Episode 267 Caitlin & Chrisie from The Lactation Network + All About Breastfeeding

Here at The VBAC Link, we want to empower you with better birth experiences AND better postpartum experiences. The Lactation Network does just that. Caitlin McNeily is Vice President of Consultant Relations at The Lactation Network, working closely with thousands of International Board Certified Lactation Consultants in all 50 states. Her background in medical device sales led to the creation of Ashland Breast Pumps. It was through this work– connecting with new parents desperate for help– that led to The Lactation Network.Chrisie Rosenthal is an International Board Certified Lactation Consultant and Director of Lactation Content and Programming at The Lactation Network.She has helped more than 7,000 families through her successful private practice, The Land of Milk and Mommy. She's worked alongside large pediatric practices in Los Angeles and as a hospital-based IBCLC. In addition, Chrisie is the author of two best-selling breastfeeding books: Lactivate!: A User’s Guide to Breastfeeding published in 2019 and The First-Time Mom’s Breastfeeding Handbook: A Step-by-Step Guide from First Latch to Weaning published in 2020. Caitlin and Chrisie are both moms who had breastfeeding struggles of their own. They are passionate about helping other moms have the care and advice they wish they had!Additional LinksThe Lactation NetworkHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have an amazing episode today for you with our friends, Caitlin and Chrisie. They are from our favorite, The Lactation Network, and are IBCLCs with The Lactation Network. We are going to get into the topic of how The Lactation Network came about but also, all of the questions and what it means to work with The Lactation Network and an IBCLC. We talk so much about preparing for birth and then birth. We talk a little bit about postpartum. We are starting to get more into postpartum because it is a really important topic, but this is a topic that is near and dear to my heart because I have had three babies and three pretty different experiences. I’ve had some challenges along the way, so we are excited to welcome our guests today talking about breastfeeding and pumping and going back to work and all of the things and what it looks like to work with an IBCLC through The Lactation Network. So, welcome ladies. Caitlin: Thank you. We are so excited to be here. Chrisie: Thanks, Meagan. Meagan: So excited to have you. I think maybe we can just start off right off the bat with what is TLN? We’ve been talking about it for a little while now, but what is The Lactation Network? How did it start and where are you today? Caitlin: Yeah. My name is Caitlin McNeily. I am the VP of consultant relations at TLN. TLN stands for The Lactation Network. We are the largest network nationally in the U.S. of IBCLCs, lactation consultants for short, but IBCLC stands for Internationally Board Certified Lactation Consultants. I am based in Chicago and have been with TLN since its inception and have seen it through a couple of iterations and have watched it grow as my fourth baby, as I sort of lovingly refer to it as. I do have three kiddos of my own– 13, 11, and 8. I had very different nursing experiences with all three of them. All three of them were C-sections and all of those were equally as different. So you know, when starting TLN, so much of it was very much in my wheelhouse at the time. I was pregnant with my third baby and going through that whole process. I wish I knew then what I know now about all of the amazing support that a lactation consultant can offer. The way that TLN was born, I think, is relevant to cover briefly but essentially when the Affordable Care Act mandated coverage of breastfeeding support and supplies, I was brought into a company to start a breast pump, what we call a DME which is a durable medical equipment company. I won’t get in the weeds there, but essentially, we provide equipment directly to patients and we handle the insurance component. It started with the breast pump DME, getting parents the essential tools that we need, certainly in the U.S. with limited maternal leave. We certainly need breast pumps if we expect them to continue their breastfeeding journey. That was where the business really started. Roughly 12-18 months into that endeavor, a lot of these parents were calling me back postpartum saying, “Hey, you were really helpful at getting me a breast pump, but now I’m really struggling with my breastfeeding journey. Can you help me?” I myself am not clinical, so it wouldn’t have been appropriate to try and troubleshoot their nursing issues. I leave that to the experts now. At the time, what happened was I reached out to an IBCLC locally here in Chicago and started sending her on some visits. Now, because the Affordable Care Act mandates that this care be covered, it was seemingly going to be a smooth transition from breast pumps into breastfeeding support. There is some lack of understanding, a lack of a pathway into insurance reimbursement for lactation care and I met that head-on by working directly with insurance providers and working through some new pathways that they could adopt to be able to cover this care for patients. As soon as there was progress made there with some insurers, we were sort of off to the races. Then what happened, was more lactation consultants were hearing about us. I was reaching out to more lactation consultants around the country as our patient base started to grow. It was very much an organic growth process, very supply and demand if you will. Now, our first visit was in 2016 so fast forward to 2023 and we’ve helped over 300,000 individuals with their breastfeeding journeys. Meagan: Wow. Caitlin: Yeah. It’s a huge nod to the exceptional care of our IBCLC network. It’s also really just standing up the reality that parents in this country deserve lactation care. I think a lot of times, we get very stuck in the conversation or drama or consideration around breastfeeding when the reality is lactation care is human health care. When you birth an infant, you are going to experience lactation on a variety of levels and in a variety of facets. However, this is a physiological and biological reality of the birth process and bodies that birth babies and lactate deserve healthcare surrounding that. Meagan: Amen. Caitlin: That is just our steadfast mission is to make this care accessible to all birthing families. Meagan: I love that so much. I love that you say lactation care in general because we are all going through different experiences. We all have these babies and then we are like, “What do we do with these things that are making milk? How do we feed these babies and how do we go back to work?” And all of the things, right? I love this network so much. I can literally scream it to the rooftops, you guys. This is amazing and it should be something that everyone gets. So you work with insurance, but are there still insurances that maybe aren’t quite there yet? How does that factor in? Caitlin: Yeah, yeah. That’s an excellent question. We are dogged in our pursuit of expanding lactation care within insurers that we do work with currently and expanding it into different pairs that are not currently working directly with The Lactation Network. We have no intention of stopping that mission or slowing down that mission. Our goal is to hold insurance companies accountable for this very essential care. The economic argument, the healthcare outcome argument– these things are black and white. There really is no gray area as it pertains to the benefit of taking care of lactating parents. In addition to insurance, understanding the importance of this care and the true economic value of this care, employers are starting to perk up as well meaning they want to make sure that when one of their parents goes out on maternity leave that they are set up for success in this arena because the statistics of predominantly women of childbearing age dropping out of the workforce to take care of their infant and their health and their mental health and their homes and all of those things. It can’t be overstated how beneficial it is for employers to take care of their employees in this capacity. They will have easier times recruiting. They will have easier times retaining top-tier talent. This generation of women having babies and families bringing babies into this world are very contemplative when they choose what business they want to enter into agreements with. So much of that right now is based on the benefits base. They want to know that their employer is going to support their endeavors at home to keep them productive at home and happy at work.Meagan: Oh my gosh. Yeah, when I was working, I had my daughter and then I went back to work. I just remember the stress of, “How am I going to do this? How am I going to pump and keep my milk supply and feed my baby and do all of these things?” At the time, my work was like, “I guess you could go in the back storage room.” That was about all they gave me, then I was like, “Okay, well the milk has to be refrigerated.” They were like, “No. You can’t. No. Bring a cooler.” So every day, I was trucking in this big pump and this cooler and all of these things. It would have been so nice to have more of that support. I probably would have stayed longer-term maybe. I don’t know but it would have been nice to not feel– I mean, I still felt more support than I know some, but I still was like, “This is weird. They are not gung-ho about this.”Caitlin: Yeah. It’s not ideal. Meagan: Yeah. It wasn’t ideal. Caitlin: It’s not ideal. Yeah. I think to paint the picture of what is available through The Lactation Network for those types of parents, it doesn’t matter if you are staying at home or going back to work. It’s not a one-size-fits-all-all, but the lactation care cadence that should be commonplace is that it should be preventative. That is where it falls in the Affordable Care Act. This is preventative care because as I mentioned before, your body is going to do this. Much like we go to scope out a pediatrician prior to the baby being born and then we go for our 7-day check-up and all of these things, we are really passionate about trying to shift the paradigm to match that type of preventative care as it pertains to lactation. What that can look like is a prenatal visit, a 3-day postpartum visit– so the day after you get home from the hospital, and then we can have adjustments because baby adjusts so much as your milk comes in and those first two weeks are so substantially different. You can have a troubleshooting visit. You can have a plan to go back to work and create a pumping schedule visit, storing milk. Occasionally, we’ll run into a case of mastitis or clogged ducts. Oftentimes, when a parent goes back to work, their milk supply can drop a little bit. It can be just trying to engage in a new schedule with your breast pump, engage in a new schedule with waking up early, stress,  hydration, and eating at work. Those things can all play into your milk supply. Working directly with a professional to a) set your mind at ease, but also to adjust that plan accordingly. Those visits can go all the way through weaning. This is really a journey. It’s a personal journey and this is where I would love to kick it to Chrisie because we are so fortunate to have her at TLN. She is just a top-notch human being and IBCLC on top of it. I think she can shed some light as to why TLN is so passionate about the IBCLC certification and why we only work with IBCLCs. Meagan: Yeah and more even on what IBCLCs truly do. We are talking about what those look like, but what more do you do, Chrisie, for parents? Chrisie: Yeah, thank you, Caitlin. I’d love to start with just what an IBCLC is because I think that there is a lot of confusion in the space of lactation caretakers to use that word, right? Lactation providers. IBCLCs are unique in that we are the highest credentialled healthcare providers specializing in lactation. We are truly the gold standard. One of the things that exists– and I always say that I love all of the supporters. I love all of the educators. There is a place for everybody, but I think it is important for families to know what differentiates an IBCLC. IBCLCs typically, it takes about 3-5 years to become an IBCLC. That includes a program that takes 90 hours of education in human lactation, coursework in 14 health science subjects, 300-1000 hours of supervised clinical experience, and then passing boards and recertifying every five years. It is definitely an in-depth program and process. Meagan: Very. Chrisie: Yes, absolutely. At TLN, we only work with IBCLCs. I think that’s important to mention. We connect these families with that gold standard in lactation care. As IBCLCs, we are working with the pediatrician and with the OB. We are focusing on the parent-baby diad and what breastfeeding looks like. Consultations definitely differ from LC to LC. We all do it a little bit differently, but in a typical consultation, we’re going to meet. We’re going to go over your medical history. We’re going to do an in-depth, deep-dive into how feeding has been going. We will probably observe a feed if that’s applicable. We’re going to talk about your feeding challenges, your feeding goals, where you want to go, and what’s getting in the way of that. I always make lots of space for parents to ask whatever questions are on their mind and make sure I share evidence-based information, then at the end, we’re going to create a plan for a follow-up and a plan for how to get from A to B and solve whatever issue it is that we are looking at. That’s typically what a consult looks like. As I said, we’re all a little bit different. I stay in touch with my patients in between consults. You know having been there that questions pop up all the time, just little questions. How long can I leave breastmilk out for? Just little things, especially if you’re a first-time parent. I always say that even for parents who have done this before, every baby is different. Every breastfeeding experience is different so as Caitlin said, really think of LCs as being there from beginning to end, from prenatal to weaning is so important. We know that it makes an incredible impact on the breastfeeding journey for parents and for babies. Meagan: Oh my gosh. Yes. I mean, I wish because I had a baby and then I was meeting with an IBCLC days later but I was already days behind in engorgement and a really upset, hungry baby. It wasn’t that I couldn’t feed my baby, it was just that my boobs were really rock-hard. I remember when I met with an IBCLC, she was like, “It would be really hard for you to latch onto a rock,” with my mouth like this. She was like, “We’ve got to soften these up.” I was like, “I don’t even know.” I was just a mess. If I had had that care before I had my baby, we would have been able to do exactly what you said– go over my plans, go over my goals, and come up with things to look for and what to know, then I would have had your help way before I was days past my breaking point of my husband being like, “I’m going to the store,” and I’m like, “I just want to feed my baby!” Chrisie: Exactly. I think that happens all the time, Meagan. I think that families are starting to take prenatal breastfeeding classes which is amazing. I always recommend my families do that. I think a piece that really needs to come to light is the value of prenatal consultation. It’s exactly what you are talking about. Meet with your IBCLC one-on-one consultation before baby is here. I highly recommend doing it if it’s not your first baby and if it’s your second baby. Talk about what happened last time. Talk about a plan for ideally how to avoid those speed bumps the next time.Also, if this is a new IBCLC to you, you’re going to get a chance to connect with them before the baby is here and find out how they work and find out if you will work well together. Is this the person you want to support you in your breastfeeding journey? But to your point, we’re also going to talk about how to navigate those first few days, how to reach out for help, when to reach out for help, common speed bumps that happen including engorgement which you just mentioned, and how to navigate that. It really lays the foundation for getting off to a good start. Meagan: Absolutely. I just think it’s so beneficial and what’s so great about The Lactation Network is that it’s really so easy to get a consult and get going. You’ve made it so easy. It’s a matter of clicking, filling out a form, and starting your consultation. Right?Chrisie: Yeah. We have IBCLCs across the nation in every state. If you don’t have an IBCLC, we will connect you with one. We will check your insurance to make sure we can get you covered, then right. It’s just a matter of scheduling. The other thing that I think is really important to mention is that IBCLCs practice in different ways. We have IBCLCs who do home visits, who have offices that you can come to, and who do virtual consults. Many of my families like a combination of those. They might start off with an in-person but then maybe move to some virtuals for follow-ups. There are lots of different ways to do this. I also think that sometimes people if they don’t know what to expect in a lactation consult, they might feel like– I’m just going to give you an example– they have to do a feed or maybe they have to do a feed virtually and that’s not always true. I think maybe they picture a very invasive physical exam. That is not true. So I also think that another thing that comes up is home visits. Sometimes people worry about, “Oh my gosh, postpartum. My house is a mess. I don’t want anybody to come in.” Oh my gosh. Don’t worry for a second about that. That is the farthest thing from our minds as LCs. We will come to you in the space that is most comfortable for you, take care of you, and make sure you have all the information and support that you need. Meagan: And truly make our lives easier and take out the question even before birth. There are different types of birth. Even like Caitlin just said, she had three C-sections. I’ve had C-sections. There are vaginal. There is VBAC. There are unexpected C-sections and planned C-sections. There are a whole bunch of things that happen in birth. We know that medication, fluids, and all of the things that happen– trauma responses and all of these things can impact maybe how and when our milk comes in. Then also, our mental state. I remember with my first, I came out of my C-section and I just remember being in my hospital room dozing off, coming up, and then there was a new person holding my baby. Then I’d doze off and wake up and then a new person was holding my baby. All I could think was, “What’s going on?” That’s all I could think, not, “I need to feed my baby. Everyone needs to leave. How do I feed my baby? I’m not awake enough to feed my baby.” You know? Should I have started pumping? There are all of the things. Do you guys have any tips even before scheduling a consult that would maybe say, “Hey, look out for these or do these things? Different births can impact the way that milk comes in and things like that.” Chrisie: Yeah, I think it is important to acknowledge that especially in the first few days how the birth that you have absolutely does impact your early breastfeeding experience. In fact, I recently found a study that points out that women who deliver by VBAC are 47% more likely to initiate breastfeeding than women who deliver by a scheduled Cesarean. Meagan: Whoa. Chrisie: I know, right? I felt like that was a little shocking when I saw that. We know that women who deliver via Cesarean birth are more likely to experience early difficulties with breastfeeding. They are less likely to have their baby to breast within 24 hours. All of that to say, it’s an added layer of significant complication in terms of initiating breastfeeding. I always like to tell my families, and in a prenatal consultation is definitely something that we cover, what your birth plans are, what your birth history is if you’ve had a baby before and how that will impact breastfeeding and what your struggles were the first time. I’m going to give you another example. If you have a long labor and you have a lot of IV fluids, that can postpone your milk transitioning. It can make it harder for your baby to latch. Your baby is more likely to lose a lot of weight quickly which means your baby is more likely to be supplemented in those early days, especially in the hospital. All of these have a real impact. Those are the things we are going to cover. With a Cesarean, there are positioning considerations. We’re going to probably move that baby off of the torso and find positions that are more comfortable. Typically, these challenges are surmountable in the first few weeks so I never want to paint the picture that these are things that we can’t have a plan for, but I think having a plan is key. Having the support is key. Having those conversations and having somebody that you can reach out to when you are experiencing any breastfeeding difficulty. Caitlin: I would like to piggyback on that. I think that a lot of people are like, “Well, I’m not one of those people who has a birth plan,” because the joke is always as soon as you make your plan, it changes. Meagan: It all goes out the door. Caitlin: Exactly. But I do think to Chrisie’s point, in hindsight, my first C-section was emergent and I was put under for it. All was well. Everything worked out, but even for my second and third, I wish that I had spoken up about different things. If I have to go under again, this is what I want to have happen. Remembering that when you’re in your labor and delivery suite, let everyone know, “Hey if this does have to go to a C-section, I want it communicated to the OR that I want the baby put on my chest immediately after delivery. I want it communicated that my intention in PACU is to immediately initiate breastfeeding and get skin-to-skin. Those are things where we can have all of the best intentions in the world, but it is worthwhile just thinking through some different scenarios. I think it is helpful to quell any of that anxiety because to Chrisie’s point, these things are out of our control and that is totally the job of the medical professionals to take the best care of us and our babies, but it is definitely possible to just have some of those high-level thoughts and conversations. For my daughter, she was my second C-section. I was conscious, but even then, it was sort of not really outwardly known that you could request immediate skin-to-skin, and then in PACU, the nurse wasn’t really working with me on breastfeeding very much. I lost some of that time and skin-to-skin that you only really realize later because you’re so in this mentality. It’s just such a whirlwind in the best possible way. They are the greatest moments ever, but really put pen to paper and think through some of those different scenarios. That’s why that prenatal visit with an IBCLC is so amazing because when you are meeting with your OB, they are really just making sure that everything is going smoothly. That’s not to say that they are not spectacular. Doulas are certainly helpful in getting some of these plans together, but as it pertains to breastfeeding and the potential different delivery methodologies, an IBCLC is really the best person to set you up for that type of success. Don’t overlook it. We can’t get all of the answers from Google. Breastfeeding is a very biological experience. We tend to like a lot of quick answers and quick fixes. Just knowing that you have time, relax into it, and reach out for help. It’s definitely the way to be prepared. You’ve made your Pinterest-perfect nursery. Let’s focus on what the actual delivery and feeding is going to look like because right after that baby arrives, that is where all attention goes. Meagan: Yeah. When we actually started talking about TLN, we had someone write in. She was like, “Can I do a review on an IBCLC and how important it is?” It impacted her. She had three C-sections. She had a history of getting mastitis with every single baby so she ended up working with an IBCLC before she had her third C-section that was planned and they worked on all of these things. She was able to avoid all of the things that she had last time. She was like, “She was literally at my hospital bed the day I had my baby.” They had scheduled it because it was a scheduled C-section so she was like, “I will come. You tell me when.” She was like, “It was so impactful. It made my experience with my newborn so much more powerful,” because she was able to take out the stress and the question and all of those things and have more of that Pinterest-perfect birth experience. It was so powerful for her. I think it’s so important to talk about those things. You know, she said, “If you can, get skin-to-skin in the OR. Do these things and then I’ll meet you later.” She did all of those things. She just said it was totally life-changing. Caitlin: I’m happy that you brought that up, Meagan. I think a great question for your delivering hospital is, do you have an IBCLC on staff and will I be able to see them? Because having one on staff doesn’t mean that you will be able to see them necessarily. If it is an extremely busy, university-setting hospital, they may have four or five lactation consultants, but they are really, really regulated to NICU. So ask those pertinent questions because once you’ve had your prenatal visit with a TLN IBCLC, you have their contact information. You can even, if you’re having a C-section, schedule your first postpartum visit for the day you get home or the day after you get home depending on how long you are going to stay in house. There are really ways to be so prepared in that capacity. For in-hospital care, it’s really important that you know going in if you’re going to have that bedside care from a hospital-based IBCLC. That would definitely be a valuable question to ask when you are preparing to deliver. Meagan: Absolutely. Chrisie: I will also piggyback on that. It’s such a great point because having worked in a couple of big hospitals here in Los Angeles, and I don’t know if this is true for every hospital, but even if there is a hospital IBCLC, we are often stretched pretty thin. One of the things that I tell my families when I connect with them prenatally is to request to be seen by an IBCLC when you move to the postpartum floor. I know from my experience that families requesting to be seen were at the top of the list. The next group was the patients that either the nurses or the doctors wanted to see to round on. The third group who might not get seen are the families that seem to be doing okay and haven’t asked for a visit. Again, that was my experience, but I think it helps to ask. That’s a great thing to have your support person do to advocate for you. Ask your nurse or the charge nurse to have the IBCLC come by every day when you’re in the hospital. Meagan: Yeah. I mean, one of my experiences, and this is why I think having an official lactation consultant, an IBCLC, is because I did request and they said, “It’s the weekend. They’re not here.” So to your point and to Caitlin’s point, asking ahead of time, “Hey, do you guys have IBCLCs? Not only do they have them, but do they work 7 days a week?” Because I was on the weekend and then I had these C-sections and then days later, I finally found an IBCLC and I was so far behind when I maybe could have connected. Maybe it could have even been a virtual like, “Hey, how does this latch look? It’s hurting,” or all of these things. We could have nipped a lot of problems in the butt honestly. Chrisie: Exactly and then to compound that issue, I often hear from families that while they are in the hospital, they will hear a lot of conflicting information about breastfeeding from different care providers and it’s so frustrating for them. Most families are coming from the place of, “I’ll do whatever I should be doing, but please provide a consistent plan.” That is where either the IBCLC on staff or the IBCLC you’ve connected with prenatally can jump in and help you and be the person who clarifies that plan for you and gives you a way forward.  Meagan: Absolutely. Well, we have some questions that people from our VBAC Link community on Facebook asked if you don’t mind. I would love to ask some of them. This one was from a mom. It says she is due in April. It says that she is a stay-at-home mom and has a toddler as well. Her goal is to exclusively nurse because she thinks that pumping will be too much. “How do I navigate nursing a newborn and caring for a toddler’s schedules, general trips, etc.” She nursed and pumped last time. Chrisie: Such a great question. First, again, huge plug for a prenatal consult right there. Let’s have a plan. Let’s have a plan. Then, I’ll just share a couple of tips that I give my families in these situations. The first one is babywearing. Babywearing makes such a huge change. It really helps keep that newborn close. Skin-to-skin has so many benefits. We know breastfeeding does better when babies are skin-to-skin. Babywearing is just skin-to-skin while your hands are free and now you can also take care of your toddler. I’m also going to say a huge plug for support. We know where those difficult moments tend to be. The first six weeks, growth spurts, let’s plan for them. If you are alone with your baby and your toddler, let’s have a plan for support. Who is offering to come help? Who can help you take care of the toddler? Can somebody come to relieve you so you can get some shifts? Is it in the budget to hire a postpartum doula to come and support you? Support, support, support especially in those early weeks. Then as we progress a little farther into the breastfeeding journey, I always like to share with my families some tips for navigating feeding times with a baby while also having a toddler because you probably know this, but it tends to happen that you put the baby to the breast or to the chest and then your toddler wants your attention. Meagan: Mom!Chrisie: It’s not a coincidence, right? It’s the moment when you’re doing this thing. “Oh, I’m really not available.” So how do we navigate that? Again, having a plan in advance. Maybe we reserve some special toys or activities for nursing time. Make it positive. Maybe that’s also snack time for your toddler. Maybe as breastfeeding gets a little bit easier, you’re able to have your toddler come sit with you and read a book. But basically have a plan to make breastfeeding a positive experience for your toddler as well so it’s not set up as this competition for them trying to get your attention during that time which is really difficult for parents to navigate. Meagan: Yeah. I love those tips. This other question from this mama says, “I will be tandem nursing when my next baby comes. My first daughter has a slight lip tie and has always had a little bit more shallow of a latch. Just wondering if there are any ways to get a solid latch if the next one comes with a slight lip tie. It didn’t seem to affect my first daughter getting milk out while nursing, but I do think it caused my supply to never really come in fully.” Chrisie: Yeah. Yeah. So love that she is asking this question in advance for sure. There is a lot we are still finding about restrictions or ties. One thing I would look into in this situation is if the second child does have a lip tie, is there also a tongue tie happening? Often, we know when there is a lip tie, there is a tongue tie. Not always, but often. That’s when working with an IBCLC, they’re going to help you navigate what’s happening with breastfeeding and do you need a referral to what we call a preferred provider? Typically an ENT or a dentist who specializes in ties. Let’s have that baby evaluated by the specialist. Let’s find out early on. Are there any lingual or bilingual restrictions that are preventing the baby from removing milk both efficiently and comfortably for the parent? Information is key there, right? Especially if we know there is a history. IBCLCs in your community will be able to give you the names and contact information for those preferred providers so that we can find out that information right away. I also love that she brings up an important point about supply. Sometimes, very strong supplies can mask tongue ties and lip ties even and really make those issues not so obvious in the beginning, but then they might show up later on. Like she said, maybe it affected her supply. I often see people who do okay even though their baby has some restrictions, but then the 3-month regulation hits, and suddenly their nipples are sore. Suddenly their supply is really feeling an impact and it’s because there was an underlying restriction this whole time. Meagan: Yeah. Chrisie: So early information, let’s find out. Meagan: Yeah, I was just going to ask you if IBCLCs can technically diagnose a lip or a tongue tie or if they can say, “Hey, it looks like maybe there is something going on.” I also had some restrictions. I had some issues in the beginning with my milk coming in. I talked at the beginning about how I was a little bit out of it. I had a rocky first start, but then when my daughter was five, she went to the dentist and the dentist said, “How did she eat? How did she eat as a newborn?” I was like, “We had our troubles, but we got through it.” He was like, “Good for you. She actually has a severe lip tie. We actually need to take care of it because it’s going to start impacting as her teeth are coming in.” It was so thick. I was like, “Oh.” So yeah, those two questions. Can an IBCLC diagnose or can they just say, “Hey, it looks like we may have some restrictions here. I would suggest you go to this provider.” Chrisie: The latter. We are not allowed to diagnose. It is not in our scope to diagnose, but we do connect you with the appropriate medical provider who does. Meagan: Yes. Chrisie: They will do an evaluation and make a recommendation. Meagan: Obviously, we love our pediatrician and we love our docs, but my pediatrician, I asked and she was like, “No, not at all.” Sometimes, I feel like pediatricians aren’t as skilled as IBCLCs at recognized, so maybe they can’t diagnose, but they can recognize and get you to that next-step provider to help your feeding journey and your supply and all of these things be better in the end. Chrisie: Exactly. Exactly. I second that. I also love pediatricians so much, but IBCLCs are really the experts in navigating the lactation aspect and referring you to again, what we call a preferred provider for evaluating lip ties and tongue ties. Meagan: Yeah. I love that. Again, a whole other reason why we need an IBCLC through The Lactation Network. Okay, so this question, I think again plugs into getting that prenatal or that consultation before. This mama says, “I would like for my husband to take some of the nighttime feedings to allow me longer stretches to sleep.” We know sleep is so important. It says, “He wants to help with this too. Is there any way to do this without negatively impacting breastfeeding or getting up in any way to pump?” You know, having her to actually lose sleep and giving it to the husband in a bottle. It says, “There is conflicting information online and I’ve heard from most mothers that they just end up doing the nighttime feedings anyway. Maybe their spouse could help with diapers instead.” This is such a good one because sleep is a good one we know for our mental health, especially after birth and recovery, especially if we’ve had a long birth or a Cesarean and things like that. We just need that sleep, but how can we help our partners be involved without negatively impacting? Chrisie: Yeah, I love that question. I will also say that it taps into something I hear all the time which is about conflicting information online. There is so much conflicting information about breastfeeding online. To be honest, there is so much bad information about breastfeeding online which again, is a plug for an IBCLC. That’s why you need that expert in your back pocket to be the person who says, “Okay. Here is the deal. Here is what we need to do.” In this specific example, I do have this conversation all the time because I think one thing that is important to note is that I find the first six weeks to be the hardest for so many reasons, right? But if you’re a first-time parent, I know it’s common, and I felt this myself, when it’s your first baby and you’re doing this for the first time, it can feel like, “Oh, this is what it feels like. I’m never going to sleep again. Oh my gosh. This is what breastfeeding is like.”I think it’s important to know the different stages, what breastfeeding looks like, and what sleep looks like at the different stages. So just having those expectations and that information can go a long way. In the first six weeks, babies tend to be nocturnal. They tend to be more alert at night. Nights are tough for the first six weeks. Throw in growth spurts where we have all of the cluster feeding. Nights tend to be a little bit harder during those times. We know that. We know that sleep is going to be tough in the first six weeks. It’s important to know that it does get better. It usually does get better after what we call the six-week growth spurt. That is one factor. But to answer the specific question, I like to talk to my families about what I call tag-teaming at night which I think is what she is asking about. Once we introduce a bottle, then you do have a little bit of play in terms of how the partner can support those nighttime feeds. Again, it’s such an important topic to talk about before the baby gets here. How are we going to navigate nighttime feeds? It’s so important. Sleep is so important. One possible scenario and this really depends on the specifics that are happening within the family, but once we are introducing the bottle, it might be possible for the parent to pump before they go to bed. Maybe the partner grabs the next feed with a bottle and then the parent who pumped right before bed is able to skip that feed and then grab the next feed. So we kind of pre-pump essentially. This plan works for some people. We do have to introduce a bottle. Where a lot of people go as well, the standard information is that I shouldn’t introduce a bottle until 4-6 weeks so that plan is not going to help me. My take on that is that we don’t always have to wait 4-6 weeks. Let’s talk about the specifics that’s happening with your baby and your family. But also, it is important to note that in general, we do need a one-to-one ratio,  one pump session for every bottle in order to protect your supply and preserve your breast health. If we go too long, especially in those first six weeks, if we go too long before removing milk from the breast, we can get clogged ducts. We can get mastitis. We can get other issues. Now, unfortunately, prolactin which is the hormone that is driving a lot of this, peaks in the middle of the night. So often, we have our strongest supply right in the middle of the night. So how are we navigating all of that? That’s what comes down to the specifics of the IBCLC putting together a plan for you and your family. I will say that generally, we are usually able to carve out a longer stretch of sleep for the birthing parent after that six-week growth spurt. But absolutely, sometimes we can if we just take that scenario. Maybe the other parent or a support person is giving a bottle and it means you wake up, do a 15-minute pump session, and go back to sleep. That might be a lot faster than the process of feeding a baby from beginning to end. These are all things that we look at creating a plan for. Meagan: Yeah, plans are important. Caitlin: They are. They are. I’m not clinical, so mom to mom we’re saying a lot of things that can be interpreted as overwhelming. I want parents so much to settle into this amazingly delicious life moment and we are very much a fast-moving and fast-paced world. This time is so precious. It’s so amazing. You will just want to inhale your new baby. It’s so– I just think giving yourself permission to take those 4-6 weeks to really just rest, recuperate, and establish that connection. Your brain is going to really go to Target. Find some time to go to Target. Maybe that’s with a support person, so that if you get there and 15 minutes later, you need to ditch your cart and go nurse in the car, someone else can stand with your cart or they can say, “This is totally fine. I’ll put back the items and we’ll meet back in the car.” If you are feeling that real urge to get out and do things, make sure you get out and take a walk. I saw a really funny meme yesterday where it said, “Nap when the baby naps.” It’s this new parent with a stroller outside and she lies down on the sidewalk. Obviously, that’s great advice, but in practice, it’s difficult so just know that you will rest. You will sleep. It is the best, most special time and we are here to help you prepare for it the best we can. It’s not a Google time. It’s not something that you can really search Google for all of these answers. It’s important to go into it knowing you can trust yourself, trust your body, and advocate for help. This used to be done with a huge village. We lost that village a bit. Bring in an IBCLC in early and often to be that outside person who comes in and is solely focused on this feeding relationship to nourish yourself, your baby, and your family to give you, your spouse, the grandparents, the siblings– all will be impacted by this peace of mind and this support. It’s very, very crucial and lovely. I wish all of you tons of snuggles. Meagan: I literally just got the chills. Such a powerful message right there. So, so powerful. Women of Strength, if you want to schedule your consult right now, all you’ve got to do is click in the show notes or you can go to our Instagram and look in our bio. It’s really easy to schedule a consult and start your plan today. Then one last question– if we have IBCLCs maybe who are listening, because we do. We have such a large birth community who listens. They may want to join The Lactation Network. How could they do that or is that possible? Chrisie: Yeah, absolutely. Caitlin: Yeah, absolutely. I would encourage anyone listening to check out our website. It’s tln.care. T as in the, L as in lactation, and N as in network dot care. Come visit us. Come ask questions. We are just so, so passionate about this space and are so grateful that we have had this time. Meagan: Well, we love you guys so much. We are so grateful for your time. We just know that you are literally changing lives all over. Thank you so much.  ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands