The early days of breastfeeding can feel overwhelming when you are recovering, tired, and trying to sort out what is normal. In this Follow-Up episode, I revisit my conversation with Melissa Mancini, RN, IBCLC, to talk through what helps in those first days and weeks, from prenatal prep to milk production, skin to skin, feeding cues, and cluster feeding.

In this episode, we cover:

• How to prepare for breastfeeding before baby arrives

• Why prenatal breastfeeding education matters

• What is normal in the first few days of milk production

• How prolactin and oxytocin support breastfeeding

• Why skin to skin can help with feeding and supply

• What supply and demand really means for milk production

• When feeding on demand makes sense

• When more structured feeding may be recommended

• Why cluster feeding is common in the early weeks

• What kind of support can make breastfeeding feel more manageable

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00;00;00;00 – 00;00;23;18

Dr. Mona

Welcome back to the follow up. Doctor Mona Hair, pediatrician, IBCLC and mom. And this is a series on the PedsDocTalk podcast where we revisit a favorite conversation in less time than it takes you for your newborn to start cluster feeding again, and for you to wonder, is this normal? Today’s episode is actually a top episode of the podcast, and I’m bringing it back for a couple reasons.

 

00;00;23;21 – 00;00;44;09

Dr. Mona

One, it’s incredibly helpful for families navigating the early days of feeding a newborn via breastfeeding. And two, I’m re certifying my IBCLC license this year, so I thought it would be the perfect time to revisit some breastfeeding conversations that parents have loved over the years. And this is one with one of my favorite inclusive ebooks, Melissa mancini.

 

00;00;44;16 – 00;01;03;27

Dr. Mona

She’s a registered nurse, lactation consultant, mom of two, and my IB calc mentor. Whenever I have questions about the space about patients, I always turn to her. You may know her on Instagram as a more underscore than underscore milk. In this episode, we cover so many of the questions parents have in those early days of breastfeeding and pumping.

 

00;01;04;01 – 00;01;27;02

Dr. Mona

We talk about how to prepare for breastfeeding, postpartum, what you actually need and what you don’t. The physiology behind early breastfeeding, why cluster feeding happens, and whether feeding on demand or feeding on a schedule makes sense. In those early weeks. We also talk about common hurdles to establish breastfeeding. What to do if breastfeeding is painful. Whether nipple shields are okay, when to introduce a pacifier, and so much more.

 

00;01;27;04 – 00;01;46;20

Dr. Mona

You can get all of that in the longer episode, and if this episode resonates with you, make sure you download it, subscribe to the show, and download the full episode in the caption. Share it on social media and tag at the PedsDocTalk podcast and at more underscore then underscore milk so we can see that you’re listening. All right.

 

00;01;46;20 – 00;01;53;25

Dr. Mona

Let’s get into this week’s follow up.

 

00;01;53;27 – 00;02;02;13

Dr. Mona

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;02;02;17 – 00;02;24;14

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;02;24;22 – 00;02;43;19

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 hyperspeed class to make sure you have the fundamentals.

 

00;02;43;19 – 00;03;03;15

Melissa Mancini

So absolute 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. Those few drops are what your baby needs in the beginning.

 

00;03;03;19 – 00;03;29;04

Melissa Mancini

That will increase over time. And then to have an understanding of, you know, the the factors that contribute to two newborns losing weight. They do lose weight and do more weight loss is normal. What’s not normal are higher percentages 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;03;29;07 – 00;03;47;04

Melissa Mancini

Then we understand that you need support. So instead of saying, okay, this baby’s lost the high percentage of of weight on day two, what are we going to do? We know. Okay, well, we reached 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;03;47;06 – 00;04;07;23

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 you’re home. Obviously the environment in the hospital is not always calm, but you’re going to have support there.

 

00;04;07;23 – 00;04;28;28

Melissa Mancini

You’re going to have nurses, you might have lactation consultants. You can help you. Once you’re home. You need a calm. You need a calm space where you can go breastfeed your baby. Sometimes what happens 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.

 

00;04;29;01 – 00;04;52;01

Melissa Mancini

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. 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.

 

00;04;52;04 – 00;05;13;08

Melissa Mancini

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? 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;05;13;11 – 00;05;30;16

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 was in the hospital in ICU for two weeks.

 

00;05;30;16 – 00;05;48;13

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;05;48;20 – 00;06;10;17

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;06;10;19 – 00;06;36;13

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;06;36;15 – 00;07;01;16

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 as 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. And whether or not you leak breast milk is not any indication of your supply or whether or not you have it.

 

00;07;01;19 – 00;07;22;20

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;07;22;22 – 00;07;46;12

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;07;46;12 – 00;08;16;06

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;08;16;08 – 00;08;35;27

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. And 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;08;35;27 – 00;09;00;09

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;09;00;11 – 00;09;22;22

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;09;22;22 – 00;09;40;03

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;09;40;07 – 00;09;47;09

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;09;47;12 – 00;10;04;21

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;10;04;21 – 00;10;12;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;10;12;28 – 00;10;39;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;10;39;26 – 00;11;00;11

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;11;00;13 – 00;11;18;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;11;18;10 – 00;11;37;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. If that baby is 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;11;37;00 – 00;11;47;02

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;11;47;04 – 00;12;08;15

Dr. Mona

And that’s your follow up. Just a small dose of the real relatable and eye opening conversations we love to have here. If you smiled, nodded, or had an moment, go ahead and download, follow and share this episode with a friend. Let’s grow this village together for more everyday parenting wins and real talk. Hang out with us on Instagram at the PedsDocTalk podcast.

 

00;12;08;22 – 00;12;24;05

Dr. Mona

Want more? Dive into the full episode and more at PedsDocTalk.com. Because parenting is better with support. And remember, consistency is key. Humor is medicine and follow ups are everything. I’m Doctor Mona. See you next time for your next dose.