Thanks for tuning in a MomTalks with Christa guys. I’m so excited, this is our second interview with Kristen Sorondo. We started a new segment where she's coming on the last Monday of every month and answering your top breastfeeding questions on postpartum questions and so, if you miss the first episode we did I highly recommend you guys go back and check that one out. She talks about boosting your milk supply in the first few weeks of your baby's life so without further ado welcome back Kristen.

Kristen: Hi, how's everybody? So I’m Kristen, I’m a lactation consultant in central Florida and super excited to be able to be doing these segments with you to help guide you guys through your breastfeeding experience from pregnancy all the way through a healthy nursing baby so I’m super excited.

Christa: Awesome, so today we're going to focus a little bit more on the first month, little bit more about breastfeeding tips and so on. We’re going to think each interview we’re kind of focus on different topics so either more questions from the audience and from our followers, so when do you know it's time to start increasing your breastmilk?

Kristen: So what happens in the beginning is milk and we talked a little bit about this in the first video. The first three to five days typically is when milk production starts to come in, but then it will continue to establish over the next couple weeks based upon the baby's needs and demand. So I always tell mom's think of it like an amazon guy came and just dropped off your package and he doesn't know what's inside of it here you go. So, when the baby is born your body doesn't know how you’re your particular baby needs. So when your milk comes in it just comes in and your body's got to regulate that. So it will do that overdose first couple of weeks, so what we do it unless there is some medical necessity that we want you to introduce pumping ahead of time. What we like you to do is wait a good three to four weeks until breastfeeding has been well established, babies doing good at the breast, your body has regulated its milk supply and then kind of go from there. There are moms that naturally have an overproduction and moms that might struggle a little bit and that could be from a variety of things from diet, maybe not drinking enough fluids, not being consistent with breastfeeding, or pumping, or whatever, everybody is completely different but if you're kind of getting to that point, say I’m going to be going back to work soon, baby’s doing really good, maybe dad wants to give a bottle every once in a while, we want to be able to go out on a date again, get out of the house. How do we start introducing that pumping or increasing the milk production at that point? So what I usually will tell moms is you want to do it when your milk supply is at its highest, so your prolactin which is your milk making hormone naturally increases and decreases throughout the day. So, it's going to be the highest in the early morning hours and then well like in the middle of the night early morning hours and then in the afternoon after lunch time, it drops down. So, you really don't want to be doing a lot of pumping or additional stimulation during those late afternoon hours because your supplies already going to be at its lowest than any other time of the day. So naturally most moms will say, oh that's why my baby is really fuzzy in the late afternoon and the evening, where they want to eat very frequently, they’ll want to eat closer in time, and maybe longer sessions and of course that's when dad’s coming from work and if you have other kids they're coming home from school and it can just be kind of a hectic time. So, there is no point in really doing additional stimulation at that time where you're already going to be at a low point. So what I usually will recommend to my moms is do it when your supplies at its highest, so you know maybe one of your middle of the night feeds, if you can tolerate it if you're awake sometimes I’m up in the middle of the night and it's hard to go back to sleep. That will be a great time to do it or one or two of the feedings in the morning. So say, the baby nurses at 6:00 after the baby nurses and you get them back down to sleep, go ahead and pump for about 8 to 10 minutes just a little bit after the babies already eaten. What is leftover is what was what we call a residual, what is left over after the babies already eaten, that milk is actually going to be very high in fat content because it's the milk at the end of the feeding. You might not get a lot but that's ok but if you do it two to three times a day you should have enough to wear, maybe you could get one bottle per day that you can be storing and then that’s kind of how you start your stash or just naturally doing some of that extra stimulation to increase your milk supply in general. So moms are maybe struggling say maybe the baby typically takes 4 oz. and you are great at 4 oz. pretty much every time the baby eats that's about all that you're making. Just adding in a couple of those pumping sessions during the day will help increase that to where it should be able to continue to keep up with the baby versus you know decreasing. So couple times a day may be the first two feedings in the morning and then like at night before you go to bed or in the middle of the night and that just by that doing that extra stimulation and it can be with the breast pump, it can be manual, expression, it could just be doing some breast compressions, and manually expressing breast milk doesn’t necessarily have to be pumping but just additional stimulation on top of what the baby’s already done.

Christa: When it comes to the extra pumping sessions, what are some other ways that moms can increase their breast milk when others tons of different foods out there that’s recommended or supplements? What do you recommend your clients that come to you that are kind of like okay I have try this extra pumping sessions, what can I do now?

Kristen: The main things in general is making sure that your drinking lots of fluids. People don't realize that actually just drink drinking water can increase milk production in you think about it, if you're dehydrated you're not actually having enough fluids for yourself so how can your body make more extra milk for the baby? So you got to make sure that your hydrated, so make it sure your drinking plenty of fluids that can be water, juices are ok, try to eliminate your caffeinated drinks about 1 to 2 a day with breastfeeding but really just the water itself in general is good. So making sure you're drinking plenty of fluids, making sure that you’re stimulating, making sure that you’re resting. So the key for me what I usually will tell moms is the stimulation and the hydration. Okay if my mom will tell me you know I was super busy yesterday and we were out running around and I literally proudly drink a bottle of water next day they will usually see that their supplies lower maybe baby's fuzzier they don't seem as content, but say one day she drinks a lot of water and then they’ll say oh my gosh I got up this morning and my breast were actually engorged it's because your body has enough to take care of you as well as supplement those needs for the baby. So stimulating the breast hydration making sure that you’re resting. Foods, foods are great because it's going to kind of help boost a little bit, but say if I have a mom who's making an oz.? foods are not going to increase it to where she is making 4 to 5 oz. okay? so these are just things to kind of give that a little extra boost that maybe mom needs. So anything that has oats in it so regular oatmeal, granola bars with oatmeal, lactation cookies, anything that is oat-based super helpful. A lot of products that you'll see that increase milk production as far as marketing things will have brewer’s yeast so that's another really great one. A lot of green type foods so asparagus, spinach, avocados, apricots, dates, black seed, flax seeds so there’s lot of things that you can just add in to your diet in general that will help increase supply but moms will say ok well I ate two avocados today I didn't see anything well it's kind of a collaboration of everything, the additional stimulation the drink enough fluids the adding some of the things to your diet and then if I have a mom that really needs to increase supply then were looking at ok definitely the lactation cookies that have the brewer’s yeast or adding some brewer’s yeast into maybe some of your cooking or galactagogues herbal supplements that have things in them that will help increase supply. Sometimes moms or are much more compliant just by taking a pill vs doing a whole bunch of cooking and dieting things that you know ok just easier for me to take a pill that will help increase of fibers is doing some of the other stuff. So there’s a lot of things but again just remember that two main things are increasing your fluid content and stimulating the breast. what is taken out is going to get replenished? okay, so the more frequently you’re breastfeeding the more frequently with your stimulating the sooner that the body is going to produce milk and the more that we’re able to produce for the baby. Awesome, yeah we always try to stay like when people reach out to us like it's not a magic potion like you can’t just eat a cookie and it's going to automatically come in like everyone is different but there's so many different parts to it hydration. Yeah it’s a key and it’s kind of like a whole puzzle. It is well and that is why I tell moms that’s like we got to figure out what the missing puzzle pieces you could be breastfeeding, you could be pumping, and you could take the supplements and nothing is still happening. So then we have to look at the big picture and that's usually when you're seeing a lactation consultant. You know make sure that they're asking you what your history is it could be something so simple as oh I bled after delivery wow that is a huge key you know when you lose a lot of blood your body is dehydrated so that has to get compensated. Maybe you have several siblings and none of them were able to produce milk so we have to kind of look at the big picture so know that if you are doing those things that we tell you to do those key items and you're still having trouble increasing supply, there's another piece of the puzzle that's got to be put in there and order to figure out what is going on so definitely make sure that you reach out to somebody a lot of times it's just an easy fix. I had a mom a couple years ago that she was doing everything baby was a good nurser and just was not making milk like she still had colostrum milk like two weeks out and here to find out she was still having a lot of menstrual bleeding from the baby and she actually had retained placenta. So when you have retained placenta, your body still has a higher level of estrogen and progesterone which when you deliver the baby you deliver the placenta. Your female hormones fluctuate and by doing that it increases your prolactin which is your milk making hormone. So because she had some retained placenta it wasn't actually counteracting in increasing that prolactin so her body was still kind of thinking it was pregnant so she was just still producing colostrum. Once we were able to take that she was able to make a full milk supply without any problems, so it was just a matter of me ask you know going through questions and saying ok well how is your bleeding since you’ve had the baby? and right there was one of the keys and that could just be something so simple that we could fix that into fixing the whole problem and in the breastfeeding without any problem is there on that so yeah, it's definitely a puzzle that we’ve got to kind of put all those pieces together.

Christa: Wow, that's amazing that something I think a lot of people don’t think of that you know it's just this one size fits all but it’s actually such an individual thing. So we get this question a lot, what can moms do to increase fat content in their breastmilk?

Kristen: Again a lot of times with all of this stuff is just a matter of putting it in a way that people can understand that don't have any type of medical background. Think of the fuller the breast, the less fat content is going to have. The softer the breast, the more fat content the milk is going to have and that kind of sounds funny because it’s like well I got more milk then I should have plenty of that. What that means is kind of like the milk is in the beginning of the feeding is foremilk it’s kind of like skim milk and even when you guys are pumping or you’re expressing it's going to be more of a water consistency vs that really rich darker milk that you see at the end of pumping or same when you manually express, baby feeds and put on your nipple It looks completely different. So the milk at the beginning of the feeding is like that skim milk it’s still very healthy for the baby but the babies that are really chubby and really fat babies. Those are the babies that are getting to the hindmilk on a regular basis if not every feeding that's the weight gaining milk. That’s going to have them have that really great skin that they are just going to be those nice chubby babies because the milk at the back of the feeding is that really high fat content so we want to make sure that the babies emptying the breast. Ok so if the breast feels full before feeding and soft after you're doing good, but if say the baby feeds and the breast is really swollen and it still feels really swollen afterwards it baby probably didn't get to that hindmilk. see your duckling got to want to make sure that you reach out to somebody and just kind of get some feedback maybe what's going on in your particular situation. Other things are when you are feeding during breast compressions when you're pumping do a lot of breast compressions when you’re pumping. What you're doing when you're doing that is actually trying to release all of the milk out of the breast so it's getting all that fatty milk out which in return is going to replenish it which is going to continue to increase that fat consistency. We need that fatty milk for brain growth and development and for the babies to be healthy so we just want to make sure that they're getting it. So I would tell moms, if the breast feels full before feeding soft after the baby’s peeing and pooping they’re gaining weight baby is probably getting nice fatty milk and it’s so funny because sometimes mom will say well how can I send my milk to get studies on it to check the fat content? it's not something that really needs to be that big of a deal just know that if the breast is whole before soft after their gaining weight they're doing fine. Most moms fat content of their milk so when you look at formulas it’s about 20 cal formula, most breastmilk is about 22 calorie, some can be a little bit more, some can be a little bit less and you'll see moms all the time especially I have seen in the group where they pump and they put it in a refrigerator becomes like the solid clump of stuff that’s some really fatty milk and then there's others that say well mine doesn’t look like that mine just has a layer of that that's ok too. Remember, your body is making the nutritional needs for your baby. That's one of the biggest things with breastfeeding that I try to educate my moms is this is not black and white there is a huge gray area. Just why you have a lot of conflicting information when you google stuff online with breastfeeding because it's not what is right for Suzy next door is not necessarily right for you. Your bodies are different, your babies are different, their nutritional needs are different so your body knows that by the baby physically breastfeeding and alters and changes things accordingly. So don’t necessarily compare what you have compare to somebody else just as different and if both of your babies are growing their doing well that's okay that yours doesn’t come out as a big clump vs moms who is still like with just a little layer of fat. So as far as the question goes you know how can you increase that fat content frequent feedings making sure that the baby is getting to the hindmilk, you’re emptying that breast, doing breast compressions when you're feeding, or when you're pumping.

Christa: And so I’m kind of seeing this question before as well for babies that tend to have shorter feedings and it seems like they're only getting that foremilk how do you make sure where that they do get the hindmilk? or is it bad for them to just get the foremilk most of the time?

Kristen: I wouldn’t say it’s bad for them to get the foremilk most of the time however it's going to be a domino effect of issues the baby is not necessarily going to gain weight as quickly as a baby who would be getting to the hindmilk. These babies will typically be babies that spit a lot they’re very gassy, their tummy is hurt and their stools can be a wide range of colors of green just because of just getting that foremilk. So a lot of times moms will say well maybe the baby’s got colic or the baby's got reflux, well babies that have either one of those it just was a side effect of them getting too much foremilk and not enough hindmilk ok? so if you do have a baby that you feel like it's only getting that foremilk or they have really short feedings couple things that you can do is you can either manually express and get a little bit of that excess milk off, pump for a few minutes just to kind of relieve some of that, and then get the baby to the breast and let them feed so that way they’re getting that hindmilk however, it’s kind of catch 22 because remember whatever was taken out is going to get replenished so the next feeding it's going to be the same issue. so definitely would reach out to lactation consultant to observe. I’ve had babies that will come in to my office and they are very efficient eaters and could eat in three to five minutes and completely empty a breast and they've gotten both the foremilk and the hindmilk and transfer 5 oz within that time frame. That doesn't mean that there's anything wrong with that baby, or there is anything wrong with that milk, you just have a very efficient eater however I have a baby who's slow with late game just really fuzzy not feeding well mom’s breast still feels full all the time after feeding then that baby’s probably just getting that foremilk and so then what we have to look at okay but what else is going on are they actually getting quantity wise enough milk to where it makes their tummy feels full but they're still not getting heavy enough milk to let them last in between feedings or are they not actually transferring the milk from the breasts so they're never really getting to that hindmilk they’re kind of just taking that a little bit of foremilk. They're tired they can't really pull any more milk out of the breast and then in return you’re going to notice that within like an hour and a half they’re going to be ready to feed again cause they actually did not get enough in that particular feeding to sustain them until the next feeding. So if you're in that particular situation again you can pump a little bit before you feed the baby, kind of see how that goes for a little while and see if that kind of resolve some of your issues or reach out to lactation consultant to do like a pre and post weighted feed, also to do a residual pumping to kind of see what the supply is, what's going on, is it actually a baby issue cause like I said these babies can be very gassy and spitty. The pediatrician might say well maybe it's because you have too much dairy in your diet and then they start doing a lot of elimination diets or the baby spitting up well maybe it's reflux and they put the baby on reflux meds but it wasn’t really any of that it just all was a milk issue to where that can be very easily fix just by getting some help and kind of transitioning your milk to where the baby is getting enough of the hindmilk to resolve all of those other issues. So it's sad when I see a baby come into the office and mom’s taken everything out of her diet and the baby’s put on meds and they're still having the same issues and all it was just something that we could tweak with the milk production. So most insurances pay for lactation services now ok so I tell all my moms reach out to somebody you have usually at the hospital that you delivered at usually will have an outpatient center that you can follow up with search for lactation consultant in your area, there's a lot of lactation consultants now independently taking health insurance and health care savings account but at least reach out to somebody cause a lot of these things are easy fixes to help prevent you struggling for months and until things kind of work itself out on its own so definitely reach out for help because it could just be something really easily that we tweak within your routine that changes everything.

Christa: Awesome, and I’m sure the sooner the better as a good option just because you know going months and months stressing and worrying about not giving them and often you know lactation consultant could probably be the answer.

Kristen: Well you know I mean obviously they trust their pediatrician they trust with their pediatrician’s telling them but the pediatrician is not going to observe a feeding. The pediatrician’s usually not going to spend long periods of time with them they're here to check the baby, they're just going off of symptoms and things that you're telling but also those could be correlated to lot of other things so absolutely the earlier the intervention, the better the outcome and you know so if you feel just like things are not going well right from the beginning, it's much better to reach out to somebody to save you pain, sleepless nights, a lot of irritation in baby, just to see somebody to kind of help see if there's any issues that need to be fix.

Christa: All right awesome, and so I know for this last question, it’s a big topic but I do want to bring it up briefly here and that is breastfeeding with a lip or tongue tie?

Kristen: Okay so this is definitely you know big controversial topic from pediatricians, dentists, occupational therapists, physical therapists, lactation consultants because it's kind of like who's right and who's wrong? This was a natural thing that you have in your mouth that has been there for years but just kind of like you know; your ear lobe didn't really have a function you know so I think that you know for years yes that's there but it's just part of the anatomy that's there but they never really correlated to having any function that did anything. So these were the kids that had maybe the lisps you know when you were growing up in school and maybe the kids that had gaps between their two front of their teeth, maybe they had delayed speech have problem saying different letters or words or whatever all because of this, and so over I would say the last 10-15 years its research is starting to show oh this actually has a purpose of vs just being there and that purpose can alter functionality of the tongue the lip and it causes all these other issues. So if you think if breastfeeding is painful, your baby is not transferring the milk, you're having a lot of issues, and when in doubt, then reach out to somebody in your area that is TOTS trained so T.O.T.S it’s an acronym for tethered oral tissues okay? they have training specifically in lip and tongue tie, buccal ties that they're going to be definitely more on educated on the topic versus those who might not have it. And we here in our area we do we have these pediatricians that are younger, maybe just out of med school that they actually learned it in school where maybe the older doctors who are we didn't learn about that we didn't learn that you know it had any effect. So you'll see there's tons of social media outlets and things for this that you'll see all the controversy and people be like it's been there for years it didn't cause any problems why do anything about it now. Well, we have lots of data lots of research now that shows that it can cause a variety of issues from bedwetting to A.D.D to speech issues so there's this huge gamut. So on our next talk we will get into we will dive deep into that on what you should do, things that you should look for, who is the right person that you need to be seeing as far as getting some of those questions answered, having somebody actually do an oral assessment to see if the baby has any of those issues. We do have kids that have tongue and lip ties that they function and their lip does what it’s supposed to do and the tongue does what it's supposed to do and there's not really an issue so we have to look at over all the function is it physically functioning the way that it’s supposed to? so is my tongue doing what it's supposed to for speech and feeding and things like that as well as my lips for sealing around the breast tissue around the bottle growth for when your teeth come in and things like that so we will definitely get into that cause that is definitely heated topics. I want to make sure that we answer all of the questions that a lot of people have and I can provide you with as much resources as possible to help kind of get some of your questions answered.

Christa: Awesome yeah, so yeah anyone that’s listening or watching right now definitely tune in to our next interview, that’ll be the last Monday of May. So we’ll focus all on tongue and lip ties. I’ll reach out to the audience and get some questions as well and yeah. I’m really excited for this because I had no clue all the different research out there now. So I think there’s a lot of people out there wondering about it so this will be awesome. Very cool, awesome this was a really informative episode and I’m loving doing this because I think people have so many questions so it’s awesome to have your expertise.

Kristen: Well thank you so much I appreciate you guys having me on and being able to educate all the moms that watch you.

Christa: Yeah and then for anyone that missed last week can you just again share your links and your website for people to come check you out?

Kristen: Absolutely, so I am Kristen Sorondo. My business here in Central Florida is Orlando lactation so it’s just www.orlandolactation.com.

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