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Ep. 146 – Popping On and Off the Breast: What gives?!

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Hello. Welcome. Happy Friday everybody. Happy. Happy Friday. It’s been a miraculous week for all of us here. All two of us, the whole team. Well, there is a greater team, but we just don’t actually see them. Yeah, I did see one of them actually.

Wow. Over the holidays I saw Tiffany Goetz who does all of our podcast transcripts and all of our Wednesday wins on Instagram. So she’s the one that does all of the amazing little shout outs for you guys and she does the award stories in our Instagram. She uploads everything to the website and she is just the person that I never have to double check like she is love, so thorough.

And she’s got three kids and a husband, and she is like, she’s the kind of person that paints her bathroom after all the kids go to sleep and always has porch decor and table scapes. And I’m like, I don’t know how you do it, Tiffany. Girl. How? But our lovely audio editor, Cherie is moving across the whole ocean.

Yes. Cherie Louise Turner is following her real passion, which is baby lambs all the way to Ireland. We love Cherie so much. Cherie has been our podcast mom now for two years. Mm-hmm. How long have we been doing this? And Cherie has always loved Maureen’s baby lamb stories and always used to lament about the times that she went to Ireland as she used to live there back in the day, and all the wonderful scenery and the, and the castles, and the people and the lambs.

And she just told us the other day that she is moving back there. Yay. So yay. Congrats to Cherie chasing her dreams. Now we can trade baby lamb pictures. Yes. Yes. Everyone should be living their best life with table scapes and baby animals. Absolutely. How are you living your best life, Maureen? Goodness.

That’s a great question. You know what? I’m not right now, but I should be at some point. It’s just not happening this month. What’s your deal? Well, you know, it, I just I feel like. I, so right now Ivan is mostly off work cuz it’s like a seasonal thing. So I’ve been working more and it makes me feel like I should then be able to catch up, but I like still haven’t, do you know what I mean?

Mm-hmm. So I’m just living in this constant state of like minor existential dread about my like, ability to do things. Oh my god. It’s great. Anyway. Yeah. But but otherwise my kids are actually great. I don’t know what happened, but my seven-year-old like turned a very, like, he, he turned like a maturity corner.

Mm-hmm. I don’t know, like he’s. Not. I like a lot of the behavior problems that were really driving me up the wall have just kind of like faded away. Oh, that’s nice. Not all of them, you know. He is still a kid, but yeah, like I dropped him off at a friend’s house the other day, which usually like her kids are buck wild and so are mine, and I was like, here, take mine for a couple hours.

She was like, yeah, there were no problems. He didn’t fight with my kids. He didn’t shout even when they were shouting and I was like, wow, that’s great. Yeah. One less thing to worry about. I know. It’s great. And he’s not like complaining about school right now too, which is nice. That’s awesome. I know. Heidi went and played with a friend our, our neighbor friends the other night, maybe yesterday.

I don’t know what. Time’s a black hole. And I asked my husband how it was cuz I was away for a girls trip and he said, oh no, it was really good other than one small incident where Heidi choked James out because he wouldn’t give her something she wanted to play with. But other than that they did great.

And I was like, why do we have the kid that will choke out another four year old? Like, what’s happening? That’s so Okay. I, I sympathize with that Heather. And then again, why don’t we all just choke people out when they don’t give us what we want? Yeah. And when I see my toddler do things like that, I’m like, I get it.

Yeah. Yeah. It’s like hard to be mad where you’re like, well, honestly. Yeah. Well, like Griffin loves to get in Lyra’s face. He just wants to like kiss her and love her all the time. Mm-hmm. and she just literally punches him in the face. Mm-hmm. . . And I’m like, yeah, I feel that. Yeah. And you’re like, well, don’t get so close next time.

Oh yeah, I’m, I’m like, look, dude, if you didn’t ask her if you could kiss her on the face and then she yells and punches you in the face because you did it without asking, there’s really nothing I can do there. Yeah. Yeah, I hear that. Let’s see. Updates on my end. I finally have a new office that is in progress.

We have started the buildout as of today. Scary. Hopefully my husband is signing the lease as we speak with a notary. I know that is a big deal. Chase or Ca, chase Cash. Jesus Christ. Back up. What’s his name? Who am I married to? Chase. Ooh. Cash. I used to swapped the H in his name. Mm-hmm. He better not fuck that up.

Yeah. Don’t mess this up. And it’s gonna be beautiful. So we’re gonna have three exam rooms with three lactation consultants. Oh my God. And I hired Chief Operating Officer. Wow. So she is going to be doing all of our, everything. She, everything you hoped and dreamed. Yes. Oh my. And more so she’s one of my best friends since like kindergarten and we actually met in Sunday school, which is hysterical.

We, yeah. If you knew us now, . So anyway, she’s gonna be keeping us on the straight and narrow and doing all of the things with binders and details that my brain just won’t do. Wow. All of the writing that I wanna do for PR in, in our state and promotion of breastfeeding and things like that. So big stuff.

Also last week, the reason you could not reach me, Maureen, basically is because I am now in network with P E I A. Oh Lord. And I. That’s good. Thank you. Thank you. I’m scared. Yeah. So we’re gonna be billing some insurance directly. Not all, because they don’t all play nicely with lactation and I have to keep the lights on.

Yeah. But we are also trying to get a network with WVU’s new insurance. Oh God. Keep health. And so that’s been a little bit of a process. Sure. And there’s been a lot of emailing and just trying to set everything up. So new, new, new building, building, building and time sensitive stuff. Mm-hmm. Yeah. So scary, scary.

Good job though. Thank you. You know, sometimes I look in the mirror and I’m like, I can’t believe I’m allowed to do any of this stuff. I feel you. Like sometimes people get off like a consult with me and I just like stand up from my desk and I’m like, I just don’t know why people like, What is happening?

People listen. Yeah. They wanna get better. And you have the answer and you’re like, how did I get the answer? I don’t know how I got the answers. We just keep talking about breastfeeding. So anyway, speaking of things that are a little annoying to deal with. Yes. Difficult today we’re gonna be talking about babies popping on and off the boob.

Yeah. This one gets you guys. This is Maureen and I were just talking about the fact that when someone calls for a consult about popping on and off, we already know we’re gonna have like 50 questions. Yeah. Just to figure out which camp we’re gonna have to put you in. And then you know, reverse engineer what’s going on.

And to be honest, this has been on our to-do list for like eight months. Mm-hmm. And, and every time we go to record, it’s on there and then we’re like next time. Yeah. Well, I mean, I think it’s important though. Yes. And I think a lot of people are clicking on this one because popping on and off the nipple is one of the number one complaints that we both get from parents.

Yeah. Uh, We, we have to tackle it. I just have to say, you’re welcome, because I worked my butt off for this episode because, like Heather said, a consult about this is pretty much just like 20 questions over and over and over. So it’s hard to like make that into an informational episode. But we’re gonna do our best, and you may still have questions after this, but hopefully this can give you an idea of like where to start.

Yeah. So, you know, and it’s not all bad. So these are not all bad things. So if your baby’s popping on and off mm-hmm, your baby’s not broken and you’re not broken sometimes it’s actually great. Yeah. And it means your baby’s a genius can be totally normal. So let’s just go through these reasons one by one.

And if you are listening and you start feeling overwhelmed by the episode and you still can’t figure out why your baby is doing this behavior, then I highly recommend you book a consult with one of us or another lactation professional to try to figure out what’s going on because something is going on.

Yes. We can be your booby detectives. Your boob detectives. Yes. So Maureen reminder is in Elkins, and so if you are near Elkins, West Virginia and you can do an in-person visit with her. Yes. That would be great. But she also does telehealth. I am in Morgantown, West Virginia, so if you wanna see me in person here, or telehealth, that’s amazing.

And I am in network with some insurance, no matter what state you’re in. So always just reach out and ask. Yeah. And you know, even if you see that our out of pocket price is really high ask anyway. Yeah. You know, I, I know it might not happen, but we might be able to say, Hey, I can’t do it, but this person can.

Mm-hmm. You know, or this is a free resource we’ve already made and let me give it to you. Exactly. Exactly. Okay, well, before we go any further, I wanna thank a new patron, Amy S. Thank you so much for joining us on Patreon and we really appreciate everybody’s support. Yes. For as little as 25 cents an episode, you can support us too.

So let’s take a minute to thank one of our sponsors, and when we come back, we’re gonna answer a question from a listener about something that I previously said in another episode. Oh, yes. I have to clarify something.

Have you guys ever been listening to our show and thought to yourself, man, I really wanna work one-on-one with Maureen. I do every day that I sit here. Podcasting across from you. Well, lucky for you and everybody at home. I offer both in-person and virtual support through my business and in my business.

High Lamb birth support, I’m dedicated to mentoring you guys through your childbearing year. So that could start with fertility all the way through pregnancy, childbirth, postpartum. I offer home birth, midwifery services, doula services, lactation support, herbal support, anything you guys need. You even do miscarriage support.

Absolutely. I do. That’s one of the biggest things that is so hard to find, and I think that your people that are local to you are so incredibly lucky to have this service. Thank you. And I just feel really happy to serve everybody and I’m so happy I can expand my services virtually as well. Yeah, telehealth for lactation has been really important through the pandemic, and I think we just about.

Perfected at this point. So if you guys wanna work with me, head over to highland birth and check out what I can offer you. That’s H I G H L A N D, birth

Welcome back everybody. Let’s get into this question about something I said. Clarifying questions. So this question is from a new patron, Holly S, here’s your question. You said in a previous episode that if you had another kid, you would be an over producer because of your knowledge now. Can you elaborate on that at some point?

I’m an over producer but start to struggle when I go back to work due to the pressures of being a retail pharmacist and time constraints of walking away from customers. Mm-hmm. So here’s what I meant when I said that. I was a half ass breast feeder. True. With both of my kids. I did not educate myself beforehand.

I did not use the correct flange size. I did not own a haka. I did not have a milk storage plan. I had previously pumped into Ziploc bags. Not all the time, but when I ran out. I really put in extremely minimal effort and I was a just enougher. So I was saying, I just assumed that if I prepared in any way, maybe didn’t give a bottle in the first three days of life or didn’t do a pacifier or maybe didn’t do a circumcision with my son, or, or, or just like put effort into storing milk early or using correct pumping things.

No doubt. No doubt. If I had done anything right along the way, I think I would’ve been an over producer, which means more than just enough. Yeah. It doesn’t necessarily mean a crazy over producer like hyper lactation. It just means I would’ve had a surplus of milk. Right? And so what we, what she meant by that, and I think what a lot of people are able to do with the right knowledge is to plan for those difficult times that you’re talking about, right?

When you say you struggle, when you go back to work because of X, Y, Z, now you know that you’ve been through that before. And so next time you can say, okay, I know the problems and I know the solutions, so let’s make a plan so that those can happen. Right. And Holly, I just wanna tell you, if you were my patient, the thing that I would focus on the most is your equipment set up.

I would wanna make sure that you had the best pump with the correctly sized flanges and all of the stuff that you needed to be successful. And that might mean more than one pump. It might be a hands-free pump. That’s usually what I recommend for folks in that situation where you know they’re not always able to sit and take a break.

Make sure you have a hands free pump that you can wear and have a really good sit down pump when you are able to sit down and use it. And make sure you know what your rights are now that the Pump Act has passed. Uh, Yeah. Because now at the federal level, 9 million more parents who are lactating at work have access to those rights, which is great.

Yeah. At some point we’re gonna elaborate on that. Somebody asked us to do an episode and I was like, yes, I would love to when I can sit down and actually read the whole thing by myself, , and not just rely on somebody else’s interpretation. Yep. Good call. So TBD ,TBD, but just so you know, that happened and we always direct people to the Center for Work-life Law and that is a nonprofit.

Mm-hmm. with lawyers on the other end of a free phone call to help you navigate pumping at work if or being pregnant at work. Yes. Wonderful. All right let’s pop off. Oh my God, I knew you were gonna say that. I just knew it. Who I was waiting for it. I’m gonna pop off on you for saying that . Okay. So let’s start.

Can we start in the first few days of life? I think we should start then. We should start there at the, because age matters. It’s part of our assessment. When you say, my baby won’t stay latched. Yeah. How old are they? Yeah. So if it is the first few days of life, it could potentially just be normal reflex integration.

Absolutely. And by that we mean when your baby is born, they have motor skills that their brain automatically tells them to do, but they have no context for when and how to use them. Mm-hmm. . So that’s actually what they’re learning. Quote, you know, when they learn to breastfeed is not actually how to latch and how to suck.

It’s when to latch and when to suck. And also babies are born with like, This is an arbitrary number, but a million trillion, more neuronal connections than we have. Way more. Yeah. So they have to actually prune them out by lack of use. Yeah. So that’s why they’re so disorganized. That’s why they can’t like pick up a pencil with their two fingers and they just like shake all the time.

Yeah. Or why they latch an unlatch and latch an unlatch and it often with that newborn looks like they’ll put their mouth over your nipple, whip their head back, shake it around, and then put it back and then whip it back and shake it around. I’m doing it to the microphone right now and that, you know, pretty much every baby, like 90% of the babies I’ve seen at birth do that within the first hour.

Right. But some babies. Continue that for a couple days. Yeah. I always kind of equate it to throwing spaghetti at the wall, , the way they do their sticks to see what their burning. Yeah. And if something sticks, i e they suck on a nipple and they get milk, their brain goes, Ooh, you got rewarded. Do it again.

And that’s why when we see that in that initial reflex integration period, we’re often gonna say, Hey, can you express a little bit of colostrum, spread it on your nipple, put a drop on baby’s tongue, and just kind of help bridge the gap for the association of what’s going on there. Yep. We, it’s, it’s brain training.

It’s just like when you bring your puppy to the pee pad every single time, be like, this is where you pee. This is where you pee. And then eventually their brain is like, I have to pee. I have to go to the pee pad. . Yeah. You know, so you don’t wanna necessarily get frustrated with your baby, that’s, you just look at your baby and you go, oh my gosh, look at you learning new things.

Mm-hmm. , good for you. Now I will say, Other things that tend to happen in the first few days of life that can complicate this or make this drag on a little bit longer than it normally would are circumcisions. Yeah. So that is something I think I have almost never seen someone informed of before they go in for a circ.

And I’ve had a lot of consults about this and a lot of complaints and a lot of stories of, oh, right after the circumcision, my baby never breastfed again. That was my husband, that was his mom’s story. And the reality is we can usually get those babies back to the breasts. It’s a pain management issue and it’s a very short term issue, but we have to be consistent.

Well, and it’s also because they will give your baby a pacifier during the procedure with sugar water. Yes. Like nine times out of 10, more than that, 99% of the time they’re gonna get a pacifier with sugar water. And that pacifier. in that early, early phase of life where their brains are like Play-Doh.

Mm-hmm. , and very pliable. It can completely change their suck. Not all babies, but some babies. And we just don’t know what kind of baby you have. Yeah. So there’s that issue to consider. And we also have to consider like, are you just accidentally like putting pressure on a fresh wound when you’re holding them in like a cradle position or something that worked 20 minutes before the procedure but isn’t gonna work now?

Mm-hmm. . Yep. And so we also will see a little bit of this nipple confusion after a bottle supplement in the hospital. Yeah. So maybe we had some jaundice or some low blood sugar and we supplemented with a full bottle. Not a spoon, not a cup, but a bottle. And so I actually just did a whole continuing education.

Mm on this. And I really like the analogy that the instructor used where she said, this is like Serena Williams switching tennis rackets right before the big game . So she’s like, it’s similar. That’s funny, but different. And then when she goes back to her original racket, that’s bad. , right? So now it’s like a mess because it’s so similar, whereas the cup or the spoon is so different, it has a net zero effect.

Mm-hmm. on the suck. Yeah. So that’s why lactation consultants will often use spoons and cups versus bottles in those initial days where their brains are like Play-Doh. Yes. Yeah. Particularly when the goal is exclusive breastfeeding and we know that that supplementation is a short term thing and we’re like, okay, we just have to get through a couple of days.

We can totally do this and we want baby back to the boob and this is where we will try finger feeding. Yes. A lot of times so if your lactation consultant comes in the hospital and starts doing finger feeding with you, with a lot of this popping on and off behavior after a bottle or after a circumcision, Please don’t get overwhelmed and think you have to do this forever.

This is something that we are tackling one feet at a time. Yeah. It might literally be a few hours of that intervention because their brains are so pliable. It might be a few days, it’s not gonna be months. Yep. And this will be with mom’s finger, so, , you know, it feels like your skin. Mm-hmm. , and then they’re getting a little bit of that milk and sometimes they just need a little bit of food to calm down.

Mm-hmm. so they can organize themselves to get back to the nipple. Absolutely. And that’s one of the tactics we use often with popping on and off, kind of regardless of age, is like if baby is frantic, they’re not going to coordinate their movements to latch correctly. So, hey, let’s spoon feed them a little bit.

Let’s cut feet a little bit. Let’s get them to calm down before we begin a difficult task for them. Mm-hmm. . And then worst case scenario, they’ll put a nipple shield on and be like, at least we are at the breast. And then we’ll deal with that later. for sure. That’s a whole episode. We do have an episode on Nipple Shields, by the way.

Yes, we do. Don’t know the number. We’ll, we’ll put that in the show notes. Yeah, it’ll just be down there. Go find it. . Okay, so let’s jump ahead. Mm-hmm. on the timeline. So now this is more like a six month and beyond issue popping on and off for older babies. Could be just distracted nursing, which means maybe they’re not that hungry and they’re just dicking around.

Yeah, it’s, and you know, I feel like it just always comes back to their little brains . They’re just like, around that age, they just suddenly realize the rest of the world exists and that like, they wanna be a part of it and it is okay. You know, to then be like, okay, so if we want a nurse, we’re going upstairs in this room with the door closed , and it’s also okay to just put them down and be like, well, yep, if you’re, let hit me up when you’re hungry.

Yeah. Most babies are going to regulate their hunger and eating correctly. Some babies do avoid eating and get really over hungry, but that’s not gonna be most cases. And we will. Link the episode to nursing older babies. Mm-hmm. in the show notes as well, because we tackle a lot of that. Yeah. As well as our recent episode with Gia Gambaro Blunt.

Ah, that was such a good episode. Yes. And she is a toddler behavior expert. So if you’re nursing like a two year old who’s popping on and off and you’re like, okay, I’m done. All right. You know what, with a two year old popping on and off. Absolutely. Put them down and say, no, thank you. And walk away. Yeah.

Just walk away . Okay. All right. So that, that, honestly, that was the easy part of the episode. Here’s the difficult part because if those are like the first things we ask, and if those aren’t the answers, we’re like, cool, let’s dig into 800 Other reasons. I, so I kind of tried to categorize these, but just go with the chaos, everybody.

It will make. So let’s talk about supply and milk flow as a general reason that we could have baby not staying latched. And it’s kind of like an either extreme of our spectrum here could be a problem. Can we start with a fast letdown though? Yes. Okay. So fast letdown is subjective? Yes. Okay. So I have heard from people, oh my gosh, I have such a strong letdown, and then I watch it and I’m like, I mean, yeah, and it doesn’t always correlate with oversupply.

Exactly. I have, for example, a fast letdown and just very strong boob muscles. Right. I only have it on one side. Yeah. That’s also normal . There’s a wide variation of normal and a fast letdown is not necessarily abnormal. It’s not, and it’s not usually a bad thing, but it can just be a little bit difficult for some babies to keep up with.

And I, I think a lot of the time what I see is the babies with. , you know, without super obvious oral dysfunction, but maybe they’re like a little hypotonic or they have small ties that went unnoticed. They’re the ones that just suddenly struggle with that. Yeah. So this’ll look like choking, coughing, popping on and off.

Or they learn because they’re so smart that you have a fast letdown. So they’ll pop on and off to get your milk to spray and then they’ll back up . So it’ll spray all over their face or all over whatever. And you’re like, what the hell? Little Brian. Like, I just had to wait it out, mom. Yeah. And they just like look up at you and wait for it to be over and then they nurse.

Yeah. And you’re like, would you mind ? Can you not? It’s a mess. It’s, but it’s actually quite smart. And you know, a, a lot of people, their initial response is, oh my God, I’m choking my baby. We have to bottle feed. Mm-hmm. . And I’ve seen that a lot. Usually. , it’s very small. Interventions fix this problem.

Often we are simply talking about changing from a laying down nursing position to an upright one that gives baby the control if they do need to take their mouth off the boob. Right. Or it looks like when you feel you’re let down coming or you see babies start to exhibit those signs, you simply take them off, switch sides, put the hawk on that side, you know?

Or you give them a little break to take a burp, let some milk dribble, soak it up with a washcloth, put ’em back on. Yep. That’s what I went with. Yeah. And usually as they mature and grow, they keep up with it. Yep. And eventually one day they just suck it down. And then I hear from people, I think I’m starving my baby.

And I’m like, why? And they’re like, because they’re only eating five minutes at a time. Don’t. And I’m like, what? And then they come in for a weighted feed and I’m like, oh no, your baby transferred four ounces in five minutes. Right. Absolutely. And typically the turning point I’ve seen is between three and five months.

Agreed. You know, and that in that time period we see just this exponential maturity of baby’s muscle control for their head and neck. Mm-hmm. . That’s true. And also they got to know you pretty well and they learned how to finagle you and hit the right combination to get what they want. And you also know what you’re doing at that point too.

right? You’re like 4,000 feeds in by three months. . All right. So if you have any questions about that, yeah, let us know. But we’re gonna move into low supply and slow let down now. Mm-hmm. . So trigger warning, . Yeah. I think this is a really hard thing for a lot of people to tackle because it feels like there is no solution.

This is often when I hear people say, my baby hates my boobs. They don’t like breastfeeding often. This is kind of the root of the problem. And so, How we figure that out. is difficult. We might do weighted feeds. We might have you pump in clinic or you know, pump and tell us what you got out of pumping.

Right. Which I kind of hate that one, but me too. But sometimes it’s effective. I, no, let me say this. I like it when someone is pumping in front of me and I can see it. Me too. What I don’t like is when a pediatrician or other healthcare provider pump says, go home and pump and see what you get. I don’t like that.

And then bottle feed the baby. Yeah. And then the bottle, the baby who is used to a slow letdown is like, oh yeah, this is what I want. And then they won’t get back on the boot. Yes. And then I’m like, okay, no. That is not what we’re doing here. Mm-hmm. and often. Mm-hmm. , let me say this too. These people that are in this category of possible low supply and slow letdown, they have already been bottle feeding.

Yeah. Or supplementing because of, of something that happened and now we have a low supply as a result. Right. Or, or it could be unrelated, but that happens to, and. . One of the things that is a red flag a about this for me is people will say, okay, baby will latch on, and they’re fine for about two minutes nursing.

And then they get really frustrated and I’m like, okay. So essentially during your letdown is the only time that they are satiated while feeding. Mm-hmm. . So that either tells me you have a slow flow or a low supply or the baby’s muscles Yeah. Aren’t strong enough to remove the milk Right when it’s not.

Forcefully sprayed into their mouth. Absolutely. So typically first steps for me here are, okay, let’s try just like we would try hands on pumping. We’re gonna try hands on nursing, we’re gonna try breast compression. Right. You know, and, and we’re gonna see if we can help babies suck more effectively. Do they need some kind of like chin support or cheek support to suck better, right?

Yeah. We’re gonna do weighted fees. We’re gonna make sure we keep a really close eye on poops and peas and weight gain just to make sure, is this the real problem? Are we looking at something else? And also additional trick is you can, after your first letdown on the first boob and baby, you can see baby’s already getting frustrated, just.

Put them up on your chest. Mm-hmm. switch positions on the same boob and your baby’s gonna think it’s a new restaurant, , it’s gonna be like, Ooh, a second boob time. And you’re like, ha ha ha. It’s the same boob in a different position. Yeah. And they will suck aggressively thinking it’s the second boob and they could potentially stimulate a second letdown so we can just work with what we have and potentially help your supply and help your letdown and help the milk transfer by doing two positions on each boob.

Absolutely. You know, and if we do determine, hey, you know, you’re not quite making as much milk as baby wants, that is not the end of the world. And in most cases, we can work to correct that. Yes. But try not to do that on your own. Think stressful. It’s really important to have support in that, whether even, even like minus the clinical guidance part.

Like just having someone who can say like, Hey, we’re gonna check in about your emotions during this process where you feel completely invalidated by your own body. Right. And friendly reminder. , your value does not equal your milk volume. Yes. Okay. Absolutely. Okay. . Yeah. So one of the next things that can cause this issue is if your baby is not latching deeply enough.

Kind of connected in with like a slow flow because a shallow latch can essentially not trigger a letdown, right? And can restrict your milk flow. So, , are we seeing like when your baby un laps, does your nipple look like a tube lipstick where it’s got that little like angle at the end? Are you having pain with latching?

Do you have flat or inverted nipples? Like, we’re gonna be asking about these things to try to assess that, especially if we haven’t seen baby latch and this is gonna be another one of those most likely early on things. Yeah, early first couple weeks. Yeah. Primary engorgement is a huge factor in this where your breasts are just like giant cantaloupe and it’s like trying to latch a baby onto a kneecap.

Yes. And the baby’s like not getting stimulated to suck because the nipple is never reaching that magic button at the soft pallet at the top of the lip of mouth. That is what triggers their suck reflex. Yeah. And you know, the thing is too often. if we, it’s not in the first week or two. This is often tied to poor positioning or oral dysfunction.

So this can get complicated really fast if we’re like, oh no, they’re latching shallowly because they have a tongue tie, because they don’t have good muscle tone. You know? However, don’t be afraid of this. . I think it’s really important to know if this is happening because there are some things that you can do at home to see if you can help baby latch deeper.

You can use different positioning techniques. You can use things like different breast holds or like the flipper technique where you kind of like do a sea hold and you like flip your areola down onto baby’s bottom lip and your nipple like points straight up at their, you know, pal. Takes a little practice and assuming you’re, you’re not engorged and your breast isn’t into cantaloupe, you’re not flipping a cantaloupe dressing that’s not happening.

Yes, we can, and if we’re engorged, we’re gonna try hand expression first. If you have flatter inverted nipples, we might try things like a latch assist to try and evert those a little bit, little reverse pressure. Softening. Yeah. Maybe a little haka beforehand to alleviate some of the pressure. Definitely Ibuprofen.

Do we have an episode on engorgement? I feel like we do. We have one on the first few days of life. We’ll link the first few days of life. One, that’s an early episode where I was still doing the audio editing, so apologies for the quality test. It’s fine. We did our best . We did our best. Yeah. Gosh, honestly, at this point when someone’s like, do you have an episode in that?

I’m like, don’t I? Maybe. Yeah. Have you Googled it? , Google Milk Minute podcast plus sign, and whatever topic you’re looking for, and it’ll probably come up. You might be there, . Yeah. But you know, and I know this is hard to hear when we’re like, Hey, try one of these 20 things. But if you’re doing an individual consultation with someone like us, you know, we’re gonna be able to give you a prioritized list.

And typically what I do, right? We’re on the phone or we’re in person and I’m like, okay, I’m giving you this list. But don’t, don’t worry about it. I’m gonna email it to you as soon as I get off the phone with you, and I’m gonna prioritize it. I’m gonna say, try this first. Try it for this long. . If that doesn’t work, try this.

Try it for this long, try it with this other thing. Because you shouldn’t have to be a lactation expert to feed your baby. Yeah. Or like try it right now and let me watch it. Yeah, exactly. So Elsie’s are there for you for this? Yeah, we live for that moment where you get the baby on and you’re like, yes. And we’re like, stay calm.

Nobody, even though we wanna shout nobody, move and scream. nobody. Move or breathe. Breathe. Hold your mouth right, . Alright, well we’re gonna take a quick break to thank a couple sponsors and when we get back we’re gonna talk more about reasons for popping on and off.

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Go ahead and check out the link to Arrow Flow in our show notes and order your pump through them.

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Welcome back. Let’s get into kind of like the difficult assessments where we’re talking about pain and discomfort for baby. So sometimes it’s just that baby needs to burp or fart or fart . Those are the simple ones where we’re like, put baby upright. Oh look, they just pooped . Yeah. And so if they are making this noise or like.

Ugh. And it’s like repetitive. Yeah. Higher pitch crying. They’re trying to pressurize their chest cavity. Mm-hmm. in order to force a burp out. Yeah. Or force a fart down . Mm-hmm. . Yeah. And typically, you know, that’s not a bad thing to check for always. It’s just like, okay, let’s put baby over my shoulder, give ’em a little pat, pat, put a little tummy pressure on and see what comes out one way or the other.

Yeah. It’s not gonna hurt them. It’s not gonna hurt you. And some babies, regardless of what we do, are just gassy. Little, little. People They are. And we always recommend Evivo probiotic for these babies. We’ll put that link in the show notes. Yeah. And you can use code milk minute for $10 off. I love it for all the babies and it can definitely help with gas.

Mm-hmm. . And it can help to kind of slowdown that process of digestion that is always churning, churning, churning when we have extra mm-hmm. stuff to digest. So it kind of helps the digestion along. Absolutely. And then, . If you see your baby back arching a lot, everyone always goes, I think they have reflux.

They’re back arching. I saw it on Instagram. Mm-hmm. . And I’m like, oh my God. So do we have an episode? Episode on reflux? I don’t know. I think we do. Not yet because it, no, no. So we don’t, because every time we talk about it, we get really mad about like non-evidence based medication practices. Yeah, regarding reflux.

And then we’re like, we should get somebody in here to talk about it and then we don’t. So, okay. Well that’s on the list too. , but so reflux, true Reflux in babies is pretty rare. Yeah. They are on an all liquid diet and they lay down most of their lives and their sphincters all along their GI tube are pretty.

It neurologically, immature. They don’t know when to open and close at the right and wrong times. So your baby is not constipated most likely because they don’t have a giant turd in there that is not able to be passed. It’s liquid. It’s their sphincter being like, do I open now? No. Yes, no. Yes. I’m gonna sharp.

I’m just gonna sharp 12 times instead of opening one really good time. And so that’s why they are doing that like mm-hmm. . Mm-hmm. arching thing. They’re just trying to figure it out and physiologically help their body do the things. So give it time. Unless your baby is losing weight, refusing to eat absolutely miserable.

I really don’t. Or their horse constantly. Yeah. If they are horse, absolutely. Constantly projectile vomiting, obviously. Go to your pediatrician. Yeah. Other than that, they’re just happy spitters that need to mature a little bit most time. Yes. Okay. So one of the other things we see, especially soon after birth is that babies can have some neck or back pain.

Right. Particularly those who were asynclitic where they were like, let me just turn my head 20 degrees this way and you can shove it out of a birth canal and I’m not gonna turn it back. . Right? Yeah. And oftentimes, if you have a C-section. Mm-hmm. because of stalled labor and your baby comes out with a crooked cone head, you’re like, yep, that’s what happened.

That’s it. So if your baby is showing side preference or you have incredible pain on one side mm-hmm. where baby can’t open their mouth wide enough, it could be that they are super tight on one side. Yeah. And typically, if that’s the case, you’re gonna notice when baby sleeps, their head is facing one way, or when they move their arms, one of their arms isn’t gonna have the same range of motion as the other one.

It doesn’t usually. only appear when nursing. If you can pay attention, you might see those signs other times. And if you’re a lactation consultant listening and you’re wondering how to manage that in the first couple days of life, you know, obviously we’re not rushing off to the chiropractor 24 hours after birth.

But what you can do is you can gently hold the baby and tip them upside down. And this always freaks the parents out. I love the upside down releases . Yeah. Because it’s like, first of all, your baby was just head down for the past 10 weeks. Yes. I’ve warned people that before I do it, I’m like, I’m going to invert your baby upside down.

However, might I remind you that we have been telling you it’s a good thing your baby is upside down for the last six weeks of your pregnancy . Right. So we’re, and we’re not completely upside down, we’re just. At a decline. Yeah. And so we’re going to gently tickle the baby’s cheek on the side that they don’t wanna turn to.

And so we’re gonna use their reflexes to help them by elongating their spine and neck with that gravity position. And we’re going to encourage them to turn their head the other way. And oftentimes they will just slowly release and they’ll be like, oh yes, thank God. And then we try, do you know, so I, years ago was training with a midwife when we went to postpartum, they were having issues like this.

And she was like, okay, I’m gonna do some body work for baby. And she did a couple of different things. But one was basically a full like dangle inversion, like she had her forearm, like around baby’s waist with their legs kind of tucked over and had him against her torso, you know, so supported, but like fully inverted.

And I had measured baby earlier in the appointment. . And then so when she was all done, I was like, do you think I could take baby’s length again? Like, I’m just curious now, . And that baby gained like almost a whole inch, just like unfurling. Whoa. Their body. It was wild. That baby was so tense. Oh, that’s crazy, crazy.

Now, I’m not saying you should like dangle your baby upside down. This was a trained professional and it was a specific technique. However, it can be very effective. You can consider, you know, if this is a problem, it’s a persistent problem. And you have the resources. There are lots of professionals who are trained to do that kind of body work for baby.

And who you’re gonna go to usually is dependent on who is local and who is trained, right? Some occupational therapists have training in this, some chiropractors, some osteopathic doctors, et cetera. So the thing is, you’re gonna have to call around and be like, Hey, do you have training and experience in working with infants of this age with this problem?

Yep. And if you’re like, I would never think about doing chiropractic on a baby, we will link our chiropractic episode in the show notes because you need to learn more about it. Right. And it’s, you know, if you’re not comfortable with that, that’s okay, but don’t discount it just. , you know, without learning a little bit Right before you put your kid in a helmet,

Yeah. Maybe consider for sure some other preventative options before you get to that point. Yeah. And you might also find someone who’s trained in cranial sacral therapy. But you know, the point is, I guess there’s a variety of different therapy techniques that can help with this. Okay. Next we have mouth pain, so possibly baby is popping on and off because there’s something going on in their mouth that is really hurting them.

The mouth pain one is hard, cuz every time I’ve had to tell this to a parent, they immediately feel immense guilt. Right? Yeah. They’re like, oh my God, my baby has had a sore in their mouth and I didn’t know. Yeah. . It happens. It’s okay. Often babies get sore spots in their mouths just from repeated friction against a hard object like a pacifier or a bottle nipple or aggressive bulb suctioning.

Yes, with the bulb syringe after birth where they jam it in there. By they, I mean, probably not you, but maybe you. Yes, and it’s okay when it is improperly used. Right? Because when we’re taught how to do this, we are taught only suction what you can see . So you’re supposed to actually visualize the area before you suction and not just like shove it in and roll it around and suction, however, that is not always how it’s executed.

Often the area that is affected is the junction between the hard pallet and the soft pallet. It’s like every time there, or what I’ve seen is like just kind of on the side of the like inner area of the back gums were a molar would come in. Mm-hmm. , you know,

and the way we kind of work through this, unfortunately there’s nothing you can put on it topically. We have to work with positioning. Yes. So obviously we eliminate the hard object. We have to get baby fed. So cup feeding, syringe feeding, finger feeding, or just trying to feed in a more upright position.

Mm-hmm. . So an upright position can really kind of take that pressure off because of gravity from the roof of the mouth. So, yeah. And you know, the good news is mouths heal quickly, right? They’re a mucus membrane. Seriously, like two to three days. Sometimes those are completely gone. If we have removed the offending, like cause, right?

But we have to be super, super careful about how we’re feeding in that time. If we have a sore and we’re constantly hitting it, even with a nipple, it might not. Yeah. And some people actually have hard spots on their nipples. Mm-hmm. , which can cause that. So if you’re like we don’t use a pacifier, we haven’t used a bottle, we didn’t have a bulb syringe, and this is, and then you look in your baby’s mouth and you see like a giant butterfly shaped can or sore between their hard and soft palate.

Look at your nipples. Do you have a rough spot on your nipple potentially? Like, do we just need to sideline nurse or mm-hmm. , maybe just change the position completely for a solid week and, and we might need to just mostly cup feed for a couple days, which stinks , but. . You know, the quicker we can get this to heal, the better we’re gonna have.

The better like latch and long-term breastfeeding we’re gonna have, if you wanna know what that looks like, you can Google it. But essentially, if you’ve ever had a canker sore where it’s like a white shiny patch in your mouth, they basically look like that. I’ve seen them look a little bit more like bluish purplish before, but they usually have a white sheen.

Yeah. Also on that same note is yeast. So if we have a really bad yeast infection in the mouth, it can be very bothersome to them. Yeah. It usually has to be pretty severe to cause them pain. Yeah. You probably know by then, cuz I’ve seen a lot of kids that have yeast, like one little patch of yeast in their mouth and it just stays there for months and it never gets worse.

It never gets better. It just kind of hangs out until baby gets a virus and then it like explodes with yeast and I’m like, ah. So we just keep an eye on it. So if you know your kid has a little spot, you know, and the just keep an eye on it. Just keep an eye on it. And then with. always with mouth pain. We have teething.

Sometimes teething creeps up on us way earlier than we expected, right? Very rarely. But you know, sometimes a two month old comes in and they’re like, wow, they won’t latch. They won’t say, and I look in and I’m like, oh, grown a tooth. Sorry, . And sometimes it’s an older baby and we just are so flustered and sleep deprived.

We haven’t thought about it being teething. Yep. And we will link our episode on teeth. , it’s called Tooth Care for your Gummy baby. In the show notes. Yeah, on that note, Lyra, I feel like we’ve hit that point where she’s just going to be growing like seven teeth at once until they’re all in. Mm-hmm. , you know

Mm-hmm. like every time I look in her mouth, it is like a horror movie in there, but there’s like teeth half erupted and inflamed Gums and . I’m sorry. . It’s okay. Honestly, like the, she’s not that crabby about it most days, but Poor Baby. I kind of forget about it as being an issue until sometimes I look and I’m like, Ooh, what’s the new one?

Sorry about your mouth, . Okay. So just basically get through that time, get more resources, and yes, be easy on your baby and yourself. One of the other very, very common and easy to fix causes that I see is simply an unstable position. And this is when I see people say in, you know, they’re holding their baby cradle with one hand.

Their butt in their legs are like out in the air . Or you know, they’re holding baby against them, but their head and their body are twisted different ways or their arm is stuck. And that is understandable, especially with a newborn. They’re crying, you’re flustered, you don’t know what you’re doing, they don’t know what they’re doing.

So you just kind of get them close and latched in any way you can, but it might not be a sustainable position for them. Yeah. They don’t like to feel like they’re falling. Mm-hmm. especially. So you gotta put something under their feet, maybe try to, to check the following things. Is any part of their chest facing the ceiling?

Yes. If it is, stop doing that. Is the posterior arm, so like the bottom arm. between the baby and your breast. If so, remove that arm and put it around the boob so the arm isn’t pushing baby away. Giving me a little hug. Yeah, we need a big giant boob bear hug. We don’t need the arms stuck in the middle. And that’s tough in the early days cuz they’re so contracted up and they really wanna keep those arms close to them.

And then the other thing is make sure their chin is flicked down. Mm-hmm. . So their bottom lip is popped out. And just go ahead and flick that chin down. Just you won’t be able to see the bottom lip. Just do it. Anything else with baby’s butt and feet? Typically what I do is I tell people to have their hand under their butt and then shove a pillow under their feet or like a blanket or something, and that you know their feet.

You must be, A lot of people are like, why do I have to support their feet? Look, it is one of those like OT tricks that a lot of people use to get folks eating who haven’t been eating in a long time, like especially geriatric patients, pediatric patients, if they’re sitting at a chair with their feet, dangling it for whatever reason, doesn’t always set you up to eat well.

So making sure their feet and their butt are supported at the same time is going to help them latch. . And again, we have an entire episode on positioning tricks for mom and baby. Yeah. That we will link in the show notes because sometimes we need to adjust you as well. Yeah. And I know we’re kind of keep mentioning episodes we’ve done.

That’s because this problem is so multifaceted that we basically in every assessment have to bring in like little pieces of knowledge about all of the different possible lactation problems. Yeah. And so if you’re like, Ooh, that one’s me, go to that episode and learn more about it. Yeah. Okay. The other thing, of course, tongue to tongue on buckle tos, this one gets a lot of press.

Yeah. I don’t know why but it does. I mean, I know why I know. I, I guess. But anyway, so there’s a lot of hype about oral dysfunction, tongue ties, lip ties. When do we need to cut them? What do we do? We’re not gonna go into all that right now. There are many differing opinions on that. Not a whole lot of great research on it, but it’s coming in, trickling in slowly.

However, in this assessment, we’re gonna, you know, we might need to do a full oral functioning assessment. Do we have a tongue tie? Can the lips both flange out? Do we have strong enough muscle tone to suck? Well, does babies sleep with their mouth open because that is a sign of oral dysfunction. When their mouth is closed, does their tongue rest on the roof of their mouth, which you can test by opening their little mouth and seeing if their tongue goes.

Like off . You know, and, and we might need to do a really hands-on assessment for that. Oh yeah, for sure. Yeah, for sure. I mean, and also I will say during virtual assessments mm-hmm. , I will have people send me pictures of the baby’s mouth when they’re crying pictures of their mouth at rest. It has to be well lit.

Like it’s not impossible , but it’s harder. I’m like, can you do a panorama of your baby’s mouth with, oh my god, with surround lighting, , and listen, I’ll do it. Yeah. I will do it every time. But you know the very obvious ones where your baby’s tongue when it sticks out looks like an m So an M shaped tongue.

Yeah. That tongue is not gonna be able to hold a nipple in the mouth. No. And so if your baby is sounding like this throughout a whole feed, not just in the beginning Yeah, during the letdown, but the whole feed. . Right. And they’re getting upset and they’re just constantly like ra. Yeah. Another good red flag to notice is do they also have trouble with the bottle?

Mm-hmm. , like is it not just your nipple? Do they leak when they’re drinking? They refuse pacifiers. Mm-hmm. . Right? You know, this kind of oral dysfunction can be so complicated to manage and to assess, but you know, we, we can give you guys some of those red flags to look for and that usually is gonna tell you, okay, I should probably seek some professional help with this.

Things that we can consider, you know, you can certainly consider revisions for tongue ties or lip ties. I would strongly encourage you to also do body work, both before and after that if you’re considering it, occupational therapy, things like that. Yep. And when all else fails, . Try a reset. Yes. Which is skin to skin On the chest or just on the chest?

Mm-hmm. . So chest to chest. And that is your home base until kindergarten, , and beyond and beyond. When you’re having a bad day, don’t you wanna hug chest to chest with somebody? Take a nice deep breath and calm down. Yes, I do most of the time, you know, or I think I don’t. And then someone makes me do it and I go, oh yeah, this is mm-hmm.

Yep, you’re right. I need to reset. And so calm down the nervous system of both of you. Take a deep breath, lower your shoulder blades in the, on your back, make it the bottom of your shoulder blades, kiss. And then once baby’s brain is back online, give them a little bit of milk on a spoon. Mm-hmm. to calm their brain down.

Let them know that they’re gonna have some food. Talk to them like a real person and say, I’m gonna get you some food. Little O’Brien, you don’t need to be upset. Right. It’s here for you. And then you try again in a new position with support and do your best. Yeah. And I know this is what might sound a little crazy to you, but, so a lot of people shy away from nursing while baby wearing.

However, if you can do it and just baby wearing in general is gonna help. But if you can nurse in the carrier, a lot of babies calm the fuck down. . Mm-hmm. , because it’s like they’re being swaddled doing skin to skin and nursing all at the same time. Yep. And you might need some help with this the first few times.

So you. . Don’t feel bad if you don’t get it. But it’s worth practicing. Yes. Okay, so who, who We did it Marathon. I feel like we just read a dictionary of popping on and off. I, I think we just went through like the glossary of like your lactation textbook, . Oh, actually I should, we should have consulted that.

might have made this a lot easier. Oh goodness. I wish we were smarter. Well, I hope some of that is helpful to you. I’m sure that we missed some of the possible reasons for that, but I also kind of want you to understand that if you’re experiencing this and you can’t figure out what’s wrong, that’s not your fault.

This is a complicated problem. Sometimes it has a really easy solution but assessing it can be very difficult. Yep. Yep. A hundred percent. All right, well, let’s take a minute to thank one of our sponsors. Before we get to our favorite segment of the show, the award in the alcove.

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Human milk oligosaccharides. That’s actually 15% of breast milk that your baby will then be able to utilize. Whereas if you don’t have the bacteria, there’s so much extra in the gut, which is why American babies poop like 10 times a day more than babies that are colonized with B infants. I have personally seen this probiotic help my baby and the babies of many of my clients, and frankly, if we’re dealing with any of these symptoms, it is the first thing I go to.

And the best part is it’s not like any other probiotic that we would take when we’re sick or taking antibiotics where you take it every time you go through antibiotics for the rest of your life. If you give your baby a vivo in the first a hundred days of life, it actually colonizes in their gut and becomes a part of their immune system, which then they can pass to the next generation.

And this is how we make change Y’all, Aviva is amazing because it’s gonna safeguard your baby’s health today and give you peace of mind in the future. Check out Evivo probiotics through the link in our show notes and enter code milk minute for $10 off.

All right, Maureen, it’s a good award today. Do you wanna read it? Yes. I’m very excited. I feel like I haven’t done this in forever, . I know. We actually, we have not been in the studio for a little bit, so this is exciting. Yeah, yeah. Okay. So today we have a nomination from a friend of the recipient and she says, I want to nominate Kayla Clauson for giving birth to preemie twins and immediately getting to work, pumping, learning about pumping schedules and equipment, asking for help when she needed it, and building her support network.

Very important. She’s a rockstar and I’m so proud of and excited for. . Okay. I love that. I know. Isn’t that amazing? Yeah. She just like hit it full on. She’s like, huh, you should nominate your friends people. This is heartwarming. Yeah. Nominate. We have never had someone nominate a friend before. Yeah. So this is, I mean, you should also hype yourself up.

Yeah. Like that’s what we’re all about. But also hype up your friends. Yeah. That’s what we’re doing here. Community. So I wrote three ideas for awards. I’ll let you pick one. Okay. I know what we’re gonna do. Kayla, we’re giving you the Single-minded Double hearted award. Yes, I knew you’d pick that one. I worked hard on that one.

It’s a good one. We’re super proud of you. We know just how hard it is to be managing all of those different things at once. And you did it. Good job. Great job Kayla. And great job to your friend who is understanding the assignment of how to support a breastfeeding parent. Mm-hmm , whoop whoop. Okay. And we’re gonna close out with an Apple review.

We love our Apple reviews. They make us so happy we read every single one of them. And if you have a minute, 30 seconds, could you give us a review as well? And we’d love to read it on air. This one I had to text Heather the other day cause I was like doing stuff and I was like, oh my gosh. We have a new review and it’s so good.

It is so good. So this is from Sun 4K eight, which I assume is sun for Kate. The subject is, I just love every minute. I am an LC in Ohio and fairly recently found this podcast. Every episode has made my heart and mind happy from geeking out, listening, and then bringing info to my hospital team about the new mastitis protocol to episode 141.

Hearing for the first time my personal feelings of motherhood articulated so simply and profoundly. I just don’t know the words to say more than thank you. You guys are on point and I am so thankful to have found you and for your willingness to share and be vulnerable. Now I know I’m not alone and as I’m sure you are discovering more and more with each episode, that you are not alone either.

What a gift. Thank you. Thank you so much. Let’s let a sweet review and so well written. I know that is beautiful. Thank you so much. It really helps us to feel like this podcast is making a difference. Absolutely. And thank you guys out there, all of you for listening to this episode today. The way we change this big system that is not set up for lactating families is by educating ourselves, our loved ones and our community.

If you wanna support the podcast you can leave a review like that. You can bring the information you learn to your friends, family, and coworkers, and you can find us on Patreon at if you’d like to support the show monetarily. All right guys, we’ll see you next week.



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