A Mining City Story: Jessica Walsh - Lactation Specialist

Guest: Jessica Walsh, IBCLC, BSN, RNC (Intermountain Health St. James Hospital)

In her role as Lactation Specialist, Jessica provides an invaluable resource for families, guiding them through their infant-feeding journey and supporting them as they navigate the choices and challenges of providing nutrition in a way that meets the needs of both mom and baby. 

https://news.intermountainhealth.org/st-james-healthcare-offers-guidance-to-mothers-struggling-to-breastfeed-their-babies/

https://infantrisk.com/

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Transcript

Emily: Welcome to Mother Love Season 4. I'm Emily Freeman, Storytelling Coordinator at HMHB and your new host of the podcast. This season we're launching a special series, A Mining City Story, co hosted by Cass Weber, whose motherhood journey we shared with you last season. The series will highlight the work of five labor and delivery nurses in Butte, Montana, who realized that more could be done for moms and babies in their care.

Through individual effort and community collaboration, they were able to expand resources and services for birthing families. Over three years and two pregnancies, Cass benefited from a transformation of Butte's perinatal landscape. This season on the podcast, she and I will speak to these nurses and care providers to learn more about what they did, why they did it, and the impact it had.

Our hope is that their stories might inspire you to seek out or create additional resources that your own community may need in order for families to thrive. I'm Emily, and you're listening to Motherlove. 

Emily: Can we just start in? 

Cass: I think, yeah. 

Emily: I have an icebreaker that sort of relates to this.

Cass: Oh, that's perfect. 

Emily: What was a parenting win from this morning? I think sometimes the mornings are so exhausting, so crazy. I don't know about you guys, but there's plenty of days where my kids leave for school and I feel like, Oh, I screwed up every aspect of that.

Jessica: A hundred percent

Emily: So, to focus on the positives, what was a win this morning? 

Jessica: I actually love this question, because this is something that I do daily in my life with my kids is think about wins for the day, because if you don't, it can feel very daunting. I would say the biggest win for us was my youngest getting out of the door out to school on time, and she's actually been on time all year this year, which is a very large win for us. 

Emily: It's a big deal. 

Jessica: Yes, definitely. 

Cass: What grade is she in now? 

Jessia: She's in third. And she's a procrastinator till the end of time, but if I just leave her alone she does it, she gets it done. I've taken a lot of lessons on my part. 

Emily: What about you, Cass? Did you have a win to share? 

Cass: It was a tough morning with a slightly sick four-year old who did not want to be left with a babysitter. But I have figured out the hack for Isla, the one-year old, for when I go to leave the house without her, which is, she loves food, so we put her in the high chair and we give her food and I leave while she's still eating.

Jessica: A little distraction. 

Cass: And then, so far it's been okay. How about you? 

Emily: My win was getting both kids to different places that they needed to be at wildly different times. It was one of those nights where when my husband and I finally chatted about what the morning was going to look like and he was like, well I'll be gone because I'm going hunting. And I was like, oh, okay. So it was getting the sixth grader successfully to a 7am new basketball thing that's happening before school, so that very early and then dragging the 14-year old out of bed, very tired, very reluctant, very don't-tell-me-what-to-do stage, as we've talked about and not only getting him, breakfast, dressed, homework done that was needed to be done, and to school on time. Every one of those felt like it could have been just a disaster, a minefield, and somehow it all lined up, and then I was on the highway on my way to Butte more or less on time.

Cass: Very good. Wonderful. Maybe we better make sure that we get you introduced. So we are here with the lovely Jessica. Do you want to give your full name and your job title for us? 

Jessica: Yeah, so my name is Jessica Walsh. I am a registered nurse. I'm certified in inpatient OB and I'm a board-certified lactation consultant.

Cass: Thank you so much for being here. 

Jessica: Yeah, thank you for having me. 

Cass: Just to give you a background of what we're even up to here. I've told you a little bit, maybe the last time that we had an appointment, but I witnessed all of these awesome labor and delivery nurses add to their careers and begin to do different things from one pregnancy, one delivery to the next, and just got really fascinated about learning more about your stories, and what your career choices were all about,and how that's going for you and what the challenges were and to make sure that you guys know how wonderful and impactful it was that you made those choices so that the women here in Butte have your services now when we didn't before. 

Jessica: Thank you. That's amazing. Those are the reasons and the words why I did what I did and why I keep doing what I'm doing. 

Emily: So just going back into the past, did you always know you would do work with moms and babies or did you find your way into this career path unexpectedly? 

Jessica: It's funny. It's a little bit of both. When I was in high school, I remember wanting to do ultrasound, because I wanted to ultrasound pregnant women, cause I thought that was so amazing and so fascinating that you could do that. And then I decided to go to [Montana] Tech and try nursing. It wasn't like something that I always knew I wanted to do. And then when I was in nursing school, when I did my OB rotation, it was like my favorite clinicals by far, favorite to learn about. I felt like just learning stuff was so much easier because I was so much more interested in it and curious about it. When I was done with school, I 100 percent knew that's where I wanted to be. I graduated in the summer and I started an OB in the fall that year. I’ve been in OB and working with moms and babies for the last 19 years. 

Cass: When you do your clinicals, do you do those on the labor and delivery floor, or do you do it in the OB office, or the mix?

Jessica: They do different things now. When I did it 20 years ago, it was all on the OB floor. We didn't do any clinic. I graduated with my associates first and got my license, and then while I went back to school for one more year to get my bachelor's, I worked at Rocky Mountain Clinic and worked for a lot of the OB providers there in that year. So I got some more exposure to that, working in the clinic there too. 

Cass: So can you tell us more about that transition that you made, like when did that change start for you? You were a labor and delivery nurse on the OB floor, when you decided that lactation support and traveling that path was of interest to you. What did that transition look like? 

Jessica: I think part of it was going through, breastfeeding and postpartum with my three kids and just having that experience and the challenges and what was great about it and what was hard about it. And then we started to be required to get a CLC certification through St. James, which is a certified lactation counselor, and when I went to that training and then some other conferences, I learned so much. And again, I was like, it was one of those things when you're just really interested in it and passionate about it, you just learn things easier and faster. And I really actually enjoyed those and just felt like they gave me tips and information on how to better support moms. And so then I got more involved in it when I was at work on my shifts and things like that. I started to come in a little bit extra if people were having trouble, they would sometimes call me and I would talk to them over the phone or maybe meet them at the hospital or start at the beginning of my shift if it wasn't busy and try to give more support after they went home from the hospital.

And then I didn't really know exactly where it was going to go, but I knew I wanted to just move to lactation and breastfeeding. So I decided to get my IBCLC certification and it wasn't really this is why you're getting this, and this is what you're doing. I was just like, I know I want to do this and I can't do this here, I'm going to do it somewhere. So I'm just going to roll with it and figure it out as I go. 

Cass: Yeah, that makes sense. Was that able to be done online or were you doing it in person? 

Jessica: So with that certification, you have to have 90 hours of education in breastfeeding. So it was all online courses that I found and did on my own. And then you have to have a thousand clinical hours before you can sit for the exam. And I was able to use my experience on the OB floor as those clinical hours. 

Cass: That's great. 

Jessica: Yeah, so that helped a lot. So probably from start to finish, I think I decided and started studying and things in the fall, and then I took the test that next spring and then had my certification in the summer. Once it was like, okay, I'm going to do this, it was, it felt long when you're in it. I hadn't studied that hard in a really long time, but it went pretty quickly, if I look back at it now. 

Cass: That seems fast to do that much while you were working full time and mothering three children. Were you still breastfeeding at all when you were going down those educational journeys or is it all after?

Jessica: Nope. When we started to be required to have the CLC, that was around the time when I had my third, and I was so much more successful in that journey than I was with my first two. And I felt like I knew a lot as a labor nurse, about breastfeeding and you don't know what you don't know. And there was a lot. I didn't know. And it made such a big difference, and part of it was she was my third, and I actually worked part time by that point, which I think also makes a really big difference. But really I think the biggest thing is I just had so much more knowledge and the science base behind it and just how to make it be easier and more successful. And that really made such a big difference, for that journey, for sure. 

Cass: Yeah. That's really cool that you got to experience the benefit of the education for yourself too. 

Jessica: Absolutely. A hundred percent. 

Emily: Was it, this may be going off on a tangent, we're not ready to go down yet, but I'm just curious, was it mechanical stuff that you were learning? Was it diet and nutrition? If someone stopped you on the street and said, what are your go-to three best tips for someone who's trying to improve their breastfeeding experience? 

Jessica: I think it was how to maintain, protect and maintain milk supply because that's a big struggle for a lot of women, especially when we're expected to go back to work, very early for most people. So I think it was that, and it was also how to be more successful in the early days with latching and skin-to-skin and hand expression and like all those. I had helped hundreds and hundreds of moms with latching and that kind of thing, but I got more fine tuned with that as I got more information and I think better teaching skills. Like I was always like, I know what I'm looking at, and I know how to get the baby on, but I didn't really know how to explain it to people so that they could feel confident, doing it when they went home. And so I think, a lot of that really made a difference and for me, I think most of it was tailored around how to protect my supply and how to just maintain that relationship when you are bouncing back and forth between work and home and that kind of thing too.

Cass: I'm curious. Because you were in the world of OB and working with so many moms and stuff. Were you aware of the fact that there was no IBCLC around for your moms to refer to or to, did you know that system was broken when you were seeking that education? 

Jessica: I don't think I really realized that for quite a few years. When I was working in labor and delivery because we just focused on when you're there to have your baby and we help you and then you go home and then we don't really hear or know or understand what goes on after, and I didn't feel like it was an issue for me to not have someone to reach out to, but I also didn't understand how beneficial that could be either, and so I think it was one of those you don't know what you don't know, and you don't really know what you're missing out if you don't really know that it's there and it's an option. 

Emily: Cass, with your first baby, you're saying there were no lactation consultants in Butte? 

Cass: No. I got really bad timing. 

Emily: Oh, COVID baby. 

Cass: COVID baby, but even if I had everything, Butte just had bad timing too, so we had a really experienced IBCLC working out of the health department for a very long time, and I knew that she was there. So I was expecting to meet with her at some point when I got pregnant, but she stopped working right before COVID, and not because of COVID. I think she stopped in maybe January of 2020, right before Rowan was born in April. So I remember even before I had any breastfeeding needs or anything like that being sad for the community and oh, shoot I don't have that resource if I need it anymore. And then Rowan had a bunch of issues that we didn't know about because we were so isolated during COVID and he had. A tongue in a lip tie, but his latch didn't hurt me and he was really motivated to eat. So he was just eating all the time and I didn't have any of like what I had with Isla, which was experienced breastfeeding moms around like saying hi, my sisters or friends seeing that he was breastfeeding too much. It was either he was sleeping, nursing or crying, like that was it with him. And so we were just in survival mode, COVID-wise, new-baby-wise, and inexperienced in like the real feeding experience of normality. So we're just like it doesn't hurt and he's eating, so things are normal.

And I remember telling Matt oh, I wish it was chubbier. You want that like chubby baby of cuteness, and he was skinny and then we went to our first-month checkup and he hadn't gained any weight and so doctor was really concerned and we immediately started trying to figure out formula that would work while we started figuring out how we get an IBCLC appointment, how we connect with the milk bank, which is all the way in Missoula, and what to do next.

So that became quite a struggle quite a journey for us in that because there was no one in Butte, and it was COVID so it was hard to meet with people in person anyways we were able to at least find support in Missoula and get an IBCLC who helped figure out that there was a tongue tie, lip tie issue who referred us to a dentist in Helena. We went to get that revised and then we got to do the pure torture that is the physical therapy post-aftercare of a tongue tie release.

Emily: I would love to talk about tongue tie. Partly because yesterday when I was taking a walk with my 12-year old and said I was going to Butte tomorrow and he asked why are you going to Butte? Who are you interviewing? And, I said it was a lactation consultant and then he started asking because he remembered hearing that he had his tongue tie cut, and that whole thing, and had all these questions about it. And so we chatted about it a little bit and hadn't really thought about it in years, he's 12. I saw some article recently about how people are doing it too much and hospitals are charging too much, and I'm just curious to ask your thoughts on it, to maybe define it in simple terms for someone listening who doesn't know what it is. Can I pick your brain about it?

Jessica: You can. It's a very hot topic. It is. And it's very controversial in the medical community and different communities that support moms and babies. So there's different classifications of tongue tie, but just to simplify it the most, it can depend on where. The lingual frenulum, which is the attachment under the tongue, attaches to the tongue. If it's more towards the tip, it's considered anterior. If it's back farther in the mouth, it's considered posterior. American Academy of Pediatrics is not totally on board with tongue tie release, mainly the posterior release. That's the one where you go and have it lasered. at a dentist and there's aftercare and things like that.

The anterior portion is usually very thin and usually the pediatrician can clip it with scissors, give a little better tongue mobility, tongue extension. Sometimes it's enough. Sometimes it's not. I think the most important thing. For people to remember when they're thinking about tongue tie, is it can look very different from couplet to couplet.

So like you had no nipple pain and you were like, he's feeding and he's motivated to feed and it doesn't hurt for other people. They might have like significant nipple pain and damage. And again, a baby that's not gaining weight because they have a hard time transferring milk because they're not able to use their tongue effectively.

Some can gain weight just fine, but they're constantly puking and fussy and crying all the time because there's a lot more air intake with it. And so it looks very different, which makes it a cloudy situation to say, I think this is what it is for me. I think when I look at tongue tie, I look at every baby's mouth when they come in to see me to see what it looks like. But then I'm also looking at what is the feeding assessment at the breast? How do they feed? What does it look like when they feed? What is their milk transfer like? What are their symptoms? And then going down that cascade and then deciding, are there other non-invasive modalities that we can take.

And for you, you didn't have that option. Like you were just winging it at home on your own, and so you didn't have that guidance, which is very, it's a big deal. It's a big deal to go through that and not have options and support because there are a lot of, sometimes we can look at body work. Sometimes there's some body work that can be helpful with it. And sometimes there's just position techniques that we can change. And every case is very gray. There's not a lot of black and white with breastfeeding. There's basic things that we always want to do and we always want to make sure are in place, but it's not very black and white.

Every individual is different. Every baby is different. And so it's very case by case. So for me, and I think probably for most pediatricians and, medical community, I think the biggest takeaway is that when they say it's being done too much, I think with social media and things being so much more accessible and easy to hear about and see, I think the concern is that people are just going to that thinking breastfeeding is hard, this must be why, and then having an invasive procedure done. And the important part is that you have some lactation help before you go down that road to see, is it really necessary? Are there other things that we can do? Can we correct positioning and latch? Can we do some body work? Can we look at other things?

And then I think, there's lots of different opinions, but I think at that point, if parents are ready to explore that more than we have done, a lot of what we can do to. Try to not have to do something invasive and then at that point, you know, then that's their choice if they want to get an evaluation for that and look into that and see if that can make a difference for them.

Cass: Yeah. Whenever someone asks me, a mom with a new kiddo who's having any issues, I'm going to ask them a couple questions like how important is your breastfeeding journey to you, and if it's very highly important then we can keep talking about it, and what support do you have for afterwards, because I'm not kidding about how difficult doing the physical therapy afterwards, if you want it to be done correctly, involves waking your kid up, making them cry, physically invading their space, like really, we called it the torture and for a long time, you have to do it like for many weeks, and so if you're already having a hungry kid who maybe isn't sleeping that well, who's maybe colicky, and then you get them to sleep and you're like, we got to do that. We got to do that stretch. We got to wake them up after an hour. It is torture and it's really hard and doing it when you're postpartum and you're not sleeping and maybe you're having to do triple feeding, which is what we were doing, which means you're breastfeeding and then after breastfeeding, you're supplementing with either donor milk or formula and you're pumping in order to keep your supply going. And then you're also doing that. You need hands-on, extra help to do that. It's not a one-person job. It's not a, you have your six weeks of maternity leave and you can do this all by yourself, in my opinion. I think you need help. Otherwise, it just puts too much of a mental health burden on mom or primary care provider who's doing that by themselves.

Emily: Yeah, that's a really good point. Like being tuned into how much are, how much is mom prioritizing baby or her expected vision of how this was going to go to her own detriment. So mom's mental and physical health is suffering because all this effort, emotional effort, physical effort, all of it is being put towards this singular goal that you had in mind when you were pregnant, and that, that I think brings up an interesting question, have there been times where you've recommended someone step back from the idea of breastfeeding or of exclusively breastfeeding or, whether for their own, physical or mental health reasons or, obviously the goal in your line of work is to support them and to see success as the goal, but are there times where you've ever been like, it's okay.

Jessica: Yeah, I don't know that I have ever recommended and said, hey, I think you should stop, because I don't think that's my decision to make, but yes, are there times when, we have to have a very hard conversation of right now, they're either not able to transfer the milk that they need to gain weight, or you're not making enough milk. And that takes some detective work. That's not just a come see me for 10 minutes and we talk about that, it takes some time and some visits. But yes, if I feel like it's a health concern for baby that we need to add in some donor milk or some supplement, absolutely, we're going to talk about that because we want to make sure we're looking at both ends.

And then for me, I think it's information on what paths we can take. Here are a couple of different paths that we can go down. This is what this would mean. This is where we could go. These are some options that you have. These are benefits of each option, maybe some drawbacks of each option. Then we talk through those and helping guide them to find their path that they feel the most comfortable with. And yeah when breastfeeding doesn't go like you imagine you want it to go, there's a grieving process with that. There's a lot of heaviness. And that's you're sometimes very much built into your identity as a mom, and it can be a very brutal process to heal from and navigate through. So absolutely. And sometimes moms come to the conclusion that they want to wean completely, whatever that reason might be. And if we've talked through all the options. 

My biggest thing is I don't ever want anyone to feel like I am pressuring them to breastfeed. I want them to have knowledge and information on why breast milk is helpful, why breastfeeding can be good, but also it's their choice. I just want them to have the information so that they can make an informed choice and not look back and say, if somebody would have told me that, maybe I would have made a different decision. And then, once they decide, then it's: okay, this is what we need to do next, and this is how we can wean safely so that we don't have clogged ducts and mastitis along the way, and, here's some support groups that might be helpful, and here's some books that might be helpful and things like that to support them in that grieving process.

Cause it's big, it's really big. 

Cass: Yeah, it makes a lot of difference to have that support and that help. And when you're having the struggles, cause it does just get so wrapped up with that motherhood identity. And for me, it really was wrapped into grieving for my mom who had died. and wasn't there anymore for me, and breastfeeding was a huge part of her identity as a mom. She breastfed for multiple years, five kids. She started the first La Leche League in Montana. 

Jessica: Oh my gosh, which for that generation, like that's huge. 

Cass: Yeah. Other moms are being told to feed karo syrup. So that was like where she was radical a little bit, and one of the really cool, interesting things about her and. I breastfed till I was four. I have memories of breastfeeding, so it was pretty important to me, which is why we went down the path of doing all of the things, even though it was extremely difficult because it was really embedded and a part of my value system. And I just would not recommend someone who doesn't have that internal, forceful motivation to go down such a difficult path when you're already doing the hardest thing that there is to do, which is raising a zero to three-month old. Really hard time to add that in.

Jessica: Yeah, you definitely have to be In the right frame of mind and have the support, like you said, and some moms choose not to do it purely because they don't have the support or they have to go back to work and they would have to have a daycare provider doing the stretches and, things like that, and that's just adds a very, another large layer of trickiness. 

Emily: I think as we all progress on our mom journey, we, I laugh sometimes at the things that I find myself doing or saying with my kids and I never imagined I'd be giving them a frozen pizza for dinner. I rely heavily on frozen pizzas these days! It feels like motherhood is like a long journey of small grief moments and yeah, maybe breastfeeding one is a big one, or just like we were talking about becoming a mom of a teenage boy and grieving the former identity as a mom of a younger kid, and just being really having a lot of grace and kindness for the other moms and women in your midst who are on these journeys and not ever shaming someone for their feeding their kid a certain way, or not breastfeeding or breastfeeding too long. We all make the choices we need to make to get through the day, to keep our own mental health intact, or our own financial health intact, and having a big heart for other women on these journeys.

Cass: It's so much work. I can't remember now the exact number of hours that breastfeeding for a year is, but it's like right under a full time job. 

Emily: Yeah I just distinctly remember, and I was part of a sort of a, where I lived, in the time when I was breastfeeding, it was a very kind of attachment parenting, like baby wearing, I breastfed all the time, partly because I was exhausted and it was just simply easier to, do it that way. But I do distinctly remember always being so hungry and never feeling full for two years, and then realizing once you wean and you're like, not just making food for two humans and you're like, oh, I ate a meal and I'm aware that now I'm full instead of just being this machine that's constantly like creating fuel and yeah, just always hungry. I got really worn out by it. I think if I were to talk to my younger self, I'd be like, hey, what are you doing for you right now, to fill your tank? Because I was definitely like running myself ragged in service of this idea that I had, this ideal, so I love your approach, that you're not saying, this is the way we do it, this is the best and only way. But that you're like, here are your options, here's some good science-backed information, and how can I help hold space for you to make the decision that's best for you and your family?

Jessica: Absolutely. Because I can, when they tell me what their goal is, then a lot of times I'll say, and maybe it's triple, we have to do some triple feeding for a while. And it's okay, best-case scenario is we're pumping after every feeding, which is about 8 times in 24 hours. But what do you think that you are able to do over the next 24 to 48 hours? Because I can tell them all day long, this is what I think you should do. And I don't want them leaving my office thinking: she's nuts. There's no way that I can do this. There's absolutely no way. And so I want to have a realistic idea of what do they feel like they can handle? What do they feel like they can take on so that we're on the same page?

Because if I think they're doing one thing and then they come back and see me five days later, and they've done a very different thing, then we're having a very different conversation. So it's something that I want to make sure that they're not feeling like I'm putting unrealistic expectations and pressure on them, so a lot of the conversation is, this is what I feel like would be the most beneficial best-case scenario. What do you think you can do, based on that, and sometimes they're all gung ho and sometimes it's like, they're very realistic and they're like I have four other kids. There's no way I'm gonna do that in a 24-hour time period, and then we talk about what they think they can do, and you know what we can build up to and you know have realistic expectations that way as well.

Cass: Can you think of a specific mom who really benefited, who really got a lot out of working with you? 

Jessica: I was thinking about that question and, I can think of some specific people that stand out, but really, I feel like It's almost an unfair judgment for me to say this person really benefited a lot, because even if I look at a problem as this is pretty small, easily fixed, that might feel so huge to that person. And another person where I'm like, oh my gosh, like this is such a disaster, and they're like: it's fine, we'll figure it out. It's fine. So I feel like they, what they get out of it, I think is the most important part. And sometimes, it's moms coming in and in tears because it hurts so bad. And their baby's crying all the time and hungry. And, when they can get that pain relieved, nd see that their baby gains weight, you can just see the relief on their face. Like I can see from one visit to the next, I can tell the minute that I see them, if it's going better or if it's still hard, you can see that all over their face and sometimes I'll have moms that have mastitis and they have. a fever and body aches and headaches and chills, and they feel absolutely terrible.

And, having them come in and teaching them how to do lymphatic drainage and shifting swelling out of the breast, like it brings their pain level down almost instantly. And they're like, oh my gosh, thanks. Like you're sitting there, helping them massage their breasts and I thank you so much, and then you talk to them 48 hours later and they're like, I feel so much better.

Emily: And I think that's like being a woman in general. It's navigating pain throughout your life and never knowing like what's a sort of normal or acceptable level of pain in different parts of your body. And so I think, yeah, for a lot of people, not knowing maybe it's supposed to hurt or maybe, or maybe it's just helping someone identify and navigate discomfort is, it's huge. 

Jessica: There's like leaking fluids everywhere. And there's, some people are not comfortable with that. And some people are not comfortable feeding in public. And so they're navigating the discomfort of figuring that out and finding a plan for that. And can they work into that and become more comfortable or can they not? And, so I think there's just so many things to navigate from person to person. And when I do see people in the community, I saw a little two-year old the other day coming outside the Y and, I was like, I can't believe she's two, and mom’s like she's here because of you. And I'm like, no, she's really not. But, I think they, they feel so deeply appreciative for that support and that help because feeding is a huge part of taking care of a newborn and an infant, that's literally the majority of what you do for the first several months of their life. And when that's a struggle, every couple hours that is so daunting.

And so I think, everyone gets benefit from it in a different way. And it's like maybe helping them come to the realization that maybe this is the end of their journey and that can be okay. And helping guide them in powdered formula versus ready-made formula and donor milk and different options and paced bottle feeding and how to feed in a way that we're not overwhelming and overfeeding them with a bottle.

And, so there's a lot of different ins and outs. So I don't know if I could really like totally pinpoint, oh yes, this person, because I think everybody takes a little bit different of what they want from it, if that makes sense. 

Cass: Totally makes sense. Yeah, it's so funny. It's also just such a roll the dice, luck of the draw, what kid you get a little bit too, but education is so important. We met when I was pregnant with Isla and I knew you were around, but my midwife was like, oh, you should have a prenatal appointment. I'm like, I definitely want a prenatal appointment. Even though I'd gone down the crazy breastfeeding rollercoaster that I'd done with Rowan. So I learned a bunch and I experienced a bunch. And he ended up breastfeeding until he was six months old. And as soon as solids got introduced to that child, he's like I'm done with that work. You crazy people. This is awesome. And he was just voracious.So I was very happy to make it to six months with him.

But I knew with the new pregnancy that having that support and developing the relationship with somebody who I might get to meet if I had any issues later when I was still pregnant was I was so grateful for the opportunity to have that so different than what I experienced the first time to be able to know that I would have somebody I could just call on immediately if anything weird was happening and it was even in after I met with you, and we just did that prenatal appointment that maybe you can tell us more about to what that kind of entails and what purpose that serves.

But for me, it helped me go okay, now I know how the system works and how Jenna and the nurses can help me connect with Jess if I need to in the hospital. And it's like in my plan. And then you can just let it go as a worry, as an anxiety, as a mom, which is like half of the struggle of every single thing as a mom, I think, if you can find a way to – 

Jessica: Check something off your list. 

Cass: Check it off the list so you don't have to think about it anymore. Then things tend to work out a little bit better in general because anxiety causes so many problems with all of these systems and all of the things. So that was really helpful. 

Emily: I'm interested in this idea of a prenatal visit with a lactation consultant, if you could speak to that more. In my experience, I think we learned about it, but then we only wound up going to a lactation consultant once the baby was there and having some difficulty and, more of a reactive, rather than a proactive kind of thing.

Jessica: Yeah, and you're exactly right. It's more proactive. And so it's basically a class when it's just me and that, mom or that, whoever she wants to bring with her as a support person. I always encourage that because two sets of ears are better than one. And I usually tell them bring whoever's going to be with you the most in the first couple of weeks after baby's born, and it's just education on the benefits of breastfeeding, how to position and latch a baby, how to hand express some basics on pump and pump fit, and I feel like I have a hard time because I want to tell everyone everything and I want them to know all the things and then sometimes I like flood them with information and they're looking at me like, oh, gosh. So I'm always reinforcing, you're not going to remember all of this. It is not something that everybody, anybody expects you to remember all this, it's exposure, so when the nurses repeat it, you're like, oh, yeah, I do remember she said that when I repeat it. Oh, yeah, I do remember she said that. 

And then the other thing is just knowing I know she told me something about this and I can't remember what she said. Maybe it's engorgement, whatever, but they know me. They have a relationship with me. Hopefully they're comfortable with me after meeting with me and they feel comfortable calling and saying, hey, I'm having this problem, what should I do? And then deciding, is it something I can help them with over the phone or do they need to come and get some more in depth care with an appointment? So I think it is information because those first couple of days are really important for building and protecting milk supply. Latching we can like work on as we go along and we can keep working on that. But if we don't protect supply, it makes things a lot more challenging. And so it's just taking the guesswork away a little bit. So they know what's normal, what's not normal, what should I be focusing on? And then, like I said, they have my number, they know my face, they know where my office is. It doesn't feel like this big, stressful thing to figure out how to call and make an appointment and where do I go and where do I check in? They've been through it and so it just takes some of that guesswork and that stress away and they're like, I know her and I'm gonna go get some some help rather than never meeting me before and somebody just mentions, hey, there's a lactation consultant and you're like, I don't know this person. Is she gonna be helpful? Is she not gonna be helpful? 

So that's the idea is just them understanding their resources so that they don't feel like they're just out there flapping in the breeze, trying to figure it out. 

Cass: And within the system, if there's an issue right away at birth, you do have the ability sometimes to come to the labor and delivery unit if necessary. 

Jessica: Yep, so right now the nurses are the main support in the hospital at St. James and they're all certified lactation counselors, as long as they've been there long enough to get into the class and take the class. And then if the patient's pain's not getting better or the nurses are like, I'm not really sure what to do from here, they can talk and the patient can say, hey, is Jess around or the nurses will sometimes be like, hey, let's see if Jess is around and see if she can come take a look at this. And as long as I'm not full in the clinic doing the outpatient side, then I can come up and see them that day. And I do my very best to make that happen if it needs to happen. And if worst case scenario, it's a phone consult to figure out what's going on and what I can support them with in the meantime over the phone, and then getting up there at least within a day or getting them into the outpatient clinic within a day and that kind of thing too.

Cass: I think those systems being integrated is so helpful. And then what I know from having done the prenatal appointment and a postnatal check in is that if you opt in to the text message check ins, then you get an automated text message checking in on your breastfeeding, like, where you're at, and seeing if you need any help, and if you say, yes, I do need help, then Jess gets a message and calls you to check in.

There's so many barriers in that time period for parents to seek help or know that they need help and having that check-in reminder to say, oh, yeah, maybe this isn't going so great, or I do have a little question. I can't even remember what my little question was when you called that one time.

Emily: Yeah, but that's such a good point when you're so overwhelmed and exhausted and disoriented by this whole new experience you're going through, that's the hardest time to be like, I'm going to make a phone call and seek out some resources. Like, you're just surviving. 

Cass: I'm going to call somebody and leave a message?

Emily: And wait for them to call you back. And maybe it's a good time. 

Jessica: I have to talk to them on the phone? I know. It's the worst. 

Cass: And probably, I don't know, as generations change too, the younger generation is way more comfortable via text a lot of the time. They don't want to make a phone call, so being able to have you call. 

Jessica: Yeah, it's helpful. Yeah. And MyChart is another option that I use a lot. Sometimes it's, okay, I need to ask you way too many questions. So we just need to try to talk over the phone. But I find that some people, that's the only way I can get ahold of them is to message them and then they'll get back to me right away. And I think that's, there's just a difference. People are, some are comfortable and some would rather have a phone call and some are like, please don't talk to me on the phone. It's just good to have those multiple options. 

Cass: So that system makes me curious about your journey, because you were a labor and delivery nurse and you did all this education on your own and got the certification on your own without any systemic support, right? And then what do you do with that? You want to make a career transition and you found a way to navigate that career transition to being in creating a completely new position in the hospital with a new office and a new billing system and a new everything like that had to be a ton. 

Jessica: It was a process. 

Cass: To figure out.

Jessica: It was a very long process. And I had to really put on my patience pants because I really wanted it to happen right now. And, that's not how it works. 

Cass: Systems move slow. 

Jessica: Yes. When you're trying to create change. And I think, funding was a big barrier in the beginning. The St. James foundation was very instrumental in helping us get started and until we could get higher volume and that kind of thing, we did get a grant and we're always looking for more grants and more help with that for sure. That's been a really tricky, honestly, thing to find is funding.

Cass: The foundation is ,for people who don't know, the charitable side of the hospital, so they do fundraising and help fund specific programs like the breast-checking bus and your program. So yeah, that's really great that they were able to jump in and help get that started.

And that even though it took a lot, the system made space for you. 

Jessica: Yeah. And I think getting word out that it was available. That it was there and having people come, and feel comfortable coming, and getting word out to the providers that it was available and you know what in just feeling your way through and okay, this is working.

This is not working. We need to tweak this and shift this and move this, and just fumbling your way through some of that. And I did a little bit of both for a while. I still worked labor and delivery and did outpatient clinic part of the time until I felt like it was at a point where I could just move to the outpatient side. I felt like I could do that sustainably for my family and stuff as well, and, that was a balancing act trying to figure out how to, balance work and home life and stuff too. And yeah, it was a journey and it was a process. Lots of amazing moments and lots of very frustrating moments, but it was all worth it, and we're still growing and still expanding and still working on new things. 

Cass: And being in the hospital, does that help you bill insurance or are people able to pay with HSAs or FSAs for services? How does it all work on that? 

Jessica: So most insurances cover lactation visits now, which is helpful. The tricky part is Medicaid. Medicaid does not recognize an IBCLC as a billing provider. And if I were to go on my own and have a private practice, I would not be able to bill Medicaid. And I would be able to bill insurance on my own, but in our community, Medicaid is a really high portion of our community and they need support, just like everybody else needs support.

Emily: Do you know if there are any conversations going on about, trying to find a way to cover that in Montana? 

Jessica: In other states, it is covered, and I know it's being talked about in Montana, but it's, my understanding is probably several years off. In the hospital, we can bill both insurance and Medicaid because St. James is the billing provider. I am not the billing provider. And so that's how that works logistically. So it's nice because I can see everyone, regardless, and we have a patient compassion fund. So if we have a patient come in that is not connected with Medicaid and services, and they don't have insurance and they’re private pay, and they can't, we can connect them with help with that so that we're never excluding anyone those services because they can't pay for them.

Cass: Those tricky healthcare systems navigation pieces. 

Jessica: Yeah, so we need the big players to step up and understand how important that start is for people and there's so many health benefits for moms and babies and it's just, it's starting off on a good foot. I just don't think we view it as a health benefit as we really should. And I think we forget that moms have lower risk of breast ovarian and uterine cancer, and they have lower risk of heart disease, and type two diabetes, and postpartum anxiety and depression, if breastfeeding is going well. If breastfeeding is not going well, it's very triggering to depression and anxiety, there's a lot of significant health benefits for moms in addition to babies, and I don't think we really recognize that or paying enough attention to that. And so I think, just those policy makers and those bigger players are the people that we really need to get their attention and get them on board with it as well.

Emily: How do you advocate and get provider buy-in from a place that you're working? What's the angle? Do you tie it to some financial benchmark? Do what do you recommend? 

Jessica: I think you have to have a lot of grit and perseverance. And I think it does help to have a positive relationship with providers, because when they feel like what you're doing is helpful and beneficial, they're going to back you a little bit more, and I don't know that there was any one thing that it was tied to it. At this point, for us, it's not like a money-making thing, we don't make money from it. But I think that they get a lot of feedback from patients on how helpful it is. And the nurses have given feedback that when patients come in and have prenatal consults, they do way better with comfort, with positioning and hand expression and all those things that they're asking them to do in those first couple of days. For the most part, they can tell, they're like, we can tell when they've come and seen you before and, when they haven't, it just really makes a big difference. 

And so I think hopefully, it takes a little bit of push to be like, hey, this is really important. We need to do this. And then as you go along, people start to see how beneficial it is. And then it's more accepted and it's more this is just something we have. This is something we offer. This is something that we use all the time. It's not oh yeah, there's also this thing over here that's maybe going to be a little bit helpful too. 

Tracking breastfeeding rates, it's a healthy people goal. And so if you can track that, which is tricky, and that's part of those follow-up calls is getting some feedback. Are you exclusively breastfeeding? Are you breast and formula feeding? Or are you just formula feeding? And that helps us track a little bit. It's not great because it's only the people that actually respond. So it's not everyone, but trying to be able to show that you're actually moving some numbers and you're those kinds of things is super beneficial also because it's not just me saying, hey, I see how helpful this is for people. 

Emily: But having some data to back it up. 

Jessica: Yes, exactly. 

Cass: If you ever need someone to speak to anyone about the benefit, you just tap me in.

Jessica: You've got it girl. 

Cass: And I also see you, because I'm in Butte and I am aware of stuff, like you're also helping get supplies at the hospital to be able to be purchased locally in town, because I know like I needed different sizes for my flanges and stuff like that. And you can't, there's nowhere in Butte to find any of that, or there wasn't, and I know that you've been working hard to get the [hospital] gift shop to be carrying some breastfeeding supplies, like really useful, practical things for people. 

Jessica: Absolutely. There's a lot of logistical things that come with it, but we were able to get, the supplies in the gift shop, which is really helpful because then people can come and get a little silicone insert that just pops right into whatever the pump they have and it sizes it for them, which is significantly important in comfort when you're pumping, and for milk output when you're pumping and in our culture, in our society, like pumping is just a part of it. Like we don't get, we're not supported well in having time off, and a lot of people feel really good that they have 12 weeks.

And if you look at Canada and the UK, they get a year maternity leave paid at 90 percent and then they can take a second year, I think it's at 60 percent. And we're like, yay, we get 12 weeks and we use our PTO time. 

Cass: If you're really lucky at 12 weeks. 

Jessica: Yeah. And so pumping is just a reality. If you want to breastfeed after you go back to work, pumping is a hundred percent something that you have to have, unless you get to bring your baby to work with you. And for a lot of people, that's just not an option. And so I tried to focus on the things that I thought would be just the down and dirty, most important things that. We would need because not every person needs the same things, there's a lot of products. There's a lot of breastfeeding that's a big market. There's a lot of products. You can spend a lot of money. And a lot of times, we spend money on things that we want to help us, but we're missing the basic lactation pieces and the science behind it. And if we don't have that down, you're going to have all the pieces and parts that you can imagine, and it's still not going to help if you don't know why you're using them and how to use them and if it's appropriate for your situation and that kind of thing too. So yeah, it's good that we have it and it's also important that you make sure what you're buying and why you're buying it.

Cass: That's the beauty I think of having it connected like at the Nursing Nook where you're talking to the lactation consultant and they can help you navigate what to buy and what's gonna be the best for you Same thing here like you being able to say I'll take you over there, op over there like we'll just go look and we'll find I'll help you find the right one That reads the correct millimeters for your particular nipple that we just measured in my office. And I know, we know it's right and all of those things. That piece is so much better than ordering it from Walmart and going and picking it up and hoping that it's the right thing. 

Jessica: Yes, absolutely. 

Emily: How do you see the landscape of breastfeeding support and just generally birth-related services and supports changing in Butte over the years that you've been in this world. Are there more professionals in the work? 

Jessica: I think in the hospital Just starting within the hospital first like we do things so differently than when we did when I started 20 years ago and we're much more on board with research-based science behind breastfeeding and how to get it off to a good start and that kind of thing and I think The culture in Butte has just changed that we just rally around moms far more than we used to, having the opportunity to have the prenatal classes and the Spinning Babies and the breastfeeding class before and those kinds of things. 

And then, having that midwifery model is a really different model of care and. I think it's brought a lot of women back to Butte because there were women that were leaving town to go for that model of care. I just think that we have realized that it's not just you take care of the mom when they're pregnant, and then she has her baby, and then you just forget about her because it's, that's not a thing anymore.

We're much more in tune with maternal mental health and making sure that we're staying on top of that and supporting all of the pieces that come with postpartum and where it can be tricky and hard. I feel like where I want to see some change is like support group type situations. I am hoping to maybe start a breastfeeding-specific support group right now. I'm just gauging interest to see if people would be interested in coming. So that's something I'm working on. There's something about being in a room with other moms with their babies and the same season talking about what's challenging, talking about what's working, and just feeling like you're not alone in that situation and that scenario and some people have a lot of friends that are the same age and have kids and they have that support and stuff and they don't necessarily need the support group, but some people don't have that and so having an option for that support.

Cass:  It's complicated. I think finding a way to disseminate that information to the people who really need it, who are isolated, is hard and a communications challenge. And then getting them motivated to go, like incentivizing, maybe that a little bit, finding a way to incentivize it so that they can experience it. Cause it's just a lot, that's a hard thing to ask even when people really need it. And maybe even, especially when people need it, it's especially hard to leave and get all the things, parts and pieces organized. 

Jessica: And yeah, we have a option for a virtual support group through one our sister hospitals in Denver, and so sometimes I talk to moms about that. If they show real interest, that they could, they don't even have to leave. They could just get on and sometimes leaving is important, but like you said, sometimes they're not going, it’ss not an option. It's at least it's an option to get on and connect with some other people.

Cass: And maybe once that connection starts, they'll be motivated to say, Oh yeah, this is helpful. I will go motivate to get out of the house and do this. And as somebody who moved to Butte and doesn't have family here, even though I have a very good friend community around, not having any direct family, that system of raising your kids together as a village is really hard to manufacture. Even if you're a good community connector and you have a lot of folks, that kind of deep level villageyness is really hard to find, especially when you need it the most, which is when you're swamped in early, the first couple of years of babyhood. When you don't have the family here, so it's definitely needed and I think it would be really wonderful to find more ways to get people connected to that.

Awesome. Any other questions? Anything we didn't cover, Jess, that you can think of that you wanted to share? 

Jessica: I just hope people know that I'm there, and that it's available and hopefully they're comfortable coming and maybe even other providers that aren't at St. James, knowing. And I do have a relationship with some of the pediatricians from Anaconda and they refer people to me sometimes too. So just getting the word out to surrounding communities and things like that too is the biggest thing, just knowing and understanding that it's, sometimes I think people are like, I'm going to go see this lactation lady and she's going to be really pushy and want me to do all these things that I don't want to do and, hopefully people understand that's not what it's about. I'm there to support them and whatever they choose and it can be all kinds of, it's basically infant feeding. Yes, I'm a lactation consultant. Yes, it's a lot about breastfeeding, but really it's infant feeding and just making sure that they're comfortable in the place that they're at with feeding their baby. 

Emily: That's a really important distinction. I'm like I'm glad you brought that up because I think you're right. That sometimes what we name it really matters. Yeah. And so if someone's like, look, I know I'm not going to breastfeed. I know it's not an option for me. I'm not going to go see this person cause I'm not, I can't go down that route for whatever reason, but to, yeah, just to open it up to: it's infant feeding. It's, how can we help your baby be successful getting their first nutrients and calories, no matter how it happens. 

Cass: And trying to get rid of some of the misconceptions that new science has shown us, because I think a lot of people think they can't breastfeed because of a medication they're taking, or a diet they have to follow, or whatever it happens to be, and we have so much new research that shows that's really not true and we have some really good providers both lactation providers and psychiatrists who are trained to help you navigate what meds are safe and what aren't. 

Jessica: I think the biggest thing is if anybody's ever telling you that you can't breastfeed because of a medication or a condition, I think it's always good to get a second opinion and make sure that's 100 percent the case. I always tell patients with medications that very rare is a medication a hard stop. And, we've come a long way, even with anesthesia and surgery, there's all kinds of things that we can give that you can still breastfeed with and you don't have to pump and dump for days on end because of it and things like that. And I don't think people, some people realize that and they don't want to hurt their baby. They're just trying to make the best decision that they can, but my gosh, pumping and dumping for even 24 hours, that is heartbreaking for people. And so that's my biggest thing is if you have any question about that, like just ask, call me, ask. 

There's also a really great resource online it's called infantrisk.com and it's a website that was developed by a pharmacist who has dedicated his whole career to medications and lactation and you can get on there you can click on resources and call the 1-800 number and you get a nurse that has all of the research and information in front of her and she can say yep it's fine or yeah it's maybe okay but this other medication works in the same way and this might be a better option to start with. 

Emily: That’s an amazing resource. 

Jessica: It's fantastic. 

Emily: We'll have that in our show notes. 

Cass: Absolutely. And I think, remember to tap in your personal resources too, like I had to have two DNCs for retained placenta after Isla was born and one, they were both at St. James and I was super impressed with the anesthesiologists, and the OR nurses, and everybody, as soon as they knew I was breastfeeding, bent over backwards to make sure that I could breastfeed like right before I had any thing given to me and then get the baby to me really quickly afterwards, and so they were really on it, but then I also called my pharmacist and said are there post-op medicines that I should avoid because of breastfeeding? And there's one antibiotic that you should avoid, and I was sure to make sure that we didn't get that prescribed. It was really helpful to have that all figured out ahead of time so that I knew that my breastfeeding experience wasn't gonna be affected by that.

Jessica: Absolutely, because it's stressful enough as it is then to have to think about…I went through that with my daughter. I had retained placenta and at about a week I had to go in and have a DNC, and that was a time when I knew a lot less than I know now. So I was pumping with pumps that was way too big and anesthesia was different at that point and they were telling me to pump and dump for 24 hours, and I was like I don't think that's right, and I don't want to do that. So I was calling my pediatrician and I was like trying to look things up. It was flu season, so she couldn't come into the hospital and so then I was like trying so it was like a whole, so I totally get like that's why I like to talk to people about those things in advance so that they know I know she said that this is a thing and so that they can just be like, ask questions and call and I, like I said, I think our providers have come such a long way and understanding that there's a lot of ways that we can get around that, that we don't have to affect breastfeeding when we have an unexpected procedure and medications that we need and things like that.

Cass: Yeah, I think so. Across the board, based on talking to people who have their kiddos here, 15, 20 years ago, and then my experiences each time with providers during my C-sections and getting skin-to-skin and latch in the OR and all of that, like just so much progress has been made. 

Jessica: Oh, absolutely. A hundred percent. I love it. 

Cass: Yeah. It's great. All right. I think we're good. Yeah. Thank you guys so much. Appreciate it. 

Emily: Mother Love Season 4 was produced by Brooke Boone Miller, with music by Fred Krase. Special thanks to Shelby Carver with Platinum Real Estate for use of her podcasting studio. Mother Love is a project of Healthy Mothers, Healthy Babies, the Montana Coalition, a non profit organization dedicated to improving the health, safety, and well being of Montana families by supporting mothers and babies ages 0 to 3.

Opinions and views expressed in these interviews do not necessarily represent the views of HMHB as an organization. Visit us at hmhb mt. org to learn more about who we are and what we do. If this episode of A Mining City Story resonated with you, and you're interested in finding similar services in your own community, we invite you to check out Lyft's.

Our statewide online resource guide at HMHB LIFTS. org. If you're a provider of care to moms and babies in Montana, we encourage you to get in touch and list your services in LIFTS at no cost. Thanks for listening. We hope you'll join us next time for more stories of pregnancy and parenting in Montana.