The Ordinary Doula Podcast

E50: Lactation Tales

• Angie Rosier • Episode 50

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What if your breastfeeding journey took an unexpected turn, even after a successful experience with your first child? This episode of The Ordinary Doula Podcast uncovers such real-life stories of breastfeeding challenges that many parents face. First, we venture into the world of a mother navigating unforeseen difficulties with her second baby, despite having nursed her first one seamlessly. Her story emphasizes the unpredictability of breastfeeding and the importance of persistence, as she witnesses her newborn's weight loss and undergoes medical evaluations. We also explore the intricacies of breastfeeding a newborn with a tongue tie, shedding light on how collaborative care and maintaining energy levels can lead to successful outcomes.

We conclude our discussion with warm well wishes and an invitation to spread kindness in your communities. Can't wait to connect with you again soon on The Ordinary Doula Podcast.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Speaker 1:

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2:

Hello and welcome to the Ordinary Doula podcast. My name is Angie Roger, I'm your host and we are sponsored by Birth Learning. Today I want to talk to you about a couple of interesting lactation cases I have participated in lately. I have participated in lately, so I'm an IBCLC and I see people in their homes after they have babies for just to help with breastfeeding and lactation if there's any challenges or hiccups along the way. So I'm gonna tell you about two, I don't know.

Speaker 2:

Interesting interesting is a good word for it cases that are a little abnormal, a little unusual, and I think sometimes other people's stories just knowing the realms of possibilities, can be helpful. If we are feeling either about our birth or our breastfeeding journey, if we're feeling discouraged or confused, sometimes other people's stories can really help us. So these I'd call these stories outliers. They're on the outside realm of possibility but kind of shows us potential of breastfeeding situations and breastfeeding journeys, and a little bit of education will come along the way as well. So this first story I'm going to talk about, this baby is the second baby of this mom and she breastfed her first baby. It took a bit to get going but she breastfed her first baby nicely, you know, three, four years ago the second baby was born. Everything seemed fine. I was their doula.

Speaker 2:

Baby latched in the hospital right after delivery. Everything was looking great. They went home. The mom's milk came in. I went and saw them about four days after the baby was born and the baby was experiencing pretty good weight loss. Now it's normal for newborns to have up to 10% weight loss. If it's creeping up eight, 9%, we really start watching that. But it's normal up to 10% and kind of concerning after 10%. So this baby was at 11% weight loss. So that was in the concerning period early on. So we're watching very closely. Her pediatrician was watching closely. I was visiting them pretty regularly. The baby didn't have a great latch, wasn't super vigorous, but there was so much milk and so a lot of milk was available. They were just the milk was kind of pouring into the baby. They were using the bottle a little bit and then we did a little bit of work to was kind of pouring into the baby. They were using the bottle a little bit and then we did a little bit of work to get the baby back on the breast. So we just continued working at that.

Speaker 2:

A lot of times these breastfeeding journeys take just some persistence, take a few days, take a few tweaking of efforts along the way to get babies to where we want them to be, or milk supply, or whatever the case might be. Now the mom had no nipple soreness, no breast pain, anything like that, but she had a lot of milk and so we dealt with engorgement for a little while and she was getting a lot of extra milk too. She would just drip, like when the baby's on one side, she'd just be dripping from the other side. So she would catch milk in a haka or a milk catcher and she was putting away several ounces a day. So they're getting a nice freezer storage of milk. So they have if the baby needs it. There's plenty of food, that's not the issue. But this baby, um, and I was getting some milk from the bottle as well.

Speaker 2:

But this baby continued to like have really slow weight gains, so much so that the pediatrician much older in days than you would think normal, the pediatrician checked the baby's bilirubin levels. She's like maybe, maybe this is something curious going on. The baby has high, higher bilirubin levels than we would think and that's making the baby fatigued and not able to gain weight. But the bilirubin levels were fine. The pediatrician even checked the sodium levels in the baby. She's like let's do a little lab work and see if there's anything underlying going on where this baby's not gaining weight.

Speaker 2:

And this mom was breastfeeding 12 times a day. So she's like latching the baby religiously 12 times a day. They were topping off with bottles at some feeds, especially during the night. Um, so I met with them a few times. This particular time, let's see, was I think the baby was two weeks old and we want the baby to get back to their birth weight by two weeks old. That's kind of something we're always looking for. A lot of babies do it much earlier than two weeks. Some babies take the whole two weeks. This baby was still eight ounces off when we were at the two week mark.

Speaker 2:

So, um, and what was interesting is this baby was content. This baby seemed fine. Sometimes when we have what we call a hungry baby, they kind of just whimper. They're like they sound like a little bleeding animal and they seem hungry and they seem discontented. But this baby did not. She seemed fine. She was sleeping between feeds fine. She was eating fine. Her intakes were not crazy high, like she was getting 20, 30, 40, I could get her up to you know which milliliters and 30, about 30 milliliters is an ounce. So she was getting from the breast in a long feed. She was getting you know, a little over an ounce and that's why she was eating so frequently, but it still kind of wasn't up to par.

Speaker 2:

Her pediatrician finally settled on. Well, they must have had her birth weight wrong. Maybe they just, you know, they started her out at eight pounds one ounce. Maybe that wasn't the case at all, maybe she was only seven pounds eight ounces or something. But that would be the best explanation of what's going on here, because the baby seems fine, all tests are coming back fine, but the weights that I had because I'd been didn't track that theory.

Speaker 2:

But my, you know, we look for daily gains. We want a baby to, after they get back to birth weight, to be gaining about an ounce a day. For 16 weeks they're going to be gaining about one ounce a day and this baby was gaining about a third of an ounce a day in time as I kept visiting with them. So that was also concerning. I don't know, the gains are just super slow. So curious. And it wasn't concerning because the baby seemed fine. But it was curious and the pediatrician kind of said the same thing. So she, the pediatrician, she finally just said, well, I you know, let's just watch her. Like, everything seems fine, everything I can think of to do, we've done and there's no indications anything's wrong. Let's just kind of watch her.

Speaker 2:

So the, the couple decided, the mom and dad decided to, with all the milk that they had, which was a lot, to top off every single feed with one to two ounces. That still didn't quite do it, but in time this baby finally got up to her birth weight. She was 20 days old. So we were at almost three weeks, which is incredibly unusual. But it did take this baby three weeks to get up to its birth weight, nice and slowly. And we'll see time will tell if she kind of picks up the pace. I have another visit scheduled with them later on this week and we'll kind of see what goes on there. So kind of interesting.

Speaker 2:

So some facts to kind of take away from that. Early weight loss is normal. Five, six, seven, 8% is fine and we get up to 10%. We watch that closely. We might be supplementing either with pumped milk, with formula, with donated milk. Babies. We have about two weeks to get up to their birth weight. That's super fine. Most babies do it within just a few days. This baby took three weeks. So kind of interesting. So I love to see these realms of possibility when we see these interesting stories. Another interesting client I've been working with for lactation right now I did some prenatal education with this client, did a little breastfeeding class for her, met with her when the baby she had her delivery we were her doula as well had her delivery. Baby latched great after delivery and I saw her. Let's see, I saw her when the baby's about three days old. So they're just coming home from hospital.

Speaker 2:

Milk's not quite in yet and that can be, you know, kind of for new parents kind of a little bit of a concerning time, as they're like we need to feed this baby. We don't have all the milk we want yet. Baby's sleepy. We're looking at their, their growth and development at that point, just for their for where they're at in just mere days old. Um, and this mom was going kind of long between feeds. She was sometimes waiting five, six hours, and not a baby that old, we don't want to wait five or six hours to feed them, um, we want to be. We want to be feeding them every two to three hours until they get their weight back up and until they can get those good gains going on. So a lot of times when I work with folks in lactation or postpartum, we say you know, wake the baby every maybe three hours at night, every once in a while you can go for until they're about two weeks old, and after two weeks you can let them sleep as long as they will. We just need them to to get their weight up. So the problem that's presented there if babies go too long, they're so tiny, their stomach capacity is so small and they use up their food very quickly and eating takes a lot of energy. So if we have a baby with intakes, you know, or feeding sessions that are far apart, their energy goes down, their blood sugars can go down and they need pretty consistent, like that's such a tiny tummy, it fills and empties very quickly and it needs to fill pretty frequently. So if we get a baby that's tired or fatigued or lethargic, they're not going to feed well, which continues to tiredness. And some new parents like, oh awesome, my baby just wants to sleep some more. We go to a next feeding. A few hours later they're more fatigued, they're more tired. Kind of going to be a spiral where we want to keep that baby's energy pretty level and steady, doing those feeds every two to three hours. For a newborn that changes in time, thank goodness.

Speaker 2:

Um. So this baby I had a visit with him when they were three days old. Um, and, and you know, breastfeeding, as I've talked about before, is very much an anatomy matchup. We are matching up the anatomy of the mom's nipple breast tissue with the anatomy of the baby's mouth and of course we don't know what the baby's mouth is like until they are born. So, as I met with I, I, you know, this was the first time I'd laid eyes on this baby. Um, my doula partner did their birth and I went and the breasts were a little firm, nipples were a little on the short side, but nothing too alarming. Um, milk was starting to come in, the breasts were a little bit full, feeling a little bit firm and engorged. Um could be hard for some babies to latch to and the baby was latching okay, but this baby's weight loss was also. We were getting down to that 10% mark where we're watching it really closely and they were, you know, visiting with their pediatrician about that. And so we talked about strategies feeding the baby more, feeding the baby more frequently, doing some breast compressions, some hand expression until that milk comes in.

Speaker 2:

But at the end of my first visit with them, baby was three days old and I took a look in the baby's mouth and this baby had one of the I'm not going to say worst, but one of the most obvious tongue ties I have ever, ever seen. It was what we call an anterior and could be posterior as well, but the little frenulum or skin beneath their tongue came right up to their gum line, as if they had teeth that might be touching their teeth. So it was a very visible, very obvious tongue tie. And we look at a few other things with tongue ties. We look at mobility of the tongue, lateralization of the tongue. Can the baby's tongue elevate? Can it extend past its gum or lips? This baby had pretty good movement of its tongue, which was promising. But I said, oh, let's talk to your pediatrician, let's get a have some eyes on that, because that is a tongue tie that could be some problems. And with her particular breast anatomy I was a little bit worried with the firmer breasts not as elastic and shorter nipples that that, combined with this baby's very obvious, very anterior to the tip tongue tie, could be a problem. So she did take it to her pediatrician.

Speaker 2:

They had a visit the next day and I met with them a couple times after that and this baby started gaining weight. She was at um 10% weight loss but she gained weight really well. The milk came in and when milk comes in that can be game changer, right. That can just um help the baby get all the milk that they need. Um, there there's more food to have, they're more motivated to do it. So in the meantime the milk came in. This mom was able to save a little bit of milk on the side with. I think she was using the pump every once in a while just for comfort during engorgement, and sometimes she put the milk catchers in her broth and she was catching a little bit of milk so she had some milk if she needed it. And I went to see them again and this baby had had an incredible turnaround. So she was gaining weight beautifully. She was past her birth weight on day like six, day seven, when she'd have been at a 10% loss.

Speaker 2:

We measured her intake. She took just beautifully. She took almost um 50 milliliters in 20 minutes, so that was pretty good. Um and her daily gains are probably going to change a little bit, but we're closer to two ounces. So again, we hope for an ounce of daily gains a day. Um, that lasts for about 16 weeks, but this baby was surpassing that and gaining quite quickly despite despite having this oral restriction or this tongue tie. Um, and I loved how the pediatrician handled it. So let's just wait and see. Yes, there is a tongue tie present. Let's kind of wait and see how the baby will do with that and so far she's doing fine. I'll see them again next week and I was so pleased that hopefully we don't have to do any revisions and with diligence on feeding and the mom's working on positions and latch she's able to with their anatomy, particular anatomy situation, particular milk supply situation, things are going beautifully well. This baby regained quickly after a 10% weight loss.

Speaker 2:

So that is my second story. We kind of have two tales of lactation here to demonstrate a little bit of how things can go. And so your breastfeeding journey, or your sisters, your friends, like you'll hear some people say, oh yeah, I loved it, it was easy. Other people say, oh my gosh, so hard, so much work. But helping to know what's possible, what's normal, I think, goes a long way in how you feel about your breastfeeding journey. The support you have around it, the expectations you have hopefully realistic expectations can help make that much more enjoyable, successful journey for everyone. So take what you want from that. I love it when I have interesting things come up that are curious, not concerning, just kind of curious and, in time, pretty awesome to look at.

Speaker 2:

So good luck on your breastfeeding journey, reach out if you need help. There's a lot of lactation help to be had in the community. If you kind of know where to look. Look at La Leche League is a good place to start. Perhaps your pediatrician's office has an IBCLC. Maybe there's a lactation counselor in your community. Maybe your insurance covers it If you go to the Lactation Network. That's a network all across the country of IBCLCs who could be covered by insurance. They work with many, many insurance companies where they will cover up to six home visits, so see if your insurance will be covered there.

Speaker 2:

Asking help from family friends, getting help from WIC there's lots of places to get help. Do some research, do some digging if that's something that's going to be helpful to you. So thanks for hanging with me today. I wish you the best in your journey, whether birth, lactation, parenting, wherever you are at. Hope you have a wonderful day. Go out and do something nice for someone else. Lift somebody else's boat, because it will lift your own as well. Hope you have a wonderful day and we'll see you here next time.

Speaker 1:

This is Angie Rozier signing off with the Ordinary Doula podcast with Angie Rozier hosted by Birth Learning Episode. Credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth.