I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Happy midsummer, and welcome to the July breastfeeding Q&A episode, where you are in the hot seat.

All right, I like it. You know I like it. So I decided to come up with our opener for today. I have so many questions I love posing to our Instagram followers, and I came up with two. And of course, that was a mistake, because we got hundreds of responses on each of the two, so we don't have time for all that, but I did get a nice selection of responses on the first question.

I thought this was a fun one because there is so much about breastfeeding that women are never told, and there's so much they are told that they turn out to disagree with once they have experience with it, whether it's positive or negative.

I think one of the toughest things that all of us go through when we're conceiving or breastfeeding or giving birth is that there's such a wide array of experiences. Think about just fertility alone. There are the women who conceive immediately. They're ovulating. They get pregnant. They can't fathom why it shouldn't work. To them, it's like, well, yeah, we didn't use birth control. Of course we conceived.

And then there are women who try for years and years and years, and those women can't fathom how anyone can get pregnant easily. The same thing is true with breastfeeding. For some women, it happens so naturally, and for others, they have to invest all the time and effort and love and resources in the world to get where they get, with support from someone like you.

So when these women go into the world and tell their friends how hard it is or how difficult it is, it's very, very true for part of the population, and then it misleads everyone into thinking they're going to have the experience that they last heard about from the most persuasive friend.

Well, I would say this is not just true for breastfeeding and fertility. It's also true for birth, and a big part of the problem with all of this is what society does to interfere with it. Much of the fertility struggle that women and men experience today is due to the environment. It's due to things that society has taught us we need or don't need, interferences in modern living. The same thing with birth and the same thing with breastfeeding.

There are so many things that happen in our world, in our society, in our culture, that take us away from the most natural way of doing things, that interfere with the process. And breastfeeding is just one of those examples.

And you are right. A woman can give birth and put her baby to the breast, and it can go as easily and smoothly as possible, and she doesn't know why, and it just works. That's not the vast majority of experiences for most women. I would say even a woman who it happens for pretty easily and naturally has some struggles along the way, usually nipple pain or fussy baby or some things that definitely come up that could use some guidance.

I really feel like every woman with breastfeeding, unless she's doing it for the umpteenth time, and even then they can still have challenges, but most all women need some support and guidance, because breastfeeding is very instinctual for the baby. Latching is very instinctual for the baby, and it's very instinctual for the mother to put the baby to the breast. The whole idea of it is very innate and natural and instinctual, but the actual process of doing it comfortably and easily is not that instinctual. It actually is a learned behavior. And every time a mom has a new baby, she has to learn with a new baby.

And then you throw in all the complications that we are dealing with today that seem to be out of proportion to what you would expect, like so many babies with tongue tie and complications that make breastfeeding really difficult.

We just actually got a message this morning on Instagram from a woman who is an RN and an IBCLC, and she wrote in to express how challenging her breastfeeding relationship with her baby was for the first three months because her baby had a high palate, a posterior tongue tie. And she said, even with all the knowledge in the world as an IBCLC, I still struggled for three months before breastfeeding finally clicked.

So I guess the take-home message from that whole rant is: stick with breastfeeding. Stay with it. Get the help and get the support, because it just does sometimes take a long time before it clicks, and babies don't forget how to latch. Latch is always possible many months down the line. So breastfeeding becomes a possibility down the line, even if it wasn't in the beginning. Sorry, I probably distracted from what you were trying to talk about, but I just had to get all that out there.

No, heck no. That was great. I used to only understand breastfeeding to be instinctual. I had all the arguments to say, well, obviously it's instinctual. It's instinctual for other mammals, and women have done it since the beginning of time. Obviously, we did not have formula for more than 99% of human history.

So I didn't understand until I got to know all of this better. The big glaring difference is what you said. It's that society changed. And for all these years, hundreds of thousands of years, women were around other women breastfeeding all the time, and you did have women say, no, no, do this with the baby, hold the baby this way. They taught each other.

And now we are completely cut off from that. And put a baby in a woman's arms, and it is on the luckier side when it goes smoothly, or if she knows a thing or two about how to get it started. It's instinctual, but there were also people teaching her how to do it, or she grew up witnessing it.

I didn't know until I had a baby that the milk came out like a shower head. I don't know what I envisioned. I don't know what I thought it was like. Did I really think a little hose-like stream was possible? I don't know what I thought, but if my mind didn't think about it, probably I didn't think about it. But when I saw it came out in multiple spots, like out of pores basically, like a shower head, it was fascinating and cool. And I just was like, well, what did I think it did? We just don't know anything about it.

Well, that is the main issue, is that we didn't grow up watching it. In fact, we grew up watching the opposite. Most of us grew up watching, and still are growing up watching, bottle feeding, which is very different and works on a different schedule. It works on a different rhythm. Breastfeeding works on a rhythm. Bottle feeding works on a schedule. It's a completely different mechanism.

And you put a bottle in a baby's mouth. You do not put a breast in a baby's mouth. You bring a baby to the breast, and this is one of the biggest mistakes that people make with learning latch. They're trying to put the breast in the baby's mouth. You're never going to get a good, comfortable latch with a newborn that way.

And breastfeeding challenges have existed throughout history, always and forever, but because we were raising babies usually in a village of women, women just helped each other out. So back in the day, other women fed other women's babies, right? And sometimes a new mom who was having trouble with a latch would actually take a mother with a three- or four-month-old baby, and they'd switch.

How healthy. Good for the babies and the microbiome.

But because that mother had so much difficulty with the newborn, she could breastfeed an older baby and keep her milk supply up, and the other mom could breastfeed her newborn, and her nipples were in a different place, and her breasts were in a different place, and it just worked. We just helped each other out in that way, and that is obviously not happening today.

Babies could adapt. You just reminded me of a very, very long-ago memory that when I was a really little girl, there were commercials on, maybe there still are, but I haven't seen them since I was little. So I think this is just an old-timey thing, but there were commercials for little girls to have dolls, and it was all about the bottles. You'd see the little girl warming the bottle and testing out the milk. I don't know what they were using, but the milk on her forearm.

Oh my gosh, I can still picture those little bottles with the pink nipple and that weird creamy white stuff in the bottle that you can shake. I did it.

I was wondering what they used, because I never owned one of those, but I wondered what they had for the milk. You had one of those, and the baby's mouth was just wide open in a little round circle, and you just shove the bottle in.

One of my biggest challenges with working with moms is to deprogram that subconscious programming in their brain to put their breast in the baby's mouth. Every single mother does it, everybody.

So I asked on Instagram what went differently from what you were led to believe, either positively or negatively. And here are some of the responses we received. A lot of these were repeated too, so I felt that they were worth sharing because a number of women said several of these.

One said how hard it was, so that's not uncommon. And another said how painful it is at first.

Because your baby is not perfect at latching. And even one not-so-great latch, even if you have a baby who is latching well, one not-so-great latch can do pretty substantial damage to the nipples. And then once they get sore, every other latch after that is going to hurt.

And even if they latch well most of the time or all the time, your nipples aren't used to being wet and dry 12 times a day. That's a lot of moisture, and then dry, and then wet and dry. The nipple tissue gets a little sensitive. That's totally normal and expected.

So mild to moderate sensitivity, because not every latch is perfect. Your nipples are being stimulated 12 times a day, wet and dry 12 times a day. That's going to make the skin sensitivity increase. So mild to moderate sensitivity in the first couple of weeks is normal. Cracking, bleeding, bruising, blistering, pain is not.

What if it feels like little shards of glass are coming out?

Yeah, that's pain. That's right, because when the skin tissue gets sensitive, it has tiny little micro-abrasions in it from your baby latching, and those tiny little micro-abrasions let bacteria from the baby's mouth and your skin, your hands, your baby's mouth, into the tissue. So you have invisible cuts in your nipple tissue, which creates intense discomfort and sensitivity. So if that's happening, that usually actually needs to be addressed and treated.

Okay. Next one was how much my emotions and my stress level can impact supply.

Absolutely, because if you are stressed, you are not releasing oxytocin, right? Cortisol is the most potent inhibitor of oxytocin, and if you don't have oxytocin flowing freely, you don't release the milk as much from the breast. So a woman can have a great milk supply, and if something seriously emotionally challenging happens in her life, a parent dies or something like that, she can lose half her milk supply overnight. It's recoverable. That's the good news.

Another wrote, I thought that breastfeeding my baby would mean I could nurse anywhere, but not my baby.

If you have trouble latching your baby, or your baby's very fussy in particular about certain things, yes. If they don't like your flow, if it's too fast, if it's too slow, yes, there are a number of reasons that babies can be difficult to latch and feed anywhere, anytime.

Okay. My body rejected pumping, but breastfeeding was easier than expected.

Interesting. A lot of women don't respond that well to the pump. There are a number of reasons that the pump might not work that well mechanically, like our flanges may not have been the right fit. But many, many women do not respond as well to their pump because it's a machine. Their baby is a baby that they love and they want to hold and they want to keep close, and when they're looking at their baby, they release oxytocin. And when they put their pump on, it's the opposite. It's stress. I hate this thing. It's a machine. I feel like a cow. That really can make women not release their milk for their pump.

It can be trained. You can train yourself to release your milk for the pump if you are struggling with that. But if she didn't, if breastfeeding was working, then why would you want the pump anyway? You don't need it.

I was led to believe that it was about breastfeeding and nutrition, but it is so much more, a woman said.

I think sometimes the bond that a mother and baby develop through breastfeeding is unexpected. You don't think about that until you do it.

So many women said it was so much harder than I was led to believe, and so many said it was so much easier than I was led to believe.

All right. One woman wrote, you don't need a big freezer stash. You talk about that all the time.

Hallelujah.

Yeah, you don't. It's another thing women are led to believe.

All right. I'm convinced breastfeeding with large breasts is harder than with small. This is what one woman wrote.

I can see that. I can see that challenge. Yes. I mean, the advantage of larger breasts is you can store a little bit more milk in your breasts at a time, but the actual process of latching with larger breasts can be harder.

But you don't produce more by having larger breasts, so please clarify what you just said, so that no one thinks that's what you're saying.

Yeah, I shouldn't. It's a whole complicated conversation. There is such a thing as breast milk storage capacity and rate of milk production. You can produce just as much milk with small breasts as you can with large breasts, but your breasts can maintain longer stretches between feeds with larger breasts because more milk can accumulate in the breast over time, and that's just in the beginning. It completely changes as breastfeeding goes on. So yes, it has nothing to do with how much milk you can make.

Okay. The next one says, oh, the fallacy that told me, quote, I'm going to breastfeed for X months. So many women do that when they're pregnant. They declare how long they're going to breastfeed. It goes right out the window, in either direction, but especially so many women breastfeed longer than they think. I breastfed way longer than I ever imagined. Though I had no plan, I never would have believed it if someone had told me beforehand, like way over a year. I wouldn't have believed it. I wouldn't have understood it.

I think it feels comforting to think of it as a finite thing, because you hear that it takes so much time and it's so much effort and it can be so hard. So if we go into it with like, okay, well, I'm going to at least do this for three months or six months, it makes us feel a little bit more in control of it. But the thing is that once you get to four to six months of successful breastfeeding, it's very unlikely that it's stopping, because your baby's so attached to it at that point, and it's become so easy at that point that it just naturally carries on.

The next one, and we have a few that said exactly this, that the weight would magically fall off. A lot of women wrote about that, that they did not lose the weight that they were promised if they were to breastfeed.

Well, that's very influenced by many things in their lifestyle and their pre-pregnancy weight and how much weight they gain in pregnancy. It is true that breastfeeding demands a tremendous amount from the body, 600 to 700 calories a day. There's no exercise routine that's going to burn those calories like breastfeeding is. However, it's not that simple. Your body is complex when it comes to weight loss, and many women are actually under-fueling their body during lactation. And as a result of that, they actually will hold on to their fat storage longer, because the body is intelligent and wants to protect the ability to provide enough for the breastfeeding baby, so it will cling to those fat stores for longer if you are actually under-fueling the body.

Okay, three more. That feeding on demand would ensure a good supply.

There's so much more to it than that, but that is a very important part of it. You have to do that to have a good supply. But there's more to it than that.

One woman said, I did not expect how much it would calm me down.

Oh, yes. I'm glad she said that. Most people don't think about that. That's the oxytocin effect. So if you feel prone to anxiety, you put your baby to the breast. It's very calming, and it can actually soothe a lot of anxiety through that oxytocin effect.

And I left on a positive one here. The last one that I collected said, I genuinely did not expect how much I would love it. So why not end on a positive note? Since we had questions from all over the board, are you ready, Trisha, to now play our listener voicemails?

Yes.

Hi, Cynthia and Trisha. I absolutely love you guys so, so, so much. You guys gave me the knowledge and empowered me to have an unmedicated, successful, amazing first birth at a birth center. So thank you. Thank you so much for your work.

My daughter is now two years old. I am currently 19 weeks pregnant. We are still breastfeeding. Everything is going great. Pregnancy is going great so far, and we do still co-sleep as well. And I was wondering if you could tell me all things about tandem nursing.

I have taken this entire breastfeeding journey day by day, taking my daughter's lead, and she is still obsessed. I don't see her wanting to wean, and I know that obviously introducing a new baby is going to entirely flip her world around. I do still intend to have her co-sleep with us, and all of that. She currently mostly breastfeeds to sleep, so for nap, and then she does like it when she gets up from her nap, and also to go to bed. And then during the night, if and when she wakes up sometimes, it's mainly at those times.

However, when I introduce the new baby, I know obviously that is going to be the most important, to have the baby breastfeed, and I also don't want to unintentionally create an oversupply. And so anyways, I was just wondering any and all tips for navigating the rest of the breastfeeding journey that you might have.

Yeah. So anyways, thank you so much for all of your work. I love you guys so much.

To be honest, tandem nursing isn't that complicated. There aren't that many things that you need to know going into it. If her toddler is still interested in breastfeeding when the new baby arrives, the priority is the new baby, but she's four or five months into pregnancy. There's still four or five months of pregnancy to go, and a lot might change with their toddler, especially as the shift back to colostrum happens in her breast.

A lot of times, toddlers at that point are like, ooh, what's this? I don't really like this anymore. I don't really want this. Or they take a little break. Natural weaning often happens in late pregnancy, but if it doesn't, it's perfectly fine.

Her baby will get priority. The colostrum will come in, and then the milk will come in, and she just needs to focus on feeding the baby first. So the new baby gets to the breast first, and toddler can go after. It doesn't necessarily create an oversupply because there are two people now consuming all the milk, right? So if the toddler is nursing and then suddenly stops, then yes, temporarily she would have an oversupply. But if the toddler is still nursing and the baby's still nursing, then again, the supply is just in sync with the demand.

One other important thing that she said is she is co-sleeping and planning on continuing to co-sleep. So with the new baby, that is something that she just kind of has to navigate, because the safest way to co-sleep is just with the mom and the baby in the bed, not a mom and baby and toddler. So if she is thinking about bringing the new baby into the bed and breastfeeding on demand, it might also be a good time to think about transitioning the toddler into their own bed.

And we did an episode on this very recently with Tiffany at Cosleepy, who this was what the entire conversation was about, trying to figure out how to navigate breastfeeding and weaning and co-sleeping with multiple children.

Right. We did that around the end of April, near the end of April.

Hey there. When my secondborn was born a few months ago, she was nine pounds, 13 ounces, and I did not have gestational diabetes, but I was obese, really overweight at her birth, and she had a decent amount of glucose issues after birth. Her glucose levels were not good immediately after birth, and we had some okay reads, some not great reads. I think the hospital standard was 24. I don't know what that's out of.

We were pretty pressured to use donor milk because it has higher glucose to try to get her glucose up so that we could pass these tests. She needed to pass three glucose tests before getting discharged. It was a very stressful situation. We did end up doing the donor milk and getting discharged.

And I will say, when she got the donor milk bottle, she seemed really happy after she got it. She was pretty fussy before. Then she would latch and nurse for like an hour, but still seem really dissatisfied. And what they said was because she was so big, she just had higher caloric needs and was struggling a little bit, even though I did not have gestational diabetes.

I was curious what your take is, if that was just something that in a home birth setting would have resolved itself on its own after a couple days, or if that was the right call. Thanks so much.

Well, a couple points to make on this question. One, the glucose screening tests are really not that accurate, so we don't know if maybe she did have a little bit of gestational diabetes that developed even later in pregnancy. That's a possibility.

But even if she did not, the excessive testing of babies and their blood glucose levels, I think, is often more problematic than helpful. If a baby's not symptomatic of low blood sugar, there's probably no reason to actually be testing. They were only testing this baby because the baby was born big, and she didn't have gestational diabetes on paper, so they didn't necessarily have a need. They were just testing the baby because the baby was big.

I hate that. It's just a big baby, and they're looking to diagnose it somehow. As if there are. I mean, it's just...

Well, when a woman has the risk factors of, she did say she was obese at the time of delivery, and a big baby, it is possible that there was something going on with insulin and glucose.

Oh, that's true. She said she was. I forgot about that. She did say she was overweight at pregnancy. Okay, go ahead.

Still. They do it with any big baby, even still. Even still, without symptoms of low blood sugar and kind of borderline levels. She said 25, but usually the range is 30 to 60 and 45 to 60 after the first day.

Once you give a baby a bottle of milk in the first few days, of course they're going to be fussy at the breast then, because suddenly they just have had this rapid flow. And thank God they gave her donor milk. That's wonderful that they at least used donor milk. But they're going to be fussy at the breast because colostrum is slow. It's thick, it's slow, it takes a long time to come out. And you give a baby a bottle of milk that just floods out of the bottle. Of course they're going to be a little bit fussy when they go back to the breast.

And even if the baby was fussy prior to getting the bottle, that's not abnormal for a baby in the first couple of days. They just need to spend more time on the breast, or maybe you need to hand express a little bit of your colostrum and spoon-feed them or cup-feed them a little bit.

So, yes, do I think if she had been in a home birth setting out of the hospital, all of this would not have happened, and everything would have been fine? Yes, I do think that's probably the case. But the hospital loves to intervene, and they love to prick these little babies and test their sugars and follow their protocols and keep them in the NICU for one point being off in their blood sugar levels, even if they are totally asymptomatic.

I don't know if you know that that affects my family personally. I don't know if you know that my mom had my brothers, and they were like nine and nine and a half pounds. Then I was born, and I was 10 pounds, three ounces, and my mom is very small-framed. And after I was born, they said to her, oh, you probably had gestational diabetes.

So my whole life growing up, I heard about this thing, gestational diabetes, gestational diabetes. When I got pregnant, I was like, oh no, I hope I don't get it the way Mom had it. And I talked to my mom about it, and it almost had become legend, because my mom said, no, actually, they never even diagnosed me. They just said, oh, you probably had that because your baby was so big.

Well, my brothers were big too, and then I had big babies. It runs in our family. It was so reckless, and it affected the next generation. I mean, I really believed that, and it really worried me when I was first pregnant. It was just all an illusion. It was nothing.

That's the power of people's words. You say something, and it can alter the course of... It's a thought that can stick in somebody's brain for the rest of their life. So you have to be very careful with what we say.

Okay, beliefs. We did a whole episode on beliefs, a very good one. It was a very, very popular episode.

Yeah, it was one of our most shared episodes of last year. It was episode 324, about beliefs.

All right, let's go on to the next one.

Hi, ladies. Thank you for your amazing podcast. I listened to it during my entire first pregnancy. I had a blissful home birth and beautiful pregnancy.

I just had a question about letdown. I experience, especially at the beginning of my letdowns, like an overwhelming sense of anxiety, depression and nausea, and then I would have my letdown. So anytime I brought my baby to my breast, as soon as she started feeding, I would get this overwhelming feeling of anxiety, depression, nausea, and then I would feel my milk come in.

My daughter is now a year old, and this problem is no longer really a problem, but I do get it every now and again, and it's very, very mild. It only lasts about a minute, and at this point I know that it's because I'm about to have a letdown, so I don't really let it bother me too much. But it is interesting. Every now and again, it will be more intense than normal. I'll get a wave of nausea, anxiety, depression, and then my milk will come in.

Like I said, as my daughter's feeding has progressed, it's gotten a lot less, but at the beginning, it was pretty intense. I did a little bit of research on it right at the beginning and couldn't find too much. I did find something called D-MER, but I was just curious if you guys have heard of anything like that, if you've dealt with any women, Trisha, who have experienced anything like that.

Again, thank you so much for your show. You guys do a lot of great work for the community, and I've learned so much thanks to the two of you. So thank you very much.

Yes, she's exactly right about what she researched and what this is. This is called D-MER, or dysphoric milk ejection reflex. Terrible name. It is not a mental health disorder. It is a physiologic response to the rapid shift in hormones when you have a letdown.

When you have a letdown, you have a massive shift in the oxytocin and dopamine. And for some women, not very many, but definitely for some women, this creates exactly what she described. You can feel suddenly overwhelmed, sad, anxious, depressed. It usually passes once the letdown happens.

We actually did an episode on this way back in the very beginning of our podcast called “When Breastfeeding Sucks.”

Zainab, what was her name? Zainab Yate. Is that it?

Yes, that sounds great. She wrote a whole book on it. So I would definitely recommend looking at that as a resource, because she described all the ways in which she experienced this and the ways in which she was able to help herself cope with it.

The first and most important thing is just recognizing it. So knowing, okay, this is something that happens to me when I have a letdown, and it passes. So using breathing techniques can be really helpful.

It's also really important to make sure that you are not getting low blood sugar, that you are staying hydrated, so eating something or making sure you drink before you start breastfeeding. A lot of women don't really notice that they're thirsty until they're well into breastfeeding or after, but drink before. I don't expect you to eat eight times a day before you breastfeed, but just make sure you're not going into a breastfeeding session really depleted if it's been three hours since you ate. Really try to stay on top of that, because that can also impact it.

Using calming, meditation-type techniques, grounding techniques, putting your feet in warm water, putting some music on. I mean, when it's really severe, it is a reason that some women actually stop breastfeeding.

You can see if you notice a difference between breastfeeding and pumping. Probably not, because either way, you're having a letdown, and it is related to the letdown. But I think the most important thing is just acknowledging what it is and knowing that it passes, and doing the best you can to work through it that way. There are not a lot of natural remedies that I'm aware of that help with this, other than the physiologic things. Not things that you can take, but the breathing techniques, relaxation, calming techniques.

Yep, that episode with Zainab Yate was number 61, way back.

If you are experiencing something like that, I would recommend working with a lactation consultant, because you can try some different strategies, like maybe pumping instead of breastfeeding, see if it's any different.

All right, Trisha, I think now it's time for quickies. We just posted it, right? So let's see if we got a bunch in in the past half hour.

They usually come in pretty quick.

They do.

Let's see. Here we go. Oh, yep, yep, I think we have enough.

All right. Can latch change with teething? Yes, it can, but not much you can do about it, because when babies are teething, they are already latching themselves. You can't really change their latch after teething, but they do sometimes change their latch a little bit because their gums are sensitive. So you kind of just have to work with them and yourself and adjusting yourself.

Moms are really good at figuring this out, like moving their breasts a little differently, side-lying, laying back, sitting up, koala hold. They just try different things until they kind of get it right. I mean, in some cases, I suppose a little break of pumping and bottle feeding, but I don't generally see anyone needing to do that unless you get a cut.

Look at me not answering quick. Why did I keep going?

You spent too much time with me. It's called being thorough.

Do you remember that? Do you remember we had a disagreement about this? You were like, they have to be quick. And I said, well, they can't be five seconds.

So I remember I posted on Instagram, and the majority said between 30 and 60 seconds. So it's like, just be thorough.

Fine. How to manage heightened nipple sensitivity during periods. Ow. There's only so much you can do here. Your body is doing what your body is doing. Some people just have more sensitivity. Again, that would just be doing the best you can to make sure your baby has a good latch, or possibly sometimes using a bottle intermittently if they're becoming more sensitive.

Can my milk supply drop because my baby is now sleeping through the night? Depending on when this starts happening, yes. Your breasts are meant to adapt to this at a certain point in the breastfeeding relationship, but if your four-week-old baby suddenly starts sleeping six hours, you might have a dip in your milk supply. So yes, and this is where that whole breast milk storage capacity comes into play, how long women can go before it affects their milk supply.

I just found out I'm pregnant. Are there things I can do early on to support milk production later? No, there's nothing you need to do in pregnancy to worry about your milk production later, except to do your best to have a physiologic birth, because that is the thing that's going to support your breastfeeding best.

Is it important to nurse from both sides each time, or is it more crucial to establish a supply early? So I actually do recommend in the beginning, especially for first-time moms, breastfeeding from both breasts each time, to help bring your milk supply in and to give your breasts the most stimulation possible.

So if you're trying to build your supply, or if you are experiencing low supply later on, the more often you side-switch, the more stimulation your breasts get, and the more it impacts your supply, the more it increases your supply.

I have a question for you. I have a quickie for you.

Okay, I better be quick.

I promise it's quick. You have seen thousands and thousands and thousands of women's breasts?

Yes.

Okay, in what percentage of breastfeeding women, let's say six months out, if you just were to look at these breastfeeding women, how many have one larger breast because the baby is primarily nursing from that one breast?

I couldn't tell you, because I wouldn't notice.

Well, how many women ask you, like, is it okay that one breast is much larger than the other?

I can tell you that at least 75 to 80% of women say that they produce more milk on one side than the other, whether it's visible or not.

In my breastfeeding days, it was perfectly visible. And then it's just, you just keep doing it, because that's the breast that's always ready to have the baby on it again. It's just the self-fulfilling experience.

That's what happens. A lot of babies prefer one side, or a mother prefers one side, and so we tend to favor that side, which is part of what creates the imbalance. Sometimes moms do complain about it being noticeable and visible, or just feeling awkward.

Yeah, I didn't mind that it looked different. I knew it would be temporary, and I didn't mind anything except the worry that I was nursing from one breast. And I guess the reassurance I needed at the time was that breast is producing enough, and it was. But that was all I worried about. Like half of my breastfeeding capability is not even being utilized. So you're saying that's still normal and fine.

I mean, it's why God gave us two breasts, so that if one wasn't keeping up, the other one would make up the difference. What matters is that you're getting enough milk in your baby from both breasts. It doesn't matter if one is doing all the work and the other one is doing none of the work. That happens.

Yes, it's difficult for those of us who are Libras and we like things to be balanced. I will say that.

Well, is one breast per feed okay in the first month? Okay, similar question. Possibly yes, maybe not. It depends on if you have enough milk from the one breast. The important thing again is that your baby is getting what they need and growing at that rate of about one ounce per day. If that's happening from one breast, then fine. If not, you need both.

Again, I prefer in the beginning to try to get to both breasts to build a full milk supply. If you're just feeding from one breast at a time, that doesn't mean you can't get to a full milk supply, especially if it's your second or third baby. Then you do tend to have more milk in the beginning. But with first babies, I like to try in the beginning to at least stimulate both breasts until we're sure that the baby's getting enough at one side at a time.

Can you recommend an affordable, flavored electrolyte? LMNT is a little bit pricey, isn't it?

I think so. It is. You and I can hardly keep up with what we have, so it's hard to see it that way. I see it in so much abundance, but yeah, it is expensive. Well, I would say coconut water. It's just so much healthier than anything else you can buy. We can all shop around for electrolytes all we want, but nature has provided this, and it's in the form of produce, and it's in the form of coconut water. And that's the best answer to the question, no matter what, because nutritionally, no matter how much it costs, nutritionally, it's optimal.

You can also put a lemon in water.

Exactly. So yes, lemon, cucumber.

Yes or no salt, honey. Even putting a lemon in there actually helps a ton.

Berries.

When is it okay for a breastfeeding baby to sleep through the night? Is sleep training okay? Well, it's okay for a breastfeeding baby to sleep through the night when they start sleeping through the night. There's no real age that I can pinpoint to this question.

Sleep training can interfere with breastfeeding if you started too early, for sure, so you do need to kind of follow your baby's lead on that. But if your baby is waking excessively, then some sleep training is okay. But I can't tell you exactly at what point you can do that, because it depends on what your baby's doing. There's no specific age. It's not like after three months. I mean, definitely not in the first three months. I can say that.

Do breastfeeding babies need a vitamin D supplement?

We just did this one. This just came up.

It did?

I think in the last breastfeeding Q&A quickies. Yeah, you just did this question.

No.

You basically said no. You said the best sources are sun, even for babies. They can be in the sun. You gave a limited time that they should be, and you said primarily for the mother to focus on her vitamin D levels.

Well, okay, then we did talk about it.

I mean, I didn't just rattle that off out of nowhere. That was what you said.

Yeah. So what the evidence says is that if a mother is taking 5,000 to 6,000 IUs daily of vitamin D herself, her breast milk should have sufficient amounts. But that doesn't mean you can keep your baby indoors and ensure that they get enough vitamin D. Take them outside.

Okay, we have lots of concerns about one breast making more milk than another today, so we'll just hit it one more time.

Funny that I brought that up.

Then one breast is making way more milk than the other. Is this a concern?

That's so weird. I just brought this up. Wow.

No, it's not concerning, is what. It's just your level of comfort. If it feels imbalanced, then we can work to correct it. But the important thing is that the baby is getting enough milk overall between the two breasts, and a woman can breastfeed her baby entirely on one breast, and they can get enough.

So last one. The question is, what do you find the hardest thing to explain to someone who is new to this work?

So did they mean for both of us to answer that, like as far as the wider industry, or do they mean just for you to answer for breastfeeding? What should we assume?

Let's just answer both, just in case. Why not? We can both come up with something on this.

Yeah.

I would say the hardest thing to help people understand. Okay, let me think. Do I think the hardest thing would be to really, truly, deeply understand that breastfeeding works best when you get out of your head?

A lactation consultant is going to want to give women protocols. The hardest part of my job is helping women learn to trust themselves and me not tell them how to manage their breastfeeding journey. So to get out of the idea that everything is protocol-based, that you need to do this, this and this to make breastfeeding work, to help a mother learn how to trust her instincts, to be in her right brain about things, to not worry so much about time and schedules and following a plan and protocol to make this work. It's got to come from the mothers reading their babies and adjusting according to what their babies are indicating they need.

That's a good one, because I've heard of things lactation consultants, lactation counselors have said to clients of mine, and they're sometimes overconfident. They sometimes say things that make the women feel very guilty in the end. One lactation counselor once told one of my clients, you stopped breastfeeding too soon. Or, I bet if you gave it a little more effort, you could have kept going. Like that. Honestly, as with everything else, you need to have a high emotional intelligence to be good at your work, which you do, and I'm sure is a major part of why your clients feel the way they do about you.

And I'll tell everyone else the truth that you didn't say about the hardest thing about your work, because you just said what it was, but let me tell everyone the truth now. Okay, I know the hardest thing about your work. Trisha gets like 100 texts every 90 minutes. Oh my God, that is the hardest. The boundaries that we're always talking about, you definitely have not figured out how to implement in your work, because it's such an emotional relationship. Breastfeeding is such an urgent thing, and that's tough. And there are weeks you work seven days a week.

That's true.

Yeah?

Okay, let's flip it around and do it for you.

Okay, so I guess work?

Yeah, since this isn't specific to breastfeeding.

But I'm just going to assume, let's say it's someone who's aspiring to be a doula. I would say that most women go into this field of work, as I did, as you did, because we fell in love with how beautiful it can be, and wanted so very much for other women to have the experiences that we knew were possible or that we had.

And I see this all the time with very good-hearted women who are intelligent and they're capable of learning what they need to learn, and they are capable of managing a business. I see a lot of them get burnt out, and they can't do it.

And I just would tell them beforehand that what happens is you go in so excited to be inspired and be a part of the most beautiful thing in the world, and you invariably will end up disheartened, discouraged, wounded, angry, all the powerless emotions we feel when we see the abuses happening in the industry.

But what I say to that is it's very frustrating, because we can't change something that is systemically a part of our society, here in the United States in particular. But we can change the world one woman at a time and one birth at a time.

We were just saying this with Nancy Wainer recently. Never mind her books and all that she's accomplished, she's attended about 3,000 births. But it's not just those births and those families' lives she's changed. It's those children growing up and knowing how they were born, and them questioning and them exploring.

So even if we don't go into this field of work, and you're a mother, we really do change the world one person at a time. We really can influence the world so positively, one person at a time, one friend at a time, one student at a time, one client at a time. And just keeping that as your focus in your life, whether you're in the birth industry or not, I think is the most empowering, beautiful, and motivating thing that there is, despite all the frustrations of powerlessness that we also experience at the same time.

I think that's actually the only way to make change. It's just perspective. Instead of thinking, I have to have this mass evolution, I'm not making headway if I haven't transformed things overnight. You change things one day, one person at a time.

It's that or executive orders, which only one person can achieve.

Unless you become president.

All right, well, thank you, Trisha. Fabulous questions from everyone who called in. See you guys later.

Thanks again. See you next week.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.