Episode 64 – New Motherhood Amid COVID-19 with Dasi Ginnis, LCSW and Common Breastfeeding Questions Answered by Jessica Allmyer, IBCLC

Bringing life into the world amid a pandemic is unprecedented. Join us as we talk to a new mom who navigated COVID-19 during her hospital delivery. We’ll also learn along as she shares added insights from her role as a Licensed Clinical Social Worker with specialized work in helping women struggling with grief, trauma, and life transitions. We’ll also hear from mother and International Board Certified Lactation Consultant, Jessica Allmyer as she responds to commonly asked questions on the topic of breastfeeding.

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Resources and Show Notes

From Jessica Allmyer, IBCLC, FAQ’s:

Question 1: How do I know my baby is getting enough breast milk?

This is probably the most common question I get as an IBCLC and for good reason!

I like to start by reminding parents that it is normal and expected that newborns will lose a little weight in their first 2-3 days of life. Around 3-4 days of life we like to see that loss plateau and then start to come back up, so that by 10-14 days of life baby is back to and then starting to pass their birth weight. Baby’s healthcare provider will help determine if weight loss is within normal or a flag for an issue with feeding.

Once a baby is home, there are several things a mother can look at to make sure things are still on track. One of the most important indicators for how much is going in is how much is going out. Diaper output is usually a good gauge for determining if a new baby is getting enough milk. After the third day of life we expect that a baby will have at least 6 soaking wet diapers and 2 or more poopy diapers in a 24 hour period. If they are having less than that, that would be a good reason to reach out to the pediatrician and an IBCLC to have the whole picture looked at, including weight loss/gain and feeding effectiveness. As a babies gets older, they may begin to space out their stools more, but wet diapers should remain at least 6 saturated diapers per day.

In the first few weeks of life we also expect that a newborn will eat AT LEAST 8-12 times per day. I highly recommend that in the beginning parents track feeding and diaper output because it can be so difficult to remember all of these details when you’re a new sleep deprived parent. Is there an app for that? Of course, but in my opinion nothing beats pencil and paper for this because it is easy to get a quick glance at the information without getting caught up in the “extras” of an app.

During feeding you want to see active jaw movement, not just some cheek wiggling. Typically you’ll see 1-3 long pulls followed by an audible swallow and see a wide open jaw with a short “pause” in the chin. This should be consistent without long breaks. You’ll want to feel a strong tug on the breast/nipple, without a pinching or sharp shooting pain.

If baby is eating well frequently and having frequent wet and poopy diapers that is a good sign!

Sometimes a baby will have enough diapers but be frantic during feedings, unsettled between feedings, and have a generally “upset” disposition. Just like adults, babies can have a wide range of “personality” traits, and it is normal for newborns to want to be held and fed often. However, it isn’t a bad idea to have a feeding assessment to make sure nothing is being missed and that weight gain is on track. You can discuss this with your pediatrician and an International Board Certified Lactation Consultant (IBCLC) if you are concerned.

https://ibconline.ca/information-sheets/is-my-baby-getting-enough-milk/

https://www.lactationtraining.com/resources/educational-materials/handouts-parents/handouts-lactation/newborn-feeding-log

https://www.lactationtraining.com/resources/educational-materials/handouts-parents?task=document.viewdoc&id=23

Question 2: What’s your advice for dealing with non supportive partners, family members or friends?

This can be so difficult during an already emotional and exhausting time! I like to recommend being honest about your feelings and what their lack of support feels like to you. You might not change their minds, but hopefully will make them think before they say something.

Then find some people that ARE supportive. A lot of hospitals have new mom support groups, even during COVID many are meeting virtually. There are also Facebook support groups and national groups such as Breastfeeding USA and La Leche League. Both have online support forums as well as in-person meetings and peer counselors who are often available via phone, text, or email to give you free support and/or answer questions.
https://breastfeedingusa.org/content/breastfeeding-counselor-locations

https://www.llli.org/get-help/

Question 3: Is there research out to support breastfeeding can support the mother and baby from Covid?

Human milk is an amazing, living, changing thing. Without even considering Covid, human milk contains hundreds of antimicrobial and immune factors that are supportive of a healthy infant immune system. Keep in mind that these are protective and supportive, not necessarily 100% preventative.

As with most things Covid related, there are still a lot of unknowns. However, current case reviews and studies are showing that LIVE virus is not evident in mother’s milk, therefor transmission through breastmilk is unlikely. If transmission occured between mother and child it would likely be through close contact/droplets and not through milk itself. Additionally, in mothers that were confirmed positive for Covid, Covid antibiodies have been found in their expressed milk. We don’t know yet how much protection is provided from these antibodies, however it seems to be appropriate to assume that at least some protection would be the case, as the transmission from mother to beastfeeding infant has been very low.

https://kellymom.com/nutrition/milk/immunefactors/

https://www.reuters.com/article/us-health-coronavirus-who-breastmilk/who-recommends-breastfeeding-says-no-live-coronavirus-found-in-mothers-milk-idUSKBN23J2OZ?fbclid=IwAR0bh3MXEatM-I0AL26wALrruxRKFMd2kQJNKeWkzTa8MmLS54HQpPYz09c

https://www.medrxiv.org/content/10.1101/2020.05.04.20089995v1

https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19

Question 4: Is there anything I can do to improve my newborn’s latch?

This could probably be an entire podcast series of it’s own! I like to start by telling moms that there isn’t really a “wrong” way to breastfeed. If a mother is free from pain and the baby is able to effectively nurse and transfer enough milk to gain appropriately, then things are going well even if it doesn’t necessarily look textbook perfect from the outside. However, if a mother is having pain or baby is having problems like insufficient weight gain, weight loss or jaundice, then we definitely want to see what we can do to improve latch.

A big thing to keep in mind is that it is BREAST feeding, not NIPPLE feeding. It is important to be sure the baby has lots of breast tissue in the mouth, this is usually going to mean, that most of the areola is pulled into the babies mouth and covered by the lips. The baby’s chin should be deeply buried into the breast with the nose just slightly elevated/clear for breathing. If baby is latching just onto the nipple, you’ll likely have nipple pain and the baby will be working hard for minimal milk transfer (think trying to drink from a straw that you are pinching). Sometimes a position change or some light breast shaping can make a big difference in helping infant take more of the breast.

When thinking of the best positioning at the breast, think of how you normally eat and drink. Grab a bottle of water and take a drink.  You likely hold the water bottle directly in front of your body, you likely slightly lift your chin, you likely slightly lift your chest, you likely keep your nose free. You probably do not turn your chin towards your shoulder; this would make it difficult to swallow. You probably do not drop your chin to your chest; this would also make it difficult to swallow. These same fundamental ideas apply to breastfeeding. If a baby has to drop their chin to reach the nipple, they’ll likely pinch the nipple, cutting off some of the milk flow, and have a difficult time maintaining suck/swallow/breath so they will unlatch often. Same for their head being turned and their body being crumpled in a ball.

Help your baby by squaring their body and shoulders towards your body. We often say “tummy to mummy”. Also position them with the nipple at nose level rather than chin level so they have to slightly tip their head back (like drinking from a water bottle) and they can open their mouth and jaw wide.

If you’re having difficulty finding a position that works for you and your baby, reach out for help! Sometimes a peer counselor is just what you need for some positioning advice. Sometimes things are a bit more complicated and an IBCLC (International Board Certified Lactation Consultant) will be more appropriate. If you’re not sure who to reach out to or you have health concerns, talk to your pediatrician.

Question 5: Should I nurse on demand of create a feeding schedule?

In the simplest terms, watch the baby, not the clock! Particularly in the newborn stage when your milk supply is getting established and it is so important that the baby is growing and eating well. Remember, a newborn will eat minimally 8 times a day and sometimes 12 or more times, and it’s not likely that each of feeding will be spaced out evenly. This may mean that babies eat in clusters; it’s fairly common for babies to eat many times in a row between 7 PM and midnight. Your body will respond to this by making more milk. It’s a good time to find a Netflix show to binge on and set aside any expectations you had for a perfectly clean house.

Stomach capacity, feeding rate/effectiveness, and breast milk storage capacity (note, this is different from milk MAKING capacity) all play a role in how often your baby may want to eat. If feedings are intentionally spaced out further than those things allow, milk supply and milk intake can be impacted. Just like adults, some babies eat faster than others, some babies eat more at one feeding than others, and some babies prefer smaller more frequent feeds. Breast milk supply is demand driven, so the more frequently and fully breasts are emptied, the more milk they will make.

An exception to this “watch the baby not the clock” advice, particularly in the first few weeks of life, would be if your baby is TOO sleepy. If your baby is regularly sleeping for 4 or more hours and not showing hunger cues, you’re going to want to watch the clock and wake your baby up sooner. This is common in babies born early (before 37-38 weeks), babies with feeding difficulty, and jaundice. If you are concerned about any of those issues, reach out to your pediatrician and a good IBCLC.

I think it’s also important to note that this doesn’t mean you need to forever be “hostage” to your baby’s feeding “schedule”. As babies get older, their stomach capacity and feeding efficiency usually increase. As milk supply and weight gain stabilize, there can be a little more flexibility for mothers to encourage a more consistent (though not necessarily set in stone!) feeding schedule.

https://kellymom.com/hot-topics/milkproduction/

https://www.jognn.org/article/S0884-2175(15)31026-1/pdf

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