[00:17] Greer: 
Hi, this is Greer, your host for Femammal, the podcast that holds space for women to explore what it means to live well in our bodies and celebrates moving through this world as female mammals. Leah A. Jacobson is an international board certified lactation consultant. She's also the author of the book Holistic Feminism and the founder of the Guiding Star Project, a 501 c three nonprofit organization. She earned a Master's Degree in Health and Wellness and has spoken internationally on issues pertaining to women's health care. She is the mother of seven children. In this conversation, she shares her journey from growing up on a dairy farm to becoming a lactation consultant after she initially struggled to breastfeed her firstborn. She always starts from the standpoint of understanding and affirming the mother's health and wellbeing, allowing women to set their own lactation goals and supporting them in their choices. Welcome, Leah. I am so excited that you are joining us today and you are an International Board Certified Lactation Consultant. Could you start by telling us what that is and how you came to this work?

[01:45] Leah: 
Yeah, well, it's just like it sounds. An International Board Certified Lactation Consultant is really kind of the gold standard in lactation care internationally. It's really the only recognized credential or certification that is capable of receiving insurance reimbursement, working with really the most specialty kind of lactation issues that moms and babies face. As to how I came to this work, I've been Board Certified for ten years and I've worked in a rural access hospital in a rural WIC setting, a WIC clinic, and then also in private practice. And I came to this work really because I found that I needed help personally after I had my first baby. I grew up on a dairy farm, which I always find kind of ironic because I went from lactating animals and cows now to working with women. But having grown up on a farm, I just thought lactation, making milk, was something that's just very natural and easy. And so I was surprised when it didn't come as naturally to me as I expected it to. It was a lot more complicated and it didn't fit into my kind of modern woman's lifestyle like I expected it to. And so it was kind of a long journey of just self realization of nobody prepared me well for this. And I'm about as well prepared as you can be in terms of understanding the mechanics of milk and lactation. And I just felt like, I know there's women out there that need help. I know that I can help in this way.

[03:22] Greer: 
Oh, I love that perspective that you bring to it that's so funny about the dairy farm. Did you get the help that you needed?

[03:29] Leah: 
Well, my first baby was born on the Fourth of July weekend and he came a little bit early and so about 36 weeks he was born and everybody was out for the weekend and I didn't really think I would need that sort of help. I took this baby home very confidently. A young 22 year old mom, like, yeah, I got it. I'll figure it out. Within a few days, I was incredibly engorged and dealing with so many problems. My breast felt like these rock hard volcanoes of, like, heat and pain, and I didn't know what I was doing. I couldn't figure it out. I went back into the lactation office when they opened the following Monday, and within about 15 minutes, all of a sudden, everything was starting to make sense. It was just some very simple corrections, things I just didn't know, and it put me on the right track. And so I did get the help I needed. And it was such simple help that it just really made me think about, why isn't this just standard? Why isn't this just the expected sort of thing that every mom should get in her postpartum care? And sadly, it's really not. It's not what we get every time we have a baby all across the country. It's a huge variation in the level of lactation support that we receive, unfortunately.

[04:45] Greer: 
Yeah, it was not a service I had even heard of maybe until five to ten years ago. And I'm not a mother, but I have lots of friends who've been having babies for close to 15 years now. So it really surprised me that this wasn't more well known.

[05:03] Leah: 
Yeah, especially because we've known this has really been a public health campaign in our country. I mean, even the Surgeon General put out a call to breastfeeding in 2012, which is a pretty major step when you have the Surgeon General of the United States saying that breastfeeding is an issue of public health concern and we need to be calling women to it and providing support for them. That is a culmination of decades of research and work to be able to say that we know definitively that this is the ideal, this is what we should want for our women and our children, our babies. And so it's just fascinating that it kind of has missed the education in young women as we're growing up and as we're becoming mothers, as we're becoming fertile beings, that we're not really understanding that lactation is the natural extension of that and we're not talking about it.

[05:57] Greer: 
And sometimes that ideal gets lifted up, not as something that's really rich and a great opportunity to take advantage of, but it gets lifted up as some way to shame new mothers. And then especially when you're not going in behind and providing that additional support, you're really just compounding the struggle that people are going through and further undermining their confidence.

[06:24] Leah: 
It's just been a fascinating shift to see how quickly that this could shift in one generation, because we see and this is like, maybe a little bit of the history of it, but I think it's fascinating context for us to understand. I'm going to date myself literally right here. I was born in 1981, and at that point in time, the majority of mothers were not even attempting to breastfeed. And actually, the all-time low was in 1972, where only 24% of women even attempted to breastfeed. And so at the point where I was born, it was very out of style, it was very out of fashion. And my mom remembers, you know, she breastfed us, she breastfed all three of her children, and she remembered being shamed for it, and she remembered her sisters and, you know, her mom and her friends saying things to her like, oh, like, can't you afford formula like, only poor women breastfeed? That's gross. And so to think, 40 years later now, how far this has swung in the other direction where "breast is best" has become the anthem. It's a really a fascinating look at how quickly women's health practices can change. When you get these governmental campaigns, when you get the Surgeon General, when you get public health really on board with it, you can change what is considered best practice within a generation. Yeah.

[07:42] Greer: 
And then when you have a generation or maybe two or three generations that were actively discouraged from that, you get some knowledge loss. People aren't able to pass on their insights to that next generation because they didn't get that experience themselves. So that's a nice segue. Could you give us some basics of breastfeeding? Just things like how and when a new mom's milk comes in and what that production is like, and how long lactation persists.

[08:11] Leah: 
Yeah, absolutely. This is just kind of the Lactation 101 stuff, because you're right, there has been a loss of generational knowledge, and it creates kind of this interesting void, this gap where we don't really know how long can a woman lactate is. Is it too long to feed a baby past two years old, those sort of things. The basics of of lactation and of, you know, just breast development. You know, our breasts actually start they're maturing, you know, as we begin puberty, we start to see that breast tissue developing. But our breasts are not considered mature. We actually don't have mature breasts until we have given birth and actually attained mature milk supply. And so even the first few days after delivery, Lactogenesis Two, the phases of breast maturation. Lactogenesis is the term. Our breasts are not considered mature--the mammary tissues of cells--until Lactogenesis Three occurs, which is about a week after you deliver your baby. After a week of actual breastfeeding, of supply and demand breastfeeding happening, that's when your breasts have finally grown up.

[09:16] Greer: 
Fascinating.

[09:17] Leah: 
Yes. Isn't that fascinating? You're still going through growth.

[09:21] Greer: 
I had no idea.

[09:23] Leah: 
Yeah. And so there's a lot of research and there's a lot of conversation right now about what happens when breast tissues are kind of stalled or with pregnancy loss and with different situations where we don't attain full breastfeeding or if a woman decides not to nurse at all. This is where those risk for breast cancer and the research that's happening right now on breastfeeding's protective nature against things like breast cancer comes in because we're looking at cells that were not quite fully mature. They were set to go through another phase and then something happens. And so can they go haywire at that point? And the evidence seems to show that yes, they can. And that each year of breastfeeding helps protect a woman against breast cancer. So it's a fascinating realization that we're still developing even as we become mothers, even after we've had babies. The basics of it is you're going to start to see your breasts really change in pregnancy around the second trimester. They get larger, they get heavier, you start to see your areolas darken. Those are all really great signs that's all everything is on track. And then you might even start to see, prior to the delivery of your baby, some very thick, sticky, kind of liquid yellow substance which is called colostrum. And that's always considered, they call it liquid gold. And that colostrum is what's packed with so many nutrients and antibodies and it's really your baby's first immune system because when they're coming into the world, they went from this completely sterile environment. If they're born vaginally, they get a little bit of the colonization of the bacteria as they're born. That helps to kind of start their gut biome and starts to create an immune system for them. But really it's the breast milk and the colostrum that is their passive immunity that they receive from mom. So that stuff comes right as you're coming up to delivery. You're creating colostrum and it's very small amounts. And for the first three to four days, that's pretty exclusively what your baby is nursing, is what they're receiving from you. And then we start to see the breast go through that Lactogenesis Three, that final maturation where the, the milk starts to transition into mature breast milk and then that can go on pretty much indefinitely. So when you asked the question, I think you said something about how long can lactation last? Well, pretty much your entire life. There are grandmothers that nurse their children in other areas of the world, their grandchildren. So that's something that we're not really familiar with. We don't see that here in the United States, but it's possible.

[12:02] Greer: 
That's really interesting. So lactation ending, is that more of a choice that mother is making to reduce feeding and then that's how the milk sort of starts to dry up over time?

[12:17] Leah: 
Yeah, ideally that's how it ends. There are some women that genuinely struggle with milk production for a number of reasons, and we can look at kind of all the hormonal reasons that this can happen. There's a lot of research happening on why some women have failure to produce a sufficient milk supply and we see things like Insufficient Glandular Tissue, that something in their development in puberty that they actually didn't develop enough mammary tissue to sustain lactation. That's a possibility. We see things like polycystic ovarian syndrome and the different hormone imbalances that accompany that that oftentimes cause a low milk supply as well. So there's a lot of things in the women's health field that affect lactation that we just don't understand very well. We don't really know why puberty goes a certain way for some girls and they don't develop mammary tissue. We haven't done adequate research yet into this to truly understand the long term effects on lactation. So ideally, if you have somebody that's had great health, they've matured and developed perfectly normal, everything's been just great, their baby nursed, it didn't have tongue ties, it didn't have problems, it didn't have latch issues. You didn't end up with a ton of mastitis. You could breastfeed indefinitely. That is something that we are wired to do biologically as women, and we can relactate without giving birth. Women that have adopted babies after breastfeeding oftentimes can feed the baby that they've adopted without having given birth another time. So, I mean, it's just fascinating what our breasts are capable of. They really run on a supply and demand sort of system. And so it's the stimulation, it's the oxytocin release from the nipple stretching that actually causes the breast milk production to happen.

[14:06] Greer: 
Okay, you've piqued my interest. So someone who's lactated previously could lactate again without a new birth. How does that happen?

[14:16] Leah: 
Yeah, so if you're adopting a baby, and this is actually not an uncommon scenario, that a lot of adoptive mothers will choose to breastfeed a newborn baby that they are adopting, and that's absolutely possible if they've previously breastfed, it's actually not very difficult. We just get a pump on them and then we start stimulating the breast. We get the breast ready for the baby to come, we prepare them and oftentimes they very successfully can have a full supply and feed that baby. It's not the delivery of the baby that is causing the milk to come. So hormonally. It's actually when when you expel the placenta, so the, the progesterone that's in the placenta, when that is expelled after delivery, that's when you can begin to lactate. That's when the prolactin and the oxytocin and everything goes to work on your pituitary gland and you can start to lactate. So it's the placenta and the high level of progesterone during pregnancy that makes it difficult to lactate when you're pregnant. However, you can even lactate when you're pregnant. So there are women that are tandem nursing, meaning that they're nursing a toddler and a newborn and they nursed that toddler all through their pregnancy. That's a little more difficult, it's a little harder on a lot of women, but that also is very possible. So breastfeeding is really just this kind of crazy thing, lactation. If you're trying to lactate the stimulation is really all that's necessary. The oxytocin triggering the prolactin and the pituitary gland is what makes milk.

[15:49] Greer: 
That's so neat. What I'm hearing is that it's this really flexible experience, which is very adaptive for different scenarios and there's not necessarily a "should" behind it, but there's a lot of opportunity behind it that I imagine helped humans thrive in all different kinds of conditions.

[16:09] Leah: 
Yeah, absolutely. And you're nailing it right there. I think that's actually probably why it has that sort of built in flexibility and adaptive nature to it because yeah, there are periods in human history where famine hits and breast milk might be the best thing you've got on deck for not just your baby, but maybe for other children. And the ability to up your supply based upon that demand all of a sudden is an incredible gift, actually, that a woman's body can do this, that we can increase the amount of milk that we're making based upon how much milk we're removing. It's really quite amazing.

[16:46] Greer: 
Yeah. So I've learned so much just in the first ten minutes of our conversation here. I'm wondering what are some things that you wish you had known about breastfeeding before you became a mom for the first time?

[16:57] Leah: 
Well, gosh, I wish I had known that it wasn't as natural as it all just seems. I'm talking about all this. Our breasts are amazing. They do this. And I always believed that and understood that, but I thought somehow that it would just kind of naturally fit into my new life as a mom. I just didn't quite realize the time commitment, I think, that it takes to establish a breastfeeding relationship with your baby. And I think the other thing that I didn't realize that I learned in having all of my children, I have seven children and I've breastfeed all of them successfully, but some of them were much harder to nurse than others. And it takes two. That would be the other piece of it, that recognizing that it takes a time commitment to make this work in your daily life. That you actually have to stop what you're doing and really connect with this little person and learn alongside them. And then you have to do it with every baby after that because every baby is different and you're a breastfeeding dyad. There's two of you. It's not just mom feeding baby. It's baby also removing milk from mom. And if there are oral structures, if they have tongue ties, if they have some sort of restriction or they can't nurse well or they were born early, it makes breastfeeding much more difficult.

[18:13] Greer: 
Yeah, there's that physical component of it for both sides of the dyad. That's so interesting.

[18:20] Leah: 
Yeah, absolutely. And I think oftentimes my work as a lactation consultant is that assessment of each person individually, baby looking at oral structures and checking their mouth and just checking tone and their ability to turn their head or their injuries from birth, like, are there problems that are causing pain with this baby? And then it's also looking at mom like, what are her nipples like? Are they short shank, are they long nipples? Are they very large and wide? Are they flat? Are they inverted? All of those things. You might have one person in the dyad perfectly prepared and ready to go, but if the other is just not there, it's going to be difficult.

[18:56] Greer: 
So what are some of the types of support that you can offer and then what types of interventions might you use?

[19:05] Leah: 
Yeah, I think every woman who's pregnant needs to go through a breastfeeding class prior to delivery. That's just kind of a preparation. It's just as important as a childbirth education class. And it might even be more important, quite honestly, because there's a lot in birth that you don't really have control over and you just kind of have to surrender to in the breathing process. But breastfeeding is something that requires a commitment of your will and your intellect. And the more prepared you are, the better educated you are, the more determined you are, the more likely it will be that you will meet your breastfeeding goals and that you will be successful getting to whatever week or whatever month it is that you had set your goal for. So most hospitals now employ somebody to at least do breastfeeding education. Pretty much every labor and delivery ward in our country now has somebody with some level of lactation training or support just in their background. Don't hesitate to ask for them. Do your research too. The birth process and giving birth has effects on how likely you are to be successful at breastfeeding. So a very traumatic birth with a lot of interventions, C-sections, a lot of fluids through the IV, all of those things actually decrease your chances of breastfeeding success. And to know that coming into it and to be prepared to say, okay, well, that birth didn't go quite how I planned. I need help now. I need someone to help me come in here and reorient myself and readjust and just to really not be afraid of that. There are so many things that we, as lactation specialists, can do from just helping a mom to hand express and pump early on if there have been problems, or getting her the correct kind of supplies she needs if she does have inverted nipples, or getting her a supplemental nursing system. There's so many supplies and things that we can do to help, but we need to just have eyes on the situation. We need to just talk with you and work through and figure out the best solution.

[21:07] Greer: 
That's so reassuring because it sounds like there could be an ideal physical set up and then most of us maybe don't have that perfect scenario, but that there are opportunities to go back and address some of those issues. Whatever they might be.

[21:26] Leah: 
Yeah. And really the point about birthing practices in our country, we have to see birth experiences and breastfeeding experiences as they are very linked, because that process of going from Lactogenesis Two to Three, that final maturation of your breast tissue, it can be affected very negatively from very traumatic birth experiences. Even just not having your baby close to you in the first few hours after birth can really delay the hormonal sort of cocktail that needs to all fall into place for breastfeeding to get off to a good start. And you can be delayed several days, and then the kind of the cascade of problems can start. Baby needs to get some food. Their blood sugars are low, so then they start formula because mom doesn't have milk. And then it just throws the balance off as soon as you take those first steps away from natural nourishment. With mom and baby together, everything can be corrected, so nothing's ever lost. But it can make it much more difficult, and it can just be exhausting. And if you're already struggling in any way, it's just that extra thing that makes it really hard to keep going.

[22:37] Greer: 
And hearing that context gives me kind of that attitude of there's a lot of reasons to be gentle with yourself, especially if you went through a traumatic birth or had one of these barriers to immediate breastfeeding. But it's just a real moment to step back and recognize it's not your fault, it's not you, and there's still hope, and there's a way to move forward.

[23:00] Leah: 
Oh, Amen! And I think that there's this pressure that I think you mentioned it earlier, that so many women have internalized this deep sense of failure that they're not woman enough or not mom enough, or whatever it is, to give birth the way they had planned to, or to nurse their baby the way they had planned to. And there's so much about just our female bodies that pushes us towards a daily kind of surrender, a recognition that I am not completely in control of everything. I can do my best and prepare and set my birth plan and have everything ready to go, and my chances of success increase if I do that. But in the end, really, truly, it's oftentimes there are other things that can make this beyond our control. And it's never our fault. Our body is always trying to do its best, and sometimes it's just really struggling. And we need to be very gentle, very gentle with ourselves. I love that you said that. And I really think that that's what a good lactation consultant really, truly is there for, is to look at what is the entire situation that just happened? Like, where is this mom right now? Maybe she's three days postpartum, maybe she's three months postpartum. And we come in and we assess and say, what's going on here? Sometimes I'll come in and work with a mom where technically lactation is fine, like baby's nursing, baby's gaining weight, enough stools, enough things like by the book, it's fine. But Mom's not okay, and I can tell she's not okay. Like, there's a postpartum depression or there's some disconnect or she's just not bonding to the baby, and she's not enjoying breastfeeding. And it's those conversations that she just needs space to process and say, like, my identity right now is shaken. I don't know who I am. I don't know what I'm doing. This doesn't feel like me. And to try to reconnect her to her body in a beautiful way, in a good way, and say what your body is doing is what it was made to do, and it's good, but I understand it's scary sometimes. It's a loss of control oftentimes that we really struggle with as women. Breastfeeding is very humbling, and there's a lot of surrender involved with it.

[25:15] Greer: 
It was good to hear you mention that you could really go back and get that support at any point in your lactation journey. It's not something just for brand new moms the first week after delivery, but you said you might go back and get that support a few months in if you're hitting roadblocks.

[25:32] Leah: 
I see moms that have two-year-olds, and they're trying to figure out how to wean because their baby is biting them. We truly are experts in the entire lactation journey, so it's not uncommon for me to see a toddler as well as a newborn or premie.

[25:51] Greer: 
That's neat. So if you're giving birth, maybe you're easily able to connect to your hospital or birthing center's lactation consultant. If you're looking for a lactation consultant down the road, where would someone go to look for that?

[26:05] Leah: 
Well, I would always recommend that you, of course, because my Credential is the IBCLC Credential, and it really is kind of the gold standard. It has the most, it's the only board certified actual Credential. And so I would recommend that you look through the IBCLC directory. It's an online directory. You can search for lactation consultants by state, by region, for certified lactation consultants. There are many different credentials of lactation specialists and support people and just kind of beware, like buyer beware, have a little bit of awareness that some of them might have been just a weekend course or an online series of talks that they attended or listened to without any actual practical hands on time spent with women. And that's the piece that I just always kind of ask when a mom tells me, I've been working with a lactation consultant. I've been working with someone and they said this, this or this, and I just always kind of try to feel out, like, what really, truly is their level of expertise, because it definitely varies and you tend to see with different peer type counseling certificates that there's a lot of personal experience that comes into a particular lactation consultant sort of advice. And that's not always the most helpful, because a lot of times we come into professions because we ourselves experienced problems. And sometimes, if you haven't gone through a very rigorous training and done a lot of education and spent a lot of time working with women, you view it through the lens of your of your own past issues, and you tend to give solutions based upon what worked for you, and sometimes that's really not helpful. So I always just kind of caution women. If your lactation consultant is talking about herself more than you, that's a red flag.

[27:57] Greer: 
Yeah, that's good insight, because that empathy is really valuable, but there's also that hands on knowledge, and that sort of academic knowledge as well, that really is valuable. And then you also mentioned these services are covered by health insurance in a lot of cases, if you've got the actual credential.

[28:19] Leah: 
Yeah. And that's important to know state by state. They're working right now to get state health plans to cover IBCLC care. And some states have gotten there, the majority have not. I think there's five right now that have it covered in their state health plans. But lactation has moved forward as just kind of a women's rights issue with lightning speed, really, in the last decade that we see laws protecting pumping mothers in the workplace, we see protections. I mean, it's very common now to go through an airport or any public place and see the lactation rooms or the lactation pods, the Momava pods. It's becoming far more normal that women are expected to be accommodated as breastfeeding, as mothers. So I think we're making tremendous leaps and bounds. Our health care industry is acknowledging this is a healthcare issue, and that's important to help us get care. Almost every woman I believe in our country can probably get a free pump through medical assistance or through her WIC program or her private insurance plan. So that's just a really different thing than 25 years ago. That was not something that you would just get for free, and now you can. So we're making progress.

[29:37] Greer: 
Yeah. It's so exciting. Can you say anything about support groups.

[29:42] Leah: 
For women who are lactating?

[29:44] Greer: 
Do people get together and try to support each other or find that sense of fellowship with other breastfeeding moms?

[29:52] Leah: 
Yeah, and really, it's the original La Leche League that kind of launched this entire movement of normalizing breastfeeding. And it's a beautiful story, really. It was seven moms at a church picnic, and they looked around and realized they were the only women in their entire church that were breastfeeding. And they felt a little out of place, and they were kind of hidden away in the corner of the church bazaar, and they said, this is bizarre. This should not feel so isolating. And so La Leche League was formed, and this was the 1950s. In time they had launched a worldwide movement of women coming together in small groups all around the country, La Leche League groups, which still exist to this day. And so there's something very beautiful about that peer to peer presence. More so it's the companionship, but they do have really good training for La Leche League leaders and they have a phone line that's available and so that's really the oldest one that's been just around forever and really a gift. There's newer kind of movements that have popped up. Baby Cafes they're called, and they're really a wonderful addition to the lactation world. They're kind of a drop in. Get your baby weight, nurse your baby, talk about breastfeeding, and get back on your day if you want to. Just a lot of support groups are popping up all around the country. I run a nonprofit with women's health care centers and in all of our locations we have breastfeeding support groups that meet pretty frequently. The Milky Way is one of them and just some really fun kind of support for moms. I think they're very helpful to just see other moms.

[31:37] Greer: 
Are there any persistent breastfeeding myths that you'd like to take a chance to bust here?

[31:42] Leah: 
Oh gosh. Oh my goodness. Which one? There are thousands. There's a lot of them. I'm going to give you one resource just for anyone who's listening to this that's like, is that really true? Whatever comes to your brain. There's one amazing website that I reference constantly with moms, and I use it as kind of a fact check all the time. It's called Kellymom.com. It's just Kellymom.com Kellymom.com and it's a lactation consultant and she does excellent work with just mythbusting and just nope, that's not really how it works, so I always recommend that one. But I do hear a lot of crazy things that for the most part are not true. That lack of generational knowledge, that gap in generational knowledge, unfortunately has left a lot of really weird information out there. People that didn't actually breastfeed that heard something that might work. Yeah, I'm trying to think, is there any myth or thing that you think of? I can't even think of any right now.

[32:48] Greer: 
I can imagine that there might be some really odd ones about different substances you might put on your breasts to try to enhance breastfeeding that nowadays we'd be like, oh, that's actually not good for your baby.

[33:02] Leah: 
Well, one of them, I guess. Okay, so not a substance. Well, actually, crazy enough, people often think this is a myth, but it actually does work. Cabbage leaves. So cabbage leaves wrapped around your breasts if you're trying to dry up your milk supply actually do help to slow lactation. Just the cooling effect of it and something in the cabbage evidently helps to shut down breastfeeding. That one sounds like an old wives tale, but it actually works. I would say probably the most common misnomer, like the most common kind of thing, people believe oftentimes that you have to let your breasts fill between every feeding so that you build up milk for the baby. And that's actually not how it works at all. It's a purely supply, demand, hormonal concoction that happens that actually your body begins. You create milk on demand. In essence, you'll create a certain amount as time goes on, a small amount. But the majority of the milk that you feed your baby, you're creating it on demand in response to the suckling. And so you don't have to let your breasts fill. If your baby wants to eat every hour, you will make milk every hour. And then the other thing I think would be to be the schedule that every two to 3 hours baby needs to nurse. Yeah, that's generally kind of how it happens for a lot of babies. But scheduling a baby's breastfeeding is not helpful. Usually most moms just need to watch for cues and let your baby tell you when they're hungry.

[34:31] Greer: 
That's really helpful. What are some aspects of lactation that you wish people talked about more openly?

[34:38] Leah: 
Well, I think you kind of touched on it a little bit. Like just even that shame that sometimes accompanies it because it's so deeply personal to our identity as women. Our breasts are actually a very intimate part of ourselves and our identity shifts when we become moms. From your college days when you're wearing cute little halter tops and bustiers and showing off your cleavage, to your mid 30s when you're full of baby puke and breastfeeding and just it's not so hot anymore. And these breasts that used to kind of define you as something now define you as something very different. And there's a sort of identity change that happens in there that can be very confusing concerning our breasts. And so I wish that we would talk about that a little bit more and normalize and just see the lactating breast, the breast that has stretch marks, that is now sagging, that is not so cute in a halter top anymore, but just the beauty of it and what it's capable of giving to children in our society. And the self-giving aspect of that, I think I wish we would talk about that a little bit more. I hear a lot of women make comments to me about, well, I can hardly wait to wean my baby. I'm going to go get breast implants and get my breasts looking good again. And it always makes me just a little bit sad to hear that because we somehow think that our breasts doing what they were made to do, wrecks them, which is not the case. It's not the case at all.

[36:13] Greer: 
Can you speak a little more about that emotional dimension of lactation? I love how you highlighted how women rethink their sense of identity as they go through different physiological changes. But then there's also so much that society is putting on us, heavy expectations not as much support as we need. And what types of experiences have you witnessed as you accompany women as they process emotionally what they're going through?

[36:46] Leah: 
I think it's so different based upon the age of a woman. I've worked with some very young moms, some that have been in unexpected pregnancies and that really were not trying to become mothers. And the identity shift often doesn't happen for them. They don't ever shift into thinking I'm a mom now. In a way they do, but that really deep internalization of it. Gosh. I remember one beautiful young teenage mom. Her breasts went from a size A to about a size D when she began lactating, which was pretty, pretty awesome to go from, you know, these tiny little boobs to these giant, massive boobs. And so she ran into problems. She ended up seeing me for mastitis because she would not feed her baby or nurse or pump for about 6 hours if she knew she was going to go out that night to the club because her boobs looked hot and ginormous. 

Greer: 
Oh dear. 

Leah: 
So that was just one of those instances where I kind of paused for a moment. I was like, this is a fascinating disconnect of identity right now. And so we were talking and she's like, oh, the only problem is that I leak everywhere. I've got milk spraying all over the place.

[38:04] Greer: 
Wow. In the club.

[38:07] Leah: 
Because that's not what it's meant to do. You're supposed to get the milk out. And because she wasn't pumping, we were ending up with milk stasis. The milk is sitting there and bacteria is growing and she ended up with mastitis very predictably. When we begin to lactate, it's supposed to go a certain way. We need to be removing the milk every two to 3 hours. That's the normal cycle of breastfeeding, that we're removing this milk. It's not meant to just sit there. And then what ended up happening is her milk supply began to shut down because that's the next thing that happens if you don't remove the milk and they become very full, very large, very engorged like hers were. Your body starts to create hormones that say, stop making milk, we've got too much, we're going to blow. And that's what happened. So her feedback inhibiting hormones started to loop through and her milk supply was shutting down very quickly, to her dismay. But just that emotional maturity was lacking there. For her to really understand that the purpose of this is more than just attention. There's another person here now. There's a human being that this milk was made for. And there is some obligation on my part in some way now to feed this baby, to take care of this baby, to shift. And that was very hard for her. So that's just kind of one extreme instance of when we're not ready or we're not trying to make that identity shift and we don't see ourselves as a mother, it can be really hard because your mind and your body are kind of at odds in that moment. And it was her mind was at odds with her body.

[39:48] Greer: 
But I did hear you say also that she had some distress that she then was not providing the milk supply that she wanted to provide. So it seems like she really had both senses of identity, living under the skin at the same time and trying to work through that.

[40:06] Leah: 
You're right. You're right. It was just a very complicated set of emotions. And I think transitioning to motherhood and our body changing and our body doing things that are kind of beyond our control is always just very complex emotions. We kind of sit back and we're like, I'm not doing this. My body is doing it. I can't control it. It's just doing it without me. As a baby grows within us, it's like almost like for a moment you're like, am I in the movie Alien right now? This is so weird. I can't control this. And breastfeeding is similar in that way. It's a real surrender of I'm becoming somebody new in this moment, and it feels like a death to the old self for many women. Many women struggle with the lifestyle changes that are required to successfully breastfeed. It is a lot of time. It is a lot of sacrifice. Some women just sort of embrace it breezily and just say, well, I think it's attitudes and personalities. Some women are very like, well, okay, I'll breastfeed at the beach. I want to go to the beach. I'll breastfeed there. And they just sort of do it wherever. And it's not hard. And I think it has to come back to just personality differences and personal wounds, personal traumas, personal expectations and goals. And it's so different for every woman. I could never cast any specific sort of certainty of how breastfeeding will go emotionally for any woman. It's so complex. Yeah.

[41:32] Greer: 
When you're talking to women who are having a big sense of loss of identity and especially when that's rooted in how little time they have left to themselves because it is so time intensive, what are some pieces of hope or joy or positivity that you hold out for them?

[41:53] Leah: 
Yeah, I hold out joy that the world is becoming more breastfeeding friendly and that babies can go everywhere with us and not to feel ashamed of nursing wherever you need to be, like, just normalizing it and not apologizing. I guess the shame and the stigma being removed surrounding breastfeeding, I think, helps tremendously with women maintaining an integrated identity and shifting back into the world, because breastfeeding seems to be the thing you do at home and it's kind of hidden and you don't do it anywhere else. And that creates a lot of isolation and bitterness for a lot of women. But when you can start to bring yourself back out into the world, and you get to show off this beautiful new baby and they're with you. It's a good, hopeful approach to it. But I also just tell moms too: It's also not bad to take a break. If you need to pump and go out to dinner with your husband and have Grandma feed the baby a bottle of breast milk while you're gone, that's okay. It's okay. You need to take care of your mental health as well. So it's depending on each woman. It's such different advice based upon where she's at and the depth of her struggles.

[43:03] Greer: 
Yeah. Could you speak to the situation of women who are having a really hard time breastfeeding? And it's a goal that they have, but they're just not overcoming whatever is going on physiologically or maybe psychologically, that's really in the way. And it must be such a hard thing if you're hearing the Surgeon General say "breast is best," and that's a value that you're sharing, but then you're not able to follow through with it the way you'd like to do. How do you kind of help them with that emotional burden?

[43:38] Leah: 
I mean, I always ask women at the very beginning, what is your goal? What is your goal for breastfeeding? What's going to make you feel really good about yourself? And I'm very careful to not impose. I'll say, like, in the classes, like, well, as you know, the recommendation well, it just actually shifted recently, and there was a lot of backlash about that. It's always been twelve months. The World Health Organization has always said 24 months. But the CDC, just about a month ago here in the United States, came out with a recommendation for 24 months of breastfeeding. And there was a lot of backlash from women saying, that's ridiculous. Like, that doesn't fit with a woman's life. Just a lot of sort of reactive anger of, I didn't want to do that. I shouldn't have to do that, or, It just didn't work for me, or all the different things. But for the woman who is just struggling tremendously, it's not working for her. If her goal if there is no quit in this woman and her goal is that, gosh dang it, she's going to make it six months, then I will stand beside her and I will work with her to get that six month mark so that she feels really great about herself. Even if she's only getting 10 ML every time she pumps, even if it's nowhere near what this baby needs fully. If she has set her heart on this goal, I will stand beside her and help her get there, because there are absolutely benefits that we can say this was worth doing. You're still giving your baby immune properties. You're still your immune system there. You're able to help them get through colds. You're able to help them. Every virus you're exposed to, you're creating the antibodies, and you're giving them to your baby. So you're helping even if it's very small amounts, even if it doesn't seem adequate, if that's your desire and your goal, we're going to get there. So I think it's just kind of resetting what success looks like for different women and saying, you're incredibly successful. For some moms, success looks like baby just comfort suckling and there's very little milk transferred, if any. Maybe there's no milk at all. But it's that I can comfort my baby at my breast, and that's success. And I say Amen! I celebrate you! That's wonderful!

[45:54] Greer: 
That's really encouraging and uplifting, I think, to take that perspective of knowing that a woman's an expert of her own body and is closely connected to her baby and understands what they need as that dyad, like you put it before, that's really encouraging. Not to maybe get too tied to one particular expertise on the subject, but to take one's own experience into account.

[46:28] Leah: 
And that's the danger, I think, that we run into in just culture in general. We're very black and white. We're very like, success/fail. And there's so much gray. It's not black and white. There's so much gray area concerning breastfeeding as to what success looks like, you mentioned just that dyad relationship. Just a mom and a baby having a strong attachment to one another really is success. And unfortunately, you can see a mom who is providing milk for her baby adequately, but maybe she's completely disconnected and not attached to her baby, and it's not a good situation. That to me, I wonder, like, yes, baby is successfully receiving mother's milk, but is this success? I don't know. It's hard to define it objectively with numbers, that this is what successful breastfeeding is.

[47:24] Greer: 
Sure, yeah. And I imagine when you're having those conversations with moms, there's a whole kind of psychological component to how you broach those questions of what is your goal, what is worthwhile in this experience for you? How is this struggle that you're going through adding up and kind of, how do you want to step back and think about this? There must be a whole separate set of skills beyond just the expertise about the physical side of it.

[47:58] Leah: 
Unfortunately, I think so many women have been wounded by kind of these maybe like lactation warriors or people that are like, well, you just don't understand how amazing the effects of breast milk are. And I think women have been wounded when we don't pause to first say, how are you doing with this? Because one of the things that I try to really focus on in the lactation profession as IBCLC is there is a lot of education on psychologically first always affirming the mother, always affirming her and checking in with her and making sure that she's all right because she's the key to all of this. Her well-being is important. And things like past sexual abuse or difficult births, things like that, these play in tremendously into how she's viewing this experience. If she's being further traumatized by breastfeeding, if she's being wounded by this in some way, this might not be the best option.

[48:54] Greer: 
It is so affirming to hear you say that. Thank you for highlighting that and putting women's health first. That sounds really important.

[49:04] Leah: 
Well, it is a mind body spirit connection. And I truly believe that so many women in our culture have not leaned into breastfeeding out of fear of failure and out of so many things. And I think sometimes their spirit suffers because there's something very sacred and beautiful about the connection between a mother and her baby. And so I always try to encourage them. Listen to your heart right now. Like, your body is like your soul, your heart, your mind. Oftentimes the majority of women, the true whole experience that's going to make you feel like integrated will come when you're successful at breastfeeding for most women. But there are instances, just like I was highlighting, that if your mind and your body and your spirit are at odds with one another, we have to just pause and say, how can we help you be whole right now?

[49:52] Greer: 
That's really beautiful. How has your work in this arena impacted your own sense of self and your own sense of identity as a woman?

[50:01] Leah: 
Well, I think yeah, gosh, so the work and then also the personal experience of having breastfed babies, they're kind of intertwined as I've done it longer and longer. I think that this is a critical part of knowing the female identity. Like just leaning in and understanding what makes us so valuable to the life of society and culture and these kind of feminine traits of surrender and looking towards another little person's needs and this sort of living outside of ourselves and being in constant relationship. I think that that's really what has opened up and become apparent to me over the past decade of doing this work, is that women often feel most integrated and healthiest when they're in authentic, good, healthy, strong relationship, be it with their children, be it with their spouse, be it with their community. And our bodies, our breasts in particular are very relational for us. So it's just been fascinating work. I've really appreciated everything that I've learned from the women that I work with. Some women, it's just a very technical sort of relationship where I'm, here we go, we need to get that little frenulum clipped on that baby. We need to get you a nipple shield and we need to do this. And here's some cream, some triple nipple ointment, and let's get that yeast cleared up and we're back on the road. And it's a quick relationship where it's just very medical sort of interaction. But even those women, I often will run into them or see them later in the community in some way. And there's a connection and a deepness of this kind of sacred connection of their breastfeeding and my being present in that very kind of vulnerable, sacred space of their life. It creates community. And I don't even know how to articulate this, but there's something so sacred and deep about our bodies and what they can do that I just have been so honored and so kind of surprised to realize that that was the field that I was in. Wow.

[52:12] Greer: 
Last question that I love to ask everyone on this podcast. What have you learned about listening to your body through your experience as a breastfeeding mom and also through your work?

[52:24] Leah: 
I've definitely learned that my body is a lot smarter than I am. I've learned just charting my cycles and watching my fertility and through pregnancies when I'm tired and when my body is giving me signs of like, you need rest, that I need to listen. Sometimes my mind tries to overrule my body and say, I know what's best, but my mind does better when it listens to my body, I think is what I've learned over time.

[52:55] Greer: 
That's great advice. I have learned so much. So I really appreciate your wealth of knowledge but also your wealth of compassion for women. I have just really treasured this conversation. So thanks so much for joining us.

[53:10] Leah: 
Thanks for the opportunity. I love talking about this. It's just a beautiful part of being a woman.

[53:22] Greer: 
If today's episode resonated with you, I'd love to hear from you. You can email me at femammalpodcast@gmail.com. That's femammalpodcast@gmail.com. You can also follow this podcast on Facebook. Just search for Femammal Podcast and you will find a community of people who are interested in living well in our bodies. And of course, I'd love for you to rate this podcast and leave a review wherever you download your podcasts. Until next time, be well.