Breastfeeding … with ABA podcast transcript.
Link to the podcast episode.
BELINDA: When my breasts are hard … does that mean I have lots of milk, like after my milk comes in, like is that hardness and lumpiness milk? Because mine were so engorged and lumpy, I have such a visceral memory of that time.
NAOMI: Welcome to Breastfeeding with ABA. A podcast brought to you by volunteers with the Australian Breastfeeding Association. Breastfeeding with ABA is a podcast about breastfeeding, made by parents for parents.
In this episode we’ll be talking about when your milk comes in, what to expect, what happens and where to get help if it’s needed.
BELINDA: We are recording this podcast in different parts of Australia. We would like to acknowledge the Traditional Custodians of the land on which we are recording and on which you are listening to this podcast. We pay our respects to elders past, present and emerging and to any Aboriginal people who are listening today. We also acknowledge the Indigenous women of Australia who have been living, working, birthing, breastfeeding and raising children successfully on this country for tens of thousands of years.
NAOMI: In each episode you will hear from different mums from around Australia.
BELINDA: My name’s Belinda Chambers and I’m a volunteer breastfeeding counsellor with the Australian Breastfeeding Association, and a mum.
NAOMI: And I’m Naomi Hull, an IBCLC lactation consultant and the Senior Manager of Breastfeeding Information and Research with the Australian Breastfeeding Association, and I’m a mum.
BELINDA: My first baby was a C-section, and I remember having to hand express while my little one was in the special care nursery and wondering what on earth was happening to my body. I had a wonderful midwife to help me hand express and then on day 3 I remember watching my breasts triple in size as my milk came in.
NAOMI: Oh yeah, I’ll never forget waking up on, I’m not sure if it was day 3 or day 4, but just waking up with massive, rock-hard breasts and I’d always been an A cup. So, it was quite a surprise for me when I had my first baby.
BELINDA: The experience we’re talking about there is our milk coming in. And many mums have questions about what happens when their milk comes in. So, Naomi, what does this mean?
NAOMI: When people say, ‘when my milk came in’, they’re really describing the process around colostrum becoming mature milk. So, during pregnancy you have a high circulating levels of certain hormones such as progesterone which prevents that copious milk production. And so, during pregnancy, you may see some evidence of colostrum, not everyone does but some women will. And then when the baby is born and the placenta’s delivered, some of those various hormone levels will drop. And those hormones are progesterone, placental lactogen, and estrogen. And within around 36 hours or so, your milk will begin to change. But you may not see a noticeable difference for a few days after that.
BELINDA: So many mums will have a time that they feel that their volume of milk increases, and the milk ‘comes in’. So, for me that was with my first baby around day 3. But on my second baby it was around 2 days after birth. But one of my friends had a really long labour and it took a bit longer for her, she was around day 5 or 6.
NAOMI: Yeah, so the main thing that triggers that transition or the beginning of the transition is the delivery of the placenta. But things like keeping your baby with you, as much skin-to-skin as you can possibly handle, so you can never have too much skin-to-skin. And just being responsive with your baby and feeding them whenever they move, basically, they’re the things that can really help your milk to come in.
BELINDA: So Naomi, what are some of the things that could cause a delay in your milk coming in?
NAOMI: There are a few reasons that you could find that your milk coming in is delayed and it’s helpful to know what some of these things are because some are preventable and some you may be able to put some management strategies in place to help reduce the impact.
So, things like diabetes, whether that’s gestational diabetes or type 1 diabetes, a long stressful labour can cause a delay in your milk coming in, a pre-term birth, caesarean section particularly if you’ve had a general anaesthetic. If you had a haemorrhage in that postpartum period, or during the birth, where you’ve lost a fairly sizeable amount of blood. A smaller haemorrhage is generally not a concern. But if you lost, sort of up around that 1 litre or more of blood, then there’s a chance that your milk coming in could be delayed.
Some hormone-related conditions can cause a delay and if you do have a hormone-related condition, just check with your healthcare provider, whether that’s your midwife or obstetrician, just to check if that is applicable for you. And the other one is retained placenta. So, during pregnancy while baby’s still in-utero and the placenta is still there, the placenta causes the high levels of progesterone which stops that copious milk production. So, when the placenta is delivered, the progesterone drops, and the copious milk production starts. But if you have some retained placenta, which some women will have small parts of the placenta left behind, now if you do you usually become unwell. So, if you have ongoing abdominal pain, fevers, and larger than normal blood loss, they will often check that to see if you have retained placenta. If you have that retained placenta, you can sometimes still have the progesterone in your bloodstream and that prevents that copious milk production.
BELINDA: Fantastic. So, all of those are some things that you mentioned, that doesn’t necessarily mean that you will have a delay in your milk coming in, does it?
NAOMI: That’s right, and it’s not a definite thing, but they’re just some things to be aware of. And it’s also important to remember that even if your milk is delayed in transitioning to mature milk, it also doesn’t mean that you’re not going to be able to breastfeed. The main thing with milk production is milk removal. So, that’s the key management strategy for overcoming those problems and overcoming a delay in the transition as well.
BELINDA: So, if you are faced with a situation around birth that isn’t the normal vaginal birth, just being aware that it could have an impact on feeding and there are ways to get help and support, that can be really useful knowledge to have in the back of the brain. So, Naomi can you tell me why skin-to-skin is so helpful?
NAOMI: Well, I guess skin-to-skin is one way to ensure that you and your baby are together, first of all. It helps with the hormone regulation as well and it also makes it easy for you to notice when your baby may be ready to have a feed. So, it’s just a way to ensure that you’re as responsive as possible to your baby. Sometimes if your baby’s in one of those little cots in your room in the hospital or even if you’re at home and your baby’s in another room of the house, they may wake up and look for the breast, but because there isn’t a breast there sometimes some babies will just go back to sleep rather than crying. So it’s a missed opportunity. So yeah, skin-to-skin and keeping your baby as close as possible ensures responsive parenting and it also ensures that the baby is fed as often as they need to be.
BELINDA: Yep. And feeding baby often, it means that you are moving that milk and the baby has the opportunity to take milk often and that helps build our supply because we know that, through studies, that your body produces the same of milk that gets removed. So, if it’s removed frequently it helps to increase that volume of milk in that first couple of weeks.
NAOMI: That’s right, we also know that the more often the baby feeds in those first few days that has a positive impact on how much milk you’ll have down the track as well. Even at, you know, 3 and 6 months.
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SOPHIE: You’re listening to Breastfeeding with ABA. I’m Sophie Fernandes and I’m a volunteer Breastfeeding Counsellor with the Australian Breastfeeding Association. My first interaction with ABA was actually through hiring a breast pump. I was having difficulty establishing breastfeeding with my first baby and required a hospital grade pump to help build supply. My husband went one evening to collect the pump, and the volunteer went through it with him. I remember feeling even though I hadn’t met the counsellor, that there was this support network there for me and people who cared about my breastfeeding success. I also called the ABA a few times during these early months and the caring voice on the other end of the line was invaluable. I then went on to attend our local group catch-ups, made some friends and found a community.
JESSICA: You can find information about hiring a hospital grade breast pump at breastfeeding.asn.au along with information about hand expressing, storing breast milk, and a carer’s guide to feeding expressed milk to your baby using a bottle or a cup.
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BELINDA: Sometimes when I talk to mums on the National Breastfeeding Helpline, many are concerned that their babies won’t have enough milk when their milk comes in, that they won’t be producing enough, that they [their babies] won’t have enough to eat in those first couple of days with the small amounts of colostrum that are being produced by their body.
NAOMI: Humans are quite amazing, actually, because babies are born ready and able to cope for those first few days until the milk comes in. Their tummies are very, very small. If you can picture the size of just a normal marble, that’s roughly the size of a newborn’s tummy. And colostrum is also the perfect recipe of exactly what they need and easily digestible. Their stomach is still transitioning from being in utero, where all their nutrition came through the placenta. So, their stomach is just starting to be used and colostrum is very easy to digest and gentle on the tummy and has everything that they need until that milk first comes in and transitions to mature milk.
BELINDA: That responsive feeding that you’re talking about and filling the tiny little tummy and that marble’s a great visual picture, so feeding that tiny tummy frequently from the breast will generally be enough for them to eat. So, are other fluids generally not required?
NAOMI: That’s right, and there is sometimes quite a bit of focus on the amount of weight that babies lose in those first few days. It’s very normal for them to lose around 8 to 10 percent of their birth weight, and that’s just because they’ve been in utero and they’ve been sharing their mother’s vascular system and mother’s fluids, so they’re often born with a bit of extra fluid on board. And so their job in the first few days is to excrete that extra fluid, and that means that they will lose weight, and that’s very normal. So, the key is really, just as we talked about, the responsive feeding, and letting them feed whenever they need to, to ensure they get what they need but also to ensure that your milk comes in as early as possible.
BELINDA: So, when my breasts are hard does that mean I have lots of milk? Like after my milk comes in, like is that hardness and lumpiness milk? Because mine were so engorged and lumpy, I have such a visceral memory of that time.
NAOMI: Yeah, it’s a bit of a grey area because some of it is milk, but in those very early days a lot of that engorgement is actually just extra-cellular fluid. So, it’s not the milk in the milk ducts, and it’s not the blood in the blood vessels, it’s actually body fluid that’s sitting in between the cells. It’s kind of like when you get swollen ankles and you can push on your ankles and leave little finger marks, you know, like even when you’re pregnant or maybe you’ve been on a long flight. It’s that kind of oedema and it’s sitting in your breasts as well and it’s really just while your body gets that lactation process kicked off.
So sometimes that engorgement can make it a little bit difficult for your baby to latch because it can flatten your nipples a little bit. That’s where there are some strategies where you can use your fingers to apply some pressure around your nipple, just to soften it a little bit and push that extra fluid away, and that’s a perfect example of being able to think about how it’s actually not just milk it’s also extra-cellular fluid.
BELINDA: Because it’s a big shock to your body, when the milk comes in, it’s a shock to all of us I think sometimes [laughter]. So, where would mums go to for help if they had questions or worries about their milk coming in?
NAOMI: It’s always a good idea to seek out some help rather than trying to worry by yourself or suffer by yourself if you’re very uncomfortable. If you’re still in hospital, it’s a good idea to talk to your midwife just to see what support they can provide you.
BELINDA: But you can also call the Breastfeeding Helpline from the hospital too, can’t you?
NAOMI: Yeah absolutely.
BELINDA: Because I used the helpline regularly as a brand-new mum and I found them so knowledgeable and kind at all hours of the day and night if I needed that help.
NAOMI: Oh, that is so true. I didn’t ring the helpline until my first baby was, I think she was around 6 weeks old and she was just having such a fussy couple of days. When I rang the helpline, the counsellor I spoke to was just so reassuring and kind, I felt so much better when I got off the call. It just made the world of difference. And that’s when I went to my first ABA meeting as well because she suggested that. And I was a dutiful mother, and off I went! [laughter]
BELINDA: So, what are some other places that you could get help as well, Naomi?
NAOMI: You can also seek the services of a private practice lactation consultant. Particularly once you get home. And some hospitals actually have lactation consultants on staff as well so that’s always worth asking if that service is available to you there. But once you’re home some lactation consultants will do home visits. And if you have known hormonal issues, such as diabetes or polycystic ovary syndrome or maybe even hypothyroid, you may like to seek a consultation with your endocrinologist. Child health nurses as well, once you’re home and back in the swing of things. Some child health nurses are also lactation consultants, so that’s another avenue.
BELINDA: They can be such reassuring help in all aspects of becoming a new parent too.
NAOMI: Absolutely.
BELINDA: If you’re yet to have your baby, coming along to an ABA — Australian Breastfeeding Association — Breastfeeding Class to learn more about breastfeeding for when your baby arrives can also be helpful.
NAOMI: Those Breastfeeding Education Classes are also a fantastic way just to learn about what to expect, what’s normal behaviour for your baby, and you will also learn a lot more about colostrum, there’ll be some pictures of what it looks like, and more information about that process of your milk coming in and what happens in those first few days.
BELINDA: Just to sum up for today, your breast milk coming in is a really normal and natural process that your body and baby are designed to do, but if you do need help in those days listen to your midwives, call the breastfeeding helpline, or speaking to other health professionals such as a lactation consultant.
NAOMI: For more on this topic you can go to ABA’s website, breastfeeding.asn.au and check out the show notes below for a link to this episode’s blog post which contains further links and information. To speak to a breastfeeding counsellor, call the National Breastfeeding Helpline on 1800 686 268. Or you can also use our LiveChat, which is available on our website — breastfeeding.asn.au
BELINDA: A word about sponsorship and advertising: in each episode you will hear about ABA services and products that we think will help families. Find your local ABA group by visiting our website where you can also find loads of breastfeeding information and a link to join the Association as a member.
You might like to join our Facebook group to continue the conversation, just search for Breastfeeding … with ABA and make sure you answer the joining questions so that we can add you quickly.
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TRANSCRIPTION // Madina Hajher