Episode Transcript
Samantha Zeeb:
Find the people that support you no matter what. Breastfeeding is great. It has great benefits, but ultimately, Mom and Baby need to be healthy. You know, Baby needs a healthy, stable mom. And so you have to do what works best for your family. You have to do what works best for you, and everybody is human and everybody needs a break.
Courtney Collen (host):
Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen, with Sanford Health News.
These are new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.
This is a topic near and dear to my heart and one I’m delighted to share as a newer mom. We are talking all about breastfeeding in this episode from frequently asked questions to tips and tricks and beyond. If you’re a new mom or an expecting mother, the breastfeeding journey looks different for everyone. No matter where you are in yours, know that you are not alone and there are so many resources available and people to help you feel confident in your journey.
Sanford Health has a team of full-time lactation consultants, and Samantha Zeeb, RN, IBCLC, is one of them. She is a registered nurse and Sanford breastfeeding specialist in Bismarck, North Dakota, and I am so happy to have her here for this conversation. Samantha, welcome.
Samantha Zeeb (guest):
Thank you. I’m excited to be here.
Courtney Collen:
What does a typical day or week look like as a Sanford breastfeeding specialist?
Samantha Zeeb:
You know, we are in different locations, whether it be in the clinic or in the hospital setting, but all the way around, obviously our focus is helping moms with lactation or anybody who may be lactating. So, in the hospital, our typical day, we get to the floor and we will go ahead and look at the bed board and see who is all delivered and what those moms’ wishes are. So that’s a perfect example of why having a birth plan or an idea going into labor and delivery of what your feeding wishes are, because we do look at that and make sure that you’re on our radar so that way we can make you a priority to go in and visit.
And we will go in – we try not to bombard you after delivery right away unless you’re wanting the help or needing the help. But we will go in and check with every breastfeeding mom and just see how things are going and assist with those first latches. I think a lot of times people equate breastfeeding to natural, but natural does not mean easy. So just teaching moms those tips and tricks for proper positioning and latching and encouragement.
And we often will see moms multiple times. And so the nice thing is I do work both in the hospital and the clinic setting. So I do get to develop a rapport with my patients. And so some of the ones that I helped right after delivery, I will then help the first few weeks after in the clinic just seeing how things are going because the biggest thing about breastfeeding is it is a journey.
Courtney Collen:
And for that, I am so grateful as a new mom because having that support during those first hours postpartum and even more so in the days and weeks that followed. Talk about some of the benefits of breastfeeding or why someone would choose to breastfeed.
Samantha Zeeb:
I could kind of nerd out and talk about this for days on end. But I will, for the sake of our listeners, we’ll limit it to the big ones.
So for Mom, there’s a lot of benefits. So there’s the decreased risk of ovarian and breast cancer. There’s the decreased risk of osteoporosis. It helps decrease the chances of cardiovascular disease. It might help you lose weight. You do burn more calories when you are breastfeeding. And then it also helps you produce a hormone called oxytocin, which is going to help you feel calm.
So while moms might have stresses with breastfeeding, overall, studies do show that breastfeeding and bonding with your baby can help with postpartum depression and help with some of those anxiety-like feelings that you have post-delivery.
And for Baby, it helps promote bonding. There’s studies that show that babies who have been breastfed have higher IQs. There’s decreased chance of allergies, decreased chance of diabetes, asthma, GI bugs.
The biggest thing for moms is knowing that the breast milk that they’re providing their baby with is giving them antibodies to help protect against any viruses or illnesses that they are around. And we’re getting right into that fall season. So that’s a huge one, especially with COVID. When we didn’t know what COVID was doing for babies, in the beginning there, everybody’s like, “oh, separate the babies from the moms.” But the studies are showing that the breast milk and breastfeeding that baby is the best thing that mom can do and provide those baby those antibodies.
Decreased chance of obesity, ear infections, protective for SIDS (sudden infant death syndrome), helps decrease the chances of SIDS. And not to mention it’s easier to digest. It’s free. Kids are sick less often, so moms don’t have to take off as much work. And it’s convenient. I mean, you don’t need a bottle and a milk warmer. You just bring yourself and the milk’s the perfect temperature and it’s available whenever they need it.
Courtney Collen:
You mentioned antibodies a moment ago. I would love to learn more about the benefits of breast milk.
Samantha Zeeb:
Breast milk is amazing and there is still more to be learned about it and the fact that it changes constantly. There are live components in it that cannot be replicated no matter how much time people spend in a lab to try to replicate breast milk. The truth of the matter is, you’re never going to be able to replicate it because it has live components that are constantly changing day by day, minute by minute, feed by feed.
So as that baby ages, that breast milk is going to change, it’s going to have more melatonin at night, so that’s going to help the baby fall asleep. It’s going to increase, if baby’s needing more fat content, it’s going to increase the fat content. If you were recently around a bunch of people that had a certain cold, your body is going to get those antibodies and it’s going to put that in your baby’s breast milk.
So the more that you can have that baby at the breast and stimulating and having that saliva contact with the areola, the more you’re going to have that communication. One thing that I do get a lot of, let’s not forget our pumping moms. So sometimes people are concerned, they’re like, well, if I’m pumping, is my baby still going to get those benefits? And your baby still does because you guys are still in the same environment, you’re still exposed to the same things and you can still do skin on skin contact. In fact, I encourage it because it’s going to help with the hormones.
Courtney Collen:
Yes. And those skin-to-skin moments during that newborn phase are just the best. No matter if we are breastfeeding or not. Sam, how does our body physically produce breast milk?
Samantha Zeeb:
The breast doesn’t completely finish developing until you are pregnant. So those tender breasts that you get in pregnancy are for a reason that is your breast revving up to be able to produce that breast milk. In fact, that’s one of the red flags. If you don’t notice a change during pregnancy, that would be something we would want to know.
But what happens is around 16 weeks in pregnancy, you are actually already starting to produce what we call colostrum, which is extremely high-impact, high nutrient-dense sticky-like milk, and it’s the first milk that you produce for your baby. And before I go down a rabbit hole but to answer your question, what happens is the infant starts to suckle on the nipple. And what that does is that stimulates nerve endings. And/or if you’re pumping, same concept, stretching of those nerve endings, that is going to signal the pituitary gland in your brain to release two different hormones. It’s going to release prolactin and oxytocin. The prolactin is what’s going to tell the alveoli to take nutrients from your blood and turn it into breast milk.
So that’s a really huge kind of a wow factor for people’s learning that breast milk is made from blood. So that’s why I’m making sure what you’re taking in is very important because you, your body turns that into breast milk.
Courtney Collen:
Are you speaking specifically to like medication or supplements or food in general?
Samantha Zeeb:
Yes, absolutely. Medications and then even just like pathogens. So if you are exposing yourself to risky behaviors or if you are getting a tattoo or Botox, stuff like that, there is a risk of if there is a transfer of any like HIV or Hepatitis C, you want to be leery of those things. And then same with like your nutrients, just making sure that you’re eating a well healthy rounded diet, healthy foods, because those nutrients are what’s needed to make that breast milk.
Courtney Collen:
Yes. So important. Thank you for that. I remember being super conscious during those early months. It was winter, we were sick a lot or so it seemed, so making sure the medication that I was taking was safe for baby also.
You mentioned colostrum. And if we start to see that before baby arrives, should we save it? What’s the difference between colostrum and regular breast milk?
Samantha Zeeb:
Colostrum is beginning to be produced by our bodies about 16 weeks into our pregnancy. You know, some people will leak during pregnancy and some people will not. And that is not a marker of how much breast milk you are going to have. So when moms come to me and they’re like, “I didn’t leak during pregnancy,” that to us is it, it’s null and void. We don’t worry about that because everybody is so different.
But if you are leaking, collect it, collect it, collect it, collect it. It is liquid gold. It does have that higher nutrient density to it. It’s more proteins, more antibodies. They call it the baby’s first immunization because it is providing all those beneficial protective factors to the baby.
But the one thing about the colostrum is it is more easily digested because it is designed for infants, so they do digest it quicker. So that’s where that frequent feeding comes into play. So that’s why in the beginning days we say, frequent feeding on demand because that colostrum is readily digested and easily digested. And it also helps line the digestion tract so that it helps create a healthy microbiome of the infant and might help decrease with like chances of any allergies or just the good gut flora.
But colostrum, you can start to collect that, we would say, no earlier than 36 weeks in pregnancy and I would absolutely not recommend it if there’s any risk factors in your pregnancy. So I would say if you are considering collecting your colostrum or stimulating, I should say, it’s one thing if it’s just leaking out and you’re collecting it. But if you’re going to actually be stimulating with a pump or hand expression, I would recommend reaching out to your OB/GYN so that way they can give you the go ahead just to make sure that there are no risk factors.
Courtney Collen:
How long does it take for milk to come in, and is it different for everyone?
Samantha Zeeb:
Everybody is different. Depending on what risk factors they have, depending on what their delivery was like, depending on how much stimulation and time they spent with their baby. But typically, the average is three to five days. You know, if you were a C-section, if you were on magnesium because you were pre-eclamptic, certain medications during delivery, rough labor, you lost a lot of blood. Things like that can kind of delay that milk coming in but the best thing that a mother can do is if you are with your infant and plan to feed at the breast, is to get that skin-on-skin contact going ASAP after delivery.
Put that in your birth plan that you want that skin-on-skin contact with the awareness that if Baby is needing immediate assistance, they will have to do that, but otherwise just encourage them to put that baby skin-to-skin. You can do that in the, or if you had a C-section, just make sure you communicate that with your team.
And then that’s going to help with the hormone production and then that frequent nursing on demand. So one thing that I sometimes hear is I’ll have moms say that they just want to offer bottles while they’re in the hospital and they’ll breastfeed when they get home. And I hate to be the party pooper on it, but unfortunately that does not theoretically work out the greatest for the mothers in the long run because scientific studies have shown that the sooner that a mother stimulates that breast milk production, either via a pump or baby, the better her chances are of having a really good milk supply in the long run. And we have studies that show the data for that. In fact, the recommendation is within the first hour after delivery.
Now, is that realistic for everybody? Absolutely not. But I think if we can do our best to get that baby or pump, get to that mom as soon as possible and educate her, the better off she’ll be.
Courtney Collen:
Certainly it is a journey, and worth repeating: Everyone’s will look different. You said that first hour is so important after baby arrives, Sam, that leads to my next question. OK, baby is here. How do we get a good latch and start that process as soon as possible?
Samantha Zeeb:
So the very first breastfeed, when that baby comes out and gets placed skin to skin, I would really just encourage moms to take in the moment. So babies actually will go through a series of movements that can take one to two hours. But they do what we call a breast crawl. And so if you leave an infant undisturbed on a mother’s chest, they have reflexes where they will actually start to kind of scoot themselves up towards the breast. And the amazing thing is, is your areola emits smells that are similar to the amniotic fluid that the baby was surrounded in, in utero.
So with that scent, and then your areola is darker that helps guide the infant towards the breast, and then they will actually take their little arms and start to kind of scoot the breast inwards and try to mouth around. So they’ll kind of start crawling up. They might take a break, they might nap for a little bit, they’ll wake up, they’ll start to lick, explore taste. We do that with our hands. Babies do it with their mouths so that baby’s going to start sucking on their hand.
They’re going to start licking around at the breast and before you know it, majority of babies, if they’re not implicated by certain medications during labor that might make them sleepy or just a rough delivery, but a baby can find the breast on their own. So we do like to give them the chance to do that because studies have shown that a baby-led latch in the beginning has been shown to be beneficial and babies tend to do better, but sometimes they just need help. And so that is when you can always request either most labor nurses are trained, but also you can request a lactation specialist to come in at that moment and we can help you kind of navigate that timeframe.
Courtney Collen:
That is so amazing. I had no idea about the areola emitting smells similar to the amniotic fluid. Again, learning something new every day. But our bodies are truly incredible. The baby’s natural instinct is incredible too. Here I was thinking, baby comes out, you do skin to skin, baby’s hungry, let’s try to latch, say a prayer, cross your fingers, let’s go …
Samantha Zeeb:
(Laugh). And sometimes they need that. Sometimes they need a little bit more extra assistance, but sometimes they don’t. Sometimes they do just fine on their own. So I do like to assess when I go in and help a mom with breastfeeding. I will assess what that baby’s doing. I will assess what that mother is doing and really try to only do that if I need to. But then some babies do need a little more assistance.
So when you latch on, my biggest encouragement for moms is to take a breastfeeding class. Sanford offers breastfeeding classes online, and we go over the nitty gritty of latching. You know, there is a technique to it. There is a way, and I’ll bring out my little toy boob and show you how to do that. And a baby doll – steal my 3-year-old’s baby doll. And we do like to go over and explain like how to position that baby to latch for optimal positioning to prevent both nipple pain and promote adequate transfer.
Courtney Collen:
Do some women have a harder time producing breast milk? Are there things like during pregnancy or preexisting conditions perhaps that could lead to the inability for a woman to make as much milk?
Samantha Zeeb:
Absolutely. So one of the things about being a lactation consultant is we are trained on red flags to look for on things that could put a mother at a risk of having a decreased breast milk supply. Along with certain assessment skills that when we are helping you breastfeed, we’re not only assessing your latch, but we are looking at the baby, we’re looking at the baby’s mouth, we’re looking at mom, we’re looking at mom’s breast, the shape of the breast, the shape of the nipples. And the rationale behind that is because there are things that we can see that sometimes will give us a red flag or help us predict potential problems that may arise.
Now the biggest thing is, I want to preface this by saying that these risk factors and red flags do not automatically mean that you are going to be unsuccessful with breastfeeding.
But some risk factors to watch out for is a history of low milk supply. That won’t always necessarily be a risk factor though, because every single pregnancy and delivery, a mother will make more glandular tissue. So with subsequent pregnancies, she has a better chance of being able to produce more breast milk. PCOS (Polycystic Ovary Syndrome), that’s a risk factor. Any breast surgeries or radiation, especially if they cut around four, eight o’clock on the nipple because that could cause potential damages to the ducts and the nerves. Thyroid problems, obesity, wide spaced breasts with no change during pregnancy and just because that could be a sign of glandular tissue or insufficient milk-making tissue. I like to tread with caution because this does not automatically do me, I think I’m very cautious when I talk to moms about this because the best approach for breastfeeding is wait and see because nobody knows the answers until we start doing it.
Courtney Collen:
Yes, such good advice. Thank you.
Samantha Zeeb:
And I think it’s also important too, that I just want to add in that any amount of breast milk is beneficial. It does not have to be black and white. I think a lot of moms come in and they have the mindset that they’re like, well, I’m only making a fourth of my baby’s intake as breast milk. And that fourth of breast milk, that fourth of the intake of the baby being breast milk is important. And it’s beneficial because that baby’s still getting protective factors.
Now of course, a mother has to kind of decide what’s best for her and her family because a baby also needs a healthy mom. And if it’s just not realistic for her and her family, that’s OK. That is OK. And I think sometimes too, moms need to be able to be told that.
Courtney Collen:
The most important thing is that baby is fed.
Samantha Zeeb:
Absolutely.
Courtney Collen:
Sam, why is breastfeeding painful for some and how can we alleviate that?
Samantha Zeeb:
Absolutely. So ultimately breastfeeding should not be painful. If breastfeeding is painful, we recommend working with a lactation consultant, whether it’s you’re still in the hospital, then I would encourage you that second I want to call for lactation support. So we can come in. Sometimes it’s a simple positioning or sometimes it’s a reminder that we need to move the baby’s body a certain way, so that way that latch
Often when we’re latching and there’s pain, typically it’s due to an inappropriate latch or a shallow latch. And so what that baby is doing is essentially that baby, instead of rubbing on the breast tissue, they’re chomping on the nipple. You know, we can examine the nipples and see what’s happening. So if there’s certain creases or marks, a lot of times that will give me markers for what might be happening when they’re latching and give them tips to try to remediate the pain.
Now once damage is done to the nipple, often the latches thereafter are going to be sensitive because that damage is already there on the nipple. So until that heals that can be a little bit sensitive. I have had some moms who just in general have a little bit more sensitive nipples and immediately postpartum, the latch may be good and there’s no signs of a tight frenulum. But that mom just has sensitive nipples and some of them work through it. Some it’s too much, some can’t, and that’s OK.
So really it just comes down to getting professional lactation support so that we can help troubleshoot what is causing this pain, how can we remediate it, what might this be. Another reason that might cause nipple pain is if you are an extended breast feeder and you get pregnant again, those hormonal changes during the pregnancy can cause your breast to be more sensitive.
Courtney Collen:
All the creams, all the creams at the beginning for me, I’ll raise my hand and say, it was painful to start because not so much the latch. I mean, it was a poor latch in the beginning, and we worked through that, thankfully with breastfeeding specialists on your team. But we were continuing to breastfeed through some of the pain and trying to work through healing creams and things like that. So it was just this ongoing cycle of, oh, this is painful because they’re sensitive, but I’m trying to feed my baby as well to get my milk to come in. So, absolutely. And solidarity for any moms who are listening who potentially could experience this too, but it does get better.
Samantha Zeeb:
And there are, like you said, there are creams, so the Lanolin, there’s hydrogel pads. But the best thing is like express breast milk, rubbing that in and letting it air dry. And then, there are routes sometimes there is so much nipple damage that that Mom has to take a break on that nipple from the breastfeeding, and pumping might work better for her until that nipple heals. So there’s options and, I’m going to say again, just reach out to your lactation professional because we can kind of help walk you through those.
Courtney Collen:
As a lactation professional, Sam, I’d love to hear the questions that you get most often, either in the clinic or out in the hospital setting.
Samantha Zeeb:
One of the most frequently asked questions or one of the things that I see quite commonly, outpatient-wise at least, is I will have moms come in the first few weeks postpartum and they are questioning their baby’s breastfeeding behaviors.
So, we do usually educate mothers that cluster feeding behavior can be expected and is normal, especially at night because your hormones are higher. But I don’t think we emphasize; we say those words, but there’s so much more going on behind the scenes that I think when moms experience, they’re like, oh my goodness, this must be cluster feeding. But it seems so extreme that they think it’s abnormal.
Historically with bottle fed babies, they get every three hours, they get so many ounces. Formula sits in the tummy longer. It’s harder to digest. So they’re fuller for longer, so they might sleep longer. Well, breastfed babies need to feed more frequently. That is biologically normal because that is more readily digested. And they also do that cluster feeding behavior because the more they’re at the breast and the longer they’re breastfeeding, the fattier the milk you will actually produce. It gives your body the message that there is a newborn. And so this is just a little bit of solidarity to all the moms. Like, you’re not alone at night feeding that baby all night. Unfortunately, it’s a rough patch.
I tell moms, they’re in the trenches of it. It gets better. Babies do have cluster feeding behaviors in certain periods. They might go through it. But babies breastfeed for a lot of reasons other than just for nutrients. You know, it’s comforting if you think about it. They were surrounded in your amniotic fluid and could hear your heartbeat and smell you and hear your voice and feel your breathing. So it makes sense that a bassinet that’s flat and hard and they can’t smell you, they can’t see you, they don’t hear your heartbeat, that it makes sense why they’re a little distressed. And so that’s where that cluster feeding and that contact behavior comes from.
So I always tell moms, you can expect that you’re going to have those frequent night wakings and prepare for it. So during the day, and this is the age old “sleep when the baby sleeps.” I used to hate it when I had my newborn, but truly sleep when the baby sleeps. I mean if you have somebody that can take your baby for a feed, breastfeed the baby or pump and feed the baby and then go lay down for three hours, that three hours of uninterrupted sleep is sometimes the difference between a mental breakdown. So having a support system in place, knowing that you’re not alone and knowing that it will come to an end. It’s not forever but it is normal.
Courtney Collen:
Teamwork is so important. And even in my own experience, having a partner, whether it’s a husband, a loved one, or a friend, helping you on this journey is so critical. Talk about the role of a partner or how they can help support someone who is breastfeeding.
Samantha Zeeb:
I think my husband would like to chime in on this part. (Laugh) I luckily had a very a very supportive husband who wanted to take part. And there are a lot of dads that want to help. And sometimes when moms are choosing to breastfeed, they don’t know how to help. And so there are plenty of ways for a father to help, especially with the breastfeeding baby. So if you’re breastfeeding, Dad can change the baby’s diaper and bring Baby to you. He can put pillows and blankets around you. He can refill your ice water, get you snacks. He can swaddle and sway and rock the baby when Baby gets done eating. He can burp.
At night you can develop a system where when baby first initially wakes up and needs to be changed, Dad can do the diaper changing and then bring Baby to you. You breastfeed. And then when you’re done, give the baby to Dad for him to settle. Or if you’re pumping, Dad can clean the pump parts and he can bottle feed the baby. And dads in these newer generations are a lot more involved, I think, and they want to actively take part. There’s actually studies that show that the more a dad is interacting and taking part in these cares, the more his brain will actually change like a mother’s brain will. And he will have more of those bonding behaviors.
Courtney Collen:
My husband was my milk manager, I joke. He would make sure pump parts and bottle parts were always clean, milk was getting stored properly. But even more so making sure that I was eating and staying hydrated because it was so easy to forget to eat, to drink things. Can you speak to that for a moment? How important is it to stay nourished when you are deep into the newborn trenches and breastfeeding as well?
Samantha Zeeb:
A little life hack is to get yourself a little rolling cart that you can put in wherever you mainly breastfeed. So say you breastfeed often on the couch. Have a little cart and have it stacked with protein bars and good snacks, healthy snacks, fruits, vegetables, crackers, water. And the other thing about water is it’s important to stay hydrated, but also, I’ve had some moms that come in and they’re like, I’m drinking three gallons of water a day. (Laugh) Drink to hydrate. Drink to your thirst. You don’t need to go overboard. The rule of thumb: eat to hunger, drink to thirst.
Courtney Collen:
Yes, do it. Self-care is so important. Healthy mama, healthy baby.
If there are new moms listening who might be in the thick of the newborn phase, trying to get into a groove with breastfeeding, maybe there’s a poor latch and some pain associated with that. Maybe she’s feeling overwhelmed with engorgement making too much milk or feeling like she’s not making enough because baby seems hungry all the time. And she’s unsure if she can continue. Sam, what would you tell that woman to help feel supported and encouraged and certainly not alone?
Samantha Zeeb:
So, I would absolutely tell her to find her village. And so what I mean by that, when I say find your village, is find the people that support you no matter what.
Find the people that support you no matter what. Breastfeeding is great. It has great benefits, but ultimately, Mom and Baby need to be healthy. You know, Baby needs a healthy, stable mom. And so you have to do what works best for your family. You have to do what works best for you, and everybody is human and everybody needs a break.
I usually will say, well, what would make you feel better? Would getting sleep help? Do you have someone to take the baby so you can sleep? Do you need to go and have a couple hours alone? Do you need to give a bottle so that way you can just have a weight lifted off your shoulder? I think that sometimes as lactation consultants, people think we’re kind of breast or nothing. And while we emphasize the importance of breastfeeding, we also are there to support you and recognize that sometimes you need a break and sometimes it doesn’t work. And so we’re here to help you feel supported and we will evaluate what your goals are and we’re there to meet you at your goals.
Courtney Collen:
What do you love most about what you do?
Samantha Zeeb:
I have the best job in the world. I have moms all the time and grandmas all the time that are like, oh, I bet you just love your job. And truly I do. I kind of fell into it. So I when I was in nursing school and I was picking my internship, I got matched with our public health department and lo and behold, I was matched with an IBCLC. So an IBCLC is an international board certified lactation consultant, and that is the highest education you can receive in the field of breastfeeding.
I had my two children and I breastfed them both. And there is something about feeding an infant from your body all alone and just feeling like you two are the only ones on this earth. Just watching that sweet little baby nuzzle in and hearing the little sounds and just the bond that it gives. And I wanted to be able to give that gift to other people, and I wanted to be able to help other people.
I think women, it’s hard for us out there. Sometimes we’re providers and we’re mothers and we’re cleaners and we’re errand runners and all the things. And I think that in solidarity with that, just trying to be supportive of each other and help each other through where we can.
Courtney Collen:
Yes. Beautiful way to wrap this up. The lactation professionals at Sanford Health are angels on earth. (Laugh) Samantha Zeeb, thank you so much for your time and for all that you do.
Samantha Zeeb:
Thank you. It was a pleasure.
Courtney Collen:
I sure hope you learned as much as I did from our conversation today. This was another episode of the “Her Kind of Healthy” podcast series, brought to you by Sanford Health. For Sanford Health News, I’m Courtney Collen. Thanks for being here.
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Posted In Bismarck, Children's, Family Medicine, Health Information, Women's
