. A three week old is oftentimes quite a bit easier nursing a three month old is not something that you have to really even think about too much. You know, if you've gotten supported, everything is going well, lots of challenges right upfront, but it does get easier. It does get better. so that's what I like to remind people of, because the thing, that I hear a lot is that this is not sustainable. Like this is, I cannot on day 2, 3, 4. How, how do people do this? This is not sustainable. And they are correct what it takes to breastfeed someone in the early weeks. No, that's not a sustainable routine or thing to be doing at all, it does get better.

Natalie: 1:11:23

Yeah, what

Carrie: 1:11:24

but

Natalie: 1:11:24

thing, what an encouraging thing. I love it. Okay. Another question for both of you, what is your favorite wellness habit that you incorporate interior into your own daily life?

Carrie: 1:11:40

You know, mine would have to be laughter. Um, this was not really something, you know, Uh, favorite daily wellness habit. I'm just, just not that person. I was just really busy and I just feel like I don't have a lot of time for myself and wellness for me. Um, that's probably not the truth, but that's what I tell myself anyways. Um, but then when the pandemic hit and things just got scary and, um, nobody knew what was going to happen and It seemed like it was just bad stuff on top of bad stuff on top of bad stuff. Um, I really turned to comedy, a test to help me out and I started playing, um, silly comedy podcasts and a big fan of Conan O'Brien. So I listened to his stuff all the time. Um, just making sure I was laughing and laughing hard and just allowing myself to do that in spite of the fact that it seemed like the world stopped turning there very literally for a little while. Um, so yeah. Laughter. It gets your oxytocin flowing. It's theirs. There's really actually something to it. And I know I should probably say, uh, you know, running or exercising or walking or eating a super clean diet. No, No, I find that laughter is what helps me the most.

Natalie: 1:13:01

Awesome. Awesome. Yeah. And I'm looking for, and very honest answer and not a pre-fab answer. So I appreciate your honesty,

Sarah: 1:13:10

So mine would have to be meditation. And I don't want to be like, ah, I meditate so long and so well, cause actually I'm kind of resistant to it and there will be times and I'm like, I'm fine, I'm busy. I don't need to sit to meditate and I can go a day without doing that, or even a couple of days without doing that. But if I have visually skip that 10 to 20 minutes for myself to kind of really just get a little space between myself and my thoughts and my emotions. Um, if I skip that, I tend to get really hijacked by my feelings or my thoughts or stuff. That's not even real. And like, I, I have learned through like doing this and like not doing this and then resuming doing this and not doing this that I need to suck it up and just do this. And I just really do need to Do it.

Natalie: 1:14:04

Do you have a specific app that you use on the

Sarah: 1:14:07

I definitely like have a wandering mind and I need an app to keep me focused because otherwise I will just sit and like to do, to do, um, right now I use 10% happier and I really like 10% happier, partly because, uh, there are some meditation apps that I get really distracted by the voice of the person leading the meditation. And there are enough different leaders on 10% happier than if there's somebody that I either don't like their style or don't like their voice. I just skip their meditations. And they also have a kind of like, um, a section for people who are sort of resistant to meditation or who have the need for something a little bit. More irreverent and a little bit less spiritual. In fact, Carrie, I almost sent you one the other day because there was one about like flushing, your thoughts. And it was just this guy that's like, okay, every thought that comes along in your mind, you're just going to mentally flush it down the toilet, you're going to flush it. You're going to flush it. You're going to flush it. And I was laying down and I was just giggling because it was so like, it's not a funny concept. And it is like, it's a really helpful visualization for people who don't really like to meditate or think they don't want to meditate. Um, it's also pretty effective.

Natalie: 1:15:23

I'm going to have to use that one in my own life. I like it. I like it a lot. I talk about the pelvic floor enough and Squatty potties and all of that and pooping. So it works well. Oh, well, thank you both so much for being here today. I really am thankful that you took the time to share. And I know that all of us could talk about this for hours and hours and hours. So, um, I foresee a part two or part three, continuing this conversation in the future, but until then, where can listeners find you online? How can they book with you? What kind of services do you offer? Like.

Carrie: 1:16:06

Uh, listeners can find me. I work at midwifery and women's health care here in Midtown acreage. Um, our website is M w H C anchorage.com. And you can just call the front desk And anybody, you don't have to be one of our existing clients. You can be anybody from anywhere. And I do in-person visits. I have nighttime hours as well. That works out better for some people I'm happy to do telehealth or just phone call visits as well. So yes.

Natalie: 1:16:34

great.

Sarah: 1:16:36

And for just call Sarah for my business, the website. We'll be live soon and it's nine zero seven. Just call sarah.com. That's Sarah S a R a H. And you can also email me at, just call Sarah a k@gmail.com and then for the podcast for boob half full, um, which is Carrie and me together. Um, you can find our website@bhfpodcasts.com. Um, we're also on Facebook at boob half full podcast, and we're on Instagram at boob underscore half underscore full

Natalie: 1:17:14

Love it. And I will link all of those things and put them in the show notes as well. So I, I anticipate really good things coming out of your boob half full podcast in the near future. So Thank you guys

Sarah: 1:17:27

Thanks so much for having

Carrie: 1:17:28

Thank you, Natalie.

Natalie: 1:17:32

I really enjoyed talking with Carrie and Sarah today. And you can expect to hear more episodes from them in the future on this podcast. They could talk for hours and hours about breastfeeding and supporting moms. And I love their heart for empowering women to speak up for themselves and to know what's going on with their bodies prior to even having a baby. So my top takeaway would be to build your support system early. Find the people and the resources that you need and surround yourself with them practice using them prior to that delivery day and make an appointment with an IB CLC, meet with them during pregnancy. So you have that relationship for when you do need it. After you give birth, you'll know exactly who to call and already feel comfortable with. All of the resources that Carrie and Sarah mentioned are in the show notes. So you can find those there and you can be sure to check out the boop half full podcast. As always, thank you so much It really helps me provide more content. If you leave a rating in your favorite podcast app. If you want to hear more from Carrie and Sarah, be sure to subscribe to their podcast, the Boob Half Full Podcast, which I'll leave a link to in the description of this episode. As a reminder, nothing you hear on this podcast is medical advice. If you have questions or concerns, please remember to do your research and check with a trusted healthcare professional.