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Today Elana interviews Robin Kaplan, International Board-Certified Lactation Consultant (IBCLC) and author the book Latch: A Handbook for Breastfeeding with Confidence at Every Stage. Breastfeeding insights from lactation consultants are so important, as they help and reassure so many women in those vulnerable first days of motherhood. We discuss ways women can avoid breastfeeding challenges, the hot topic of tongue and lip ties, reflux issues with babies and so much more!
Enjoy the listen!
Robin : 00:03 We can watch all these things on YouTube or watch a video in class, but to be able to like actually sit in a room with a bunch of breastfeeding women can be really empowering as well because you’ll realize like there’s not one right way to do it.
Elana: 00:17 Hello and welcome to Whole Mamas podcast. Ooh, I just got chills saying that for the very first time Stephanie and I are beyond excited for our rebrand and the support of the Whole30. If you haven’t checked out our website at www.wholemamasclub.com. Please do. It’s packed with great information. It’s organized by resources for preconception pregnancy, breastfeeding, postpartum family and kids, so essentially you’re covered anywhere on your journey through motherhood and you can now find our podcasts, show notes, and past archived episodes at www.wholemamasclub.com/podcast. We are here to give you tools, resources, and evidence based information so you can make the best decisions for yourself and your family, whether you’re trying to conceive or navigating life with a toddler or a teenager. We’ve got you covered. On today’s show, we invite guest, Robin Kaplan, a lactation consultant, and author of Latch, a handbook for breastfeeding with confidence at every stage, so breastfeeding mamas and mom to be, this show is for you. Now, before we dive into the interview, I’ll quickly introduce myself, my cohost, and then we’ll get into the good stuff. I’m Dr. Elana Roumell, pediatric naturopathic doctor and founder of Nourish Medical Center. My cohost is Stephanie Greunke, registered dietician and program manager of Whole30’s Whole Mamas Club. Now let’s get into our podcast and invite Robin Kaplan to the show.
Elana: 01:48 Robin, welcome to the show. I would love for you to share with our guests. How did you nourish yourself today?
Robin : 01:52 So, a great question. Um, today didn’t do too much. However, I had this amazing facial a couple of weeks ago and I had never really had like a facial repertoire and so now being 42 and I don’t wear a ton of makeup and I’m like, gosh, those wrinkles are starting to kind of stand out a little bit. And so she gave me this regiment for this product or a couple of products for washing the face and a vitamin C serum and moisturizer and so I’ve been doing it for about three weeks now. And so I’ve been really diligent about evening and morning and so, and I have to tell you, I was looking in the mirror today and my face actually looks like softer.
Robin : 02:35 So that’s how I’ve nourished myself today is I’ve really bought into this whole facial cleansing treatment and it’s super easy and I’m going, it makes me feel good every morning.
Elana: 02:47 Oh, I bet. Does it feel like you’re at a spa kind of.
Robin : 02:50 I mean kinda because yeah, it’s great.
Elana: 02:54 Exactly. Yeah. And our skin, it’s so important. I mean, why not nourish it in that way? That’s great. Oh, I love that. Um, okay. So what did I do? I’m trying to think. I think the biggest thing I would say is I said no to a commitment over this weekend and I honestly just, I’m like, I’m, I was excited about, but I was like, I just need to rest and it’s so tough sometimes because like you just want to be a yes to everything exciting, especially when it’s fun.
Elana: 03:23 It’s easy to say no to something that you don’t want to do, but I’m a no to something and it feels really good and empowering and so I just wanted to share that because I think, you know, I share oftentimes I nourish myself with the food or you know, even like for you a cleansing wash or a massage or something, but just the power of just saying no to something that you even want to do I think is really an important nourishing practice to sit to do. So I hope I can inspire some people. It’s huge.
Robin : 03:49 And knowing that you just opened up hours on your weekends. Yeah, I, I do that. I probably do that more often than I should sometimes. I love knowing that like I have hours of time to just do whatever. Yes. Nice job
Elana: 04:03 It almost caused me anxiety to say yes. And then I was like, I just want like a flexible Sunday, like I want no plans yet and if I want to do it last minute then I could be a yes. But I just, I don’t want any plan. So I’m really excited about. I’m looking forward to this weekend. Alright. So let’s go ahead and jump in. So first of all, before I start, I do want to share with the guests that Robin, you were my personal lactation consultant and I feel so privileged to have met you for our guests. Just so you know, when I was looking around for my birth team and my, my, like group of amazing women, my midwives and such. Robin, you are being told, I was just told across the board you’re the best in San Diego. And I said, well I must have the best. And I have to say I’ve just been so pleased with your work and I just, I, I feel like we’ve become friends. You’re just, you’re just such a wonderful person in my life and I really appreciate all you’ve done. For our guests. I just want to share, I used to call and I still do call Robin, my postpartum angel. I would have called my midwives and my, you know, prenatal, my pregnancy angels, you know, it’s like who I have questions for or have concerns with. I would send them messages and they would be there for me and then I realized after I had my baby I still had those questions and in fact I felt like my questions were even more vast. I had so many and I was so committed to breastfeeding that you were such an angel for me in that time. I was able to connect with you. You helped me through getting Aviva’s lip and tongue tie revision and we’re going to talk about that too. And I just so appreciate your work. So I think I have a little bit of envy because you get to play with newborns.
Robin : 05:41 Like all I do, it’s like babies and puppies, like you were so lucky, you know, and they’re so yummy. I mean it’s, it’s funny, my staff and I will talk all the time about like, it’s so hard, like sometimes if mommy’s go to the bathroom or whatever, we’ll be able to hold the babies because usually we’re pretty hands off because you know, your mama bear instincts kind of kick in and you don’t really want someone you don’t know to hold your baby. And so for those moments where we get to, it takes every ounce of effort to not kiss the top of their heads because they’re so yummy and you just have to smell it. They’re amazing and they just melt into you and you’re like, oh gosh. Like mean I literally, everyone who comes to work for me gets pregnant. But um, but yeah, literally when it comes to like, you want to get pregnant, just come work for me because apparently like, yeah, the oxytocin man. It is delicious. I do have a good job.
Elana: 06:40 So just to also add, if you don’t mind with this time, I want to just share with the guests – I want to acknowledge you. And thank you because you got my sister into being interested in becoming a lactation consultant. When I had Robin come to my house within 24 hours of having Aviva. I had that home birth. There was a show on my birth story. If you haven’t heard it, you can go back to past episodes and listen. I invited Robin to my house within 24 hours just to check in on things. And my sister Laura was there and you heard her educate me about things and you kind of whispered in her ear, hey, I think this may be a good career for you. And I just want to thank you for that. Because she’s serious about it. She’s now going to school for it. It’s so cool and I’m so jealous. I’m like, this career, why didn’t I do that? She goes, well, you get to work with kids all the time. Like you’re right, but you get the newborns words. Okay. Let’s go ahead and jump into the questions. The first one I want to ask is, I think all the listeners here, and definitely Stephanie and I greatly believe in breastfeeding. I mean it’s just such an ideal form, nutritionally and just bonding and everything. However, there could be a lot of challenges for a lot of moms and I think you see most of that because the thing a lot of people come to you with that. I really want to talk about what advice you can give to just like a really proactive mom who wants to try to prevent any challenges ahead of time.
Robin : 08:02 Such a good question. So, um, we talked about this in the book actually because there’s a whole chapter on kind of preparing while pregnant. And so a couple of things that I find can be super helpful. One is taking a breastfeeding class, not all breastfeeding classes are the same, some are better than others. However, I think it’s really helpful to know what normal is supposed to look like. A lot of my patients will say, Gosh, I wish they would’ve told us about this and this and this, you know, like these challenges we could have had, but in all honesty, do you really want to hear about the challenges before you’ve had your baby? So I think instead of focusing on what the challenges could be, really looking at what normal breastfeeding looks like and then if that’s not what your experience looks like, then your little red flags will go off. Right. So taking a class, I always welcomed pregnant moms to come to our breastfeeding support group. This is one of Ina May Gartnen’s best recommendations as well. I interviewed her years and it’s because you know, it’s really helpful to be able to see other moms breastfeeding their babies. As you know, not one position fits everybody and so it’s really helpful to kind of sit there and look and watch and talk to them and find out how it’s going for them. It’s a good place for you to go to after you’ve had your baby as a way to meet other moms. A reason you get out of the house and brush your teeth, but also get some support because it’ll be a familiar place then because it can be really anxiety provoking to go to a new place that you’ve never been to with a new baby.
So another thing would be just finding a breastfeeding friendly pediatrician. I realize that sounds probably kind of silly. Shouldn’t all pediatricians be breastfeeding friendly, but some are more well versed in it than others. And so finding one that really is, you know, promotes breastfeeding and finds that lactation consultants are helpful so that way if you have questions that go beyond your pediatrician scope of practice, she or he can refer you to someone who can help and then, you know, find a good breastfeeding book that can be helpful as well. And also I always recommend for families to look into who are the lactation consultants in their area, find those while they’re pregnant because there’s nothing more scary than cracked bleeding nipples at 3:00 in the morning. And you’re literally emailing everyone in the neighborhood to find out who you should call. So if you do the research ahead of time, hope is you’ll never need that person, but if you do, you’ve already vetted them, you’ve already looked at their website, you can already see the type of person that you’d be connecting and calling and so that way it’s like you already have your list of who to call if need be and you don’t necessarily have to go meet with that person ahead of time.
But you know, reach out. I get calls all the time like, Hey, I’m having my baby in three weeks. I really just wanted to connect with a person over the phone to see if you sounded like a person I’d want to invite in my house after the baby’s born. So those would be my things.
Elana: 10:51 Those are great tips. And actually I was one of those people, if you remember, and I wanted to share with the guests, I almost felt nervous about it. I called you and I’m like, uh, I’m in my third trimester. Maybe I was even my second. I was like so gung-ho about learning all of this stuff. And I said, do you even offer prenatal appointment? I almost thought that was a stupid question. You were like, no, it’s great. In fact I wish more people took those. They don’t realize that it’s offered. And I was like, phew, I’m not this weirdo. And it was probably the best hour spent with you. First of all, I just. So if the listeners don’t know, insurance does cover a lot of lactation consultants.
Robin : 11:27 It’s supposed to by law. Sometimes it takes a little finagling.
Elana: 11:33 And to be honest, I didn’t even care. I was so happy. It was the best money I spent. And a couple of things that I came to you with was a lot of my concerns that you actually helped me negate like I actually came out of your appointment, that prenatal appointment, feeling more comfortable. For some reason I just had this vision that I was going to have to wake up in the middle of the night and start pumping like from the get-go. And I thought that I had to take my pump everywhere.
Like, I dunno, I just had this like list of questions, you’re like, nope, you don’t need to do that, and you kind of helped comfort me and say, okay, start the bottle at three weeks or start this or no, you’re not even needing to pump until.. and if you do it actually could be worse. And I brought my pump with me and you just showed me how to use it. I literally came up with a list of 20 questions and I felt so empowered leaving. So I appreciate that so much and I really encourage the listeners to also do that. Um, the other thing you mentioned, I thought that was really wise, was go to a support group, watch moms feed and one of my best friends who just had her baby who actually texted you, I was like, do you have a LC to come to her house? She was having some difficulties. She read something to share with me that a lot of women these days are having difficulties because they never saw their moms do it with their siblings or they’ve. They weren’t around it, you know, it wasn’t so popular when our moms were having us. It’s much more popular now. It’s almost like trendy, but that we’d never really grew up around it. And I remember when I had Aviva, my mom, who unfortunately wasn’t in the know of breastfeeding, she couldn’t really help me. I actually went to my sister Leora and I said, Lee, I need your help because mom isn’t able to help me with this and she wants to, but she’s telling me to go to you. And so Leora was such a huge help for the sake of the fact she’s done it three times with three different babies.
Elana: 13:22 And so yes, just finding someone with that experience. It helps you understand what’s normal.
Robin : 13:27 Because we can watch all these things on youtube or watch a video in class, but to be able to like actually sit in a room with a bunch of breastfeeding women can be really empowering as well because you’ll realize like there’s not one right way to do it so it creates a sense of community, which I think is huge. I was the first one out of all my friends who had children. So the first time I had really interacted with other people who had children was at the breastfeeding support group that my lactation consultant ran. And a lot of people meet friends and start hanging out and then they have these long time friendships because they met at a postpartum group.
Elana: 14:04 Great. I love that. And it gets them out of the house. The thing is, I remember when I would go to the groups, I learned different positions and also different boob sizes. I mean, to be honest, it’s like the football hold can be working with that, but the laying down is better with this and you’re like, oh, what are you doing? Oh, let me try that. And it’s just camaraderie. I mean, that’s beautiful. Women love to connect with you. Okay, great. All right, let’s go ahead with the next question. So many doctors and lactation consultants say that breastfeeding shouldn’t hurt at all, but most moms say that it definitely hurts in the beginning, even if it’s for the first couple of weeks. Why this discrepancy?
Robin : 14:36 Well, if, if a baby is opening up widely and doesn’t have some sort of oral restriction and mom’s nipples are going into the baby’s mouth comfortably, it shouldn’t hurt. Tenderness is normal. I mean this is an area of your body that has most likely never been used this much. And so it’s just a lot of stimulation, eight or more times in a 24 hour period for a really long time. So I would say tenderness is normal. Oftentimes the first 10, 15 seconds you might remember latching can be a little bit like, Ooh, pinchy and then it relaxes once the baby starts to feed, but cracked, bleeding nipples, stuff like that. That’s our body’s way of telling us that there’s some room for improvement. So I think not necessarily discrepancy, it’s just that even when we’ve done this before, like my, my second son was a much more challenging breastfeeder than my first and I had done that. I had breastfed before. So you’re learning a new skill with a new human being and so it can sometimes feel a little off for a couple weeks. But again, tenderness is normal, pain is not.
Elana: 15:44 And I like what you said. With every child it really, you have to go into it thinking this is a whole different adventure.
Robin : 15:51 Except that you are way smarter because you’ve experienced it before. Or you know, when things were finally going well with breastfeeding like that know that that feels pinchy over this. There’s something off. Like it’s not going the way it should.
Elana: 16:07 And I also want to distinguish this tenderness and it’s true. It’s like, yeah, that nipple has never been used in that way. Someone, told me that it’d be a good idea to take a towel and started rubbing your nipples. So super old school recommendation and I’m just like, excuse me. They’re like, yeah, you almost want to build a callus on it before baby comes. What’s your recommendation?
Robin : 16:29 Definitely not recommended? La Leche League came out in like the nineties and was like, don’t do this anymore because that was kind of the standard recommendation. I wouldn’t say callous, because you’re thinking like you callous over when they’re blistered. So it’s toughened up, but just don’t do that.
Elana: 16:56 Okay, great. So tenderness is normal. For me personally, it took about two and a half to three weeks for me to kind of be like, okay, I got this. I don’t even use my coconut oil anymore, any of the cream. And then from then on I was fine. So would you say that’s a great timeframe, two to three weeks?
Robin : 17:12 Two to six weeks.
Elana: 17:13 Okay. Two to six weeks. So I got lucky.
Robin : 17:15 Yeah. Two to six weeks, you know, again, it’s a learning curve and it depends on your baby’s birth and what their position was in utero, you know, how tight they are.
Elana: 17:23 Also your nipple size.
Robin: 17:26 Some moms who have, you know, have much larger nipples than baby’s mouth. It can take a good six weeks for the oral structure to fit. So yeah, there’s a lot of variables in there but for the most part, between two and six weeks.
Elana: 17:41 Okay, great. Well, let’s talk about this big topic. It’s such a hot topic with lip and tongue ties. I just feel like every baby now has one or, or both or a variation of it now. I do believe there’s so many theories out there, but I want to just get from your perspective. I remember you’re not a big fan of always revising a lip or tongue tie unless it’s causing an issue. So can you just give the guests just a little bit of your recommendations with the revision and then also to add to that, I’ve got some patients who are so now on top of tongue and lip tie, they’re almost ready to get it done. Even if the child doesn’t have the diagnosis, they just want to go to the dentist and get it done. And so what are your recommendations on how early you could do it and when is appropriate to do it or not?
Robin: 18:27 Good question. And I have to say also that the information that is coming out about tongue ties and lip ties and how it impacts breastfeeding, how it impacts long-term, you know, oral structure and growth and things like that is really, it’s changing vastly. So what I say today, I may not say in a year, but for my knowledge to this date, right now is that I think a lot of people are worried that they’re being overdiagnosed. I tend to agree with that as well. I mean I see people post in facebook groups all the time. I see, you know, my kid has a tongue tie my kid as an upper lip tie and stuff. You can’t diagnose it by necessarily by looking at it, you have to have someone do a full oral assessment, so gloves on the finger, checking tongue, lateralization, tongue lift, how far it extends, what the suck feels like, is it coordinated, is the tongue lifting in the back as well as in the front. Then what does the baby look like at the breast? What does mom’s nipple look like when the baby comes off? Things like that. I mean this is a full oral assessment and second assessment of how the tongue functions because every single human being has a frenulum, and I’m going to say that again because it’s really important to hear. Every human being has a frenulum under the tongue and under the lip. And so we have to look at what is the range of motion and is it impacted? Sometimes we’ll see really long stretchy freunla. Baby does just fine. When I see this though, I have to look at the baby’s pallet. So if the tongue is resting at the top of the pallet when we’re sleeping and when we’re feeding, you know when babies are feeding and pushing the breast up to the pallet, we can often get a high palate.
High pallets are challenges because they can cause orthodontia challenges later on. They can cause sleep apnea, they can cause digestive issues because the tongue needs to hit where the soft palate meets the hard palate to start peristalsis to get us to poop. So, and this can be a lifelong challenge for individuals whose tongues are not reaching to the roof of their mouth. So that being said, we want to look at the pallet too. The pallet is really important. So sometimes a tongue tie may not be causing an issue. So the frenula is there, it’s present, we can see it, but it’s not causing a challenge with breastfeeding babies feeding well, moms not in pain, baby’s not super gassy. Everything looks good. We want to alert the parents, keep an eye on this. How does baby do with solids? How is the pallet forming, things like that because there might be challenges in the future. So for your friends or colleagues, whomever were like, as soon as I see that tongue tie, I’m going to get it released. It may not be a bad thing because it could be preventing long-term things. However though, you know long-term situations with palatal structure and orthodontia may or may not happen because it depends on how the tongue functions. I have two boys, both of them have significant tongue ties that were not diagnosed 12 and 13 years ago. One of them needs to get the tongue tie released because his pallet is high. He’s having orthodontic challenges. He has sleep apnea. He has all of the classic symptoms of when the tongue doesn’t have flexible mobility. My younger son has a tongue tie and he has no problems and so again, my older one’s going to have to get his release now at 13, my younger one who will be 12, we’re just going to wait until there seems to be a challenge and if the one shall arise then we get it released. Should they have had them released as babies? Yeah, because they both were terrible breastfeeders.
Elana: 22:12 That was a great explanation. I have a couple of questions. Will your son have to go under general anesthesia?
Robin: 22:24 No. So a pediatric dentists release them on older children all the time before the have orthodontic work.
Elana: 22:32 That’s not a big deal. So my understanding was when they’re newborns, it’s so mild. I mean, of course as a new mom, everything’s traumatic. You do not want to do that. You don’t want to do the exercises. You’re just so tired anyway and you don’t want to inflict pain, but I remember for me personally, we did Aviva around like three days old, but then it reattached, but I had no breastfeeding issues, so it was like, you know what, I’m not doing this again.
Elana: 22:55 I remember we had this talk. Initially, I was like, I’m not doing it. Then she started eating solids and my good friend who’s an occupational therapist, noticed she wasn’t lateralizing her tongue and she was eating solids so slowly and she was just moving her tongue just for forward and backwards, so we decided to go ahead and just get it revised and I think she was 14 months at that time. It was awful. I mean she was screaming and she was not happy and every time we tried to do the exercise, it was just a battle and I said, gosh, I wish I just did this again when she was newborn. Even if it reattached, I wish we just did it again. However, it’s true. We don’t even know if it’s really the cause of any issues. If she’s going to have speech problems or if she’s going to have orthodontic work or if she’s going to have difficulties with sleep apnea or even just from jaw structure, but you know, we just decided, look, this can’t hurt. The only thing that is hurting is that this is just a big battle right now. But I felt like the older she got, the harder it is. But at 13 I feel like it’d be much easier to.
Robin: 24:00 I’ve been wanting to do this since he’s been four. We had to wait until he was presenting symptoms that he was complaining about and then say like, okay, so you know all that teeth grinding and you wake up with a sore throat because you sleep with your mouth open. And so now he’s like, yeah, I’m scared, but I want to get taken care of.
Elana: 24:21 See, this is why I’m not necessarily opposed to doing it. Maybe it’s not necessarily the overdiagnosis. I don’t feel like there’s much risk in doing it, except for it could reattach. That’s what happened with Aviva and I’m sure scar tissue is going to form there.
Robin: 24:39 A new frenula is always going to form. So it depends on how stretchy it is. I just took this really cool training a couple of weeks ago, but essentially for babies who after they have their tongue ties released, getting them into tummy time, which I know I’ve even done a lot of, but getting them into tummy time so that they’re constantly getting some neck extension and moving. It allows the tongue to keep lifting and have more flexibility and mobility. And so the hope is, is that when the new frenula forms, it’s longer and stretchier and not impacting mobility so you know, or craniosacral work or working with an occupational therapist, you know, not that everybody has to do that. I mean tummy time is free, so put the baby on their tummy. But um, yeah, there are different things that we can do that we now know more a little bit about to keep it so that whe the frenula does reform, that hopefully it doesn’t reform with some added restrictions.
Elana: 25:32 Well, that’s what I was going to ask is, is it possible that you get a revision and the reformation of it actually tends to be more
Robin: 25:39 It shouldn’t, no tension and no. So the interesting part when I hear that, that it’s worse than it was before. So remember your baby’s been using compensating mechanism and so now you just took away their compensating mechanisms and so sometimes it can take a good couple of weeks for them to really figure things out. However, if the tongue tie has not been fully released to say the anterior that sail that you can see has been released, but the posterior hasn’t been. So the tight rubber band underneath that, then all you’re doing is creating a situation that now baby has to learn new compensating mechanisms that in this posterior ones are stinky, they’re tight. And so usually if we’ve heard things were better beforehand, my gut feeling is that the anterior tongue tie was released but the posterior wasn’t. And so now we’ve just caused some more challenges on how to use the tongue because it’s just a whole other set of compensating mechanisms that have to be formed where if it was released completely, then they don’t have to compensate.
Elana: 26:44 Do you think laser versus scissors is best?
Robin: 26:49 That’s the million dollar question? No, I think it has to do with the practitioner who uses the tool. Okay, great. Because there are a fantastic, fantastic scissor releases. There are fantastic laser releases and they’re crappy ones, both of them as well.
Elana: 27:02 Okay. Let’s talk about like a baby struggling with reflux because it’s just such a common ailment, unfortunately. I just wanted to see..what are some things that you like to recommend to mom just to try at home, like maybe specific foods that can help relieve the issues. It’s so common. I see moms come in and they’re like, well, I stopped eating broccoli, kale, cabbage. Oh, I don’t eat tomatoes. Oh, and I don’t eat meat. And potatoes. You are nursing mom, do not stress yourself out. Nourish yourself. So what do you recommend and what are your philosophies?
Robin: 27:35 So when we’re looking at reflux, the first thing we have to do is look at, is it true? So all babies have some sort of reflux. I mean they have an immature digestive system so when baby is uncomfortable and gassy and just an unhappy kiddo we want to look at is it based on babies constitution? So is there something going on in the baby that’s causing this or is it the method in which the baby’s feeding? So the baby’s taking in a lot of air while feeding, like from a tongue tie, lip tie, or just some other challenges with tongue mobility because it doesn’t always have to be a tongue tie that’s causing that. We want to optimize positioning and also seek guidance from someone who does body work, craniosacral therapist, occupational therapist, myofunctional therapist, chiropractor to see if we can help optimize the way that they’re breastfeeding. And a lot of times that remedies the reflux spit up symptoms because babies taking in less air while feeding. So now we have a happy baby.f it has used to them.
Elana: 28:37 But when you watch the baby feeding, can you tell that they’re okay?
Robin: 28:41 Yeah. Because a lot of times their nostrils will flare. You’ll hear that like super heavy, like gulp. They look uncomfortable while they’re feeding. So that’s part of my job would be to see like is it the method in which the baby’s feeding or is the baby this, this super calm, quiet, just mouthy yummy feeder and then a half an hour later just or even five minutes into the feeding, they start arching their back and screaming and crying and then they cry for a long period of time because they’r just uncomfortable. So that would be more of a true sign of a reflux symptoms. And so then let me go down the next path that you know. Okay. So is it baby has acid reflex, which is a minimal percentage or is it something that mom is eating? Were mom or baby given antibiotics? So the gut just needs some repair. If it has something to do with mom’s diet, the easiest way that this has been explained to me, and you can correct me if I’m wrong, but essentially if a baby is reacting to a food in mom’s diet, it’s because her body is not processing it well enough, so usually we look at the biggest inflammatory foods which are gluten, soy, milk, dairy, nuts, shellfish, stuff like that, so dairy, soy, and gluten tends to be the biggest offenders. So what that means is that mom eat some cheese, her body starts to digest it, it doesn’t digest it well, and so those larger proteins go into the bloodstream. Milk is made from blood, so now we have these larger proteins in mom’s milk that are passed into the baby and then the baby’s digestive systems to mature to handle it, and so has reflux symptoms. Does that make sense? Okay, so that being the case, if we can identify a food that could be an offender or foods that can be offenders, then we would recommend that mom cuts it out of her diet for about two to three weeks to see if she notices a difference. If she does, then we stay off of it for, I usually recommend another month and then we start trialing it and seeing if the baby at that point, their digestive system is more developed and they can handle it. If not wait another month and keep trialing it because again, it’s not necessarily the baby is allergic to that food. It’s that the baby’s digestive system isn’t capable of breaking down those larger proteins. I often find that moms remove those foods from their diet. They didn’t realize that they were offensive in the first place and then all of a sudden you see her three weeks later and you’re like, how are things? And she’s like, well, baby’s doing better and I feel a thousand times better. I poop every day. I have more energy. I’m not bloated at 4:00 in the afternoon anymore and we’re like, oh, so yeah, those weren’t normal symptoms for you either, so they tend to feel better too. If the food is not the offender, then no one’s going to have any improvement and then at that point we have to look at what we can do to help the baby’s gut and that’s, you know, I have a few tips here and there, but I typically will refer them to a naturopath or a nutritionist or someone who can really kind of look at what can we offer the baby, what can the mom eat to help, what can we offer to the baby? Like slippery elm bark is something that we recommend just to coat the gut, really high quality probiotic, stuff like that. But as for cruciferous vegetables, I don’t really think that those pass into the bloodstream. And so, I mean, correct me if I’m wrong, but what I’ve heard is that it’s the protein, so don’t cut out your greens, keep eating those. I always thought that my kids didn’t do well when I ate garlic and onions, but I think it was the pasta that I was eating with it. I’m fairly gluten intolerant and I didn’t realize it until later on and so was like, oh, I think it was the gluten and the pound of cheese I put on top of it and it wasn’t the onions and the garlic.
Elana: 32:29 Great to know. We share such a similar philosophy and I think back to even my first question on what can a mom do to be proactive so that perhaps they don’t have some of these breastfeeding issues could be a food sensitivity panel. Because we want to be as optimally healthy as possible and so that means the food that we put in our bodies should always work for our bodies during pregnancy, before pregnancy, after pregnancy, because yes, it goes to the fetus during pregnancy and then it goes through your breast milk after, and this is exactly how I was taught is whatever we’re eating, it turns into toxic substances in our body when it just doesn’t work for us. And so if those toxic substances are then going through the breast milk, then of course it’s going to aggravate the child. So yeah, even doing that preventatively can be great.
Robin: 33:16 I’ve taken several courses from this amazing instructor, her name is Jennifer and she taught holistic practices and lactation and this oral habilitation of the breastfeeding dyads learning about tongue ties and things like that. And um, she always asks her patients, you know, what foods bothered you while you were pregnant. Because those are typically the ones that your gut couldn’t tolerate. And so if those were affecting you while you were pregnant, keep them out of your diet. Let’s see if that helps.
Elana: 33:45 Just like you said, the moms are going to feel so much better. They’re probably never going to want to bring them back. Yeah. So I understand that. I think that’s great. Now you could do elimination based on just what the most common allergens are or what we do here. At least at my medical centers, we do an IGG food panel. And so these are what are delayed reactions to food, not something that’s like an anaphylaxis shock, we know the things that cause immediate reaction, these are ige reactions, but we test their igg reactions so that we have an idea of what maybe you eat something today and two days from now we still have an aggravation, so I think that’s just great. So you know, eliminate them and do a trial or you can go ahead and do a test.
Robin: 34:25 So we’ve done those igg tests in our family as well and we’ve compared them to muscle testing to and they seem to be for the most part, 90 percent the same. It’s been really cool. And so, and when we’ve removed those foods from our diet, it’s like you just feel better.
Elana: 35:04 Amazing. I use that for almost every one of my patients, kids with Eczema, ADHD, kids with constipation. Okay, good. So yeah, similar philosophies. The next question is just about galactagogues. So for some of the listeners who don’t know what those are, these are herbs that help stimulate milk production. I mean it could be foods as well. So I just wanted to know, in your practice do recommend them, do find them to be effective or again, I think with natural medicine it’s also very individualized. Can you give our listeners just some ideas of what your philosophy is behind those?
Robin: 35:38 Yeah, I do think they can be effective. Are they going to double your milk supply? Probably not, but I feel like the galactagogues that are on the market and capsule form and tinctures and teas, the basic ones, fenugreek, blessed thistle, Moringa, can be helpful when we’re having effective milk removal and things like that too, because I mean you can take all the galactagogues, but if no milk is being removed, your body’s going to pull the shut off. You know, there’s this great book called Mother Food by Hilary Jacobson. She has a wonderful book all about different galactagogues and also, you know, they depend, like you said, on the person. So for moms who tend to be more estrogen heavy, shatavari is a great one for stabilizing estrogen. When we have too much estrogen floating around in our body it can decrease milk supply. So that can be helpful for women who have a thyroid condition we recommend staying off fenugreek because it doesn’t interact well and it can lower thyroid function. And so even though you know, a lot of people will think, well herbs are so benign, but as we all know foods have purposes and sometimes they don’t interact with our bodies the way that we’d like them to. And so it is really helpful to work with someone, do your research to be knowledgeable about like, is this a proper herb that would be good for your body? But yeah, they can be helpful. We recommend them all the time. But also with the understanding of there are multiple components that go into increasing milk supply and not just taking a few capsules.
Elana: 37:02 Agree. Well, I just want to share a clinical experiences that I had. I had a patient who came in literally with like a Costco sized bag and Moringa, which I think is great. I mean, and it’s such an antioxidant-rich herb, but she wasn’t even nursing yet. And she goes, what do you think about me starting this multiple times a day? And I said, hun, I want you to just see what your body’s going to do all on its own because you may not need this. And what I find is when your milk supply is really robust and great, if you’re taking these galactagogues just to be extra precautious, you can get clogged milk ducts, you can actually overproduce. And that is also an issue. Can you speak a little bit about that too?
Robin: 37:42 So a lot of people say, oh, it’d be great if I had an overproduction. But it comes with its own set of baggage, like plugged ducts, increased risks for mastitis, discomfort. So yes, if you have a robust milk supply, don’t start taking all the galactagogues because you could get uncomfortable and have a few other challenges that pop up that are probably unnecessary. And that actually goes back to that question with reflux as well that I forgot to mention that it’s not always the way the baby’s feeding. If mom has a massive production, then that could be a formal kind milk imbalance. So babies getting all that watery milk and having a hard time getting to that creamer milk because they fill up so quickly on the watery milk. Granted I feel like that’s often overdiagnosed but at the same time that can also definitely cause reflux symptoms because that foremilk can, as it’s breaking down in the baby’s belly, cause a lot of gas if it’s, if it’s not balanced out with the creamier stuff
Elana: 38:41 Would you then recommend almost pumping sometimes or expressing?
Robin: 38:46 So we don’t necessarily want to pump. So when moms have an oversupply, we recommend block feeding. So one breast per feeding and switching, like every three hours. There are different herbs that can decrease in supply. So sage and mint are used for decreasing supply. Sometimes we want to do a few things to just to temper it down and then usually by 12 weeks mom’s milk supply is really kind of leveled out.
Elana: 39:10 Okay. I just want to ask one last question before we get going. I could just keep on going, but this is actually a personal question. However, I do believe that there’s other moms listening out there, so bear with me and I appreciate you helping me with this. So I have a 16 month old and I would love to have another baby soon. However, I don’t know if I’m ovulating but I have not had my period yet. We nurse a lot. She loves moms milk and I’m not ready to wean her yet. Maybe when she’s like 18 or 20 months I would consider it. But I also said that I thought I would be ready at 12 months and I’m not. So I’m just kinda curious your recommendations with someone like me and other listeners out there who want to get pregnant and what can we do to maybe help facilitate ovulation in a very gentle way without necessarily weaning and or when we are ready to wean, what is a good gentle way to do that so we’re not totally giving up on it.
Robin: 40:04 Yeah, great question. I get this question all the time. Okay, good. So to help kickstart ovulation, obviously it’s very personal for a woman’s body, you know, how, what was she like before she got pregnant and things like that. Typically what I find is that when children start night weaning, moms start to get their pattern back, ovulation and bleeding and it’s essentially because when babies or breastfeeding through the night, it can still be used as birth control. So as we start to wean from those night feedings, that’s the gentlest way I find still keeping breastfeeding as part of the equation, but possibly starting to ovulate again. If that doesn’t work and it’s getting to the point where nothing is happening with ovulation, then some moms will actually wean and it really just depends on how old that mom is and how long it took her to get pregnant the first time. There are lots of different pieces of the puzzle there, but for women who are just starting to think about it and their children are, you know, not needing to feed in the middle of the night for nourishment. So for children of Aviva’s age for example, she could go through the night without breastfeeding.
Elana: 41:20 When you’re saying night weaning, do you even mean putting her down for bed?
Robin: 41:25 Oh sure, yeah, you can nurse her down.
Elana: 41:28 So now she’s been sleeping through the night. We’ve been really lucky. I know there’s always those nights, maybe she’ll wake up here and there, but she was going really nicely, nine or 10 hours and I was fine and now she’s been teething, so it’s kind of back to sometimes she’ll wake up. I mean I just think it’s my body that I almost feel like I have to completely stop and I’m just not ready for that yet.
Robin: 41:53 So you could also get your hormone levels tested. That would be the next thing is just see your levels.
Elana: 42:04 Every every woman is different. I mean I’ve met moms who are still nursing continuously even during pregnancy and they’re feeding. I mean, and they, they got their period and then I have some good friends who just did not get their period until they were completely done with nursing and everyone is so different.
Robin: 42:21 I think I got my period back with both my boys at 4 months. and I was still breastfeeding them throughout the night and my kids are 16 months apart. So breastfeeding isn’t always birth control, so for your situation I’m not quite sure, but for most women they find that as night weaning does happen so and again that’s just means not breastfeeding throughout the night, but you definitely can nurse down to sleep and morning, you know.
Elana: 42:45 So I can go nine hours and even when I come to work I can go like seven hours and I stopped pumping and everything and I am still not ovulating. Okay. That’s okay. You know what, I look at it like I just want nature to take its course. I mean even needs me right now and when we get pregnant with the next one, that’s perfect. So you know, one baby gets so much attention and she is not going to get that attention so I might as well. This is fun and this is great, but okay. I just wanted to see what your thoughts are. Yeah. Oh Great. Well thank you so much for coming on the show, Robin. I still have so many questions. I could pick your brain. Hopefully I’ll have you come on back.
Robin: 43:18 Good. I would love it. Thank you so much. This has been such a pleasure.
Elana: 43:22 Thanks for listening to today’s episode. If you enjoyed this episode, please help us out by sharing our podcast with your friends and writing us a review on iTunes. Let us know what you enjoyed about this episode and help us grow our village. You can also visit our website www.wholemamasclub.com/podcast to review show notes, find past episodes and leave comments and questions for future shows. Please remember that the views on the podcast are not meant to be substituted for medical advice, shouldn’t be used to diagnose, treat, or cure any conditions, and are intended for general information purposes only. Now, go on. Have a good day and nourish and nurture yourself and your family.
- How to be proactive in avoiding breastfeeding challenges
- What to expect with nipple tenderness
- Insight into lip and tongue tie revisions
- What mom can do to help her baby with reflux (does she really need to avoid all cruciferous veggies?!)
- Galactagogues to help with increasing breast milk supply
- Ovulating during nursing
- And more!
- Order Robin’s book Latch on Amazon
- Robin’s website: San Diego Breastfeeding Center
- Robin’s podcast: The Boob Group
- Robin’s YouTube Channel, Facebook, Instagram
- Mother Food: A Breastfeeding Diet Guide with Lactogenic Foods and Herbs – Build Milk Supply, Boost Immunity, Lift Depression, Detox, Lose Weight, Optimize a Baby’s IQ, and Reduce Colic and Allergies by Hilary Jacobson
- Nourish Kids Medicine Kit and Ebook
- Dr. Elana’s Medical Center: Nourish Medical Center
This episode's guest
Robin Kaplan is an International Board-Certified Lactation Consultant (IBCLC), frequent media commentator on the topic of breastfeeding, and the author of the new book, Latch: A Handbook for Breastfeeding with Confidence at Every Stage. She is also the founding host of The Boob Group, a podcast about breastfeeding hosted by New Mommy Media. Robin founded the San Diego Breastfeeding Center in 2009 and is an established voice in the parenting world known equally for her knowledge about lactation and her commitment to supporting moms without judging them, a keystone of her centers philosophy. She offers in-person breastfeeding help for families in San Diego and throughout the world, through online consulations. Robin lives in San Diego, CA with her two sons, Benjamin and Ryan, and their dog, Ellie. She loves cooking, traveling, hiking, and going to the beach.