5 Questions for an RVA-Based Certified Lactation Counselor
This is part three of my “5 Questions” series for those transitioning to parenthood. Part one was 5 questions to ask a newborn photographer (my area of expertise); part two was 5 questions to ask when you’re pregnant (very general questions for your care providers). This one is for both new mothers-to-be and those who are pregnant again, who may want a different breastfeeding experience than the first round. Edit: I also have part four: 5 questions to ask HR about parental leave.
I am not here to tell you how to feed your baby, or argue for breastfeeding over formula. Our bodies and our babies are all remarkably different, and there are lots of reasons we might choose one over the other. Or both at the same time. For those who are pursuing the route of breastfeeding, or thinking about it, this post is for you.
The difficult part about talking about breastfeeding is restraining myself from launching into a vent session about the things that went wrong my first time, the people who let me down who were supposed to be supportive, and how I went 10 whole weeks with a baby who had a severe tongue tie before I finally sought help, mostly because I didn’t know who to ask for help. The lactation consultant in the hospital who confidently told us that he didn’t have a tongue tie and that it’ll just take time for him to figure it out. The pediatrician who blamed me for the weight my son was losing two days after birth, and gave me a pamphlet on formula instead of helping me figure out why he wasn’t latching. The Facebook support group for nursing mothers who unkindly kicked me out of the group because I needed a nipple shield to try to help my son latch.
See? It’s hard. But this is not a venting post that would be better shared with my therapist. Instead, I have reached out to Sara Krivanec, Certified Lactation Counselor (CLC) with some questions, and she sent me so much great information I’d be able to fill a blog post with each of her thoughtful answers. I’m going to share some of that information here, and give you Sara’s contact information so you can reach out to learn more. As I said, my biggest problem when I was struggling with breastfeeding was not knowing where to start. I’ll give you that, here.
When should I seek help from a professional with breastfeeding? Who should I seek out? Where do I start?
I took one “child prep” class at the hospital a few weeks before birth, which briefly talked about breastfeeding and talked about different ways to hold your baby while you nurse. I remember half-heartedly holding the plastic baby to my chest, thinking that it was a silly and not exactly helpful lesson, since the doll did not feel like a real baby, and I had three winter layers between it and myself. I would not learn how to help a baby latch in that class. I also thought babies and mamas have been figuring out breastfeeding together since the dawn of time. So I figured we’d just naturally learn together in the first hour after birth, and there wouldn’t be any issues. Then when there were issues, I had no idea who to ask about them.
Sara recommends a different, more proactive approach: She offers a basic lactation class at Mybirth, and recommends you and your partner attend between 34-38 weeks (as in, before birth, and before you see problems). She covers things like normalizing what to expect in terms of how often babies will nurse, what a typical supply looks like, how to rest during the postpartum period, how partners can support nursing parents, and to trust that all we need to do for the first 4-6 weeks is learn how to breastfeed. (My 1-2 hours after birth was greatly underestimated.)
Mybirth also offers a variety of help options if you’re having issues or just want feedback or reassurance on how it’s going in those first couple of weeks. It might feel redundant since you’re already taking your baby to the pediatrician during that time, but most pediatricians are not trained on lactation, and at worst they might just offer you a pamphlet and look at you in horror as you break down in tears because you’re failing at your “one job” (there I go venting again - btw, we did not return to that pediatrician).
If you decide not to go the proactive route, and find yourself in pain after the first week, Sara recommends finding help at that point. She and Clare Heaps, the other CLC at Mybirth, have office hours and will make house calls as well.
Here’s a question for you to ask your CLC and care provider: Do I have a medical condition that will prevent me from breastfeeding?
There are several medical conditions that may prohibit breastfeeding or challenge your breastfeeding experience. Many of them are hormone-related, endocrine-related, or related to breast tissue, and some people may find that they are able to adjust medications and improve milk supply. It’s good to talk to your lactation professional and doctor during pregnancy to come up with a plan if you’d like to breastfeed.
How long should it take for my baby to start latching?
Sara says in a perfect world, newborn babies are latching within the first hour or two of birth. (Maybe that’s where I got the 1-2 hours numbers). But there are lots of reasons why it may take longer. Birth interventions can delay the baby’s reflex to find the breast during that time, including Caesarean sections with opiates, and birth inductions that often involve other interventions. It’s important to be well informed, understand consent/refusal, and make decisions based on evidence ahead of your birth. Hiring a doula can help increase your chances of having a low-intervention birth and help you weigh risks and benefits of any procedure during labor.
How do you know if your baby has a tongue or lip tie?
This one is from my personal experience. The hospital lactation consultant declared there was no tongue tie on my newborn son, and so we moved forward for weeks believing that the problem was something (or someone) else. Sara reassured me that tongue, lip, and buccal ties are not able to be diagnosed by sight and that a specialist is needed to check for them. If you are having issues with breastfeeding, Sara recommends seeing a lactation professional (CLC like Sara, Certified Breastfeeding Specialist (CBS) or International Board Certified Lactation Consultant (IBCLC)) who will look at all the clues of your issue and refer you to a specialist like a pediatric dentist, pediatric ENT, or Speech Language Pathologist who can evaluate, diagnose, and offer treatment if an oral tie is suspected.
We personally ended up going to Children’s Hospital of Richmond with my son, where the IBCLC was able to diagnose it and call in a specialized surgeon to perform a frenotomy immediately, so we could finally nurse without pain and frustration.
How much milk should I be producing?
Babies need remarkably little milk at first! This chart was a helpful visual for me my second time around, to remind me that I didn’t need to provide 8 ounces of milk at every feeding. Babies will intake one tablespoon of colostrum over several feedings in their first day of life. If you don’t know that at the time, it can feel like failure when your baby is not nursing for long periods of time right away. Sara again recommends taking a proactive class on breastfeeding before birth, so that you’re armed with knowledge and can be confident knowing when things are going well, or when you might need additional help.
If you’re ready to learn more, Sara Krivanec works alongside Clare Heaps at MyBirth, here in Richmond, where they offer a variety of birth and lactation services in basically any form: classes, in-office appointments, group support, in-home support, both before and after birth. If you’re pregnant or nursing and are interested in their education and group meet-ups, you can find their monthly calendar here. You can go to Mybirth’s website to sign up for any of their events.
Big thanks to Sara for lending me her expertise, wealth of information, and most importantly - time - to answer my questions and help me get this out to you. She’s kind, thoughtful, and here to help if you need it!
https://mybirthrva.com/lactation
https://www.instagram.com/sarakdoula/