In honor of World Breastfeeding Week, I sat down and chatted with Fort Worth lactation consultant, Heather Martin of Beyond the Breast Lactation Services.  We had a fabulous dinner and I walked away with much respect for this sweet lady.  Enjoy!

 

Q: Tell me a little about yourself.  

I'm a mom of 6, soon to be 7, including a set of twins!!  5 girls, one boy.  Married 16 years.  In Texas for 13. My husband is former military so I definitely feel a connection to the military community.  I did have difficulty nursing my oldest but a friend was able to come over and help me push through.   

Fast forward, and I was nursing my 3rd and was a La Leche League (LLL) leader at the time.  We had a WIC counselor come in and speak about WIC benefits as a secondary resource for the community.  After the meeting, she pulled me aside and told me I enjoyed this work too much and that I needed to become an IBCLC.  I finally started on the path while pregnant with my 4th.   At the time, she was nursing so long- 45-min to an hour, per session and I realized it was too long.  I just so happened to go to a speaking engagement with Dr. Kotlow.  He was speaking about lip and tongue ties and it was like a light bulb moment for me- I realized that's what my daughter had!  Dr. Cole did the release and the first nursing session afterward was 5 minutes- what a difference!  Then I went on to have and nurse multiples.  I certified as an IBCLC in 2011.

Q: What drew you to this work? 

At first it was going to LLL meetings, a way for me to meet other moms with young babies.  I knew with my husband deployed that I would need some support.  I attended for a couple of years, then one of the leaders left me in charge of meetings every once in a while.  It just sort of went from there.

Q: What is an ideal time for a new mom to schedule an appointment with a lactation consultant?  Can it be too early?

From a hospital birth, if they are having issues, as soon as they are home and feeling relaxed.  I hear a lot of "everything was going perfect in the hospital..." but in the hospital you were in a nice, reclined bed, baby was being brought to you and you had someone there to help.  Or, especially in the hospitals, moms who are experiencing pain are told it will get better.  Then it doesn't.  Another thing, if baby isn't having wet and dirty diapers, CALL!

Q: I personally wish there was better access to quality lactation consultants in the hospital setting.  Where do you see room for improvement within your field? 

One thing that I feel is a struggle now is that there is a definite change in the IBCLC movement.  It's harder for those with limited medical education to get into the field.  At the same time, it can be difficult to find balance between continuing education and running a successful businessMany aren't aware that IBCLCs need to r-ecertify every 5 years to maintain their certification.  If you have a small business, it can take all of your resources.  Hospitals have an easier time but at the same time, they are making money so they don’t want to send out for the top of the line training.  Time and money is a big thing.  It costs to go through the training and to keep up with it.  

Education within the field can be tough.  Being able to keep up on it and continuing to help others within the field, can be tough.  Also, territorialism.  We don’t have it here but I do know it’s rampant in other areas.  I think that happens with birth workers.

Q: As a doula with additional breastfeeding training, I offer basic guidance to my clients.  What do you see doulas doing right in regard to supporting breastfeeding?  What do you wish you could see more of?

Basic guidance.  Getting that basic guidance.  Understanding basic breastfeeding knowledge is a huge step.  More than I've nursed a baby or two is so important.  Knowing scope of practice, limits and who to refer out to can be a huge resource as well.

Q: What are your favorite nursing positions to show moms? 

I like for moms to be comfortable.  Not necessarily a specific position, but something they find comfortable.  Maybe leaning back in a chair, maybe using a nursing pillow.  A cradle or cross-cradle hold.  I see a lot of moms get tight and hunched over.  Let the baby melt into you!  Work on their own body position and relaxed, then bring baby to you.

When teaching a laid-back nursing position, how do you assist mom with latch?  How much guidance does baby need in this position?

It depends on the baby, truthfully.  In laid back, bring baby back to mom.  Chin at the bottom, nice wide gape.  Many babies find it easier to latch in the position.  Again, rest on mom.  Melt into mom.  It's where they want to be.

What about sleeping through the night?   

Babies do- it’s just your definition that needs to be adjusted.  4-5 hours is a good stretch for a newborn!  I have a 2.5 year old that doesn’t sleep through the night.  

One of the biggest questions I get is “how do I know baby is getting enough milk?”  What is your answer for this? 

Wet and dirty diapers and does baby look satisfied?  Most newborns through 6 weeks of age nurse every 1.5-2hrs.  If they are nursing every 35-40 minutes, there is probably something going on.  Are they happy or content between sessions?  Or are they unhappy and crying?

The second most popular question would probably be when do I need to start pumping to build a stash for returning to work.  What is your recommendation for these moms? 

Look at your work schedule and when you’re returning.  If returning at 6 weeks or sooner, then you'll need to start pumping earlier.  I also tell moms before they start pumping, become familiar with your pump.  Understand it’s working components and how to fit your flanges.   

Start out with pumping one to two times/day while you get comfortable with pumping.  Then, building to 3-4 times/day.  If you know what your work schedule is going to be, you can look and see "these are the times I can pump" and then work with human resources to make it work.

Q:What is the biggest obstacle you see clients facing when pumping and returning to work?

Getting a pumping schedule that works for them. And understanding that if they are pumping throughout the day, they don’t have to wash their pump parts every time!  Learn how to hand express!  There will come a day you’ll need it!  Invest in at least two good hands-free pumping bras.

Q: I also hear a lot of “I couldn’t breastfeed because I didn’t make enough milk”.  How many people do you see truly have physiologic impairments to breastfeeding (mom or baby) vs how many are struggling because of bad advice/hospital practices/lack of support? 

I see a lot more due to bad advice, hospital practices, poor breastfeeding knowledge or practices and lack of support vs true physiologic impairments. 

Q: In regard to IGT (Insufficient Glandular Tissue) and PCOS (Poly Cystic Ovarian Syndrome) moms- once a diagnosis has been made, what are the best tips you can pass along to them?  

PCOS/IGT very often go hand in hand.  If mom has IGT and no PCOS, then there is usually some sort of hormone or thyroid issues.  Tips for them would be open to the possibility of supplementation.  Know that it isn’t a be all end all.  It doesn't mean that you can’t breastfeed, but you may have some struggles.  Know that there is support for you.  Depending on the age of mom, especially if it is her first baby, it doesn’t mean that you’ve put the nail in the proverbial coffin.  It may be better the second or third time around. 

Q: I hear SO MANY recommendations of “supplements” to boost supply.  What are your personal favorites?

They aren’t a magic pill.  A lot of people expect, "I’m going to take all of these fenugreek pills and in three hours, I’ll be able to make milk like a cow"!  These interventions take 7-10 days to take effect.  Fenugreek seems to be most common but there is also a large placebo effect.

Please, read the labels and know the source.  I’ve had clients have success with moringa- but a concern is I've heard of women becoming pregnant again and then losing the baby.  A couple things to understand is that it is a traditional medicine used in Asian and African communities in the immediate postpartum to help contract uterine muscles.  I would never suggest it to an expecting mom but it does have the side effect of being a natural galactagogue.   

Sometimes, it is a combination that works well.  Blessed thistle and goats rue, or fenugreek and goats rue.  Or alfalfa works well.  The combination can be different for everyone woman.

A problem I see is that Moms don’t treat it as a medication.  It’s like taking a vitamin, yes, but no.  You need to share it with your care provider.  Many supplements can cause problems with medications.

Q: Where do you send moms looking for donor milk?  Obviously, it is needed quickly.  What do you suggest for moms in these situations? 

In the hospital setting, Mothers'Milk Bank is a great resource but it has requirements that have to be met.  Minimum weight, degree of illness, etc.  Look to other organizations such as Eats on Feets or Human Milk for Human Babies (HM4HB) and even within their support group.  But, ask questions.  Treat the milk as though it’s medication.  Ask the donor, "are you on regular medication, have you been sick recently, have you been on antibiotics recently, are there any supplements that you take regularly?"  If you are prone to severe allergies, there is a possibility for the same reactions in your baby.  If you use a group like Eats on Feets or HM4HB, read through the guidelines.  They have some excellent recommendations as far as questions to ask.

Remember, the first rule is to feed the baby.  Next, you want to get as close to sterile as possible.  If you have to go with formula, go with pre-made, ready to feed formula.  And remember, don't over-feed the baby.

Q: Do you have any tips for choosing a breastfeeding friendly pediatrician? 

Ask questions- ask about breastfeeding knowledge.  If female, as them if they breastfed and if so, for how long?  If male, ask if their children were breastfed and for how long.  

A pediatrician or physician who, if their first answer is to supplement, you may not have the most breastfeeding friendly physician.  It can be hard because insurance often dictates which doctors you can use.  And, word of mouth can be misleading.  Remind families that many pediatricians/physicians don’t have specific breastfeeding education.  They may not even have 4 hours in their entire internship or education.  

As moms become more knowledgeable as to what's working for their families, it is up to us to advocate for ourselves and to help educate our physician of choice.  Share resources with them so they can refer out.  They may not be appreciative at first, but if we get more moms doing it and standing up for themselves, it will change.

I don’t advocate smiling and nodding when asked things like "is baby sleeping through the night?", but saying instead that "it’s working for our family" or that "we’ll be there soon."

One thing to remember and that I share with families is that it's not just how they grow weight wise, we want to see their length go out as well.  If baby may not be gaining weight, but they’ve grown two inches, I’m going to take that as a win.  Look at the whole picture.

Q: What about weaning?  Best advice for moms looking to wean?

Depending on baby’s age, take the shortest nursing session and work on cutting that out.  Hopefully baby will be at solid food point, and you can substitute food or distractions.  Then work on dropping a feeding and replacing it with other foods.  Remember, as babies start taking bites of solid food, they are already on the path to weaning.

Q: What is your favorite source of information for breastfeeding moms?  Websites, blogs, books, etc.?

For moms, Kellymom.com is a great source.  The Womanly Art of Breastfeeding and Mothering Multiples are great books as well.  I advocate La Leche League meetings or other community breastfeeding support groups.  The Second 9 Months, a blog by another IBCLC, is also another good resource.  I don’t always advocate turning to Facebook, and no Dr. Google.  IBCLE.org is good to use when trying to locate an IBCLC in your area.

Q: Is there anything else you'd like to add?

If you are expecting, do your research.  Find out your community support before baby arrives.  Think about how you want to feed and think about what your expectations are.  Also, I would add that it's ok to ask about an IBCLC's or any other Breastfeeding Helper's experience with specific concerns. If they're a good provider, they'll refer out if need be.

"This week can be hard for some families, but no matter what it looks like for you, that bonding time with your baby is so much more important that the feeding aspect.  Being able to bond and spend that one on one time does a lot for moms, families and their babies."