Transcript:
Okay. Welcome to a rapid fire lightning round question answer episode of the Milk Minute Podcast. We have had so many questions emailed into us that I have, sorry, been kind of putting off answering because we’ve been so busy creating new content for you.
So I said, why don’t we just do an episode where we answer all of these questions at once and we just rapid fire, smush ’em all together and give you lots of knowledge all at the same time. Yes, this is going to be short form answers only. And for those of you who already listened to us in double time, like maybe go back to one time speed.
So first I just want to give a quick shout out to Beth Kristen from Norway. She emailed us to let us know that she, she actually has been a NICU nurse for 19 years in Norway and she loves hearing about what we’re doing in America. And she was kind of sharing with me a little bit about what they’re doing in Norway and she let me know they often use colostrum as an immunomodulatory therapy.
And they put a little bit of the colostrum in the cheek of the baby for the intestinal flora. That way the baby can poop early after birth. And also they acknowledge there that colostrum helps against nosocomial infection or infections that happen because you’re in a hospital as well as necrotizing and terra colitis.
So they do use colostrum as medicine in Norway and we are very, very glad to know that that’s happening over there. And thank you so much for sharing from across the ocean. We love that. Yeah. I just watched a documentary about Norway with my child when she was sick for no reason. Oh, I would love to go to Norway and visit Beth and visit the NICU and see how things are over there.
See their thousands of miles of coastline. It’s pretty crazy. Yes, yes. Oh my gosh. So gorgeous. I bet. Okay. Well, Beth, thanks for writing in, and if any of you are around the world and wanna write in, you can do that as well. Let’s take a quick minute to thank a sponsor, and then we’re gonna dive right into our questions.
All right. It’s Maureen here and I want to tell you that I have finally set up a link so you can instantly book virtual lactation consults with me. Thank the Lord. I know Heather, it took me a long time to take the leap from in-person visits to virtual, but I did it. You’re gonna love it. I love doing virtual consults.
They are the best. It serves more people. I’m so glad you took the plunge. Thank you. And if you guys out there wanna book some time with me, you can go to HighlandBirthSupport.com and then click on my lactation services tab. Is that H I G H L A N D? Yes. Okay. . I will see you on Zoom, everybody.
All right, welcome back everybody. Here we go. Strap in. We’re getting real today. We’re real every day, but we’re getting faster in our realness. Okay, today is a question from Lauren. Lauren says, Hi there. I am happy to have found your podcast. I have a question about combo feeding. My little guy is four months old and my lactation consultant and I determined I have low supply due to insufficient glandular tissue.
Therefore, after 15 to 20 minutes at the breast, I give my little one a bottle of formula, sometimes mixed with expressed milk. How do I determine how much to supplement after feeds? I have used a scale to calculate transfer weights, which was helpful, but formula doesn’t change in composition like breast milk does.
So I don’t know how much to give as my baby gets older. My consultant thought my pediatrician could help more with this. She said to watch his cues. I’ve always had a hard time with this because I swear my baby would live on the boob if he could. He’s gaining very well now, not quite on the curve yet, so that leads me to believe I’m doing something right over here.
It’s difficult to fully explain our situation. So I hope that’s enough detail to get the conversation started. Thanks so much, Lauren. Okay. Combo feeding is a little bit tricky because every scenario is gonna be something different. In general, if we are feeding mostly breastmilk it tends to work to stick to the volume of breastmilk that would be appropriate.
When we start to feed more formula than breast milk, we’re gonna have to start changing that volume to be what’s more recommended for formula. Yeah. And also I wanna just acknowledge the normal developmental changes of babies as they get older. So when your baby is one month old, they don’t do anything but lay around and eat, sleep and poop.
Yes. When you have a six month old, they are active, they’re on the move, and they don’t wanna be eating all day long. So when they start spacing out their feedings, you have to increase the formula, which is why at six months old, formula fed babies are getting sometimes six ounces at a time.
But you know, we really do kind of have to acknowledge the fact also that if you have a normal healthy baby that is neurologically intact, they can tell you when they’re hungry. So you can always start with maybe like five, especially if you’re more formula fed than breastfed at that point, like five ounces might be a good place to start. And if they look like they want more, you can give them more.
Yeah. And it’s okay to go in for extra weights with your doctor. You know, or to keep track at home, especially in that first month or two of combo feeding where you’re like, what are we doing? I have no idea. I don’t know what’s going on. Baby’s cues are weird. It’s fine. Just keep track of baby’s weight and if you are gaining at an acceptable rate, you’ve probably found a good, sweet spot.
Yeah. And I would say like a lot of formula babies eat about 30 ounces a day, which is a little bit more sometimes than breastfed babies, not always. But it’s more about getting that 30 ounces in in five feeds instead of eight to 10, right? Because now they’re sleeping through the night and they’re busy during the day.
So it’s mostly a recommendation just to let people know that you still have to get in this much during the daytime, despite naps and despite sleeping through the night and they’re busy bodies. Okay. Good luck with that.
Next question. Okay. Our next question is from Andie Ward. Andie says, Hey ladies, since you are my go-tos for all things, baby, I have a potential situation I need advice on.
As you know, I’m 21 weeks pregnant due 3/13. Baby girl is a healthy, happy as a clam little fetus and I’m interviewing for a new job. I am currently an outpatient ortho pt and I’m quite tired of it. I’ve secured an interview for a full-time pelvic health position at a local hospital outpatient facility, a passion of mine that I have been too chicken to make the change towards until now.
My first interview is with the team on Zoom. They obviously won’t see my adorable bump, but if slash when I go in person, bam, there she is. Ohio Law states employers do not have to offer FMLA until you’re with the company for 12 months, which will obviously not be the case. My thought is to just crush the interview, see them in person, hope they love me, and then try and negotiate for extended leave past the silly six week short-term disability, which is not enough, and I will not tolerate.
I know I’m not required to disclose my status initially, but I think they can ask me. Not a hundred percent sure on that one. Any advice if I should just tell them immediately or wait? Are there any rights I’m not aware of? Trying to maneuver this appropriately for all parties. I think, I would think if they work in pelvic health, they would understand the importance of extended leave for mom and baby and know what benefits I would bring to my future patients and the passion for the specialty.
Sorry, it’s long-winded. Let me know if you have any thoughts at all, Andie. Okay. Yeah. This is a tough one because I really wish I could say that oh, like it’s a pelvic health center. Of course, they’ll be compassionate about your maternity leave, but no, like we know, you know, from Obs and L and D nurses, like those departments can be the least compassionate about leave and lactation, all of that.
So no guarantee. We can direct you to the Center for Work-Life Law hotline though, which is free and we will link that episode in the show notes cuz we interviewed Juliana Franco, who is a lawyer for the Center for Work-Life Law and they can review your particular state’s laws regarding pregnancy and work and also the rights you have after.
And they can also work with your provider to write a prescription for you that might give you the time off you need without putting you in a situation where you’re so limited that they have a reason to fire you. Right. But so far I think you have a pretty solid plan. I would just double check your state’s laws.
I’m not an expert, but they do on the website for the Center for Work-Life Law, which is pregnant@work.org. They have PDFs on each state’s laws and federal laws regarding being pregnant at work and breastfeeding at work. Okay. Well, good luck with that. I know you will smash that interview and I hope that they are smart enough to hire you and negotiate with you.
Well, Heather, I have a question for you. I’m, I’m pulling an anonymous question from our Facebook group. And so this one comes with a picture of pumped milk and the right side has more milk and it is whiter, and the left side has less milk and it is more yellow. And this person is asking, why is that?
Is her baby getting sick? You know, is it because she nursed on the left side last and that’s why there’s less, she’s confused about this. Okay. Well did it say how old her baby is? No. Okay, so your breasts are sisters, not twins. They act independently of each other, and I have seen this before. So if your baby is only a few days old, it is possible that one of your breasts has more mature milk and the other one is still transitioning to mature milk.
I’ve seen that, and that’s very, very cool. If your baby is a little bit older, it could be that you nursed last on the one side and the other side had a little bit more of a chance to separate in the breast before you expressed your milk. But yeah, that’s my initial thought. What about you, Maureen? Yeah, I mean, what I usually say is when we have greater volume of milk, we have more of that water content, more of the lactose, and that tends to look like whitish bluish, right?
Looks like skimmed milk. When we have sort of more of that cholesterol, some more of those fats, it usually looks a little bit more yellow and that tends to be the breast with less milk. Right. And maybe the one you’ve fed on most frequently. And I would not say your baby’s getting sick. We will see just from our covid research that sometimes when we have more maternal antibodies, the milk almost looks a little bit green, which is interesting. Sometimes.
Yeah. Sometimes. So I, I don’t know, maybe. But I think the lesson here is that it actually doesn’t matter. All that milk is fine for your baby. Most people have one side that produces more than the other. That’s totally common. You can mix those milks together, not a big deal.
Okay, so this next question is from Susan, one of our patrons. Susan says that she got her period back at five months postpartum. Now she’s having her second period and it’s insane. I’m assuming that means it’s like a lot. Please tell me it gets better. I’m wondering how common is it for periods to affect supply? My baby’s in a mega growth spurt right now but seems to be on the boob extra extra.
Does the calcium magnesium supplementation thing actually do anything for period related supply dip? Okay. The experience of having some really heavy bleeding and maybe some more pain and things like that with your first few postpartum periods is very common because your hormones are like going crazy right now.
This is one of the first times postpartum you’ve had like a big estrogen rise, you know, and a lot of stuff is happening in your body. You haven’t shed your uterine lining in five months. Right. So things are gonna be a little bit out of whack. Most people will have like a handful of weird periods and then they kind of get back to normal.
For some people that persist longer and if you’re finding that they’re just getting progressively worse or they’re not getting better, you can definitely chat with your provider about that. Yeah, agreed. And the calcium and magnesium thing is really, we’re probably a little bit deficient in that anyway.
So it does, it’s definitely not gonna hurt you to take it. And I would try it for, you know, one cycle and see if it helps you. Yeah. I, I don’t think we, we have good studies on it though. Anecdotally, a lot of people say it helps and it’s not gonna hurt. Right. So it’ll help kind of keep your supply a little bit more stable.
And you know, we do know that calcium and magnesium do work on electrical impulses with muscle. Yeah. And your uterus is a muscle. So, you know, maybe it even helps the cramping. But again, I’m pulling that outta my ass. I’m not really sure. Yeah. And unfortunately I’ve never seen a good data set on how many people’s milk supply is affected by menstruation.
If anybody knows of a study like that, please email it to us, cuz I would love to read it. I can say though, in clinical practice and having observed a lot of people, it is not that common that it affects your supply to the point that you have to do something about it. I think it’s fairly common that people notice a little bit of cluster feeding around menstruation.
But the amount of times I’ve actually had somebody come in with supply during menstruation as a problem are very few.
Okay. This next question is from a random person that called me while I was pooping the other day, because all of my office calls get directly forwarded to my phone.
Did they know that? Did you tell them? Of course not. I would’ve had the intrusive thought the entire time to tell them. Yeah, I know. Well, I couldn’t, I didn’t have time cuz I picked up the phone and I said, Breastfeeding for Busy Moms. This is Heather. And she says, Hi, I have a question about breastfeeding. And I was like, oh God, okay.
Like it’s not even a patient of mine. And she says, am I allowed to take pre-workout while breastfeeding, you know, which is. I hate that question. And I said, well, which one? You know now I’m hooked. That’s fine. Because I’m like, God, and I’m on the toilet, so like might as well. So I was like, well which one?
And she goes, I haven’t picked one out yet. And I was like, okay. And she goes, I said, how old’s your baby? And she said, one month. And I was like, okay. Well I do know that most pre-workout has caffeine in it, so you know we do have an episode on caffeine. Yeah. That we will link in the show notes. And I was like, so it’s probably fine unless you’re also drinking two pots of coffee and slamming Monster energy drinks all day and then taking pre-workout.
And even then it’s still probably okay, but your baby might have some GI upset and some irritability, especially cuz they’re so small and also please get cleared to work out by your provider before you go like doing pre-work workout and strength training at four weeks. Yeah. So that’s rough.
Also, I just find this hilarious. Does anybody call their doc any doctor randomly just from the phone book and be like, I got a question about blah, blah, blah? This happens to me a lot. I get those too sometimes and they’re really funny. But I have to say that I hate that question and all related questions of can I eat or drink this totally normal like food thing while breastfeeding and I’m, I know it’s like it comes from a place of nervousness and insecurity and it’s fine.
I just get so frustrated because I’m like, the simple answer is probably like a 99% yes. The complicated answer is like, let me look at the ingredients. Let me see what the heck is in there. Also, I don’t know you. I, yeah. Usually it’s like people I don’t know, online or whatever, and I’m like, oh God, like, it’s probably fine, but if I look at the ingredients I’m like, I don’t know.
We don’t have studies on all these random supplements, but also like, oh no, fine. It’s probably fine. Right? And also like I don’t have your labs or your history like.
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Okay, I’m gonna pull another anonymous question from our Facebook group, and this person is asking, when does engorgement go away for good? She’s two weeks postpartum, pumps every three hours on the dot because her baby is sleeping, having trouble waking for feeds, falls asleep while feeding, stuff like that.
So mostly he’s bottle feeding. And you know, Google told her it resolves in the first week. She’s obviously passed that and frustrated. I have an answer. So if you are exclusively breastfeeding, not using a haakaa, not pumping, not bottle feeding, then yes, your engorgement should technically resolve in the first week.
However, if you are stimulating your breasts artificially in any way, either by itself or in addition to directly latching your baby, you are essentially creating a bit of an oversupply, over stimulation, and we are going to extend that initial engorgement phase beyond two weeks sometimes. So I’ve seen this happen, especially with the haakaa. So I love the haakaa as a tool for collecting additional milk in the beginning.
Easy to do. Our body often has more than it needs, but I usually try to limit people to three ounces extra a day total, not per time. Mm-hmm. So if you’re getting one ounce every time you nurse and you nurse eight times, you’re getting an extra eight ounces a day. Do the math on what that looks like after a month.
That’s a lot of milk folks. So I usually recommend just limiting yourself to three and usually that still does extend the engorgement phase, but not beyond two weeks, and it depends on the person. And the key with being an exclusive pumper or close to it, is still being responsive with your milk expression to how much your baby is eating.
So trying not to express more milk than that, or not significantly more. And I have had cases in just totally normal, like, you know, we’re breastfeeding responsively and whatever where people’s engorgement or feeling of engorgement, but not necessarily actually like being so engorged, maybe can’t latch, you know, they just feel full, maybe hot, itchy, things like that.
Sometimes that does last for a couple more weeks because that just comes down to like tissue elasticity and your specific nerves and your specific like neural pathways. Mm-hmm. And also, how much fluid did you have to start with? Were you a three day induction that turned into a C-section? Because at that point you’re gonna be super fluid overloaded, which is going to tax your lymph system, which is desperately trying to drain all of that extra fluid out.
And that process is gonna take longer too. So it kind of depends where you start at baseline, how much additional milk you’re expressing and that’s it. Okay. Well, I think that was a really fun lightning round. Okay, we gotta go. We love you guys. Thanks for listening to another episode of the Milk Minute Podcast.
The way we change this big system that is really not made to support us is by educating ourselves, our friends and family, and sharing resources like this one. And don’t forget to ask questions. If you found value in the episode that we produced for you today, you can support us for as little as 25 cents an episode at our Patreon, which is our behind the scenes VIP Club of humans.
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