A Doctor's note about Breastfeeding

August is Breastfeeding Awareness Month and today we're looking at things from a doctor's point of view.

Breastfeeding isn't always easy and for the best health outcomes the American Academy of Pediatrics( AAP) recommends exclusive breastfeeding for about six months, followed by continued breastfeeding with foods for at least two years and beyond as mutually desired. My guest is Dr. Jennifer Schwab. Dr. Schwab is a pediatrician with Rocky Hill pediatrics. She's a fellow of the American Academy of Pediatrics. She graduated Coombe laude from the College of Holy Cross and the University of Massachusetts Medical School. She serves as Chair of the Connecticut Children's Care Network, an organization of about 200 pediatricians in Connecticut, which focuses on improving the quality and affordability of health care for children and their families, which is a huge problem. She's also the Division Chief of community Pediatrics at the University of Connecticut School of Medicine, and on the board of directors at CCMC.

We talk about the health reasons to breastfeed for Mom and for the baby.  The dr. wants to make sure patients know their goals and she as a doctor tries to help patients to meet those goals. We also talk about peri-partum mood and anxiety disorders.

 Resources:

Rocky Hill Padiatrics: Rocky Hill Pediatrics
The Nest collaborative: Nest Collaborative | Lactation Experts | Breastfeeding Help
La leche League:  Breastfeeding Support / La Leche League of Connecticut (lllct.org)
Breastfeeding Coalition : Connecticut Breastfeeding Coalition - Home (breastfeedingct.org)

State of CT:  Breastfeeding Resources for Connecticut Families – United Way of Connecticut – 211 and eLibrary (211ct.org)

LactMed: Medication Safety in Breastfeeding | AAFP

CT Paid Leave: CT Paid Leave Authority (PFMLA)| Home | Official Site

https://ctpaidleave.org/s/?language=en_US



https://www.facebook.com/CTPaidLeave



https://www.instagram.com/ctpaidleave/



https://twitter.com/CTPaidLeave



https://www.youtube.com/results?search_query=ct+paid+leave

Transcript

Nancy Barrow: 0:01

Hello, Connecticut and welcome to the paid leave podcast. The title basically says it all. I'm Nancy Barrow and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut paid leave, and maybe just a little bit more. Connecticut paid leave brings peace of mind to your home, family and workplace. Welcome to the paid leave podcast. August is breastfeeding Awareness Month and today we're looking at things from a doctor's point of view. Having a baby can be the most joyous time in a parent's life and it comes with some really big questions like Do you have a natural birth? Can there be complications? Do I breastfeed? Can I breastfeed? Is formula an option. How long do I breastfeed my baby? What about postpartum depression? And for the best health outcomes the American Academy of Pediatrics the AAP recommends exclusive breastfeeding for about six months, followed by continued breastfeeding with foods for at least two years and beyond as mutually desired. Connecticut paid leave offers up to 12 weeks of income replacement to new parents who want to bond with their child so they can take time off and they can get some income replacement. And breastfeeding of course is one way for parents to bond with their newborn. Joining me today to discuss pregnancy breast and chest feeding is Dr. Jennifer Schwab. Dr. Schwab is a pediatrician with Rocky Hill pediatric. She's a fellow of the American Academy of Pediatrics. She graduated Coombe laude from the College of Holy Cross and the University of Massachusetts Medical School. She serves as chair of the Connecticut children's care network and organization of about 200 pediatricians in Connecticut, which focuses on improving the quality and affordability of health care for children and their families, which is a huge problem. She's also the Division Chief of community Pediatrics at the University of Connecticut School of Medicine, and on the board of directors at Cc mc. Every summer she volunteers at the Hole in the Wall Gang Camp and Connecticut which provides a camp experience for seriously ill kids and their families. It's a wonderful, wonderful program. And I believe you just completed the Patriot Half Ironman right in Massachusetts. That

Dr. Jennifer Schwab: 2:17

was my goal for turning 50. So yes, I did. But how

Nancy Barrow: 2:21

do you fit everything in? You're doing so much?

Dr. Jennifer Schwab: 2:24

Oh, that's a great question. I think right? The joy of medicine, right? It is an absolute profession. It's not just a job. It's really a calling and to serve your patients in the most humble way possible is an absolute gift. So I try and say yes, when it involves improving the quality and care of the kids and families that we take

Nancy Barrow: 2:43

care of. And you're doing the Hole in the Wall Gang Camp soon, right. And I go

Dr. Jennifer Schwab: 2:47

on Friday, this will be my 21st Summer volunteering. And it's such a magical place that was founded by Paul Newman. And there's kids with sickle cell and hemophilia and cancer and a variety of rare diseases. And they get to raise a little hack, as Paul Newman said, and just be kids for weeks. So that's a really fun, very different thing that I like to do.

Nancy Barrow: 3:03

What made you decide to go into pediatrics,

Dr. Jennifer Schwab: 3:06

I think I was that really eager learner in medical school, and I loved every new rotation. Everything was so fun and exciting. But with children, they just are so magical and so special, and getting to watch them grow up and to sort of join the journey with their parents is really one of the best parts of my job. And so I knew when I when I landed on pediatrics that it would make me happy for the long haul. And I've really enjoyed I wake up every day happy to go to work. I'm really blessed in Rocky Hill pediatrics is a really special place to work.

Nancy Barrow: 3:35

I remember my my doctor, my pediatrician, Dr. Shavel. I'll never forget that as long as I live in, he gave me lollipops, you know, after he gave me the shots. So it was like you hurt, but he gave you food. So it was good. I don't know if they give lollipops. And

Dr. Jennifer Schwab: 3:49

I know because the dentist asked us actually we give stickers we do sometimes do lollipops for our flu clinic to move it along. But it is but you know, remember vaccines save lives. Right? So it's a little pinch to prevent a big ouch down the road, right? Oh, yes.

Nancy Barrow: 4:02

What do you teach new medical students about breastfeeding and what their job as a pediatrician is.

Dr. Jennifer Schwab: 4:08

Breastfeeding is in some ways, the most natural thing that you could do after your baby's born, if you leave your baby on your belly, the baby will literally crawl up, sniff out your nipple and try to latch. It's so natural. But for so many women, it's scary and intimidating and overwhelming. And so we try to normalize that this is really hard. And not every baby is born knowing how to breastfeed and not every mom, including me as a new mom knows how to breastfeed and it takes hard work. But we are there to support you. And I think just like you research the carseat and you research the crib and you research everything you can possibly imagine about what kind of laundry detergent to use. You've got to do a little research about breastfeeding and you've got to get ready, right and you read those books or you take those classes. So for my medical students, I tried to get them comfortable in the room looking at Mom's breasts and looking at the baby and talking about breastfeeding and really encouraging that bonding right that golden egg Our when your baby is first born, if you can have your baby's skin to skin on your chest, or dad's chest or your partner's chest with no clothes, just a diaper and a blanket over the two of you, you're transmitting beneficial bacteria, you're helping your baby regulate their heart rate, their blood cortisol or stress levels. And when you can have that golden hour together those first couple of hours and then get the baby to latch, that's actually going to be one of the key parts of setting you up for successful breastfeeding.

Nancy Barrow: 5:25

I've heard that also the milk changes as the baby ages like it's, it's like this unbelievable science in our bodies that the the milk changes as the baby grows.

Dr. Jennifer Schwab: 5:35

And that is choosing the very beginning, a lot of moms worry that their milk isn't in yet. But that's not actually true. They have great milk, it's just called colostrum. And it's golden. It's literally liquid gold. And it's packed full of antibodies, that fight infection and protein for the body. So for the baby. So what I call it is high quality, low volume milk. And over the next three or four or five days, your milk will come in to be more of a higher volume whitish, creamish milk. But it's really important to hang in there. And I think, you know, breastfeeding is a marathon, it's not a sprint, and it's okay, if you're not good at it in the beginning. Don't throw in the towel, try and hang in there. Ask for help. And there's a lot of people now Thank goodness in the hospitals, a lot of our Connecticut hospitals are baby friendly hospitals. And they're really very supportive of new moms who want to breastfeed.

Nancy Barrow: 6:20

And I know that I've had some friends who've had a real difficult time and they get guilt and anxiety about it. How do you help with that when they're feeling like I'm not a good mom, I can't get you know, I can't do this.

Dr. Jennifer Schwab: 6:34

So I think the expression like happy mommy happy baby is the most important one. And so it's not that you have to breastfeed, it's also not that you have to get it 100% Perfect. There's plenty of moms who may nurse for comfort, but bottle feed for nutrition. Or you could do a hybrid, we have a lot of moms who do some formula and some breast milk. We never want anyone to feel guilty. And the first question I asked when I walk into a room where a mom is struggling, I'm like, What is your goal? What do you want, and let me help you support her. Let me help support you and your goal. And if your goal is formula feeding, I'm going to support you in that way. And we're still going to talk about skin to skin and other ways to bond with your baby. But if you want to breastfeed and you're feeling like it's a lost cause, or it's too hard, we are there to help you ask for help. We're happy to support you. And in the show notes will be a lot of references and resources. But I would also encourage you when you're pregnant to really kind of take that long ball view, right? Like a half Ironman, it was not a sprint. It took a long time. And when I nursed my son, you know, he was below birth weight at three weeks. And we were really struggling and I almost gave up but a wonderful lactation consultant helped me through and I joke with my patients all the time. I'm like, he's six, two, and he's at Holy Cross, he turned out okay, so we were doing a terrible job in the beginning, but we figured it out.

Nancy Barrow: 7:45

Isn't that normal, though, when you when you know the baby first is born that they actually lose weight.

Dr. Jennifer Schwab: 7:51

Yes, so all babies lose between a half a pound and a pound. And as long as they don't lose more than 10% of their birth weight, we try and just encourage exclusive breastfeeding, some parents get nervous and want to do a little bit of formula, and that's fine. But if you just keep stimulating your breasts through a pump or the baby, your milk will come in. And if the baby loses too much weight, we may ask you to supplement but then to pump to preserve your supply. And I think the biggest message for parents in those first few days is that supply and demand. If you only nurse twice in a day, your breasts aren't going to know to make more milk, right. So if you can feed the baby frequently with breast milk, or formula, that's how your baby's going to gain weight and the more you stimulate your breasts by nursing or pumping, you're going to ensure that your milk does come in and as a good rich supply.

Nancy Barrow: 8:37

It was interesting. I don't know if you've ever seen the Netflix show Firefly lane, but it's it's awesome. It's a funny show and the lead had real trouble breastfeeding and she was so upset and she got a lactation specialist and it was really a very funny scene. But lactation specialists are are a real growing industry. They really are. I talked to one not too long ago. How did you find yours? And are there are there resources to find a good lactation.

Dr. Jennifer Schwab: 9:09

There are we are so lucky in our office to have my nurse practitioners are certified lactation consultants and one of my nurses so we really try and offer that support unless somebody's out sick or on vacation five days a week. There's also an online virtual lactation service called the nest collaborative and through the Connecticut children's care network. We have a relationship where they do bill your insurance. They're available very often. They're wonderful. There's also a lot of great online supports. There's most of the hospitals offer weekly breastfeeding support groups. Oh, that's good. I also have some prenatal breastfeeding classes that I would encourage new families to take and I say family because your partner or your you know mom, dad, sister, grandma, aunt, whoever is helping you with that baby needs to learn to because they need to support you. And it's really hard a lot of times you know, we'll hear from moms that like grandma's just telling me to give a bottle the baby looks hungry. And we want to have people surround you understand how important this is to you so that we can help make it successful. That said, many new moms feel frustrated because they talk to three different people and get three different pieces of advice. And that's very true. And that's very frustrating. But I think it's because there's more than one right way to do it, right, you have to figure out the way that works for you. And just like you might like one doctor and your practice better than a different doctor, you're going to find the person that's going to help you figure it out. But definitely encouraging your partner to be a coach and to learn with you makes a lot of sense to make sure that you sleep when you can sleep, go for a walk outside every day to get some fresh air. And if visitors want to come they better be planning on being put to work to either cook clean, do laundry, or to hold the baby so you can take a nap I am 100% Serious on that. Or they can bring a hot meal and leave but you are not playing host to the all of the wonderful people who want to meet your new baby.

Nancy Barrow: 10:52

And that's really interesting that you say that because most people do want to come and just see the baby, but they don't even think about helping them. You're right. They better come with something,

Dr. Jennifer Schwab: 11:02

they better come and my dad I remember he was like, I don't change diapers, I was like you don't have to change a diaper. If you could honestly just put a hot meal on the table. That will be so tremendously helpful. I am happy to take care of the baby. I just can't take up all the can take care of all the other stuff. Yeah,

Nancy Barrow: 11:15

interesting stuff. So as a pediatrician, at what juncture do you come into like a pregnant person's life? Is it always after the pregnancy? Or do you actually see them before they deliver sometimes,

Dr. Jennifer Schwab: 11:27

so if you want to meet your pediatrician, before most practices, we'll have a prenatal consultation that's of no charge, and you'd come to the office, take a tour and meet with your doctor. Some people might do it in a group setting or just have you check out their website and do it over the phone. But you're always welcome to meet us ahead of time. Most pediatricians unfortunately, after COVID We're not driving into the hospital each morning to see the babies like we used to. So there's a hospitalist newborn Doctor Who will take care of your baby in the hospital. But we will see you a lot in the first couple of weeks of life, usually two days after discharge, even if it's a weekend, and then again, around one week of age, more weight checks if needed if your baby's struggling to gain weight or has jaundice, or was premature. And then we'll see babies at one month, two months, four months, six months, nine months a year. So lots of opportunities to talk about growth, development, behavior, sleep feeding,

Nancy Barrow: 12:18

and then how long are you involved in the baby's life.

Dr. Jennifer Schwab: 12:22

So we love to take care of your baby all the way until they're 21 or 22. So we'll see our we love our lessons. We love our teenagers, we'll see them until they either graduate from college or If college is not their path, they've sort of transitioned into their more of their adult life, then we'll help them transition into an adult doctor to go with

Nancy Barrow: 12:39

that. Yeah, I don't think Dr. Schwager will saw me much after 13 I think, and that used to be the old school,

Dr. Jennifer Schwab: 12:45

maybe I think most pediatricians in Connecticut will definitely see kids, at least until 18. But most will see them until their early 20s.

Nancy Barrow: 12:51

That's awesome. Why do you think breastfeeding is so controversial?

Dr. Jennifer Schwab: 12:55

I think we really I think we need to take a page from Europe, right? Yeah, exactly. They're natural. They are a part of our body. They're a beautiful thing. And they serve a function. And I think the more that we can encourage moms to breastfeed in public and to feel comfortable with their body, the more that we can empower the healthiest generation yet, right? Remember that when you breastfeed, you cut your risk as a mom of uterine cancer, ovarian cancer, you lower your risk for type two diabetes and obesity. When you're a baby, right, you get the benefits of lower rates of obesity, type one, diabetes, asthma, allergies, you get sick less often, right? And you have this opportunity to bond with your mom in a really unique way. But I think a lot of women experience shame around their body. It's weird, right? And it makes me so sad that women are uncomfortable. And bodies are beautiful in all shapes and sizes. And breasts are beautiful in all shapes and sizes. And not all breasts look the same. And you know, if you ever go and get a pedicure, look at everyone's feet, there are all sorts of different shapes and sizes. And who cares, right, everyone's sticking their their toes out to get a pedicure, but we're afraid to put her breasts out to feed her baby. And I would love to really encourage the culture to be a more welcoming culture. And that is going to take practice. And I think it's going to take education and

Nancy Barrow: 14:09

time maybe I mean, because really, quite frankly, Europe is it's no big deal if you see her out in public. But you know, when when a woman is breastfeeding out in public, people gawk at her, you know what I mean? There's still that stigma of of women breastfeeding in public.

Dr. Jennifer Schwab: 14:26

And I think it's really hard to lean in when you're that new mom. And I think a lot of moms worry about when they go back to work and making time to pump and that's another concern, right and really leaning in with your employer to say, this is the law in Connecticut. Yes. And you're entitled to a private room and I've written letters for some of my new moms, especially some immigrant moms who are very worried about job security. I've written letters, I've made phone calls, not every employer as as welcoming as they should be. And so you know, I've had to give my office up because we're small office we don't have a lot of private lock spaces, but I've always offered at my office, I'll just sit in the hallway or the lab to chart so that any of my employees can pump who need to pump so I think if you ask most employers will they just may not realize that they're not following the law, right? It's

Nancy Barrow: 15:07

I think it's one employee or more, they have to find a space that is in a bathroom for them to pump privately.

Dr. Jennifer Schwab: 15:14

And if you do that, as an employer, if you're an employer listening into this podcast, remember that you're going to save sick days, because the baby's going to be significantly less sick if they're getting breast milk. And so, you know, when a baby's formula fed, unfortunately, not all moms can breastfeed, so there's absolutely no guilt. But the reality is breast milk does protect against infection.

Nancy Barrow: 15:31

What if a mom has suffered breast cancer or breast surgery and she cannot breastfeed? What are the alternatives? Is it only bottle fed? Is it only Formula Three

Dr. Jennifer Schwab: 15:44

questions so I've had a mom we have a mom in our practice, a wonderful mom who had a mastectomy has three boys, she breastfed all three boys with her one breast, she did an amazing job. So one breast will give you enough women who've had reconstructive surgery, breast augmentation or breast reduction surgery, sometimes they have no problems. If you're thinking of that surgery, ask your plastic surgeon to try and preserve. Sometimes they're able to make some milk but not enough milk and 5% of moms just don't make enough milk. And so if you don't, of course, you can bottle feed with formula, but some moms prefer to chest feed. So to put you can do what's called S N S, which is a supplemental nursing system, it's a little syringe that you can tape next to your nipple. And so you can feed your baby at the breast and some parents who adopt choose to do that, too. That's so that if their breast was stimulation, your breasts will make some milk, it may just not make all the milk that you need. So you can either supplement in that way or perhaps again, nurse for comfort, but bottle feed for nutrition. So again, it's not all or nothing. There's a wide variety of ways to do this that are going to be right for your family. Yeah,

Nancy Barrow: 16:46

very interesting. I really like that. What about a mom who might be suffering from postpartum depression? And she's on medications. I know there's something called pump and dump. Is that is that actually a thing that they can do if they're on medications? So

Dr. Jennifer Schwab: 17:04

two questions packed in there. So let's get back to the postpartum depression. So post, so it's actually Peri partum, mood and anxiety disorders and they can start from the moment you conceive through your baby's first birthday and one in seven women will suffer with significant postpartum anxiety or depression. Luckily, we have a lot of medicines that are super safe to give with breastfeeding. We also have a lot of therapists in the community who specialize in postpartum depression. So ask your pediatrician, ask your OBGYN. But Zoloft or Sertraline is the most common medicine it is totally safe with breastfeeding, we have an abundance of safety data. Oh, that's great. Some other medicines depending whether it gives you're sick or something right. About antibiotics, there's plenty of antibiotics that are safe with breastfeeding. There's a great website you can use. We use LACT Med, there's a lot of options to figure out with your doctor and medicine that safe with breastfeeding. There's not too many what we'll do the pump and dump sometimes if a family is going to a wedding, and they'd like to have a couple glasses of wine or Yeah, something like that, we might recommend that but if someone's on a very serious medicine, there's a few category X medicines where we would say gosh, this particular medicines not safe with breastfeeding, unfortunately, yeah, but those are very rare.

Nancy Barrow: 18:12

Okay. Good to know. And let's talk about the postpartum or Peri partum is what you're saying depression I saw on your Facebook page that you offer a class about it from postpartum internationals website. And the class is free which is great for everybody. It's two hours, but it helps families prepare for their postpartum experience and some of the topics that are covered in it our you know, physical recovery, Partner Support, self care, support networks, lactation and emotional well being. Let's talk about that. Because you said what what is it one to nine, one in seven, one in seven women and I know men also suffer from it. I think it's one in 10.

Dr. Jennifer Schwab: 18:53

One in 10. Two, I don't have that memorized. But I've definitely had some dads in our practice and a lot of moms and so we go back to being sleep deprived, you're exhausted you're feeding your baby eight to 12 times a day. They're spitting up on you six times a day you're doing buckets of laundry you have no time to cook I joke that my kids would cry when we ate dinner we would eat at five they would cry we would eat at seven they would cry we would eat at six they would cry. They just would cry just wanted to eat dinner for five minutes and I remember crying with them. I was so tired. So if you don't take time for you so that's where you need to engage your Village and I am dead serious if you have anyone who offers to help say yes and ask in a concrete way Could you hold my baby so I can take a nap? Could you fold this laundry for me could you run to Walgreens and pick up my prescription and get us some takeout and drop it off? You've got you cannot do it all and I think that's part of that Superwoman. We feel like we need to do it all and be perfect breastfeed errs and then we fall short and we fall down and no no no let us pick you up. Let us hold your hand. Let us guide you through it. There's more than one right way to do this. It does not have to be perfect.

Nancy Barrow: 19:55

Yeah. The one good thing about Connecticut pay leave is it does give 12 weeks of income replacement to the moms and the dads or your partner, whoever that may be 12 weeks of income replacement. So it's, it's wonderful,

Dr. Jennifer Schwab: 20:07

it's wonderful. And we fill out that paperwork for parents all the time. And it's so great because the partner feels like they get to bond with the baby too. Or some families will choose to stagger it. So they don't have to pay for daycare for six months, because they have 12 weeks, and then 12 weeks, which is a total gift, because the first month is so hard. I literally joke with my parents that the one month well visit is really a hang in there visit, it's so hard, you just start to get good at things after the two month visit. And then you have to go back to work. So to have that third month is an absolute gift. That's going to be the fun part. Right? The beginning is hard. Yeah. And so you just have to be right to your point mentally prepared and to know and to know when to ask for

Nancy Barrow: 20:45

help. It's interesting, too, I think the average that they they take, which is interesting that they have to go back to work. But it's about six weeks, not the full 12 weeks. But some people do take the full 12 weeks, some people take the six weeks. So if they have a postpartum issue and they're not feeling well, they can use that other time for mental health issues, because we also cover that with Connecticut paid leave. So it's really important to if they haven't exhausted all of the bonding leave that they can also take some time for their mental health as well. That is

Dr. Jennifer Schwab: 21:20

fantastic. And remember that most therapists will let you bring the baby so you don't have to worry about daycare, bring your baby with you to your mental health appointments. That is perfectly fine to do. Yeah. And

Nancy Barrow: 21:29

how important do you think programs like Connecticut paid leave are two new parents,

Dr. Jennifer Schwab: 21:33

I am so excited for people who live in the state of Connecticut, I think people don't realize what an amazing program this is. I think I also had to go back to work right after eight weeks. So that was all that I could afford in my practice could really afford for us to do. But if you can take that 12 weeks to bond and you're able to do it, I think that's amazing how exciting for people who had no paid time off, to have some paid time off is amazing. And you know, I think if you look again to Europe or other countries, were there six months to really ensure bonding to ensure you know that the baby is feeding and gaining weight and starting to sleep through the night so that when you do go back to work, you feel human and not completely sleep deprived, and you know, POST call or, or like you're sort of underwater trying to swim to the surface. So I think we are very grateful for you guys for running such a fantastic program. Thanks.

Nancy Barrow: 22:22

It's great to work there. It really is, with the postpartum depression, since it was on your website, and I was reading about it. Does breastfeeding help the depression? Or does it cause the depression

Dr. Jennifer Schwab: 22:34

and I would say it can definitely help. It can also potentially trigger if breastfeeding is going bad badly, I can definitely make people feel really sad or bad about themselves. On the flip side is an opportunity to bond with your baby. While you're you know, baby needs you to just love and cuddle and hold them. And when you can make it work, it can definitely I think, increase the good hormones in your blood as you're making that milk. So while it can potentially be one of the causes, it can also be part of the solution.

Nancy Barrow: 23:03

Interesting. I want to ask you about a few myths. Like after you have the baby, does your uterus shrink when you are breastfeeding?

Dr. Jennifer Schwab: 23:12

That is a true fact. So you'll get some cramping. And actually it's really good for your body. Right. And so I it's not always cramping, sometimes more like labor pains, to be honest. But if you're experiencing that that's a great sign that the baby's doing their job at the breast and it's going to increase your milk supply, decrease your blood flow out of your uterus and help it shrink faster to help your body recover faster.

Nancy Barrow: 23:35

Wow, that's really interesting. And my cousin said that when you stop breastfeeding, your breasts really hurt. So she said, I've heard that you can use cabbage leaves to now she's from Denmark. So maybe that's what they do in Denmark. But I was just wondering, that's a that's a real thing to the pain, right. So

Dr. Jennifer Schwab: 23:55

regardless of whether you choose to breastfeed when your milk comes in, it's going to hurt a lot. Yeah, and cabbage leaves can definitely help with some of that pain and decreasing some of the swelling. emptying your breasts can also really help so pumping or putting the baby to breast is a great way and then massaging your breasts while you're pumping or nursing or even if you're in the shower. So to get that milk out is going to make you feel less uncomfortable. But usually the day your milk comes in Boy are you like Holy guacamole that hurts a lot. Yeah, and if you can you just want your baby to drain that milk. That's ideally what you want to do. But cabbage leaves can help you can do. Some people take bags of frozen vegetables like frozen peas or corn and put them on or take a nice hot shower and do some massage or pump. Those are all great ways to decrease that discomfort. That's

Nancy Barrow: 24:34

amazing. For expectant moms and dads looking for support groups for breastfeeding or what to expect in the postpartum. Can you give me some ideas about some good services that they might be able to go to or do they come to you for all of this is? That's a

Dr. Jennifer Schwab: 24:51

great question. We do not offer any group classes in our office right now. Most hospitals will offer a child bearing class preparation class and they also offer a breastfeeding preparation class I heard you to take both of those. Most of the hospitals in the Greater Hartford area and down towards New Haven do them so those are the easiest access points but also on the shownotes. There's a bunch of resources while he Lee Connecticut breastfeeding alliance with that also have some great support for parents and birthing classes are really important to take right? They are very important to take again, you have to take lessons before you get your driver's license. Please take some lessons before you birth your baby.

Nancy Barrow: 25:28

And what else can you tell me about breastfeeding that you think people should know before we end the podcast?

Dr. Jennifer Schwab: 25:37

Jenny Jenny's pearls, if you will, right, what's super important? I think being prepared so taking classes ahead of time, right, including a prenatal breastfeeding class. Remember that golden hour after your baby's born, if there's not a medical emergency, which sometimes happens our birth plans don't always go according to plan. But if your baby's well enough to be with you spend that hour skin to skin turn down the lights. Just let your baby in just a diaper snuggle on your naked chest or your partner's naked chest with a blanket over. really embrace that golden hour. Try to nurse often. I think that's another important thing that people don't realize you have to feed your baby a lie again.

Nancy Barrow: 26:12

Yeah, I remember my nephew. I'd have to put his stomach on my arm because he was a little colicky. And I was always like, I just think he's hungry. But

Dr. Jennifer Schwab: 26:21

and yeah, and you're never gonna go wrong. If you try and feed your baby if they fall asleep. That's okay, you guessed wrong, but I'd rather you guessed by trying to feed in the beginning. Babies don't always need to nurse this often as they get older, they nurse less often. And that's another thing that can be helpful. When you go back to work, your baby may only need to eat four or five times a day, not eight to 12 times a day after you're at that three or four month mark. It's healthiest for mom and baby and it saves you a lot of money. So if you didn't do it, you know it's wearing your seatbelt. If you can do it, do it. It's the safest thing to do. Make sure you take a nap every day when your baby takes a nap, you take a nap, ask for help. Ask for help from your friends and try and get outside and go for a walk every day. Those are probably my biggest

Nancy Barrow: 27:02

girls. That's awesome. And is there a right or wrong time to stop breastfeeding your child

Dr. Jennifer Schwab: 27:08

and a lot of moms make goals for themselves. I think the biggest misconception is that oh my gosh, I can't do this 12 times a day for a year. Oh God, no, you shouldn't be right. And so once we introduce food solid foods between four and six months of age, your baby is going to nurse less often. Usually by a year they're down to nursing two or three times a day. If they're nursing more than that they don't need to because they're eating three meals a day, and sometimes even two snacks. So just nursing morning and night. If I weaned for baby Wiens, or a baby's formula fed, I cut off all bottles at age one, and there's no morning or bedtime milk. So the second year of life is really nursing for comfort. And what you'd like to do the main thing too is most babies between six and seven months of age or even earlier don't need to nurse at all or be fed at all overnight.

Nancy Barrow: 27:53

Yeah, it's funny how people can differ like some people may want to go longer with with nursing and I, I've seen people who have had like three and four year olds that they're nursing with.

Dr. Jennifer Schwab: 28:04

And then other people sometimes will judge that and to judge right what works best for your family is going to what works best for your family. And so some moms their goals four months or six months. And sometimes I just gently nudge him like, Hey, you're doing a great job. Maybe just stick to twice a day, you don't have to totally cut back right now. But if they want to quit, I will support them and help them transition to the next phase.

Nancy Barrow: 28:23

Yeah. And how is that next phase? Like? How is it to get off? You know, weaning must be kinda tough, too.

Dr. Jennifer Schwab: 28:30

It's a little bit probably more complicated than for this podcast and that it depends on how old your baby is. But talk to your pediatrician about it and they can definitely talk you through how to wean off of nursing. Yeah, and it's not difficult.

Nancy Barrow: 28:41

Okay, good. Because I've heard people say that also hurts when you stop.

Dr. Jennifer Schwab: 28:45

No, we do it in a gentle way where your your milk supply will naturally adjust to your baby's decreasing needs or your desire to transition.

Nancy Barrow: 28:51

See, it's good to know it's good to talk to a doctor. Thank you so much for being on the podcast. Nancy,

Dr. Jennifer Schwab: 28:56

thank you your lovely host and I will put a shout out to Connecticut paid family leave. It's a great program and you should definitely take advantage of it.

Nancy Barrow: 29:02

Thank you. And for a list of resources, please go to the show notes. And to get in touch with Dr. Jenny Schwab. You can go to Rocky Hill pediatrics.com Or you could call 860-721-7561 for information or to apply for benefits go to CTP leave.org. This has been another edition of the paid leave podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut paid leave is a public act with a personal purpose. I'm Nancy Barrow and thanks for listening