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A podcast for parents regarding the health and wellness of their children.
Breastfeeding Basics
No Description
On this episode, I welcome Melissa Mancini (@more_than_milk on Instagram). She is a mother of two, registered nurse, and certified lactation consultant.
She answers breastfeeding and pumping questions such as:
00;00;07;06 – 00;00;37;24
Dr. Mona
Hey, everyone. Welcome to the PedsDocTalk podcast. I’m your host, Doctor Mona, where each week I hope to educate and inspire you in your journey through parenthood with information on your most common concerns as a parent and interviews with fellow parents and experts in the field. My hope is you leave each week feeling more educated, confident and empowered in the decisions you make for your child.
00;00;37;26 – 00;01;00;29
Dr. Mona
Hello everyone and welcome to this week’s episode where I am welcoming Melissa Mancini, who is a registered nurse and board certified lactation consultant. And we are talking all about breastfeeding basics as well as pumping. And she has an amazing Instagram account more than milk and it’s more underscore than underscore milk. And I’ll be attaching that to my show notes.
00;01;01;06 – 00;01;06;09
Dr. Mona
But everyone welcome. Melissa mancini. Thank you so much for being here today.
00;01;06;11 – 00;01;08;01
Melissa Mancini
Thank you for having me.
00;01;08;03 – 00;01;13;21
Dr. Mona
So what do you enjoy most about being a lactation consultant?
00;01;13;23 – 00;01;35;01
Melissa Mancini
I really love the idea of supporting and empowering women. This can be such a challenging and and often really stressful time. I, I have two little ones myself. And so I remember thinking the first time, well, I prepared for birth. I prepared mostly for postpartum. How hard can breastfeeding be? It can’t be that difficult. It’ll all just sort of fall into place.
00;01;35;01 – 00;01;54;06
Melissa Mancini
And then I discovered that actually it was not the case at all. And so being able to be there at a time for families when I know exactly what that feels like, I will never forget that sense of vulnerability. Being able to engage with them, give them evidence based information and support them is is incredibly empowering to me.
00;01;54;08 – 00;01;57;18
Melissa Mancini
As an educator and a nurse and lactation consultant.
00;01;57;20 – 00;02;00;29
Dr. Mona
So how many years have you been a lactation consultant for?
00;02;01;01 – 00;02;27;22
Melissa Mancini
So I, at about the one year mark, actually, before that, I was, I’m a certified childbirth educator, so I taught prenatal classes, taught breastfeeding classes, and even before that, I was a registered nurse. So I’ve always been passionate about women’s health. I’ve always been, passionate about helping women. And so this semi new venture, was years in the making, but I’m about a year into the actual, private practice world.
00;02;27;24 – 00;02;29;16
Dr. Mona
And how old are your children?
00;02;29;18 – 00;02;35;08
Melissa Mancini
They are one just turned five yesterday. Yeah. And the other one turned seven next month.
00;02;35;11 – 00;02;45;17
Dr. Mona
Awesome. So you breastfed both of them or did you? Yeah. And so you decided to do this after what you had went through, as a new mom or obviously as a second time, breastfeeding. Right.
00;02;45;19 – 00;03;03;26
Melissa Mancini
Right. I, you know, I had never heard of a lactation consultant. I didn’t know that was a field that existed until I struggled with the first one. And, you know, you don’t know what you don’t know until you get there. And so realizing that this was such, a critical period of time, and then you hear from other women who say, oh, yeah, I really struggled to.
00;03;03;26 – 00;03;10;10
Melissa Mancini
And you think, why are we not talking about this? Why don’t we know that this exists? That’s sort of how I landed here.
00;03;10;12 – 00;03;15;13
Dr. Mona
So is that what prompted you to start your Instagram page? Also, just wanting to educate more moms.
00;03;15;16 – 00;03;44;26
Melissa Mancini
It is. Yeah. I think, you know, being on social media, you see all of the misinformation, you see people having conversations. And once you know what’s what’s actually evidence based, it’s sort of makes you cringe to see what’s out there. So being able to put out that information, say, actually, this isn’t true, here’s what is, and here’s how you can get the help you need if you’re struggling or here’s what you should know ahead of time instead of those, you know, oftentimes middle of the night Google searches that that families might do, having everything in one place to say, this is the evidence.
00;03;45;01 – 00;03;50;23
Melissa Mancini
Here’s where you can find that information and have it all in one place for families.
00;03;50;26 – 00;04;09;16
Dr. Mona
And I know we’re going to be getting into, you know, obviously, basics of breastfeeding. We do encourage obviously anyone listening to take any other courses or get resources from Melissa’s page, or wherever you get resources from. But I want to know, you said it. What were your biggest struggles when you were learning how to breastfeed your first child?
00;04;09;18 – 00;04;28;05
Melissa Mancini
It turns out that he had a pretty classic tongue tie. And again, I had no idea what that was. And he had lost, pretty considerable amount of weight by day two. And that was our first indication. I had been in a lot of pain for two days. I didn’t know that that wasn’t normal. I thought, well, this is just what maybe this is just how it works.
00;04;28;05 – 00;04;47;14
Melissa Mancini
Maybe my nipples just need to toughen up. And after a few days, they’ll get used to it. So he, it turns out, had a very classic tongue tie. Our midwife connected us with resources to a pediatric EMT who we saw on day three, had it corrected. And then we sort of had to relearn a lot of what we had tried the first few days.
00;04;47;14 – 00;05;12;14
Melissa Mancini
So that led us down this interesting path of providers I didn’t know existed and, you know, really made me realize how much of a struggle it was. And in the course of going to these practitioners, you realize I if I had had a provider who didn’t recognize what a tongue tie was, where would we have been? I mean, I, I think that oftentimes people are just told either suck it up or give up, it’s fine.
00;05;12;14 – 00;05;28;20
Melissa Mancini
Maybe this isn’t what you’re meant to do. Maybe this just shouldn’t work out. And so I felt pretty fortunate that I got that support that I needed and got to the right place at the right time. And it was much easier with my second one. But I was in a space where I was mentally prepared for it to be really challenging again.
00;05;28;20 – 00;05;42;11
Melissa Mancini
So I did a lot of research that a lot of, you know, made sure I have everything lined up just in case she had the same thing. And so when she breastfed and everything went really smoothly, I thought, oh my gosh, okay. This also does,
00;05;42;14 – 00;06;07;00
Dr. Mona
Well, your comment about tongue ties, obviously, I know this isn’t a podcast about tongue ties, but it’s important because we’re talking about breastfeeding. I completely agree with that sentiment that if it’s painful, you need to talk to someone about it and you need to get the baby evaluated, but also work with a lactation consultant like yourself to make sure that you’re maximizing, the latch and maximizing positioning so that it doesn’t have to be this awfully painful thing.
00;06;07;00 – 00;06;28;18
Dr. Mona
I agree with you. A lot of mothers don’t get the help they need, because there’s this kind of stigma or misconception that, okay, well, other people do it. It hurts, but not not at all a problem just to ask and say, you know what? It’s actually hurting. Can we just make sure? I just want to talk to someone because like you said, if it is a tongue tie, and it’s obviously causing mom pain, it’s an easy fix that we can do.
00;06;28;18 – 00;06;31;17
Dr. Mona
And if we do it earlier, it’s better to maximize the breastfeeding.
00;06;31;23 – 00;06;38;22
Melissa Mancini
Right. And it’s a very seamless process in and of itself. So I think it sounds intimidating. But yes. Podcast for another day.
00;06;38;24 – 00;06;49;06
Dr. Mona
Yeah. So to start off, how can a mother best prepare herself postpartum for breastfeeding? What should she do if if that’s the choice she’s making to breastfeed? What are some things that she should do?
00;06;49;11 – 00;07;11;10
Melissa Mancini
First of all, find a prenatal breastfeeding class without a doubt. Obviously in these times, it’s not always. It’s not always possible to have an in-person class. That’s always my first go to, because I think it really is a community engagement. When you can go to an in-person breastfeeding class, if that’s not possible, find other resources in your community where they host virtual breastfeeding classes.
00;07;11;17 – 00;07;30;14
Melissa Mancini
If that’s not possible, they also have great prerecorded breastfeeding classes on the basics now, and I often have families who will reach out to me, hey, we’re doing a few days with our baby and we didn’t get to a prenatal breastfeeding class, so a lot of lactation consultants will do a sort of hyper speed class to make sure you have the fundamentals.
00;07;30;14 – 00;07;52;24
Melissa Mancini
So absolutely take a prenatal breastfeeding class. Understand that the volumes of breast milk in the beginning are very small and babies stomachs are very small. I think sometimes people get very hung up on, you know, those small volumes and it was only a few drops. And to understand that that’s normal. If those few drops are what your baby needs in the beginning, that will increase over time.
00;07;52;26 – 00;08;16;00
Melissa Mancini
And then to have an understanding of, you know, the the factors that contribute to to newborns losing weight, they do lose weight. And our weight loss is normal. What’s not normal are higher percentage of weight loss. So again if we have that fundamental in place we know this is normal. We know that maybe for whatever reason this baby has lost a higher percentage of weight loss.
00;08;16;02 – 00;08;33;29
Melissa Mancini
Then we understand that you need support. So instead of saying okay, this baby’s lost a high percentage of of weight on day two, what are we going to do? We know okay, well, reach out to lactation consultant, work with the pediatrician and make a plan. If you have those understandings before you give birth, then it’s sort of okay.
00;08;34;02 – 00;08;55;17
Melissa Mancini
You have your ducks in a row now follow them and get that support you need. And prenatal breastfeeding. Have an understanding of the normal parts of breastfeeding. What’s normal, what’s not normal, and then have a calm environment for breastfeeding. Once your home. Obviously the environment, the hospital is not always calm, but you’re going to have support there. You’re going to have nurses.
00;08;55;17 – 00;09;26;00
Melissa Mancini
You might have lactation consultants. You can help you. Once you’re home. You need a calm room. You need a calm space where you can go breastfeed your baby. Sometimes what happens again pre-COVID is we have a lot of visitors who come in and oftentimes mom is really tired. She’s not breastfeeding very frequently because she’s entertaining other people. So if you create that oasis, wherever that might be, your bedroom and you have that space to go escape to, that can really help get breastfeeding started.
00;09;26;00 – 00;09;54;24
Melissa Mancini
Well, you don’t need a lot of things for breastfeeding. You need a comfortable chair or couch, some place where you can sit. You don’t necessarily need an expensive breastfeeding pillow. You can use pillows from your bed. So I don’t recommend a lot of things. I recommend thinking about the the mental aspects of breastfeeding, of breastfeeding, and creating that environment, talking to your partner and figuring out how is this going to look for you, who’s going to be involved?
00;09;54;24 – 00;10;01;07
Melissa Mancini
Who’s going to be there to support you? Those are the most important things you can do to really prepare yourself for breastfeeding.
00;10;01;09 – 00;10;18;15
Dr. Mona
I agree completely, but I think we focus so much on the items. I mean, it’s nice obviously if you want to get the pillow, you can, but it’s that emotional aspect of breastfeeding that is actually the hardest thing. And I think for me, I think you follow my page. I, I was in the hospital in ICU for two weeks.
00;10;18;15 – 00;10;36;11
Dr. Mona
And so it is, like you said, the hospital setting, especially in an ICU with all these wires, it was very difficult and I my mental space was not able to be in breastfeeding. And I, I stopped breastfeeding because for me, I’m speaking personally because of the mental aspect that it was that the difficulty that it was doing, it wasn’t.
00;10;36;18 – 00;10;58;13
Dr. Mona
I’m sure if I kept doing it physically, it would have happened, but it was extremely draining for me emotionally. Having gone through what we did and I, I knew it before being a mom that the mental aspect is huge, but that support aspect is amazing and it’s that room that quiet room that you can have, being comfortable in the positioning that you need to be in is what’s going to be key here for sure.
00;10;58;15 – 00;11;24;11
Dr. Mona
So I want to talk a little bit about the physiology of breastfeeding, because I think it’s important that people understand that it is something obviously that kind of regulated by a lot of hormones. Obviously, it’s very it can be very difficult to establish. But can you explain briefly? You know, obviously for non-science, minds, maybe the physiology of breastfeeding, the hormones involved, with production and let down and then why things like skin to skin would help in production.
00;11;24;13 – 00;11;49;13
Melissa Mancini
Yeah. So breast milk production actually, to many people, surprise begins about 14 weeks of pregnancy. Some moms may notice that their breasts enlarge the Ariela gets darker. Your body is producing colostrum really early on. Sometimes women think, well, I wasn’t leaking, so therefore I, I definitely don’t have this breast milk. You do in whether or not you leak breast milk is not any indication of your supply or whether or not you have it.
00;11;49;15 – 00;12;10;19
Melissa Mancini
But 14 weeks your body starts making that colostrum. So very early on. And then one of the things that happens is that once the baby is delivered, once the placenta is delivered, we have this huge drop in progesterone, one of the hormones involved. And then we get this huge surge in a hormone called prolactin. And prolactin is one of the driving forces behind milk production.
00;12;10;21 – 00;12;34;10
Melissa Mancini
Oxytocin is another hormone that’s really involved in milk production. And I think a lot of us associate oxytocin with bonding or snuggling or things like skin to skin. So when babies about 3 to 5 days old, then we get a transition of milk to a larger volume, different type of milk. It’s all breast milk that colostrum. You have 14 weeks of pregnancy all the way through weaning.
00;12;34;10 – 00;13;04;04
Melissa Mancini
It’s all variations of breast milk in varying volumes. So that’s really the basics of how your body triggers milk supply. And then in order to get that higher volume at 3 to 5 days postpartum, the most important part, aside from the hormones that, like you said, are autonomic, right. Those hormone responses are happening either way. The other most important piece is, the understanding that that breast milk is about demand and supply.
00;13;04;07 – 00;13;23;26
Melissa Mancini
So in order for your body to make more milk, you have to remove milk. And if you have that understanding that removing milk makes more milk, it helps a lot of things than understanding about breast milk kind of fall into place. How do we make more milk? We remove more milk that can be through hand expression. That could be through baby breastfeeding.
00;13;23;26 – 00;13;48;05
Melissa Mancini
If the baby’s able to effectively remove milk or that could be pumping. All of those are ways to remove milk. And then if we think about that, oxytocin being involved in breastfeeding, that’s where our skin to skin comes into play. You know, obviously putting the baby’s skin to skin with mom is helps regulate the baby’s body temperature, really helps stabilize the baby’s vital signs for everything’s going smoothly.
00;13;48;08 – 00;14;10;20
Melissa Mancini
But also having the baby skin to skin is a big trigger for mom. Mom gets that big surge of oxytocin. That oxytocin. You really feel this sort of overwhelming, you know, flood of emotions. And oxytocin is one of those hormones involved that can really help your supply. So we really want to keep baby’s the skin to skin as possible as much as we can.
00;14;10;20 – 00;14;28;01
Melissa Mancini
There’s really no upper limit here. If we can keep baby’s skin to skin in between, you know, diaper changes and things like that, that’s really going to help. It’s also going to help because the baby can smell the breast milk. Baby really has easy access to the breast. So if we keep baby’s skin to skin, we recognize that that baby is showing feeding cues.
00;14;28;05 – 00;14;35;08
Melissa Mancini
We just slide the baby over and help the baby latch. So it really is about ease. It’s about access and it’s about hormones.
00;14;35;10 – 00;14;52;19
Dr. Mona
And in terms of those first three weeks, do you believe more so that feeding on demand is better? Is there ever a time where time feedings would be recommended? Because I know that’s a common question. I get as well on my Instagram. And obviously in the office, some people say, oh no, you have to make sure you are on a routine.
00;14;52;19 – 00;15;00;26
Dr. Mona
Others are like, no, let your baby tell you what are your thoughts. And I know this is just obviously education and not personal advice. But what would you say about that?
00;15;00;28 – 00;15;27;24
Melissa Mancini
I generally don’t interfere unless I need to. As a lactation consultant. So if a mom comes to me or their pediatrician and says everything’s going well, I feel great. Baby’s back to gaining their weight after that initial weight loss, everything’s going smoothly. I tell families, great. Keep going with that. If it’s not broke, don’t fix it. However, if you have a baby who is still losing weight is at a high percentage of of weight loss post-birth.
00;15;27;27 – 00;15;48;10
Melissa Mancini
If a mom is having a lot of pain, if she has concerns about her supply, maybe they started supplementing with formula in the hospital and they’re trying to increase their supply. I would tell them to focus more on the clock. So I would say things like, you know, put the baby to the breast every 2 to 3 hours or for a total of, you know, 8 to 12 times a day.
00;15;48;12 – 00;16;06;08
Melissa Mancini
Those are both basically saying the same thing, which is get that baby to the breast more frequently if that baby needs it. So interfere if you need to. But if everything is going well, let it go. Some babies are really great about, you know, cluster feeding. So feeding more frequently during certain times and then they go for longer periods of time.
00;16;06;10 – 00;16;25;00
Melissa Mancini
So again, if it’s not broke, don’t fix it. Let things go and interfere when you need to. But otherwise the expression that a lot of lactation consultants uses watch the baby, not the clock. It’s that baby showing feeding cues. Feed the baby by all means. Don’t think, well, I just fed the babies 30 minutes ago so I shouldn’t feed them again.
00;16;25;01 – 00;16;31;05
Melissa Mancini
You know, a lot of times that’s that’s the baby asking for more food. And we should follow that in those early weeks.
00;16;31;08 – 00;16;48;07
Dr. Mona
And you mentioned cluster feeding. I often get that question. Also, is there a certain age where you start to see cluster feeding should start to improve, meaning that by a certain month or certain week of life that the feeding should be spaced out? And if there’s still clustering, it’s a cause of concern or just depends on the baby.
00;16;48;09 – 00;17;12;07
Melissa Mancini
That’s going to depend on the baby. But largely the first few weeks I really tell families that it’s very normal. It’s really that’s what the baby is, is meant to be doing. They’re meant to take in more milk at certain times, just like you or I would. Right? I mean, I always tell moms to go back to their pregnant self and imagine you ate dinner and then 30 minutes later, you thought, well, I could eat a little snack if somebody told you, no, you can’t eat right now.
00;17;12;10 – 00;17;29;26
Melissa Mancini
You’re saying, I’m listening to my body. My body is asking me for more calories. So babies are doing the same thing. The thing that changes, I think, is, you know, they get those larger bellies. They do tend to take in more milk, but they tend to cluster feed later for things like growth spurts. Again, they need more calories.
00;17;30;00 – 00;17;53;02
Melissa Mancini
The other thing they might cluster feed for is, let’s say a mom’s period returns. So menstruation begins again. She might have a little bit of a dip in her milk supply, and that baby is going to elicit more breastfeeding in order to increase her supply again. So they’re pretty brilliant about noticing when things drop. And then they might cluster feed more frequently around that time, and that will increase their supply again.
00;17;53;04 – 00;18;15;23
Melissa Mancini
They might also cluster feed during times when they’re not feeling well. Right. It’s it’s it could be comfort feeding. So there’s all kinds of reasons that babies cluster feed. It could be calories. It could be that they’re not feeling well. It could be that sense of closeness. And I always tell families later, you know, if this becomes an issue, something that’s really hard for moms, then, you know, something like a pacifier might be really great for this baby who has a high stuck need.
00;18;15;25 – 00;18;41;13
Melissa Mancini
And and so those are completely fine. You know I think sometimes the reputation of lactation consultants is that we are militant. And you know we are breast only. And that’s I mean I’m hoping that that is changing and that we’re having a better understanding that we really have to meet moms where they’re at. And if a pacifier or any type of supplementation is needed, you know, those are important things for really, empowering families in the way that they need.
00;18;41;15 – 00;19;04;00
Dr. Mona
Well, that’s why I love connecting with you, because I agree that there is a camp of lactation consultant that is very hardcore. And I say I’ve met them, okay. And I it’s hard for me because it actually puts a lot more stress on a mom, than your style. Which is why when I spoke to you, when we, talked about this podcast, I was very grateful to meet you, because I want that energy, too.
00;19;04;03 – 00;19;18;13
Dr. Mona
And, you know, that sort of. This is what we’re going to do. We’re going to maximize this experience for you because it is an experience. We want it to be enjoyable and not a scary, like, you have to do this. And if you don’t do this, you’re terrible. No. It’s fun. You’re going to enjoy it. Well, not always fun.
00;19;18;19 – 00;19;30;16
Dr. Mona
And then you mentioned about the pacifier, are you do you normally recommend waiting to introduce the pacifier or are you okay if the latch is okay to introduce it? Or what’s the timing of pacifier introduction for your opinion?
00;19;30;18 – 00;19;53;24
Melissa Mancini
I generally will tell families to wait and see how breastfeeding is going. If if everything is going beautifully and that baby is latching, mom has no pain. Mom’s milk volume increases. I usually say, you know, after a few days if that baby has a high suc need. And that’s comforting for that baby. Absolutely. Introduce that. If mom has a lot of pain, babies not gaining very, you know, good weight, then I always sort of say, let’s just wait.
00;19;53;24 – 00;19;59;23
Melissa Mancini
Let’s get this problem solved first and then we can introduce the pacifier once those problems are solved.
00;19;59;25 – 00;20;18;08
Dr. Mona
I agree, obviously I’m not a lactation consultant, but a lot of parents do ask me for the preliminary questions and if they have concerns, they’re going to the lactation consultant. But, I definitely agree with that comment. I think there was a misconception that you can’t introduce it until much later, but no, you can introduce it once. I agree with the once, it’s once.
00;20;18;11 – 00;20;35;13
Dr. Mona
It’s not painful. Once things are okay, there’s you can do a little earlier, but you might as well just wait 4 or 5 days, you know, seven days and then introduce. What would you say is the main issues or difficulties mother would have with breastfeeding? Is it the latch? Is it production? Is it a little bit of both.
00;20;35;20 – 00;20;36;19
Dr. Mona
What do you think?
00;20;36;22 – 00;20;57;21
Melissa Mancini
I think that the misconceptions around breastfeeding are a huge issue. Like I said, I didn’t even take a prenatal breastfeeding class. I didn’t really see it as something that I needed to do. I think that happens pretty frequently. I know at the hospital where I taught, I think our percentages, we were at about 25% of families who would take the breastfeeding class.
00;20;57;23 – 00;21;16;01
Melissa Mancini
And so if you think about it, that’s a very large percentage of people who probably go into it with very little information. So a lack of information, I really think fundamentally a lack of support. And, you know, we often tell women at all stages struggling with lots of different things in motherhood, you know. Well, I did it.
00;21;16;01 – 00;21;34;01
Melissa Mancini
Or you’ll figure it out or, you know, they’ll hear horror stories. I don’t think that does moms any justice. I really think pointing them in the right direction and saying, hey, you might struggle with this, you might not. But if you do, here’s how to get support. So I think a lack of education and a lack of support are the two things that I see.
00;21;34;04 – 00;21;42;02
Melissa Mancini
And, you know, those can lead to production issues and all kinds of things. But I think fundamentally, those are the two top things.
00;21;42;05 – 00;22;04;25
Dr. Mona
Yeah. And I think they’re for me. And I’m just speaking personally, from what I went through, I think there was also a self-inflicted pressure. And we talked about this earlier, but this sort of pressure to breastfeed. And I, I say that because that’s great that it puts, you know, that motivation into you. But it also it also made me very stressed about the experience when we had what happened, you know, in the hospital happened to us.
00;22;05;01 – 00;22;21;03
Dr. Mona
I felt very overwhelmed with the fact that I want to breastfeed. It has to happen. It has to happen. And I it wasn’t happening. And I think a lot of it was due to my stress. But it’s that not putting so much pressure on you that saying I want to breastfeed, I’m going to take all the resources I can.
00;22;21;03 – 00;22;40;10
Dr. Mona
I’m going to educate myself. I’m going to, you know, listen to this episode like we’re discussing right now, but I’m also going to go into it as that. I’m going to handle it day by day. I thought I was going to do that and it just for me didn’t happen. And, you know, if I am fortunate enough to have a second child, I would like to experience breastfeeding.
00;22;40;13 – 00;23;10;27
Dr. Mona
But I think going into it, understanding that, you know, you will get through it, obviously there are resources available to walk you through whatever choice you make for your child, whether it is solely breastfeeding, fully pumping, supplementing or formula feeding. So I love that we were able to talk about this more so because as a lactation consultant and for me, being a pediatrician who formula fed my son, who is very pro breastfeeding, I think it’s so nice that we can have this conversation about being pro mom, but also pro breastfeeding at the same time and pro formula at the same time.
00;23;10;27 – 00;23;27;22
Dr. Mona
So that’s the goal of this episode. In terms of a latch, I know it’s obviously hard on a podcast episode to talk about all the different latches. But how can a mother best find a latch that works for herself? Would that be through the courses? Would that just be from trial and error? A little bit of both.
00;23;27;25 – 00;23;50;00
Melissa Mancini
A little bit of both. I think when you take courses there, they generally have very good visuals. If you take an in-person, of course, they’ll usually have things like having a hold a baby doll. And you know, there are certain aspects of that that are really useful and helpful. The one thing that I always try and point out to families is that when you and I eat or when we drink, our body is pretty much in alignment.
00;23;50;00 – 00;24;11;04
Melissa Mancini
We don’t turn our chin over our shoulder and try and swallow. We don’t tuck our chin all the way down to our chest and try and swallow. So think about the very basic fundamentals of how we eat and how we swallow, and how uncomfortable it would be if your chin is tucked all the way. So if we have this baby all scrunched up and their chin is diving into their little chest, that’s really difficult to swallow.
00;24;11;04 – 00;24;28;12
Melissa Mancini
That’s really difficult to have a good latch. And oftentimes what babies do is they bite down. And so that’s when I go to help a family. And I will hear something like, oh, every time they latch, it really feels like they’re biting. And then I look and sometimes it’s sometimes it’s very simple. It’s just really working on the positioning of that baby.
00;24;28;17 – 00;24;48;29
Melissa Mancini
So I think they’re able to see it is helpful in a class. But then you know, a certain aspect of it, holding a baby doll is not the same as holding your newborn. There just is a a trial and error, a find a position that’s comfortable for you. I don’t like the dogma surrounding you have to hold your baby this exact way or you know again, if it’s not broke, don’t fix that.
00;24;48;29 – 00;25;06;27
Melissa Mancini
If a mom is holding a baby and the baby is doing well and everyone’s comfortable, I am fine with that. You know, I don’t. I don’t need to interfere in a way that she doesn’t look like the textbook picture. If everything is going smoothly, that’s great, but any pinching or biting sensation in the latches, that is an immediate red flag.
00;25;06;27 – 00;25;25;19
Melissa Mancini
You should never feel pinching or biting. You might feel a little bit of soreness in your nipples. That can be normal special in the beginning, but pinching, biting, that sense of curling your toes every time. Baby latches. Those are big red flags that signal that you need. You need support and you need to support early on. You shouldn’t just wait and think, well, maybe this is normal.
00;25;25;19 – 00;25;30;08
Melissa Mancini
Maybe it’ll get better. Definitely ask for help earlier rather than later.
00;25;30;10 – 00;25;50;19
Dr. Mona
And the other aspect, obviously, is production. So we talked a little bit about the physiology of breast milk, which I think is important to start off with. So I’m glad we did that to understand like the mechanism of, production. But what can a mother do who may not be producing as much milk? What would be your, you know, basic tips for that.
00;25;50;21 – 00;26;10;01
Melissa Mancini
Would be to look at how often your baby is feeding if, if, if it is an issue of the baby, not feeding frequently enough, I would have her increase the number of times that she feeds the baby if the baby is feeding frequently, but maybe baby is not removing a large volume of milk, then I might have her pump after breast feeding.
00;26;10;01 – 00;26;31;01
Melissa Mancini
So breastfeed first and then pump for 10 to 15 minutes after. What that’s doing is that’s telling the body I need more and so if we’re removing more milk, the body’s really going to get those signals to increase the amount of supply it could be pumping. It could be a hand expression. It could be, you know, breast feeding more frequently.
00;26;31;03 – 00;26;48;17
Melissa Mancini
The thing that I want to point out that I see the most is that I will hear families say things like, well, what about these teas? And what about these lactation cookies? And I am quick to point out that if you want a cookie, enjoy the cookie. Enjoy the best cookie that you can find. They’re not going to save your milk supply.
00;26;48;19 – 00;27;06;21
Melissa Mancini
And there’s just a lot of very good marketing that is targeted toward women that if you drink these teas and if you eat these cookies, this is going to solve all of your supply problems. And that’s not that’s just never going to happen. Enjoy the cookie, enjoy the tea. But if we want to make more milk, we have to tell the body, hey, we need to remove more.
00;27;06;22 – 00;27;18;09
Melissa Mancini
And that body will get the cues, the hormonal cues to make more. So no cookies or tea are going to solve your problem. Removing more milk in the form of more breast feeding or pumping is the most important way to do it.
00;27;18;13 – 00;27;36;14
Dr. Mona
And I’m so happy you said that because I, you know, I when I became a pediatrician and I got pregnant, I was seeing the market of teas and cookies and I’m going to be full disclosure, I bought them, okay. I bought them when I was in the hospital, a little struggling with breastfeeding because I was desperate. Okay. And I ate them.
00;27;36;14 – 00;27;55;18
Dr. Mona
And in Indian culture, we take a lot of fenugreek. It’s actually very common. We use it in a lot of, fruit, like sweets and foods because it’s thought that it, you know, can help with breastfeeding production. I ate my mom would make me all these things to help produce the breast milk, but I didn’t. Okay. And I appreciate you saying that because it’s so much more than supplements.
00;27;55;18 – 00;28;13;04
Dr. Mona
And that’s just the nature of medicine in general, right? Our bodies in general, we can’t rely solely on an exogenous thing that we’re taking or eating to be the end all, be all. It may help me, right? But maybe it makes you feel better. It could be a placebo. It could be that you’re doing something and that makes you a little more relaxed.
00;28;13;04 – 00;28;35;12
Dr. Mona
And that’s in turn helps you breastfeed. I don’t know, but the science is not there to support that. You need to take these things in order to be a good producer. And things like that. And that’s just the reality. And so I really appreciate you saying that. What? So we’re going to switch gears to pain because I know, obviously I didn’t go through it because I didn’t end up, breastfeeding fully.
00;28;35;15 – 00;28;48;11
Dr. Mona
But pain with breastfeeding is very common. What are some things that we can do? Maybe first to prevent the pain from happening, like, you know, focusing on like preventing as much as possible and what a mother can do if she is having pain with breastfeeding.
00;28;48;13 – 00;29;12;27
Melissa Mancini
So one of the first things that you can do if you’re in the hospital, ask for a lactation consultant. Generally, hospitals do have IB classes or International Board certified Lactation consultant on staff. They can come. They’re really the breastfeeding experts in the hospital. Nurses do have a fundamental, you know, basic amount of information. But if you can get a Navy Seal, see in the hospital, ask them to come and take a look and say, you know, this is painful.
00;29;13;01 – 00;29;35;20
Melissa Mancini
I’m not really sure what’s going on. Like I said before, it may be that we just need to adjust the baby’s positioning a little bit, but, you know, we will tell families, you know, they’ll be quick to hand you nipple cream and you can use that in between breastfeeding. But I always tell families, if you are buying a industrial supply of nipple cream, that is a giant red flag, you might need that early on, but you shouldn’t be relying on that.
00;29;35;20 – 00;29;58;01
Melissa Mancini
The nipple cream is not going to solve the pain of breastfeeding. That is generally a physiologic issue. You know, the baby needs to be able to pull the nipple all the way to the back of the throat. They don’t use their gums, they’re really using their tongue. So that tongue works in these very peristaltic motions to pull the nipple onto the back of their throat, to swallow the milk.
00;29;58;04 – 00;30;20;12
Melissa Mancini
If that’s not happening, and instead they’re biting or pinching for whatever reason, like we said before, that could be it could be a tongue tied, could be that that baby can’t get that tongue up and elevated to do those nice peristaltic motions. It could be that the baby is sort of positioned sideways, and they’re feeling like they need to bite down instead of using, you know, their their typical physiology for swallowing.
00;30;20;18 – 00;30;43;24
Melissa Mancini
So look at positioning first and foremost. That’s always the most basic thing. And then let’s start looking at whether there’s a physical reason that this baby is causing this pain. And third, you know, like I said, that the soreness is common in the first few days. Use the nipple cream if you have it in between feeding. But if it persists, please ask for help and please get help early.
00;30;44;00 – 00;31;00;14
Melissa Mancini
And don’t think that, well, this is normal. Or you know what all of my friends saw? The breastfeeding was really painful and they got through it. Don’t rely on what other people say. Advocate for yourself. Keep asking for more support and help when you know you need it. And don’t take no for an answer. If someone tells you this is just normal.
00;31;00;17 – 00;31;10;01
Melissa Mancini
Oh, I felt really terrible. Breastfeeding was awful for me, but it got better around four months. Don’t accept that as an answer. Really advocate for yourself and ask for the help that you need.
00;31;10;04 – 00;31;29;18
Dr. Mona
Agree. Anything in motherhood is like that, right? I don’t even if someone said it was hard and you’re going through something that’s difficult. It doesn’t diminish the fact that it’s still hard for you and that you don’t deserve to get help. I agree with that. Even from mental health aspect for moms like it can be hard and anyone can have multiple children and they say that they went through it.
00;31;29;24 – 00;31;43;03
Dr. Mona
But if you’re feeling not like yourself and if you want help, you have a world of resources available for you. And I love that you, promote that. What are your thoughts about nipple shields? Do you ever recommend them, or do you are more against them? Or what’s the thought about nipple shields?
00;31;43;05 – 00;32;03;11
Melissa Mancini
They’re such a loaded a loaded issue in the lactation world, in the hospital when I interned in the hospital, and we do hand them out pretty frequently, I think what ends up happening is and the hospital, as you know, anyone who’s ever worked in hospital, it’s pretty short staffed. You’re constantly feeling this pull to go from one patient to another.
00;32;03;12 – 00;32;23;07
Melissa Mancini
You never really have the amount of time that you want with each patient. It’s exactly the same with lactation consultant and patient. So sometimes a nipple shield is a very convenient way of of helping a mother who you can’t really figure out what’s going on. So we’re like here, here’s the nipple shield. Let’s see if this helps. They can be very, very useful.
00;32;23;07 – 00;32;45;11
Melissa Mancini
When my son was tongue tied and we didn’t know that he was tongue tied, we use the shield because it was sort of a barrier between him and my nipple in terms of not biting and pinching. And so some people do find that if they’re struggling, the nipple shield can be useful. With that being said, sometimes we do hand them out too frequently and we don’t do a whole lot of education behind them.
00;32;45;16 – 00;33;00;15
Melissa Mancini
And then moms go home and they think, well, what now? Am I always going to breastfeed, breastfeed with this nipple shield? How do I wean off of it if I don’t want to anymore? And that’s part of the problem with that lack of continuity of care. When you leave the hospital is then you’re home and you don’t know what to do.
00;33;00;15 – 00;33;19;24
Melissa Mancini
So I am very much on a case by case basis. I do carry them with me in my supply kit. There are always a time and place for them. They can be extremely useful and then it just is important to help families understand if they want to stop using them. How do they stop using them? So it’s a very case by case situation.
00;33;20;01 – 00;33;36;27
Melissa Mancini
I say if someone hands you a nipple shield, that’s a really good time to seek the help of someone. Once you leave the hospital so that you have a plan going forward, it can be a Band-Aid. And I don’t think a Band-Aid is the way to treat it. Here, take this home. All your problems will be solved. And then you go home and you go, what now?
00;33;37;00 – 00;33;50;25
Melissa Mancini
What do I do now to do? I keep using this. So again, advocate for yourself. Search for help. Once you’re home and figure out what is the long term strategy. What did we slap a Band-Aid on and is it something that needs more investigation?
00;33;50;28 – 00;34;09;20
Dr. Mona
That is a great tip, I agree, because when it goes into so much of what happens in the hospital versus outside, you get all this information. You just had a baby, you’re tired, your hormones are going like crazy, and then you get home and you’re like, wait, what just happened? Like, this baby is with me all the time now, and I and I don’t know what to do.
00;34;09;20 – 00;34;30;04
Dr. Mona
And that’s that’s a normal, validated feeling that new moms go through. And like you said, either using the lactation resources or your pediatrician to find the lactation resources if you need help is great. What other common misconceptions or mistakes do you hear a lot of that you would love to explain? Or you know, spiel the truth about, about breastfeeding.
00;34;30;08 – 00;34;54;16
Melissa Mancini
So the thing that we just talked about, which is that I don’t really need to do breastfeeding education because I will have the staff full people in the hospital to help me. And number one, there is almost never adequate staff for someone to sit with you and do an effective amount of education. Number two, what we were just talking about, when you have a baby, you just cannot comprehend how exhausted you are, you know?
00;34;54;16 – 00;35;17;15
Melissa Mancini
And this is assuming that things go well if everything goes well. And when you have situations like the one that you were in, there is no amount of time or energy that you can have that you could have taken an any amount of information in that time, right? It’s about survival. It’s about mental health. It’s not. There is a time and a place for education and postpartum, is not it?
00;35;17;17 – 00;35;44;08
Melissa Mancini
So postpartum, especially with with families who are going through really emotionally charged situations, if you’re in the NICU, you cannot do education there. I mean, you can, but we’re talking to a mom who is exhausted, overwhelmed, and depleted, frankly. So do not think that going into the hospital, you are going to be receptive to any information that comes at you postpartum, because even in the best of scenarios, you aren’t there.
00;35;44;08 – 00;36;06;07
Melissa Mancini
You just are not there emotionally. And I don’t think that before you’re in that situation, you can truly appreciate what that feels like. So don’t assume that you are going to get everything you need postpartum, and they’re going to educate you then, and they’re going to teach you everything you need to know. They’re going to give you a whole folder full of beautiful handouts that you may never look at again.
00;36;06;10 – 00;36;29;24
Melissa Mancini
And it’s just not the time and the place for education. So take that education when you’re clear eyed and, you know, ideally still pregnant and can really be receptive to that information. So that’s really important. Have an understanding that we really don’t know what breastfeeding is going to look like for you. You know, we all have these misconceptions about what birth might look like, or what breastfeeding might look like.
00;36;29;24 – 00;36;48;13
Melissa Mancini
And I think, you know, again, your example is so beautiful in that it can be so hard to put these ideals on ourselves and to really, truly believe that you’ve done all of the work. And this should all line up and it should be perfect. That’s not always the case. It might be beautiful, you might need no help at all.
00;36;48;16 – 00;37;09;26
Melissa Mancini
You might need a lot of help. And so if you have good providers and I know you feel like this is a pediatrician, and I feel like this is a lactation consultant, if you don’t have a provider who’s meeting you where you’re at, if you feel like someone is judging you for your decisions. And this is absolutely true of lactation consultants, if I have a family who comes to me and says, this isn’t working out, I need to wean.
00;37;09;29 – 00;37;28;23
Melissa Mancini
I feel zero zero judgment toward that family. I’m going to meet them where they’re at 100%. These are not my goals, that I am not the one living the scenario. I’m going to help and support you no matter what. And I know, you know, pediatricians that are the same way. They’re going to meet you where they’re at and they’re going to advocate for you and be your support.
00;37;28;23 – 00;37;58;27
Melissa Mancini
So understand that if you don’t find a provider in any aspect of your life, who is treating you that way, that you should 100% find another provider, lactation consultant, ObGyn, pediatrician, anybody, they should all be on your team. And if you go into motherhood, I think with that in mind, you are your advocate. You are your baby’s advocate, and this is about the two of you and what’s best mentally, emotionally, physically.
00;37;58;29 – 00;38;19;29
Melissa Mancini
If you can keep that in mind, I think, like you said before, you can be the best parent for your baby and this is really about your family and not anyone else’s. So if you can go in with that in mind, I think you’re really setting yourself up for success no matter what breastfeeding or birth or any part of motherhood looks like for you.
00;38;20;02 – 00;38;53;08
Dr. Mona
You’re speaking to my heart and it’s not even just as a pediatrician, but also as a mother who went through all this, right? I mean, you said it beautifully. I got all the resources I did the lactation consulting classes. I actually taught a class with a lactation consultant at my practice every few months. So I had all the information I knew I had to lactation consultants lined up when I left the hospital that I was going to, you know, if I had any issues that I would, you know, obviously you used for sessions and it just is different.
00;38;53;08 – 00;39;12;18
Dr. Mona
And it’s okay to tell yourself it’s different. It’s not bad. It’s not good, whatever. It’s just different that your expectations may not always line up to reality. And that is okay. And to put that pressure off yourself, like I said earlier as well, because you could know everything. And when you’re actually in the heat of it, you don’t know anything.
00;39;12;18 – 00;39;31;23
Dr. Mona
And even as a pediatrician and mother, that is, you know, people ask me like how, you know, is there anything that you thought would be different when you became a mom? That is it. My breastfeeding journey, as short as it was, it was like eight, ten days. It was it was the short, a short journey. But I learned so much about myself and about how I view things.
00;39;31;23 – 00;39;43;05
Dr. Mona
Right. I thought I was I knew it all. I thought I would be okay, but it doesn’t always work that way. And that’s okay. We’re, you know, we’re human beings and we we adapt and we learn. And that’s the beauty of growing as a mother, too, you know.
00;39;43;08 – 00;39;43;16
Melissa Mancini
Right.
00;39;43;16 – 00;40;00;28
Dr. Mona
And so the next, section we’re going to do is about pumping. And of course, we could do a whole episode about this, but we’re going to just talk, for all of you listening about just the basics of incorporating pumping in those first few months. So my first question is when would you recommend a mother of starting to incorporate pumping?
00;40;01;06 – 00;40;11;07
Dr. Mona
First, just say, if it’s a mother who’s having supply issues, how can they incorporate pumping to assist and supply issues? Or when should they do that?
00;40;11;09 – 00;40;30;27
Melissa Mancini
This is going to depend on how early on. If we figure out pretty early on in the first few days, we might just incorporate pumping here and there. So it could be that we have mom breastfeed and then we have her pump after. So a couple of fundamentals about milk supply your supply. You get a surge of prolactin at night.
00;40;30;27 – 00;40;51;05
Melissa Mancini
So your supply of milk is highest in the morning and is lowest in the evening. With that in mind, sometimes the most helpful thing to do is to pump earlier in the day. So breastfeed the baby and then pump maybe 15 minutes after feeding the baby. It may be that we immediately give the milk to that baby. If there’s a supply issue for working on that baby gaining weight.
00;40;51;07 – 00;41;20;10
Melissa Mancini
But if that baby is gaining weight and for whatever reason, mom’s still hoping to increase their supply, maybe she’s saving that for later. So generally I recommend after breastfeeding. With that being said, because I’m such a proponent of mom’s mental health, this is going to depend largely on how mom feels about it. If I see a mom who is completely exhausted, completely defeated, and I’m then asking her to breastfeed and pump afterward, that is an extra level of tired that we’ve now added on.
00;41;20;10 – 00;41;39;26
Melissa Mancini
We’ve now added on a whole second job to that tired mom, so this is going to depend on the family structure. How much support does she have? If we have, you know, a supportive partner who can really take that baby and, take care of the baby while she’s pumping, then I always tell the partner or support person, I then want you to wash all of the pump parts.
00;41;39;26 – 00;42;04;09
Melissa Mancini
I don’t want mom doing any of that. Mom’s sole job right now is healing herself. And then is also about feeding that baby. And if she’s working on increasing her supply. So it’s going to depend on what her support system looks like, what is her emotional state. But largely if everything if she’s doing okay with it, I’m going to recommend pumping after breastfeeding to increase that supply, and then either give the baby that bottle of milk or store it for later.
00;42;04;11 – 00;42;13;26
Dr. Mona
So pumping after the breastfeeding, meaning the baby is taken to the breast, and then immediately after that breast is done, you pump that side or pump the other side.
00;42;13;28 – 00;42;32;26
Melissa Mancini
I generally will tell moms use a two sided so pump both sides at the same time. And that’s just really for efficiency sake. You know, if you pump one breast at a time, it just takes longer. So use, you know, pump both sides at the same time just for efficiency.
00;42;32;28 – 00;42;51;01
Dr. Mona
And then the other question I get about pumping and want to incorporate is just say it’s a mother who is doing okay, fine with taking the baby to the breast. The latch is great. The common question is, when do I start incorporating pumping? When if I’m going back to work? Is there a time frame or is it just really whenever you feel comfortable starting to do it?
00;42;51;04 – 00;43;09;21
Melissa Mancini
Yes, I hear that one constantly as well. I generally tell families that there’s a sort of sweet spot between about four and six weeks where, you know, let’s if everything’s going well, I don’t need moms adding one more job to their plate. So don’t add in pumping unless you need to. For the first four weeks. It is a lot more work than I think most people anticipate.
00;43;09;26 – 00;43;28;00
Melissa Mancini
They think, oh well, pumping should be the easy part. Pumping is really challenging. And so for anyone who’s exclusively pumped, my hat is off to you. Because it is. It is a lot of work. So if you are, everything is going well. Don’t add that in as another task for yourself if you have the ability to do so until about 4 to 6 weeks.
00;43;28;00 – 00;43;53;10
Melissa Mancini
The sweet spot there is that generally by then we’ve, you know, perfected the latch. Everything is going well, baby. Baby’s gaining adequate weight. There’s also this sweet spot in for 4 to 6 weeks where babies are still receptive enough to take another nipple so we can introduce that bottle. And usually they’re okay with taking a bottle. Also understand that some babies are more finicky and they may not accept the bottle right away.
00;43;53;16 – 00;44;18;07
Melissa Mancini
And then we want to go back to that calm environment. If we are in a really chaotic state and we have somebody who’s really stressed about returning to work, she’s trying to get a baby to take a bottle. Sometimes. The number one thing I will say is have not mom give baby the bottle. That might be grandma, that might be dad, you know, nanny, whoever that might be, hand that off to someone else because sometimes the baby is is not receptive to taking the bottle.
00;44;18;07 – 00;44;37;10
Melissa Mancini
For mom. That’s normal. But in that 4 to 6 week spot, we typically get babies who are okay taking that bottle. Mom can start adding and pumping and we’re not going to send her supply and overdrive. If you have a really great supply and you then introduce pumping in the first two weeks, you’re telling your body that you have another baby there that you need to feed.
00;44;37;17 – 00;44;58;02
Melissa Mancini
And then we get things like clogged ducts, we get more mastitis. We don’t want your body to make more or less milk. And sometimes people think, well, if I make more milk, that’s good, right? And it’s not. It’s a, you know, it’s just as complicated sometimes as having an undersupply that comes with more discomfort. So don’t add in pumping unless there’s some medical reason to do so early on.
00;44;58;05 – 00;45;11;26
Melissa Mancini
Just kind of let your body figure out that homeostasis of how much milk it needs for that baby. And then you can add in pumping here and there, without the risk of oversupply and the problems that come with it.
00;45;11;28 – 00;45;33;02
Dr. Mona
So to avoid the overproduction, you know, blocked off what you just mentioned. So if a mother is going to be going back to work, do you recommend like just say she’s feeding the baby six times. Just give an example. Do you recommend instead doing pumps for the whole feeding or still doing the, the strategy of feeding and then pumping right after?
00;45;33;04 – 00;45;53;07
Melissa Mancini
I usually still will say to feed and then pump right after? It’s never a bad idea, by the way, if you’re going back to work, particularly full time, to sort of work with the lactation consultant to figure out how much milk do you need, how do you want to store it? All of those things. I do not for any reason recommend that moms have freezer fulls of milk.
00;45;53;07 – 00;46;12;26
Melissa Mancini
And sometimes I think I think part of it is our generation. We really feel like everything could go wrong, and I need to have this deep freezer full of milk for my baby. Don’t do that. You should have a little bit, you know, to have on hand, but you don’t need a freezer full. You just need enough to replace when your baby’s late for me.
00;46;12;26 – 00;46;24;01
Melissa Mancini
So that’s six feeds. Then you need roughly six feeds. Maybe an extra here and there. But you don’t need a deep freezer. Full of frozen breast milk in order to go back to work.
00;46;24;04 – 00;46;33;28
Dr. Mona
And so the other question is, how often should a mother pump? It really will just go in line then with how often the baby was feeding. If right in terms of the frequency. Okay.
00;46;34;00 – 00;46;54;06
Melissa Mancini
Yes. So when you go back to work, the idea is that you want to pump at the intervals when your baby would normally be feeding. So if your baby is generally every three hours, you should be removing milk every three hours just to keep up with that baby’s demand. When moms do go back to work, a very frequent thing that happens is that when mom gets back, babies want to feed more frequently.
00;46;54;06 – 00;47;19;18
Melissa Mancini
They might also wake more frequently at night to breastfeed more often. Those are very normal. Some of that is their stress response to suddenly being away from mom. And they want that sense of closeness. And for breastfed babies, that’s the way to get that closeness. So it’s normal for them to breastfeed more frequently. It’s not necessarily an indication that your supply is low, it’s just that they want to breastfeed more frequently once they’re suddenly separated.
00;47;19;21 – 00;47;30;03
Dr. Mona
That is a great tip, and I love that you mentioned that earlier, too, about how babies can change their wake times and sleep times based on if they know that there needs more production to happen.
00;47;30;05 – 00;47;31;20
Melissa Mancini
That is so a brilliant.
00;47;31;20 – 00;47;32;25
Dr. Mona
Yeah, and it’s so much.
00;47;32;25 – 00;47;34;06
Melissa Mancini
Smarter than we realized.
00;47;34;09 – 00;47;54;13
Dr. Mona
I mean, breast milk as we know it changes. Like even the quality of your breast milk changes if you’re sick, if baby sick, your breast milk can change. It’s a very fascinating thing. And I’ve always loved learning about that. But I actually that’s new for me about and that makes total sense about the fact that they may wake up or want, you know, want to breastfeed because they need it.
00;47;54;13 – 00;48;11;04
Dr. Mona
They are trying to help you produce. They’re like, mom, no, I can sense that you may need me, and you may need me or the pump or something to help you produce, the breast milk. So another question I get is if a baby is sleeping through the night, does a mother need to wake up to, do they have to just listen to their body?
00;48;11;07 – 00;48;19;25
Dr. Mona
Because babies can start to stretch sleep at various ages, and a lot of moms think that they have to wake up and wake up. What are your thoughts about waking up? If baby is sleeping.
00;48;19;25 – 00;48;45;02
Melissa Mancini
If the baby is gaining adequate weight and we don’t have any concerns about where the baby’s that growth wise, and moms Supply isn’t having any issues, let it let it be. You know, the thing that often will wake moms up, actually, is that the baby with their breasts. So they you do you get a large increase in milk volume overnight because of that prolactin that you get when you’re asleep and that you know, that relaxation.
00;48;45;02 – 00;49;02;16
Melissa Mancini
And so your milk supply does come in. So some women will say, well, I wanted to keep sleeping, but my breasts were so full and so uncomfortable I couldn’t keep sleeping. So that’s a very case by case basis. I may I might tell mom, you know, if you have a Hakka, for example, if you want to just drain a little bit so that you’re still comfortable.
00;49;02;19 – 00;49;25;28
Melissa Mancini
But if you’re hoping that that baby keeps sleeping through the night and you don’t want to pump, try to avoid pumping at night. Because again, when we remove milk, that body is saying, okay, we need that milk during that time. That’s a critical period of time. So if you don’t need to don’t if you need to help soften them up just enough so that you can rest so that when the baby does wake to feed later, you haven’t pumped, you know, overnight.
00;49;26;00 – 00;49;47;25
Melissa Mancini
So case by case, if a baby is not gaining adequate weight or we have concerns about the baby’s growth or mom has supply concerns, I always recommend pumping at night because of that prolactin because that is the larger volume milk. I want to make sure that we are optimizing mom’s body and timing it. So we’re going to work with the hormones instead of against them.
00;49;47;25 – 00;50;06;07
Melissa Mancini
And I will recommend her pump in the middle of the night. Remove that milk, save it for later. If baby’s still sleeping, you know you can feed it later if the baby sleeps through that feed. But don’t be quick to drop that pumping session if we have any concerns about milk supply, because that is a really important window of time, especially at night.
00;50;06;07 – 00;50;29;21
Melissa Mancini
And so we don’t want to let that bypass because again, we switch that, we get rid of that pumping session. The body down regulates how much milk it makes. And then we’ve sort of missed that that window of time. So if you have supply concerns growth of baby concerns then yes do pump at night. Otherwise if all is going well try and sleep that the terrible adage of sleep when baby sleeps is true.
00;50;29;21 – 00;50;33;04
Melissa Mancini
In this case, don’t wake the baby if everything’s going well.
00;50;33;07 – 00;50;58;08
Dr. Mona
Yeah, these are great tips. I. I love learning so much, which is why I’m just so glad we could talk about this. And you’re all your. The way you presented is also so awesome. So I appreciate it. Now the other question is about pumps. Like is there certain pumps that are better? I mean, I guess you don’t have to name brands, but certain styles of the pumps, things like that, whatever you feel is, I know hot air is a great one, like a manual one, but when should you know?
00;50;58;08 – 00;51;00;21
Dr. Mona
What should people be looking at when they’re looking at pumps?
00;51;00;23 – 00;51;22;03
Melissa Mancini
So first of all, realize that most insurance companies should cover a breast pump. I believe that’s still the case. So you should you should still be eligible for a free breast pump from your insurance company. And this is for each pregnancy. So with each new baby, you should be eligible for a new breast pump. Which pump? That is, you know, you’ll have to call your insurance company and find out.
00;51;22;10 – 00;51;52;12
Melissa Mancini
Otherwise, if you are in the hospital having breastfeeding issues, if you have a baby in the NICU and you’re separated from baby, one of the most important things you can get access to is a hospital grade pump. Those are really important. If we have babies separated from mom or any issue in the very beginning. A hospital grade pump is important because we have got to make sure that mom’s body gets those cues very early on, and hospital grade pumps are more effective than our standard pumps.
00;51;52;12 – 00;52;25;08
Melissa Mancini
Our standard pumps are great. It doesn’t really matter the brand, but, they work differently than a hospital grade pump. Hospital grade pumps are meant for more demanding use. And they are they are, you know, it can be thousands of dollars. You’re not going to want to buy that pump for going back to work, but you do need that pump if you, need if you need it early on in the hospital once you are discharged and, you know, maybe you get the hospital or the insurance granted pump, it doesn’t really matter the brand what matters is that it’s comfortable.
00;52;25;08 – 00;52;48;15
Melissa Mancini
So things like the flange. Now everybody’s going to Google what a breastfeeding flange looks like. A breastfeeding flange should fit you well. So for example, you know, everyone has different physiology with regard to breasts and nipples. Some nipples are larger than others. You might need a larger flange size. So if you’re feeling like there’s friction when you’re pumping, you should not feel friction and you should go up a flange size.
00;52;48;15 – 00;53;10;19
Melissa Mancini
Those are more important than the pump itself. Now there are all kinds of other pumps. Now, just in the last few years, there are hands free pumps. You can get hands free bras. You can also get pumps. Now that you literally just shove into your bra that don’t have, you know, our cord free pumps. Those are amazing, particularly for women who are pumping a lot, pumping at work.
00;53;10;21 – 00;53;26;06
Melissa Mancini
You know, want to be a little bit more discreet? There are all types of amazing breast pumps on the market. Now. The most important is finding one that you’re comfortable with that’s effective for the use you need it for. So if you have a baby in the neck, you I don’t want you using the the the free insurance pump.
00;53;26;06 – 00;53;42;17
Melissa Mancini
I want you using a medical grade equipment. But if you are just if you’re going back to work and you’re separated from baby just a few hours a day, then those standard pumps work great. Otherwise, you know, if you don’t have plans to go back to work and you don’t want to pump very much, things like the Hawker Fantastic, you can throw it in a diaper bag.
00;53;42;21 – 00;53;59;07
Melissa Mancini
You can really use it to just catch milk when you’re feeding on one side. You can store that for later and and keep it for when you need it. But there’s just so much equipment now and so many different variations. But most of them are effective for what we need them for.
00;53;59;10 – 00;54;16;05
Dr. Mona
And the other question I have is about something called power pumping, which I actually did. I didn’t know of until a few like a few years ago. I didn’t learn about, obviously, power pumping in residency. Why would we not know? But it. Anyways, what are your thoughts about power pumping? It actually, does it mimic kind of like cluster feeding?
00;54;16;08 – 00;54;39;14
Melissa Mancini
It does. So I’m glad you brought that up. So the idea is when babies are cluster feeding, when they’re feeding more frequently, they elicit multiple letdowns. So they do these very quick bursty sucks. They don’t do deep slow sucking. They do these very quick bursts. It elicits a letdown from mom. So the milk comes out. And then once that milk stops flowing they do it again.
00;54;39;21 – 00;55;00;03
Melissa Mancini
And so the idea behind power pumping. So just to give you an idea of what that might look like, if I have a mom who’s worried about her supply dipping and I don’t want her pumping after every feed because of time, or maybe she’s got a toddler she’s chasing around. I will tell her maybe once a day in the morning, because again, that’s when your milk volume is the highest add in a power pumping session.
00;55;00;03 – 00;55;18;11
Melissa Mancini
So I will tell her. Put the breast pump on for five minutes. No matter how much milk comes out, stop. Walk away. Go get a drink of water. Go get some food. Go snuggle your baby, whatever that might be. Come back and pump for five more minutes, stop for five minutes, pump for five minutes and you are doing you are eliciting multiple letdowns.
00;55;18;11 – 00;55;38;28
Melissa Mancini
And so you are really telling your body that you know what your baby would be doing if they had a growth spurt or something. They are cluster feeding and the pump is doing the same thing. And so if you add in a cluster feeding power pumping session, you know, once a day, I have had quite a few moms notice pretty good results.
00;55;38;28 – 00;55;55;21
Melissa Mancini
After a few days of doing that, and realize that they will be pumping more than they did before. So it is effective. It does help, and it is a nice sort of time saver to the alternative of pumping after every time you breastfeed. That’s pretty pretty tiring.
00;55;55;23 – 00;56;12;18
Dr. Mona
No, I’m happy I asked because it’s something a new, newer, newer concept in that I didn’t know. And so I was like, it’s good to be educated about the use of that. Any other common mistakes you see when mothers are trying to incorporate pumping or, you know, utilize that in any way with their breastfeeding.
00;56;12;24 – 00;56;30;23
Melissa Mancini
I think that pumping elicits a stress response a lot. I think, again, that’s not something that we realize until we’re in that situation. Pumping is stressful and a lot of moms will tell you pumping is very annoying. You don’t. You know when you put a baby up against you, you have this sort of calm that comes over you when you have your baby close to you.
00;56;30;26 – 00;56;48;24
Melissa Mancini
Having a pump attached to you does not feel like that. There’s no oxytocin flow, you know, you just feel like you’re standing there, you know, a lot of wanting to say, oh, I just feel like a cow. You know? I’m just connected to these devices. And that stress response can actually stop your milk from letting down, which is what happens a lot.
00;56;48;24 – 00;57;08;17
Melissa Mancini
And some moms will say, I stared at it for 15 or 20 minutes and nothing happened. Well, if you are in a state of stress and your cortisol is really high, much like other mammals, our body says not now. Now’s not a good time. It’s not safe. So cortisol is is not the friend of oxytocin. Just like in labor, we don’t want cortisol flowing.
00;57;08;22 – 00;57;27;24
Melissa Mancini
In breastfeeding we don’t either. So if you have to pump or want to pump, one of the top things you can do is don’t watch the water boil. Don’t stare at the pump waiting for one single drop. It’s going to make you insane. You’re going to go crazy, and you’re going to become kind of angry about it. It becomes very frustrating.
00;57;27;24 – 00;57;47;25
Melissa Mancini
So one of the things that I will tell moms is if you have a hands free bra or something, connect to that, get set up, turn your pump on, throw a receiving blanket around the pump so you don’t even see it, and then watch your favorite funny sitcom. Or pull up your phone and look at pictures of your beautiful baby.
00;57;47;29 – 00;58;06;26
Melissa Mancini
Nothing elicits an oxytocin response better than hearing those cues of your brand new baby or looking at your baby. I mean, that is the way to get that flood of hormones that tells your body now’s the time to make milk for this baby. But that stress response is really common and can really just put an all out halt to breastfeeding.
00;58;06;29 – 00;58;26;06
Melissa Mancini
Through no fault of your own, right? It’s your hormones saying not now. This is this is not the time. So if you can find distraction techniques, I talk to people. It’s like early labor, right? If you’ve fussed about every little contraction and early labor, you’re going to go crazy. So don’t focus on it. Distract yourself. Go. You know, keep busy while you’re pumping.
00;58;26;10 – 00;58;40;28
Melissa Mancini
If you can find a funny sitcom, bonus points. And make yourself laugh and feel lighthearted. That can be a better way to pump than to do it in a very irritated, you know, fragile state that that can help.
00;58;41;00 – 00;58;46;24
Dr. Mona
I completely agree. I mean, I cannot tell you are like, were you in my house?
00;58;46;26 – 00;58;51;03
Melissa Mancini
I don’t I was in many hospital rooms. Many like your rooms, and.
00;58;51;05 – 00;59;08;01
Dr. Mona
Now you just send my son off and then, you know, and it was literally the sort of I got so angry because, you know, what had happened. And obviously I’m not with my son and I’m like, how can I be separated? It was a whole emotional snowball. And you, like you said perfectly, I would just stare at the pump.
00;59;08;01 – 00;59;25;14
Dr. Mona
And I was obsessed with the amount, and I would just look and I’m like, and that does. You’re right. It retrospectively, looking back, it’s serve no purpose. And it I know that it didn’t help my supply and the thoughts that ran through my head and the disappointment I had in myself and how I was like, why is it this way?
00;59;25;14 – 00;59;35;01
Dr. Mona
And I’m like, I again, I learned so much from the experience that I think is going to help a lot of moms now when they go through it. Because I felt it in every bone of my body.
00;59;35;01 – 00;59;35;28
Melissa Mancini
The what?
00;59;36;00 – 00;59;53;21
Dr. Mona
The emotions that go through a mom when they’re when they’re trying to breastfeed, when it’s sales, when they have to pump, when it fails, when they have to formula feed and they make that choice. I’ve gone through that whole realm of decision making in a matter of two weeks, while my son was in the ICU and I was in the ICU, and it it really does.
00;59;53;21 – 01;00;13;19
Dr. Mona
You said it beautifully. That is that is it that we have to understand that it is so much more than just the physiology. It’s so much more than the having the right products. It is the emotional state. And I appreciate you, recognizing the pumping, being a source of a lot of stress. Because I see, I hear it a lot.
01;00;13;19 – 01;00;42;10
Dr. Mona
I pulled my audience too, and my, my followers that they felt more depressed or more anxious if they were doing pumping, or exclusively pumping. And I think it’s important people realize that they’re not alone in that feeling, because it is not easy being attached to a machine. Even breastfeeding alone is not easy. But when you’re attached to a machine and your baby is sleeping and you’re so tired and you just are trying to increase supply, and all you want to do is sleep or rest and you’re just with the pump, it can get emotionally draining.
01;00;42;10 – 01;00;44;04
Dr. Mona
And I appreciate you recognizing that.
01;00;44;07 – 01;01;03;02
Melissa Mancini
Yeah, absolutely. And again, this goes back to the same idea that we have to meet moms where they’re at. And if we’re not recognizing that, you know, if I’m sitting with a mom in the NICU and telling her, well, you know, how hard can it be? That is everyone a disservice? And being able to recognize, number one, that motherhood is hard at a baseline.
01;01;03;08 – 01;01;26;23
Melissa Mancini
If everything goes beautiful, it’s hard. It’s challenging. But being faced with additional challenges like that, we have got to be compassionate about meeting them where they’re at and recognizing that she just may not be at that point where that’s going to be effective, and that’s okay. And how do we support her through it? And how do we make sure that she feels, you know, as empowered about her situation as possible?
01;01;26;23 – 01;01;48;09
Melissa Mancini
Because the worst thing that could happen in my mind is that a mom could leave feeling worse than when she came in, you know, that’s that to me, is worst case scenario. And so whatever breastfeeding looks like for you, you have got to be surrounded by people who believe in you and who will lift you up when you’re feeling like, you know, feeling like nothing worked the way that you were hoping.
01;01;48;09 – 01;01;52;15
Melissa Mancini
And those are the most important times that that moms need us.
01;01;52;18 – 01;02;10;18
Dr. Mona
Oh, Melissa, I love you. I think this is so great. And, you know, I really appreciate you coming on today to talk about all of this, because I really think we got through a lot of topics. Obviously, this is just a, you know, breastfeeding pumping one on one. It’s not the nitty gritty that I know a lot of mothers may end up needing.
01;02;10;20 – 01;02;29;16
Dr. Mona
But I think it’s just such an important conversation. And I love the way you view breastfeeding. And I love the way you view women empowerment and pro mom life. You know, that is so needed. What would be your final message for everyone listening? I know you gave so many amazing motivational pearls through this episode, but what would be your final one piece of advice?
01;02;29;18 – 01;02;52;00
Melissa Mancini
I would say in any aspect of motherhood, if you need help and support, there is absolutely no failure and admitting that you need help and support. You are not less of a mother for reaching out and getting help. You are doing exactly what you’re meant to do, which is advocating for yourself and your baby. So in any phase of motherhood, never be afraid to reach out and ask for help.
01;02;52;03 – 01;03;12;22
Dr. Mona
I agree and everyone you have to follow Melissa on Instagram. Again. I attached it to the show notes more than milk. And there’s an underscore between Moore underscore then underscore milk. Her page has great information and as you can see, she’s just such a wealth of information and so kind and so empowering. And it was so nice connecting with you.
01;03;12;22 – 01;03;19;12
Dr. Mona
And I’m sure maybe we’ll do a part two again. Anyone has any further questions? But thank you again for being here today.
01;03;19;15 – 01;03;22;09
Melissa Mancini
Yeah, absolutely. Thank you for having me on.
01;03;22;12 – 01;03;41;03
Dr. Mona
Thank you for tuning in for this week’s episode. I hope you guys enjoyed it. As always, please leave a review, share it with a friend, comment on my social media, and if you’re not already, follow me at PedsDocTalk on Instagram. I love doing this for all of you. Have a great rest of your week. Take care.
01;03;41;04 – 01;03;41;28
Dr. Mona
Talk to you soon!
Please note that our transcript may not exactly match the final audio, as minor edits or adjustments could be made during production.
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