Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 19 Dr Rachel Yang
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Dr Yang is a Breast surgeon and IBCLC candidate. As a Breastfeeding Medicine doctor she seems clients prenatally for education and support, lactating for assistance and also oncology patients as well. While she is a traditionally trained surgeon, Dr Yang also understands and uses alternative methods when appropriate, such as recommending probiotics instead of antibiotics for mastitis. Dr Yang is a part of MarinHealth.
Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially tongue tie and gut/allergy related issues. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com
Disclaimer. This content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a left one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Ostadt, BSN, RN, IBCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Thanks for joining me on the podcast today. We have Dr. Rachel Yang, a physician specializing in breast surgical oncology, benign breast disease, and maternal complications of lactation. She attended Wesley College and the University of Pennsylvania School of Medicine. She completed an internship and residency in general surgery at Stanford University. She then completed a breast surgical oncology fellowship at the University of California, San Francisco. She's a certified lactation counselor and an IBCLC candidate. She now works at Marin Health, where she has a unique practice combining breast surgery and breastfeeding medicine. Dr. Yang cares for women with a wide range of breastfeeding challenges and provides tertiary care for women with complex lactational issues. Please welcome Dr. Yang. Thanks for joining me today, Rachel. It's so great to finally get a chance to chat. I know you've had a busy transition moving over into your office in Marin. Do you feel like you're getting settled now?
SPEAKER_00I am. I really am. And I'm so happy to join you today. Thank you for having me.
SPEAKER_01Thank you. I am so excited that you are in the Bay Area because there has been no resource in Northern California, which is shocking to me when you consider the population and the number of people up there and the number of babies born every day for breastfeeding medicine doc or a breast surgeon with any lactation training or understanding. There just hasn't been anyone to go to when you, you know, have a client that needs more support. So I'm thrilled that you're there. Are you finding yourself busy right away?
SPEAKER_00Yeah, I think I'm just shocked how busy it's gotten in comparing to my other colleagues who are breastfeeding medicine docs. I think it's ramped up really dramatically faster than most because of the exact reason that you've described. There's really no no one else, maybe one, I think one other individual further north than me, but no one else in the immediate Bay area who's a breastfeeding medicine doc. And so I'm seeing a lot of patients from all over the Bay, the East Bay, the South Bay, of course, the North Bay, the city, and that's a big population. So there's lots of need, and so excited to be able to help all of them.
SPEAKER_01Yeah, there definitely has been need. I've, you know, I've recommended telehealth down to Katrina Mitchell before a couple of years ago. And it's like, that's an option, but it is nice to have someone closer to home.
SPEAKER_00Yeah. And I'm I'm certainly always able to offer telehealth to those who are further away or can't make the drive with a new baby, but there's something incredibly valuable about being able to meet a person and the baby in person and witness breastfeeding and perform a physical exam of the breasts and nipples that's really irreplaceable.
SPEAKER_01Yeah, especially when you're dealing with things like mastitis and abscesses and all that type of stuff. Definitely I would say yeah, that hands-on is going to be very informative care.
SPEAKER_00That's exactly true. It really is so important.
SPEAKER_01So being a you know, breast surgeon, but also someone like we had talked about you're a CLC and you just sat for your exam. Congratulations. And I hope that you know everything comes out as you hope. And so that, you know, potentially you'll be an IBCLC just in a few months. How does that kind of change your practice? Like, do you typically see more breast surgeon patients in a day or lactation, or is it very just every day?
SPEAKER_00Yeah, it's a great question. I think if I didn't have any special expertise, training, or interest in breastfeeding medicine, it would be a pretty straightforward breast surgery practice, like all the breast surgeons in the country, which is vast majority breast cancer or pre-invasive breast lesions, as well as benign lumps and bumps and high-risk patients and other things, such as inflammatory conditions of the non-lactating breast and and um and breast pain. But um now that I have this interest and expertise, it's really great to be able to provide breastfeeding medicine services. And that's completely transformed my practice. So I really started with a more standard practice and quickly transitioned to probably 50%, even sometimes more, uh, majority being breastfeeding medicine related patients. I don't have specific days that are designed for my breastfeeding patients versus days for my breast cancer patients, but mostly because I feel like breastfeeding conditions and challenges require often urgent attention. And so I want to be able to provide for patients as quickly as possible. But the the two really intermix throughout my clinic days. So that's um really fun and creates for me a wonderful balance of of patients and diseases to be thinking about.
SPEAKER_01Yeah, I can see it definitely brightening your day too, where you're not, you know, dealing with breast cancer all day to kind of have some some positivity in there. And you're definitely right. I mean, I would say that there's no, I always say there's no true breastfeeding emergency, but that's because I came from labor and delivery where was in patient labor and delivery for 15 years, and three minutes is life and death. You know, you can't wait at all. So there aren't breastfeeding emergencies, but there are definitely people who need to be seen today or tomorrow. And, you know, waiting a week is going to definitely change their course of, you know, it could change the entire course of feeding for them.
SPEAKER_00Yeah, that's really true. And I think, you know, mastitis and abscess are really probably some of the most emergent needs. But I even think about a baby having breast refusal when you don't get educate a mom on how to reverse that as quickly as possible. A week later, it could be a very challenging time to get a baby back on the breast. So I find that for most of the reasons people are seeing me, the sooner the better. Of course, I try and triage, but but certainly try and see all my breastfeeding patients within a few days of them contacting me.
SPEAKER_01Yeah, I definitely agree. I try to tell people sooner is always better because for most things, I mean, and it probably applies to a lot of medicine, but I recently did have a breast refusal client and the baby hadn't gone to the breast in a month. And she's like, Well, I've tried all these things. And I was like, Oh, I wish you would call me like 25 days ago or 28 days ago. You know, it's so hard when we meet a client very, you know, what we consider later in the journey or the problem, you know, whether it's nipple pain. I mean, all too often I'll have someone say to me, Oh, well, you know, I figured it was normal to have, you know, cracked bleeding nipples for three weeks.
SPEAKER_00And I'm like, no, not normal. Yeah. It's sometimes really a joy when someone needs me for um a pre-delivery consultation. And getting to work with them throughout the journey is just really quite rewarding because it seems to go much smoother when they have all of the advice up front and have me available as a research resource immediately after the delivery of their child.
SPEAKER_01Oh my gosh, that's so funny. I've been saying that recently to everyone because I did two prenatals that have both delivered in the last couple of weeks. And it's made such a difference because I feel like I'm right there. One of them, everything's going smooth. The other one, baby, was tongue tied, but I was right there and we and the one with the tongue tie baby was expected. Her first was tongue tied. And so she kind of had sought me out to be proactive and to have a different course than she had last time. But it just makes such a difference when you're there on, you know, day three versus day 30. You know, it's a it's a big difference. I didn't realize you would do prenatals.
SPEAKER_00Yeah, I've had I've had a few, and I think some of them are women who just had a really challenging breastfeeding journey previously and wanted some expert help just go around. Sometimes it's a history of breast cancer, it's often a history of breast surgery and helping, whether it'd be implant augmentation or breast reduction. So there's certainly a role, and then I welcome anyone to see me, even if it's not anything complicated. So it's it's really a joy to see people from the beginning. I think my practice, probably one of the big differences with most lactation services and lactation consultant practices, is that I don't typically see people right after delivery. I'm not inpatient. I typically am being referred patients when a problem has really manifested as complex and persistent. And so that often will be several weeks after delivery of the child. And that often makes it more challenging, but also can is more interesting. And that's where my role is is really specialized. But it is different than seeing people early on. And so a lot of that brings some challenge with it.
SPEAKER_01Yeah, I definitely agree. I think that everything you mentioned, though, is a really great idea, especially for somebody with breast augmentation, breast surgery, breast cancer, or reduction. I mean, I've actually had had a harder time. I've had clients have a harder time with breast reduction than breast augmentations. And, you know, for them to have just who have even met you and to kind of what I tell people too is the the thing is we don't know what we don't know. So you can't know when to call for help if you don't know what's normal, right?
SPEAKER_00Yeah, very true.
SPEAKER_01And that's one of the biggest things that I, you know, focus on during a prenatal is, you know, how to set yourself up for success, but also what are the signs for when you need more help? And that, you know, especially in those high-risk populations, that would be great for them to know you and to have, you know, to kind of have you on speed dial and to be able to call and say, okay, we're starting to drift that way, because it is so much easier to correct a little thing than a big one.
SPEAKER_00Yeah, that's exactly it. And and I think setting expectations is really important and and really understanding, as you said, what's normal and what's not and when help is needed.
SPEAKER_01Right, right. When you're seeing these women with breastfeeding struggles, are you seeing a lot of increase in postpartum mood? I'm in my practice now. I mean, I'm seeing, I'm also seeing ones that are either paying out of pocket or sometimes insurance. I do, I am in network with a couple of insurances, but generally most of them are struggling. Occasionally I'll get that prenatal and everything will go nice and smooth and we'll have just a couple educational visits. But for the most part, my practice is people who are struggling with feeding, and I just see a high correlation of postpartum mood with that. You know, is that something that you're seeing in your practice now as well?
SPEAKER_00Oh, yes, absolutely. It's really unfortunately a big part of my practice related to the breastfeeding patients. And I and I think research has corroborated this and shown, I don't remember the exact numbers, but women who have breastfeeding challenges to have much higher incidence of perinatal mood and anxiety disorders, which is PMADs, is what is it's short for. And I see that absolutely for me. I really have to pay attention to the affect of the mom, the mood that I can witness. And I I try and always ask some mood-related questions more open-ended, but somehow to get at how they are feeling overall since delivery. And then there are women who I very much am concerned about that I do perform or administer some postpartum mood screening questionnaires and see if that's something that should lead us to refer to a psychiatrist. I also have a lot of collaboration with the psychiatrist in my community. And because it is so hard for women to get mental health services and get in with a psychiatrist or an OB who's willing to prescribe, I feel very comfortable with my medical degree providing some medications, usually in the SSRI category, to bridge a patient until they can meet with the psychiatrist. And usually that prescription also involves a referral and a note to the psychiatrist about what my concern is, why I started medication, and making sure that that psychiatrist is also in agreement about which medication, what dosing to use. But it tends to be a really collaborative approach and a holistic approach to women's mental health and making sure that their priority is getting care as urgently as possible, because mental health is something that often becomes more catastrophic the longer we wait on it. And so I think those few weeks delay to get in with a provider can be very, very detrimental, not only to the breastfeeding relationship, but to the mom's health in general. So if for me, it's if an opportunity arises to assist a woman in getting care more quickly, I feel really comfortable with and happy to help with that.
SPEAKER_01Yeah, it's unfortunate how much commands we're seeing and that the increase since COVID is just unbelievable. I think the the increase in depression anxiety in the country has pretty much gone through the roof. And I will say, ever since COVID, it's harder to get care. You know, I'm definitely finding a lot of my clients are, you know, when they do take that step finally and call and ask for a referral, it's very challenging to get a therapist. And especially if you want someone who has any knowledge in, you know, perinatal health, mental health. And it's it's very challenging. And, you know, I think I'm very grateful that you're there and able to prescribe and get them started while they're in that holding pattern, like you said, because I always feel like these moms generally are not thinking about themselves as much, right? They're very focused on a baby. And they're a lot of times what I see is women that are very good at, you know, pretending or putting aside their own needs. And when they finally are willing to accept help or acknowledge that they need some support, it's rather important. And it's been a while, you know. I mean, it's not uncommon for me to even bring it up with a client for a couple of different visits and really encourage and hand out a referral. And finally, you know, weeks later, I might get her to make that phone call. So when they hit a wall and they make a phone call and then they're told, well, there's no therapist that can see you in three months, it's it can be very detrimental.
SPEAKER_00Absolutely. Yeah, it really's a tough scenario for women to be in. And I think my role is also very much in helping to normalize it and knowing that women are not alone in this experience, that the changes hormonally based and and not that happen to the brain postpartum are experienced by most of us. And and some of that becomes accentuated and leads down a pathway towards a true mood disorder, and some doesn't, but that PMADs and associated mood disorders in the peripartum time period are just exceptionally common and to help decrease shame and embarrassment around that topic because it's it's really something that we should be talking about more.
SPEAKER_01Yes, I think in general mental health as well, but perinatal mental health is such a big one. And you're right. I mean, there's just such an issue with shame and guilt. And I think I hear frequently that these mamas are, you know, not wanting to take time to take care of themselves, that they feel that somehow that's going to take away from the baby. And I I'm always trying to encourage and remind them that you have to, you know, like all the good analogies, you have to put on your own oxygen mask first. And that nobody should be doing this in a vacuum, right? Even if you're a single parent, it really doesn't matter. No one should be doing this in a vacuum. We all need support. This is a major life transition. And I really, I know it's in the top 10, but I have to say, I've moved and I've gotten married and I've bought a house, and nothing prepared me. Nothing was like parenthood. And the, you know, the amount of changes it inflicts on your life, like it impacts every aspect of your life.
SPEAKER_00Yeah.
SPEAKER_01There's just so much lack of support in the community now, especially since COVID.
SPEAKER_00That's really, it's really unfortunate. And I think people assume that breastfeeding providers, whether that be a lactation consultant or a breastfeeding medicine doc, are so heavily focused on the breastfeeding outcomes that they're not mental health focused. And I really try and impart on all of my patients that my biggest focus is their joy, their happiness, and their well-being. And anything that interferes with that, really, I want to be making sure that we change. And so it manifests in really different ways based on the patient. But I always remind women that as much as I believe and stand by all the incredible benefits of breastfeeding, that I know very much so, that a mother who can be present and happy and joyful with her baby and be able to attach emotionally with her child is so much more important than any milk that can be provided. And so, you know, in the settings of women with really profoundly low supply, when there's, you know, honestly, as expected in that diagnosis, really a lot of grieving and a lot of emotional challenges and very commonly P MADs present to really try and focus on the mom's well-being in that situation and making sure that they know that their love is much more important than the breast milk and their wellness. And so sometimes it's about figuring out how to make the direct breastfeeding more a part of their experience. Sometimes it's about pumping more and doing less triple feeding. Sometimes it is about helping a mom get more sleep at night and stretch out. If she's an inclusive pumper, the times she's pumping. And if she's not an exclusive pumper, helping her get some restful sleep between the nursing at night. Um, and sometimes it's about helping people make peace with not pumping eight times a day if they have a very low supply and being okay, providing a little bit less to their child to preserve their mental health. But I really try and make that a focus of almost every visit because there are a few people who aren't having some effect on their well-being. And my very, I very much, my, you know, my ultimate goal is having everyone be able to achieve exclusive breastfeeding if that is their goal, which it is for most, but not everyone. And there is certainly data in my experience as well as a provider and seeing that success in exclusive breastfeeding is very protective of mental health. That's been shown in several studies, but it's not always possible. And in those cases, it takes a lot of creativity in making the balance between breastfeeding and mental health work.
SPEAKER_01Absolutely. And you're right, there is definitely a grieving process that these women go through when they have a very low supply and that, you know, it's not an issue of effort, right? And they've tried everything and done everything, and they're pumping eight times a day, and they're getting very, very small amounts, you know, not even a feeding when they put all the pumps together. And it is very important to then get to that point where we're really focusing more on mental health and just understanding that they've done all they can do, but you know, there's such a grieving. And I think for many of the moms that I see, I will also hear, well, the labor didn't go like I wanted, and I didn't have the birth I wanted. I figured I would at least be able to breastfeed like I wanted. So sometimes it's not just this moment, it's the combination of the previous ones and them feeling like they had a plan. They wanted certain things, and none of them happened. And it's a definite grieving process.
SPEAKER_00Yeah, and I think so is the whole experience of motherhood and whether it be for pregnancy with some or delivery, breastfeeding the child that you expected is different from the child you get, and grieving that, but also making sense of how life is not as we ever expect. And unfortunately, most of these things around motherhood we can't control. But I think most of us go through that transition and ultimately come out a wiser person because of it. But when there's been a lot of trauma and a lot of loss and a lot of outcomes that are different than expectations, it it often requires a lot of support from providers. And it's a big challenge to have a mom who had a tough pregnancy, complicated by an early delivery and a baby in the NICU, and then a really challenging breastfeeding relationship. I mean, all of that is a lot, a lot for a young mom or any mom.
SPEAKER_01Yeah. It's I think there's a lot of hopes and dreams and expectations that go into it as well. And then those don't turn out, right? And we expect, you know, I think people can be somewhat realistic and we'll say, well, we know we're not going to get everything we want, but we assume we'll get at least a few things. And I don't know, maybe everyone's not like me, but I feel like I say that just to totally trick myself because I don't really mean it. I do mean I want everything I want, but it it doesn't usually happen that way. I mean, occasionally it does, but for most women, they don't get the pregnancy and the labor and birth that they envisioned before they got pregnant. You know, I mean, even just pregnancy alone, I thought it was gonna be magical. You know, I did I didn't know the glow came from the puking, you know. So I mean, I think there's a little lack of of reality, you know, sometimes it goes into those very blurry images of, you know, this lovely, happy pregnancy and perfect little belly, and then, you know, nice birth and everything else. And it's it's not exactly realistic to begin with for some of us. At least it wasn't for me.
SPEAKER_00Yeah, it's very much true. And I think breastfeeding is just an extension of that. And, you know, maybe some of it we have a little more control of. But I think making sure that the advice we give is evidence-based and that there is thought behind all the intervention, if any, that we provide. And also respecting and acknowledging the the wisdom that our bodies have and the ability to breastfeed that has happened for millions of years and for all the mammals on the planet, but also being able to recognize when things are amiss and professional help is.
SPEAKER_01Right. Absolutely. And I think there's times that we just don't realize that it doesn't always work in nature either. We just don't think about that. You know, I mean, I'm sure there are animals out there and in each species that either, you know, weren't able to reproduce or weren't able to successfully raise young. It's just not always thought about. But we are, while we're meant for this, you know, I tell people we're meant for it, but we're we're meant to do it in a supported, knowledgeable way. And it isn't just an instinctual. You can't expect to just know what to do with all breastfeeding once your baby comes.
SPEAKER_00Yeah. And I think there was quite a bit of shared wisdom we had as communities before a lot of the more modern times that we live in now that we have lost in some ways, or aren't there are no villages where we're having many women surrounding a new mother and sharing a lot of the tips to breastfeeding and helping with the baby's positioning and these sorts of really standard things that come about in the first few days after delivery. And so because of that new structure of our society, we don't benefit as much from the shared knowledge of one another.
SPEAKER_01Yeah, it's definitely true. I mean, if you look back, people used to live in communities where they shared knowledge, not just for pregnancy and birth, but parenting for everything from, you know, the beginning to the toilet training to the dealing with teenagers to all of it. I mean, I think we have all lost that shared knowledge, and we're all trying to find ways of rebuilding it. And I've seen some great options out there. I mean, I met with a wonderful lactation consultant who used to be in the Bay Area. She used to be based in Oakland, but is now in Santa Barbara, who started a nonprofit that really is there to provide that support and that community. It's called Then Comes Baby. And it it's really a parenting resource center, you know, and we have to find ways of creating that because we don't all live within short distance from all of our, you know, important family and friends.
SPEAKER_00That's really true. And you know, a lot of the changes that happened in the 60s, 50s, 60s, and 70s with formula industries, a lot of our parents and grandparents didn't breastfeed. So we don't have that ability to have that wisdom passed down.
SPEAKER_01Right.
SPEAKER_00Um, yeah. And I've really been inspired by the breastfeeding medicine community and the other doctors in this country and world who've started pursuing this as a specialty and as a passion, who seem to have quite a shared interest in developing standards and not necessarily guidelines, but well, maybe guidelines, I guess, but uh shared approaches to common problems so that we can collectively multiple minds put together, think about what are the best ways to approach common problems in breastfeeding so that we do have that communal knowledge.
SPEAKER_01I am extremely thankful for breastfeeding medicine dots like you. I mean, I routinely will use the American breastfeeding medicine protocols. You know, protocol number four is mastitis, and that's one that I've sent out many, many times to clients. And I will say this is a good protocol. This is what we should be using, this is our standard and where we should be starting from. So I feel like they're they do offer some uniformity and some evidence base because we definitely need more evidence in breastfeeding medicine. And I'm very appreciative of those because they they help us have a more supported practice as opposed to people thinking lactation is just, you know, somebody holding your hand or showing you how to position the baby and having more evidence behind it in showing that this is a real part of medicine, that we're not, this isn't just a supportive care that we are offering here. So I feel like that is very important. And I am, you know, I will heavily rely on the ABMs because those protocols are very useful.
SPEAKER_00Yeah, I find that to really be the case. And I know the ABM is coming out with the revised mastitis protocol, I believe, this summer. And I really appreciate their continued review and application of new evidence to update all the protocols as we continue to learn as a community of lactation consultants and breastfeeding medicine docs what works and what doesn't, because I think we all have to be humble and acknowledge that the data is really lacking and it hopefully will continue to grow each year and we'll learn more and know what's better for our patients. And that's sort of what is exciting about this field for me is that it's not something where we know everything yet. We know very little, and there's a lot of room for discovery, and there leaves a lot of opportunity for me, hopefully, to contribute from a research perspective one of these days, and also for us to all continue to think creatively and analyzing the evidence as it comes to be.
SPEAKER_01Yeah, definitely. Is research something you're interested in at some point?
SPEAKER_00Yeah, I had a quite a big research um interest in my days as a student and a resident and published quite a bit in breast cancer. My transition to a breastfeeding medicine practice is in a non-academic setting. So it is very different to conduct research now, but I am very much planning to continue that pursuit in different ways, and I'm uh slowly collecting ideas and data as I move along. And hopefully in the coming years, we'll have some publications to contribute to our shared knowledge about breastfeeding.
SPEAKER_01I definitely look forward to those. You're right. I mean, there's so little evidence-based knowledge that we have. I mean, we know more about cow's milk and dairy milk than we do about human milk. And I would just love to see more, more research and more understanding in this because this is our first food is humans. This is massively important and, you know, shapes so much for new babies that it's really important that we understand and we start to get a better grip of, you know, what is really in the milk and how dynamic it is and how much it changes and how much the physical breastfeeding changes, you know. I mean, I know how that makes a big impact on facial structural development and, you know, how the bones come in and the palate, and you know, these things are were designed with a purpose, right? That's what I always say to clients is there's no wasted things in a body. Everything is designed with a purpose and usually many purposes. I mean, breastfeeding serves so very many purposes. So I think having any research will be absolutely fantastic. I look forward to that.
SPEAKER_00And feeling that lactation consultants are often really isolated from the medical world and thought of as just merely a support service and a bit fluffy. And I think my role, at least as I interpret it as a breastfeeding medicine doc, and I think most of my colleagues share this is that we also need to be very much advocates in the medical world and make sure that understanding and awareness of breastfeeding is something we share with all of our colleagues, from family medicine to radiology to infectious disease, everything, because unfortunately it's something that's really lost in medical education. And it's quite amazing how many hours and years we spend as medical students studying the human body and learn very little, if not anything, about the normal, the physiologic, intended physiologic function of the breast, so which is lactation. And I, you know, I did a breast surgical and phycology fellowship and I learned all about all the disease states of the breast, but very little about breastfeeding and what normal breast physiology is like during pregnancy and during breastfeeding. So not only is it important to advocate for improvement in medical and graduate medical education, but also sharing with other specialties in medicine how to be more up to date about breastfeeding. And sometimes that's making sure our radiologists know what imaging studies are safe and that they don't need to suggest pumping and dumping to women after a CT scan, or our anesthesiologists understand that a woman can breastfeed her child as soon as they're awake and capable in the posto-operative care unit as they're recovering. And so much of so many ideas and folklore about breastfeeding have been perpetuated by all of us as physicians as well.
SPEAKER_01Yeah, the pump and dump thing is very unfortunate. I mean, it's I understand in some ways it comes from a place of wanting to prevent harm, right? And I I do totally appreciate that. But I also think that there's a point where if a lot of physicians, if they didn't know, they would refer you to somebody else. You know, if you were at your GI doc and you said, well, you know, is this gonna affect my cardiac med, they'd say, Well, you know, you really should ask your cardiologist about that, right? I mean, they might just refer back to whoever is is treating or dealing with that. And I even had a client the other day that went to the dermatologist and had a, I mean, a minor little mole removed from her back. And she's like, they used lidocaine and said that I should pump and dump for 24 hours. Oh my gosh. And I was like, really? Okay, well, I'm glad you emailed me immediately. And I'm glad I saw it right now. And please don't pump and dump. You know, the baby is all, I mean, I think he was all of like two and a half weeks old. And I'm like, no, no, it's lidocaine and it was in your back. We're totally safe. But there there is unfortunately a very common response to just pump and dump of thinking that that offers no harm and that you're protecting the parent and mostly the child, which I appreciate the idea, but unfortunately, they're not looking at the fact that pumping and dumping and separating that mom and baby can be very harmful. Yeah, and that can be very impactful upon their whole feeding journey, depending upon how it's going and where they are.
SPEAKER_00Oh, absolutely. So impactful. And I try and it, although it's really one of my biggest pet peeves and can be so aggravating, I try and take each of those as an opportunity to educate. And I very frequently send educational pieces to our to whichever provider made a recommendation like that, because it is just it's so wild to me how we can be as a medical profession so evidence-based aside from this one piece of the puzzle with lactation. We just, I don't know why, as a community, forget to think about the evidence or inquire, be curious, and to just repeat something we heard someone else say that is just so incredibly wrong and unfortunate that a lot of people hear that advice.
SPEAKER_01And there are resources. I mean, you can use your hail book, you can log on to LactMed. I mean, like there are ways that just like we would for any other medication, right? I mean, if someone's taking an SSRI and a cholesterol med, their physician might want to look that up and make sure that there isn't anything that's going to interact and cause a problem there. We have medical resources for lactation.
SPEAKER_00That's exactly true. And again, I think it reflects uh an absence of that training in medical school. Um, and hopefully something we'll see change in the coming years. But the words of a physician matter a lot, and it is I I try and um take opportunities to bring it up with a lot of my colleagues so people can learn. And fortunately, I feel respected as a this is a physician who has a specialty in breastfeeding medicine as well, someone that people typically trust. But every every day there's usually an opportunity for discussion and education around this topic, specifically the pumping and dumping. It's really, it's really something quite remarkable that has been perpetuated, unfortunately.
SPEAKER_01Yeah, you actually you remind me of um Katrina Mitchell and Dale Tyler and how they're, you know, have expressed to me that they view themselves as advocates and as trying to bridge those gaps and get this information to other providers so that better care can be delivered uniformly, right? Like you can only see so many people in your office every day. You can only answer so many phone calls or emails about pumping and dumping. Like you need to share the knowledge, like you're doing, right? So that the more it's out there, the more people can be reached, right?
SPEAKER_00Yeah, I think every person, you know, shares the word. And even with my really standard breastfeeding consults that might be seeing me for something unrelated to medication, I try and kind of mention common things just so you know, these are reasons that need to pump and dump or an X, Y, and Z. And you know, you can always reach out to me if questions come up. And people do reach out to me months later with questions about medication interactions and such. And I think um being a resource is just crucial. And it was so funny. My husband is an oral surgeon and he he's now like a don't pump and dump advocate. So he even um even that one person can make a change, and then he might say it to someone else, to another oral surgeon or a dentist, and then that can perpetuate. And so I try and think of it as all opportunity for change.
SPEAKER_01Absolutely. And hopefully that will, you know, bring about more knowledge and more evidence. And I think part of it is lactation is a fairly young profession, right? I mean, the IBCLE is pretty young. I think it's in its like 40-something year. So, you know, I think that definitely, as new specialties happen in medicine, it takes a little while for them to be fully embraced and for things to not seem, I don't know, hokey or something. I mean, functional medicine's been around a while and still I hear people being like, well, you know, I mean, that's great if you want, you know, completely natural stuff. But if you want any evidence medicine, you have to go to a regular doctor. And I'm like, so I think it takes a while for things to adjust. Um you know, and and it's it's definitely has its own timetable. It's not really as as fast as I would like it to be, but it's a large system with a lot of people in it and a lot of ideas from you know, years and years and decades. So it does take time. It does take time to get it out there.
SPEAKER_00It does. And I think because of that, it makes for an exciting profession that lies ahead for me to see a lot of change, I hope.
unknownYeah.
SPEAKER_01Speaking of change, when they there's been a few changes in recommendations for mammograms and breast exams and everything. And I would say that both as a provider who, you know, meets with women and talks about breast health regularly, and as a woman in our 40s, I find it confusing. Like there, there are different recommendations based on different sites you go to, you know, whether it's the American Cancer Society or, you know, my my OB had a different idea, and it's it doesn't seem like there's quite a uniformity on mammogram and and breast exams. And what resource do you generally like patients to use?
SPEAKER_00Well, I think we're still really learning about what role mammogram has in in screening and prevention. I think we've seen quite an uptake since mammogram has been implemented more widely in breast cancer cases, but many of those have been really early breast cancers, and we haven't seen much of an impact on overall survival or mortality from breast cancer. And so I think what that tells us is screening is really effective. It catches things early, but we want to catch everything that early. Does it even matter? And if it's not changing mortality, maybe we're putting women through too much by catching things early. I think that aside, in a country like ours that has resources available, it's really hard to not advocate for mammogram annually at the age of 40. I think there are countries that are really exploring offering this starting in the 50s or not doing it as frequently. But I certainly wouldn't want to be someone who isn't starting my annual mammogram at 40. But I think it comes with the caveat of knowing that whether it be early mammograms or a recommendation for MRI based on high risk of breast cancer in your lifetime from a genetic predisposition or a family history, it is important to be aware that all of this screening does lead to early diagnosis. And for that, a lot of times there needs to be less fear around the diagnosis because many of many women diagnosed are getting getting diagnosed with very early stage, very treatable breast cancers or pre-invasive lesions. And that's not true for everyone, but as we're learning more about the molecular biology of breast cancer, it's we're becoming more able to distinguish between the cancers that are truly life-threatening and the cancers that are not, and being able to advise our patients about when one needs to have great concern and when we know that the treatments and the available to them are likely to be very effective.
SPEAKER_01Yeah, it's it's a it's a tough one there though, because I mean you say the word cancer, and I think that there's a very big gut reaction. That's that's a word most people really don't want to hear, right? I mean, it's a scary word and it's a scary thought to think that you know that something in your body is making you sick and it's a big deal.
SPEAKER_00It certainly is, and breast cancer really is it's not one disease. We we've really learned in recent years that there are several different diseases within one category that all behave very differently and need to be treated differently. And so hopefully most women see a provider who's able to help them understand those differences and what type of tumor they have. Um, and and back to your question about you know breast self-exam, I do feel that some of the changes and now not encouraging breast self-exam by women themselves are for good reason because I think it generates a lot of fear and constant concern for women. And the reality is breast cancer will be picked up typically by mammogram by screening imaging if someone is having their screening imaging. So putting that on a woman to constantly examine their breasts and have this concern that they're so somehow responsible for finding their cancer is a big, it's a big mental load for women. And and instead, I really like the word breast awareness and knowing your breast. And you know, we all should be comfortable with our breasts just like we are with our fingers and toes and arms and legs. And if something feels amiss, we should know to bring it to our provider's attention. But you know, when something's when a big lump forms, it's obvious you don't have to be performing some specialized breast exam and and knowing the how your breasts feel and and um and how they change over the course of your cycle. That's an important, um, important skill to be familiar with, but but not going crazy, feeling like you have to every month at this time examine your breast really thoroughly in some specific manner.
SPEAKER_01I love to say it's that term breast awareness. I mean, I remember, you know, when I was going through puberty, my mom had, it was what we did back then, and we had the little, there was like a little plastic hanging thing that she put in the shower and it showed how to do a breast exam in the shower and everything. And it was like, okay, you have to do this every month, or you know, basically the thought was, or bad things happen. And as a parent now of I can't believe I'm saying this, it's a parent of a teenager. She just recently turned 13, which I just don't know where the years went. I'm learning so much. It's one of the things that I do honestly love about being a parent is I feel like I'm constantly learning as well. And I'm learning so much more about body awareness and in a different way than I feel like I was raised in the 90s. You know, there was much more, at least the way I was raised, I can't speak to everybody during that time period, but more focus on birth control and controlling and not really, you know, having a very more clinical period and controlling things. And now there is this very new, wonderful emphasis on understanding your body. What does it do throughout your cycle? What is it telling you? And like you said, the breast awareness, how does it change throughout your cycle? I'm finding that's really so different and probably goes along with a bunch of other holistic changes that have been happening in recent years. But it's a really wonderful attitude, I think, and so much less stressful, like you said, than the breast self-exam. Definitely had a negative and a stress to it.
SPEAKER_00Yeah, and that's so well said. And also I think we have to recognize that everyone's breast is so different. And I think to tell a woman that any lumps or bumps need to be lead to imaging and biopsy is just not true. Like there's some women who they're in both of their breasts are entirely lumpy and bumpy. And that is something that is normal for them and has always been since they've developed breasts. And there are some women who have no lumps and bumps in their breasts. And someone gave me an example once they said, you know, if you if you put your hand into a bag of marbles, you know what it feels like. If you put your hand into a bag of marbles and there's a dice in there, you know that's not normal. And I think that's a good way of thinking about our breasts. Like it can feel like a bag of marbles. Um, but if if there's something abnormal or different there that we notice that pops out to us, yes, absolutely. Tell your provider as quickly as possible. But it's not going to feel like putting your hand into a cup of water. It is, it is lumpy and bumpy for most people. There are variability in the in how their breasts feel, and especially related to their cycle, and and understanding and being aware of what our breasts have always felt like and and not being not being scared to touch our breasts.
SPEAKER_01That's true, but I definitely, I definitely for my practice, emphasize gentle because I see too much damage when women have, you know, what they perceive as a plugged up or something going on, a larger lump that they're surprised is there. And I mean, I've seen women bruised, and you know, they've told me, well, I took my my heel into that, you know, that lump and I really couldn't get it out. And I'm like, oh, ouch. Like, okay, let's let's know our breasts, but let's be gentle to them. You know, they're they're complex. I think we have this idea that it's either a big muscle or a balloon, right? And it's neither.
SPEAKER_00Mm-hmm. And and really this whole concept of being gentle and avoiding aggressive massage is one that I'm super passionate about because it relates to a lot of the problems I see in my clinic. And I think one of the biggest misconceptions and misinformation that's circulated about breastfeeding is that if you have a something you believe is a clog to just try and push it out and aggressively massage it. And this couldn't be further from the truth of what leads to resolution of these painful lumps in the breasts. And I think really starting the conversation over and saying what is what is this clog or plug people have been talking about. And a lot of the new data, new findings is that it's not actually a plug in the duct. It's not a clog or plug of milk. It's inflammation around the duct that's narrowing the duct. And that inflammation is happening from a number of reasons, oftentimes oversupply, oftentimes an alteration in the microbiome called a dysbiosis, but certainly not something that I've ever been up been able to see on repeated ultrasounds of women's breasts who have quote unquote clogs. It's really something where you don't see any dilation of the duct but you see inflammation squeezing, collapsing the duct. And so there's nothing to massage out and actually massaging it makes it so much worse. It's like someone with a sprained ankle massaging that ankle it's going to create more inflammation at that area. And really one of the best ways to treat a quote unquote clog or an area of inflammation is to leave it alone, to let the body do what it knows how to do and to heal and to resolve that inflammation with your own natural anti-inflammatory properties and to help it along with some ice and some ibuprofen and maybe some sunflower lecithin for those really narrow ducts to help the milk flow. But typically the body knows how to fix it and it's the intervention and the atrogenesis and the women really massaging that actually makes this so much worse where I see people then develop an abscess or a galactosyl, which is a collection of milk outside of the duct where a deep massage has actually ruptured a doctor or the massage has been so deep it's it's made that clog into something that's so the area of inflammation something so much larger and more painful and more difficult to resolve. So I I try to really basically tell all of my patients that the breast is not something should ever be deeply massaged. And when the organ is lactating it has a lot of blood supply and a lot of dilated lymphatics for its drainage and and those ducts are are fragile when you are lactating and then to respect the breast in some ways.
SPEAKER_01I get a little frustrated at times with the amount of products that are made and put out there being you know telling parents you need this you need this everything from the snoo to the you know all just all of the baby things but the ones that definitely irritate me the most are things like the breast massagers and stuff. And I'm like, no that's that's not I mean there's so many things wrong with that picture. Not only should the woman not be massaging her breast with this big vibrating thing but she shouldn't be going out and buying something to massage her breast like there's just so much wrong with it that picture. And that's definitely one that I have a big issue with is we just don't need to be doing that to our breasts at all.
SPEAKER_00Yeah and I have to say I love my snoo so I'm not I'm not saying anything against the it it was my lifesaver but the breast is different because we have we have evidence now and we have knowledge that these things don't work and and yet we have these this capitalistic you know world and big industry just preying on women at such a vulnerable time and and knowing that because there is any sort of information or folklore about the necessity to massage the breast whether it be right or wrong that they may develop a product to sell to women. And so it really is it's just a to me an immense disservice to women to not only teach them to not trust their breasts but also to think that purchasing something will give them more control over their breastfeeding outcomes and and and oftentimes the purchasing of something leads to a bad outcome because it's something that they shouldn't be doing to their breast.
SPEAKER_01Yeah I I feel the same way especially when we talk about other quote unquote lactation aids like lactation cookies and all these supplements and everything and I'm like most of the time you really don't need those. You know there are times that herbs can be beneficial but I also tell clients anytime that herbs are beneficial, I have never recommended a combination because that might not be what you need. And a lot of those very popular combination ones don't tell you how much they're getting of anything. You know and lactasia cookies are so frequently like oatmeal cookie with maybe some brewer's yeast or something and like and they charge you know $10 for two cookies.
SPEAKER_00I'm like okay. Yeah the cookies and the teas really are not at are not at doses that are usually even effective if you're really talking about a supply issue. And I and really before even talking about supplements I just really try and focus on the basics which is like frequency of milk removal and that is what that's what helps our supply and it has and it shouldn't be something where we're thinking we need to purchase a product and there are certainly situations and people that really have are struggling with low supply that's out of their control when they're doing everything right. And in that case I do find that certain supplements and sometimes for me a combination of a few different ones purchased individually can help. But you're right the the products that have multiple combined in one are almost always too low to be of a dose to be effective anyways and then really just a marketing tool.
SPEAKER_01I just think it's unfortunate because I feel like when a mama's in a store and they see that amount of stuff and the you know are you making enough and then you know lactation teas and all of this like you said it's preying on their fears their fears that they won't be able to feed their child. And it's very unfortunate because what we should be doing instead is reassuring and lifting each other up and saying you've got this and you've got support if it's not working. But unfortunately there are just people out there who are happy to make money off of it and not looking at the harm that that can cause not necessarily that that cookie is harmful, but it it may be harmful to their mental health. And you know I just try to encourage mamas that you've you really you've got this you know what you need is is more support potentially but not stuff is rarely the answer.
SPEAKER_00Yeah absolutely I think very rarely is any lactation aid device item ever something that I recommend and and the more we can steer away from that the better. And and really I think the one of the greatest detriments we can do to women and new moms is undermine their trust and their ability to lactate and to breastfeed and and to undermine that confidence is just incredibly detrimental. That's what leads a woman who's having a perfectly fine breastfeeding relationship add in a pump session at night because she's fearful that her supply will tank in the future. And that added pump session leads her to oversupply and mastitis and it's one thing after another the number of women I see with some problem resulting from a undermined confidence in their abilities to breastfeed their child is just so common and really unfortunate because it's not necessary and and I I try and actually focus a lot of my visits on making women realize how wonderful they're doing and you know any woman who's trying to breastfeed is really achieving something remarkable but also reassuring and providing confidence around issues that may have come up that oftentimes aren't true. Someone told you they have flat nipples where most flat what are called flat nipples are are just normal nipples that will become um protuberant and erectile when the baby sucks on them and that's what nipples do. And that again comes down to all the variability across the way the breast look and feel among and nipples among different women. So trying to really be cautious about what words are ever used that may be undermining.
SPEAKER_01I recently had someone one of my prenatals came to me because with her first someone told her to to try pumping and seeing if she was making enough because you know it seemed like her baby was eating more foods and he was like eight months old. And so she tried pumping once and was like oh I'm I'm clearly not making enough for him so I better stop you know and it was like it's so sad because this gets said to women that you know well if you if you aren't pumping you know a certain amount or in a certain amount of time or something then you obviously aren't making enough and I'm always telling people that's just how much you pump just shows you how much you can pump using that pump on that setting and everything else. And it may not even be right. I mean too often women have cute flanges for small nipples. I mean so or they don't know how to use their pump at all or you know so there's so many other factors and I'm like that that is nothing compared to an effective baby.
SPEAKER_00Yeah there's many women who can't have a good let down with a pump but weighted a weighted feed is such a better way to measure like how much a baby is getting and and also I think anyone who's got a baby older than six months the the supply and the how much milk is needed needed is really variable based on the baby baby. We know that the amount of milk necessary really changes from six to 12 months and by 12 months you don't want the baby to be having any more than 16 ounces a day. And and so that natural transition is a little different for every mom and baby and and there is a a lot of concern that women have about their supply dropping in that window when when really most of the time it it truly is physiologic and within the normal amount of milk it's just less compared to what she was making in her first few months.
SPEAKER_01Right. I know and you know I I have this this idea that someday parents will get to go to every pediatrician appointment and have a lactation consultant or maybe they'll call us infant feeding specialists or something else because I want to support and educate bottle feeding parents just as much as breastfeeding parents. You know, and I think there's so much room for education and it doesn't end at that when breastfeeding gets going well at one month or two months or whatever. It's like you said there's a big change between six and 12 months and I love to I love when I have insurance clients and they can continue to see me and we can do a solid food visit and discuss, you know, what does this look like? How does it change our supply and you know what does it look like in a year and how do we how do we adjust to stopping pumping and you know all of these things someday I I just hope that we will routinely have that education offered to parents.
SPEAKER_00Yeah I I find that the I really enjoy encouraging parents to reach out to me when they get to that six month and 12 month mark because of the changes that are so inherent and often challenging. And so it's a really neat role to be able to help advise along those changes that happen. And I love helping with the introduction of food. It was one of my favorite times with my firstborn and same thing with how to how to drop pumping and and talk about full term how as I like to call it breastfeeding meaning breastfeeding into toddlerhood. I think a lot of education and awareness is missing in those realms.
SPEAKER_01Definitely I think sometimes parents and even providers will say you know how am I going to breastfeed eight times a day for like a year or two and I'm like it changes. It changes as much as that baby changes because they're not the same person in a year, right? Yeah. Their needs aren't the same either. And so there's definitely plenty of room for education out there. And I'm so thankful that you are in the Bay Area and that you can not only support clients but really try to help like you said advocate and educate other providers so that we can all have you know some more basic lactation knowledge and and know where to get the resource when we need it, you know, for even if that if other providers if all they take from your info on you know not pumping and dumping is your name and being able to send the client that's that's a start you know but it's it's definitely good to start getting this information out there. So I'm so thankful that you are in the bay and I'm very thankful for your time today. I know you're in high demand.
SPEAKER_00Thank you so much and I feel like it's such an honor to be able to talk to you today and also to be able to support so many new moms and in my community and extended community and and hopefully be able to be a part of much change that comes in the in the upcoming years in our field.
SPEAKER_01Yes it's a very exciting time I think there's so much happening in lactation that it's just it's exploding with knowledge and with new providers and with research and there's very exciting things to come I feel like in the next five to 10 years.
SPEAKER_00It really is and for for anyone interested in becoming a lactation consultant or breastfeeding medicine doc, I think it's just absolutely one of the most rewarding things out there as far as careers. So I'm I'm really blessed that I landed upon it from a challenging first breastfeeding relationship to where I am today. Just I'm so grateful for this opportunity for being able to serve women in a really special way. So um anyone can reach out to me by email rachel.yang at mymarinhealth.org and providers or patients feel free to ever email with questions. I love being a resource to people near and far. And um thank you so much Katie for having me it's been wonderful to talk to you.
SPEAKER_01Thank you and I'll put your contact info on the website and so thank you so much. When you change the way you look at things the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast please share