Dr. Rebecca Dekker – 00:00:00:
Hey everyone, on today’s podcast, we’re going to talk with Katie James, midwife, IBCLC, and host of The Midwives’ Cauldron podcast about how to overcome challenges with low milk supply. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.
Hi, everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast. Today I’m so excited to welcome Katie James to the Evidence Based Birth® Podcast. Katie has been a midwife and international board-certified lactation consultant, or IBCLC, for more than 20 years. Katie is also host and creator of the podcasts The Midwives’ Cauldron and The Feeding Couch. Katie has worked in a variety of settings ranging from hospital to home birth and community. Within her role as an IBCLC, she has supported all areas of breastfeeding and lactation, including supporting families with small and vulnerable babies in the NICU. With a huge passion to keep improving lactation education, Katie focuses much of her time on creating podcasts, online courses for birth workers or parents-to-be, meditations to support lactation and breastfeeding, and providing consultations for lactation globally. Welcome, Katie, to the Evidence Based Birth® Podcast.
Katie James – 00:02:39:
Thank you, Rebecca. Thank you so much for having me. It’s a pleasure to be here today.
Dr. Rebecca Dekker – 00:02:44:
We’re so excited for you to talk about a subject we’ve not really covered previously on the EBB Podcast. We have a lot of birth workers and parents who listen to our content. And I was wondering if you could start off, before we dive into real and perceived low milk supply, can you share with us a little bit about your background as a midwife and IBCLC and kind of what brought you into this field and made you so passionate about breastfeeding support?
Katie James – 00:03:11:
Oh, that’s a good question. I started off, obviously, you can hear my accent. I’m from the UK. And I started off my training as a midwife back when I was 19 because my mom told me I wasn’t allowed to be an actress, as I said at the time. And I became a midwife. And then through a case of kind of a genetic condition that I have, it meant that I couldn’t continue working as a home birth midwife and a community midwife. I couldn’t walk very well. And they didn’t know what to do with me. And back in kind of the early 2000s. A job role came up that no one else wanted as the infant feeding support midwife. And so they said, oh, you’re going to run this drop-in clinic with one of the peer supporters. And basically they stuck me in there. And that was it. I just realized the power of being able to support a new dyad, this mom and baby, these parents, this entire family. That could suddenly come in with tears and feeling so disheartened and walk out smiling, feeling confident and powerful and almost changing their entire outlook. And they may have had a really complex and challenging birth, but they then were regaining their power. And for me, that just got this passion going. And then it became about… learning more, becoming an IBCLC, moving to Australia, and then training my peers, my colleagues, and getting into the education side of it and realizing that when I can educate, I don’t help just one-on-one. They’ll go on and help thousands. And that for me was just marvelous. And then the passion went into the NICU as well, which is an area where breastfeeding and lactation support is often the last thing on the list. Unfortunately. So that’s kind of like my little road, how I got into here.
Dr. Rebecca Dekker – 00:05:12:
Yeah. I can almost picture you in that clinic with, you know, those first families that you worked with. And you mentioned that there was lots of tears. Can you talk a little bit about, you know, what makes people cry when they’re trying to feed their baby? Like, what are the… the troubles that people come across and why is it so emotional and difficult for us, as parents and mothers?
Katie James – 00:05:38:
It’s almost like, why? What doesn’t make us cry, I think, in those first few days? I think it has a lot to do with the hormones, but also expectations like, and not, we have the wrong expectations. It’s innate in us, to want to feed our child. As mammals, we are designed to feed our young. And so whether we are consciously aware of that and thinking of it, of I want to breastfeed, I want to feed my baby. Or not, there is a part of us that it’s within us, and it’s like a reflex that we want to do. And when that doesn’t work out as expected or as in the pictures or as we see on social media. It can be devastating. Also, what happens is our systems, particularly in the U.S., the UK, Australia, The more and more we medicalize birth and the outcomes that happen, the more and more we have breastfeeding difficulties. They go hand in hand. But what’s not happening is we’re not providing that training to our midwives, to our nurse midwives, to the OBs. So the knowledge base out there is not yet, I’m being positive, so not yet improving. And so the information that new mothers and parents are getting is still not really matching the dynamics of what we’re seeing currently with how we birth and how babies come out very sleepy and they’re not interested to feed. And no one’s really realizing we need to do something now to make sure that there’s a successful breastfeeding scenario.
Dr. Rebecca Dekker – 00:07:21:
Okay, so what are some of the ways then that birth, you mentioned babies being sleepy, perhaps from medications used during the process, but… What are we doing that does not support breastfeeding and lactation in those first couple hours or during the birth itself?
Katie James – 00:07:36:
It’s a really good point. And it’s probably one of my passion areas to talk about is why we’re getting these babies who don’t kind of come out and go, oh, there’s a breast. I’m going to go and feed straight away in that first hour. We’re getting these very sleepy babies for several hours, if not 48 hours. And that tends to be for those births that have had an induction of labor, an epidural, Cesarean section, whether planned or emergency. So we know that those interventions are impacting and affecting how the baby feeds in the beginning. There are other factors like gestational diabetes where we tend to see more babies come out more sleepy or with a higher chance of being sleepy and not interested to feed in the first few hours or days. And so there tends to be quite a few of these factors. And, you know, they coincide with this kind of cascade of intervention that we do throughout birth. So one picks up from another. And I often talk about how if there is intervention in birth and that may well be needed, then we shouldn’t be ruling out that we might need intervention to support the feeding going forwards. So we might be needing to use some tools and some tricks for the first few days to just boost milk supply until that baby picks up the pace and starts going, oh yeah, I meant to be feeding like 12 times a day here.
Dr. Rebecca Dekker – 00:09:07:
Okay. And so you were talking about the critical importance of those first few days and stimulating the milk supply by the baby wanting to feed frequently. And you’re saying any condition or traumatic birth or any experience that makes it so that you’re more tired, your baby’s more tired, you’re not going to feed as often, that kind of then. Has an effect down the road.
Katie James – 00:09:30:
Yes, because we have that marvelous hormone, one oxytocin, the love hormone, which we talk about a lot, but actually prolactin. So I like to talk about the two hormones. Prolactin is the chef. She makes the milk. And oxytocin is the waitress. She delivers it. But I’m really interested in the chef because at the beginning, in those first three days, she needs to be getting lots and lots of orders. And what happens is that means that there’s plenty of this prolactin hormone swimming around. And prolactin then goes and latches on. That’s a pun, really, sorry. It connects into these milk-making cells. And once they connect together, that milk-making cell goes, woohoo, I can make milk. It’s like switching on all the light switches in these thousands of milk cells. But if we haven’t done that within three days, these milk cells will close down and they won’t make milk. So if they don’t get connected with the chef hormone, the prolactin, they won’t then go on to make milk until the mother gets pregnant again and the milk cells are waiting and ready to connect. So we have these time windows to switch on the milk making cells, build up a massive supply. And then that’s the supply that’s going to keep going from month one to six months.
Dr. Rebecca Dekker – 00:10:55:
And when we talk about like low milk supply, which… I understand is a really common problem. Can you talk about like what that is? How you define low milk supply? How do you know it’s an actual condition versus perceived? How do you know, is it preventable or not preventable? Can you just kind of give us an overview of what this condition is and perhaps how common it is?
Katie James – 00:11:18:
Such a great question. Okay, let’s go with real low milk supply. So basically, this is going to probably be seen in the first four weeks. Or the first two months. And actually, this is the number one joint spot for the reason why women stop breastfeeding before they want to. So that and sore nipples. And this is all about, are they making enough milk by the end of two to four weeks postpartum? And what is enough milk? I mean, if your baby’s gaining weight, and they’re pooing and they’re weeing, you’re not even going to know what volumes are going into them. So we have this research from babies in the NICU, from pumping volumes. And we know that the average amount of milk by the end of around about 10 days, we’re making is about 800 mils in 24 hours. So we need to be getting to those volumes. And of course, there’s a wide variety. That’s the average. Some women are making way more than that. Others are making much less than their baby is thriving. But the fact is that if these babies are not feeding well, say at the beginning, they’ve been really sleepy and we haven’t done anything to mimic the baby. We haven’t started pumping or expressing the milk out. And that baby hasn’t been sucking on the breast, creating vacuum, stimulating that prolactin hormone. Then we might end up where milk supply volumes are not rapidly increasing. They’re just kind of a little bit increasing. And it might be that then that baby loses lots of weight. And what do we do? We introduce formula milk. And then the baby’s getting a supplemental feed and goes less and less to the breast. And then at five weeks down the track, say that mom or parent is coming in to see me. And she’s never been able to get off of the formula milk. And she’s breastfeeding six times in 24 hours, but every feed she needs to top up with two ounces of formula. Once we get past that four-week window. It’s too late to boost milk supply significantly. So we might be able to boost milk supply by 50 mils, 100 mils in 24 hours. And this is what is not being discussed with new parents, is that often we put people on these feeding plans and they go on and on and on for weeks. And no one discusses that there are actually windows when we can boost milk supply.
Dr. Rebecca Dekker – 00:14:08:
And when are the best windows to boost milk supply?
Katie James – 00:14:10:
Within that first four weeks. That’s really that open window to activate the hormones, to switch on the milk making cells and to ramp things up. And if after that point you’re making, for example, 400 mils and your baby needs all these formula top-ups, then you will continue to have probably around that much milk.
Dr. Rebecca Dekker – 00:14:33:
Mm-hmm.
Katie James – 00:14:34:
Does that make sense?
Dr. Rebecca Dekker – 00:14:35:
Yeah. So formula supplementation will just continue to be your norm for a while.
Katie James – 00:14:41:
Yeah.
Dr. Rebecca Dekker – 00:14:42:
And what are some of the, like, what are medical causes of low milk supply that may be not related to just not stimulating the breasts enough, but are there actual conditions that you can inherit or have that make it harder for your body to produce milk?
Katie James – 00:14:58:
Yeah, totally. And actually, we hear about IGT or insufficient glandular tissue or hypoplasia, which is hypoloplasia is the development of the breast tissue, the mammary gland. And we know that that can be part and parcel with some other conditions, like we might see it more often with someone who’s got polycystic ovarian syndrome. It’s all these PCOS, IGT, all these analogies. And the thing is, there are certain characteristics of the breast that we can look at, particularly as lactation consultants, we’re taught how to identify. Now, it’s not always 100%. And it’s a bit of a, we have to look at the baby feeding and weigh the baby and monitor the mom-baby dyad and keep an eye on how much milk is actually being made. But there are some pointers that we can see in certain breast shapes and sizes that might give us an idea that someone has insufficient glandular tissue. Now, the other thing to note is that throughout the Internet, you will probably see if you Google insufficient glandular tissue, it affects about two to 5% of the population. And actually, when you do a search of the evidence, there’s nowhere that actually says that just is one of those things that’s been said, and it gets said at conferences, and we keep saying it. But actually, we don’t know. We don’t know.
And the other thing is that we also, there’s, you know, a fair proportion of women who will have had breast reduction surgery for some reason. They may have had breast augmentation. And that’s always important when you’re a birth worker or a midwife or is to ask those questions during the antenatal period, because then we can put in place that referral to a lactation consultant, we can start talking about it. And often, you know, as lactation consultants, we might be seeing people who’ve had breast augmentation on one side and not the other, because there was this asymmetry in the breast. So, they might have an A cup. Do you use A cups in the U.S.? I can’t remember. In bra size on one side. And like, I don’t know, let’s just go really crazy. An A and a triple F on the other side. So, there’s this marked difference. And so, they’ve had augmentation to match them out. But for someone like us, who work in this field, that’s a sign of, hmm, maybe something’s going on there. Maybe that breast that didn’t develop isn’t going to make milk in the future. And so, when we’re able to have that discussion with our clients during pregnancy, it’s so much nicer because we can put plans in place. It doesn’t mean breastfeeding is over. There’s no chance of it. It just means it might look different. And being faced with all of that information and a different way of feeding your baby and working it out in your brain over several weeks before they’re born is so much easier than, you know, day three, the hormones have hit, baby’s lost loads of weight. Someone’s now saying, oh, well, I don’t think you’re going to make milk. It’s devastating. It’s overwhelming. And there’s a lot to take on.
Dr. Rebecca Dekker – 00:18:23:
Mm-hmm. So there’s IGT, which you mentioned, different kinds of breast or chest surgery, PCOS. I’ve also read that gestational diabetes makes it more likely. And I know that affects, you know, 11 to 14% of families?
Katie James – 00:18:39:
You’re absolutely right. And there’s been some new research out looking at whether that is the case, because there’s been lots of theories and thoughts. And we weren’t really sure what led to that. It’s a bit like a chicken or the egg situation. Is it that these babies tend to come out quite sleepy and then they don’t activate switching on the milk cells and no one starts a pump regime going? And therefore, low milk supply occurs because of us not doing what we should to support our clients? Or is it that there’s a higher chance because of how the hormones are working? And what we’ve seen is, yes, it’s actually both.
Dr. Rebecca Dekker – 00:19:22:
Okay, so that’s another condition you might want to talk with an IBCLC beforehand to have a plan in place.
Katie James – 00:19:27:
Definitely. And in a lot of countries, anyone with diabetes or gestational diabetes will be having the conversation about colostrum harvesting, which is when you are expressing colostrum during your pregnancy from about 36 weeks and storing it so that if your baby does have low blood sugars and they’re very sleepy, then we can give them a little bit of your colostrum that has been taken out during pregnancy.
Dr. Rebecca Dekker – 00:19:55:
Interesting. Okay. So that’s standard of care.
Katie James – 00:19:58:
Pretty standard in the UK, in Australia, Germany. Not sure if it’s quite there in the U.S. standard of care yet.
Dr. Rebecca Dekker – 00:20:05:
Okay. I don’t think it’s mainstream and like not being talked about that much. So that’s a potential issue. I think, you know, we have like these more medical internal conditions and then we have interventions, which we kind of talked about briefly. But another thing that I’ve heard, I was wondering if you could confirm, is that having a Cesarean can like indirectly lead to lower milk supply? Do we know why that is? Why it’s not as protective as a vaginal birth for lactating?
Katie James – 00:20:37:
This seems to be the, we’re not intervening at the right time. So again, these babies come out quite unwilling to feed, a bit sleepy. They’re affected by the medications have gone through them. It’s quite safe, but you know, it’s a lot for them to take on board. So they might be sleepy for 12, 36 hours. And again, this is the window, those first three days. That makes a difference.
Dr. Rebecca Dekker – 00:21:01:
They might have had more separation in recovery.
Katie James – 00:21:05:
Totally. That’s exactly it. So they might not have had that first skin to skin. They may not have had the first feed in the first three hours. So I always like to talk about the windows of opportunity of the three threes. First three hours, first three days, first three weeks. What we do in those periods of time can make or break our milk supply. So it’s, this is why when we’re interrupting that with separating mom and baby, like you said, when we have a baby who’s really sleepy and we’re not going, think of the breasts, not just think of the baby, think of the breasts, do something, activate them, switch the milk cells on. All of that will just compound and lead to the natural physiological processes not kicking in. It’s as simple as that. And we can stop that happening really simply. But if the education is not there by the healthcare stuff, then it’s on, the onus is on the parents to get that education during their pregnancy, ideally. So, they’re aware if XYZ happens. I can be doing expression. I can be doing breast massage. I am aware of these early feeding cues. I’m aware that saying no to separating my baby is a really powerful, empowering and helpful statement to learn.
Dr. Rebecca Dekker – 00:22:33:
So going along with that separation theme, I would imagine that that affects babies in the NICU who are born preterm or have health conditions because then they also aren’t stimulating the breast at the same amount that a healthy term baby would be.
Katie James – 00:22:49:
Yeah, exactly. And the thing is, though, as soon as someone hits the NICU, it’s like they’re given a pump. But when they’re on the maternity ward or the postpartum ward, and the baby’s not feeding, but the baby’s lying next to them in the plastic fishbowl, wrapped up like a burrito, we don’t think, oh, maybe we should give them a pump. So what happens generally in the NICU is even if the staff are not aware, they know to roll the pump in, give them the laminated sheet on how to use it, and off they go. Get them started. Exactly that.
Dr. Rebecca Dekker – 00:23:28:
So, moving on to like perceived low milk supply, how, you know, what is that? How is it different from an actual low milk supply when it’s perceived but not actual?
Katie James – 00:23:42:
It’s such a horrible term, isn’t it? And it’s what’s talked about in the literature all the time and talked about online. And I just think it makes us, it almost puts us in the silly women camp, you know.
Dr. Rebecca Dekker – 00:23:54:
Right.
Katie James – 00:23:54:
Go back into your-
Dr. Rebecca Dekker – 00:23:55:
It’s like you feel icky kind of saying it, but is it a thing? And, you know, or is it, you know, people might say it’s all in your heads. But, you know, talk to us about this phenomenon.
Katie James – 00:24:07:
Yeah, I think that was good to clear up that we don’t agree with that word. But yes, it is a phenomenon. And it’s again, this is tends to be after those first four weeks, more or less. And this is when we start seeing breastfeeding being stopped because of this procedure, this thought that my baby is not getting enough. And it tends to be all of these external influences. So the parents of the parents, you know, the grandparents, the Auntie Joan that comes in and goes, oh, is that baby wanting another feed? You never put that baby down. You know, all of the old wives tales, all the little bits of information that just keep planting the seed of doubt. And then what happens is it’s 3 a.m. And your baby has done the classic thing from around three weeks of age. And they are just having that sort of four or five hour period at night where they just cry and feed and cry and feed and cry and feed. And you are maybe five days into this and feeling like I don’t have enough milk. Clearly, I don’t. Otherwise, my baby would be sleeping. And we’re so exhausted and we’ve had all of this kind of seeds of doubt that we probably go back into the cupboard where we put that sachet of formula that was given to us. That still allowed in some countries for that to happen from chemists and pharmacies and hospitals. And we just think, I’ll just give one formula just because clearly I’m not enough for my baby. And we doubt ourselves. Because we’ve been bombarded with all the information.
And what happens is then we give whatever, three ounces of formula, the baby will chug it back. Gug, gug, gug, gug, gug. And they look like they’re having a wonderful time filling their belly. And what do they do? They fall asleep. Of course they do. And then they fall asleep probably for the longest sleep that those parents have seen in weeks. And then that really deepens that seed of doubt. And maybe the partner says, hmm, maybe you don’t have enough milk. Maybe we better give another one. And so this is like the top-up trap or the top-up puzzle in terms of we have the doubt, so we add in some extra milk. And then what happens is the same thing repeats the next day. So we add in another bottle. And the human body is not silly. If you miss a feed, you know, it’s a lot of energy to make milk. If you miss a feed, after three or four days, the body goes, oh, you’re weaning. Oh, I’ll reduce your milk supply then. So then we have the reverse effect. So actually, then the milk supply goes down. And then we need to even introduce even more formula. And so we’re in this vicious cycle.
And what becomes the narrative of those moms and parents who end up no longer being able to breastfeed? I didn’t make enough milk for my baby. My milk wasn’t good enough. The fat in my milk wasn’t good enough. I needed to give formula milk. But what’s happened was it was like a trap. You gave one or two or three and no one gave you the education that you actually needed or the support you needed to say, do you know what? You’ve got plenty. Look at your baby. Look at those fat rolls on their thighs. Look at this pooey nappy that’s coming out and how many wet nappies they do every day. You’re doing an amazing job. Keep going. This unsettled period’s really normal. It’s going to fade out. And just some love and reassurance to get going through those next week or so. Instead, they had all the doubt. They had all the messages from everywhere. They had all the formula company messages telling them that sneakily, your baby could sleep better with this. And then what happens is their body reduced the milk supply because it thought they were weaning. And so you end up in this really, really difficult scenario where you’re trapped and you feel like you can’t get your milk back. It’s really sad.
Dr. Rebecca Dekker – 00:28:28:
I can also imagine, though, for some families that they’re okay with that decision. Like, you know, that they weaned that one feeding. And they feel empowered that this solved, you know, this problem that I was having. Do you see, you know, how do you address that as an IBCLC?
Katie James – 00:28:48:
Oh, absolutely. It’s never black or white. I think the perceived milk supply problem that ends up with breastfeeding that stops and someone didn’t plan to stop breastfeeding, that is tragic. That’s deeply sad for them. That’s how they feel. That’s how they tell us. That’s what we see in the research. It was not my choice. But for someone who says, do you know what? Right now, in my situation, I want a mixed feed and this works out for me. Blooming marvelous. Blooming marvelous.
My job as a lactation consultant, and I believe every job as a lactation consultant, is there to give education and support. Not to judge, not to tell someone what to do, not to assume that everyone’s life is this and they have to exclusively breastfeed. That’s absolute, just awful. I don’t like that type of person in any healthcare professional. Like, it’s about a holistic approach. And when I train midwives and doulas, and when I’m talking with my clients, The first thing I’m thinking about is up here is brain, then breasts, and then baby and mum and how they work together. But we have to look at the psychological aspects. And that’s very different for every individual that we serve.
So no, I am not against formula. And there are also medical reasons for it. And a medical reason in the Academy of Breastfeeding Medicine is not just excessive weight loss, for example, or an illness. Also talk about the psychological well-being of that mom or parent. And that is absolutely vital. But I think what I feel really saddened by, and this is in so much of the research. And the World Health Organization talk about this, is that the marketing of formula, not the formula itself, just the marketing tactics, and the external influences of false information is what plants seeds of doubt. And then parents end up in a cycle of doubting themselves when we should be raising them up, we should be lifting them up, we should be giving them information and support that makes them feel like a bloomin’ champion. I’m feeding a human. Even if it’s 10 mils a day of their milk. They are still creating it and I think that’s where we have these polarized areas in our in this field.
Dr. Rebecca Dekker – 00:31:23:
Mm-hmm. I’m so glad that you cleared that up because I’m sure there’s parents listening who’ve been on different sides of the situation and in the middle, like you said, because it’s not black or white. When you talk about the seeds of doubt, let’s say you or your client are having seeds of doubt about your milk supply. You know, what are the best ways you can tell that your baby is getting enough milk that it’s not necessarily a supply issue, but it might be something else going on? So how can you, like, help? Address those feelings of doubt about your milk supply.
Katie James – 00:31:58:
I think that’s great and really important. And I think it sends me back to being a student midwife. And a really older, wise midwife gave me the information of, as a midwife, if you have a client who ever just says to you, but I just don’t feel good about this, it’s in my gut, you will never, you know, swipe her over. You will listen. You will take that seriously. And you will follow up.
Even if someone says to you, don’t be silly, Katie, they don’t know what they’re talking about. You go and you find another doctor. And I have spent 25 years of my career doing that. And every time, and it’s not often. That they’re really, you know, that gut instinct is so powerful. And I think as health professionals, we really need to listen to it.
And I would say as a new mom and parent, also listen to it. If there is that niggling that’s saying this, just, I just feel like someone’s missing something. Find someone else, seek another opinion, because we do miss things. And the education currently that we give doctors and nurse midwives and doulas on breastfeeding and lactation is poor. And it is not specific enough necessarily.
So we’re not seeing those babies who are having those sucking challenges where, yes, there’s a million things on the Internet about tongue ties, but then we do a tongue tie release or a snip or a laser surgery. But it doesn’t improve. And then they just say goodbye and no one can figure it out. So where’s all the sucking challenges information out there? It’s hard to find. And yet in my clinic, I see a lot of babies with sucking challenges and it might have been caused from the birth or molding or the cephalohematomas or plenty of other reasons. And, you know, the latches that just aren’t quite right. And we’re not really sure. The positioning of the attachment has been checked a million times. So I think for me, there could be many reasons. And that’s where my job as a lactation consultant in a way is interesting because I become the detective. And it’s where you need to refer to a lactation specialist. But I think it’s more about… Instinct, if that gut niggle is there and you have sought help from one or two other health professionals and you just feel, I feel something’s wrong, don’t ignore it.
Dr. Rebecca Dekker – 00:34:42:
So there’s gut instinct, like you, I think, did a really great job of explaining, but there’s also anxiety, you know, about perceived threats that maybe aren’t real. So how do you tell the difference between those two things?
Katie James – 00:34:56:
Speaking as a lactation consultant. So if I’m seeing a client for lactation, then what I’m doing is I am, holistically looking at this pair. It might be three of them actually walk in, but normally it’s two that walk in. And I’m looking at them from a psychological aspect, I’m looking at them from a physical aspect, I’m taking into the fact I’m watching a feed, I’m looking at weight charts, I’m looking at output nappies wet nappies, I’m looking at pattern. How often is that baby feeding? When they say to me, this baby feeds constantly. What does constantly mean? Because you could ask a hundred people, and that is a very different answer. What is their background? What you know, has this mom got a history of anxiety, and depression did she have a really traumatic birth. Is she’s suffering with nightmares and flashbacks? What else is going on? So, you know our job as a lactation consultant, is to do a macro view, and then a micro view. And all of that has to happen in, hopefully a 90 minute consultation, because an hour’s consultation could be very quick sometimes to try and figure all that. And then be the detective and be looking at it like from the brain, the breasts, the baby. What is going on? Where’s the problem? Aha! I’ve pinpointed it. And that can really help us work out. So just taking that wide view, and then putting all the pieces together.
Dr. Rebecca Dekker – 00:36:24:
I think, yeah, what it basically boils down to is getting support from someone who’s educated and knowledgeable and can see the big picture and the small picture, like you said. Trying to wrestle with it on your own or going to a pediatrician who just kind of, you know, dismisses your concerns or just says, well, let’s no problem. Then let’s just do formula to switch to formula. And even if that’s not your desire. So getting that support from a lactation professional is key.
Katie James – 00:36:56:
Yeah, totally. And, you know, it should be that it’s included in everyone’s insurance or in a way of getting access. And sometimes it isn’t. And I think it can be a big outlay. If you have the means financially to get a lactation consultant and if it is your desire to breastfeed, the quicker you see a specialist or you go to a La Leche League group or you go to a peer supporter. It can be anyone with specialist breastfeeding passion, I would say. They’re just going to give you more answers and more suggestions and more options. And again, it’s not going to be that black and white approach. And unfortunately, we know that pediatricians probably haven’t had any training in the U.S., in the UK, it’s hit and miss whether they have any training on lactation and breastfeeding or they might go to a four-hour seminar. There’s a lot more than four hours can teach you about breastfeeding. Yeah, you’re so right.
Dr. Rebecca Dekker – 00:37:56:
Yeah, I was going to say IBCLC spend years, you know, building their knowledge and training and they’re still always learning.
Katie James – 00:38:03:
Continuously, you’re absolutely right.
Dr. Rebecca Dekker – 00:38:05:
Yeah, it’s definitely a whole field and a specialty. Going back to you mentioned the rule of threes, the three hours, three days, first three weeks, correct?
Katie James – 00:38:16:
Yes.
Dr. Rebecca Dekker – 00:38:16:
We kind of talked a little bit about the first kind of hours and days and the importance of stimulating the breast if the baby’s not able to. What if you’re in that first three-week window and you’re concerned about milk supply? What are some things you can do? Like you said, to stimulate the chef-making hormone or the chef hormone of prolactin before that window kind of closes at the end of the first month.
Katie James – 00:38:41:
Yep. I think don’t put all your eggs in one basket and think a lactation cookie is going to solve it. If it would, I would be definitely selling them and on the street handing them out. They may help, but it’s not going to be the one thing.
So it really is a case of if a baby for whatever reason is not able to get enough milk out, then we need to take more milk out of the breast. The more milk we take out of the breast, the more milk your breast will make. It’s a simple equation, supply and demand. And if not enough milk is currently being made, then we have to kind of pretend you’ve got twins for a short period of time. And it is blooming hard work, this feeding plan. It’s often known as triple feeding. A mom or parent will be breastfeeding. Then expressing after feeds for about 15 minutes, 20 minutes max, not hours of expression. It’s very important. And then if the baby’s not gaining weight, well, then we’ll be also topping up. So that’s the third part of this trilogy of feeding plans.
So really the most important thing is to check a baby’s latch. Is there something going on with the way they position and they attach? Are they well attached? Are they able to actually drain the milk out of the breast effectively? If not, that’s number one thing to sort out.
If they’re not able to drain the milk out effectively, then probably we’ve got low milk supply. So we probably need to boost it and we boost it by expressing more. So we put more orders in to the chef. We get delivered more milk. It can take a couple of days. We might absolutely use those things called galactagogues, which are either herbal or even you might get a prescription for a medicine, which can boost this prolactin hormone. We will also be encouraging things such as, or I’ll be encouraging things such as build a nest, like and stay in skin to skin contact. Like just cancel the diary plans for a week because this is one hell of a feeding plan. And make yourself a beautiful nest somewhere comfy on the sofa or wherever’s good for you and stay in skin to skin contact with your bambino. I mean, obviously you can go to the toilet, you can have a break, but for the majority of the time, staying in skin to skin contact, trying laid back feeding styles, kind of repeat what happened at the birth or straight after the birth. Maybe do co-bathing together. I talk about this on my website, have information about it and how to do it safely. And doing all those nice yummy things. Don’t worry about the washing and the ironing and all the, it can wait. Your milk supply can’t. And seek help and support as soon as possible because the earlier we get in there, the quicker we can make a turnaround and save this milk supply.
Dr. Rebecca Dekker – 00:41:53:
Thank you for that beautiful crash course in increasing milk supply. Katie, thank you so much for all of the wisdom you’ve shared with us so far. Do you have any final tips for birth workers or parents who are listening and maybe struggling with these topics and in real life?
Katie James – 00:42:11:
Yeah. Firstly, if I can just get the message out that when you’re pregnant, don’t think and prenatal course that has like a massive long list of what’s in the course and then just tacks on and we’ll do breastfeeding is enough. Seek out an extra breastfeeding class, go and learn because if you’re armed with all of this information and knowledge. You’re just going to fly because you’ll probably encounter challenges. Let’s face it, it’s life, but you won’t be overwhelmed by them. You’ll be like, ah, I know there’s a solution. I just need to find it, blah, blah, blah, blah, blah. Yeah, I wrote that down. Okay, now we do this. So that’s the first thing. But obviously, if you’re listening to this and you are in those first few weeks, that’s pretty difficult. I think the biggest thing is that you have this time window and just be kind to yourself. And if it’s something you really want to do, please seek help. Please action it. And if it means that you, I don’t know, you pay for a lactation consult, and I don’t mean this flippantly. I just mean that sometimes we prioritize, I don’t know, a breastfeeding pillow, for example. And it’s the same cost as a lactation visit. Then prioritize the lactation visit. If you find it hard to pick up the phone and work out where your closest Le La Leche League group is, ask your friend to do it. Don’t be frightened to ask for help. Remember, when someone asked you for help a long time ago, whenever it was, you would have felt really great that your friend felt that your friendship was strong enough that she could ask you for help. So be that person. And I think sometimes we just need to stand up and say, I just need some help right now. It’s not easy. And the way will become clear.
Dr. Rebecca Dekker – 00:44:11:
It’s beautiful. I love your suggestion, you know, to think how you feel when you help a friend who’s struggling. And with your point about education, I want to add with partners too, because… You know, they’re the ones watching you cry or struggle. And so if they’ve had the same education as you and gone through the same learning, they will remember things that you might not when you’re in the haze of the sleep deprivation.
Katie James – 00:44:39:
Oh my goodness, absolutely. Over the last 20 years, I used to run obviously courses in the hospitals and I’d have people coming up to me and go, do I need to bring my partner to the breastfeeding one? And I’d be like… yes, it’s just as important as birth. Like seriously, your brain is mush when you’re given birth and it’s meant to be. You’re meant to just be in this total love haze, you know. And what do I do as a lactation consultant? How often did the baby feed? How many times? How many wet nappies? How much did they weigh? Like all the numbers. Partners are great for that. Partners are great for going, oh, do you know what? I’m just going to film what’s happening right now and how you’re positioning and the different changes and the exercises that the lactation consultant has given the baby. Like they are awesome and they want to have a job. So you are so right. Thank you.
Dr. Rebecca Dekker – 00:45:31:
Yes. Thank you, Katie, so much for all the work you do. What’s the best way for people to follow your work, learn more about lactation from you?
Katie James – 00:45:39:
They can find me online at katiejames.site, but I’m also over on Instagram @katiejameslactation.
Dr. Rebecca Dekker – 00:45:46:
Yeah, and please check out Katie’s two podcasts, The Midwives’ Cauldron and The Feeding Couch. Katie, it was an honor having you today. Thank you for joining us.
Katie James – 00:45:55:
Thank you so much for having me.
Dr. Rebecca Dekker – 00:45:56:
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