Breastfeeding questions answered, with IBCLC Barb Demske

In this week’s episode, I had the opportunity to chat with Barbara Demske, IBCLC, about all things breastfeeding. Barbara experienced immense challenges while nursing her first son. That difficult journey became the catalyst that drove her to become an IBCLC to offer support to new moms who may be struggling to meet their breastfeeding goals. She is the face behind @firstlatch on Instagram and offers e-consultations. Barb and I dove right into all of the questions ya’ll sent my way!

What is normal, in terms of breastfeeding, for a newborn? When will my milk come in? 

Barb recommends getting some sort of prenatal breastfeeding education. This can be really helpful so that you have an idea of what to expect when your baby comes. The Womanly Art of Breastfeeding is a good resource. There is a wide range of normal when it comes to newborns. In general, newborns feed a lot. Every hour to every two hours. At a minimum, newborns should be at the breast every three hours. The more baby is at the breast, the more that tells your body to start transitioning from colostrum to more mature milk. Your milk doesn’t actually “come in” but it transitions from the specialized colostrum that is the perfect food for newborns, to the more mature milk that will nourish them until they are weaned. 

Do I wake the baby to feed?

Yes. Yes, you do. Barb shares that frequent milk removal is important not just to ensure that the baby is getting enough milk (which you can determine in the first few days by counting soiled diapers) but also to make sure that you will have an abundant milk supply. Until the baby reaches their birth weight, they should be woken to feed every three hours or so. 

What are your thoughts on pediatricians and the focus on weight gain? Isn’t every kid different? What should I really be paying attention to and how do I know if my kiddo really is gaining enough weight?

Barb shares that weight gain is important. Especially with newborns, it really is the gold standard for determining if they are getting enough milk. However, not every child needs to be in the 80th or 90th percentile. What is important, is that the kiddo is following their own growth curve. You can also look at things like whether or not they are hitting developmental milestones on time.

How does milk production work? Is it all supply and demand?

In general yes. If you have a baby that is nursing well at the breast, it does work by supply and demand. In general, the more you remove milk, the more milk you will make. Barb likes to say that “if you can make some milk, you can make more milk.” Going back to work can make this tricky, so you need to pay attention to the number of milk removals. Barb recommends at least 8 milk removals in 24 hours. 

Does it matter how spread out the feeds are?

This depends on how far postpartum you are and your milk storage capacity. When the breast fills up, that signals the body to slow milk production. So a woman with more milk storage capacity can sometimes go longer between feeds because it takes longer for her breasts to “fill up” and signal to the body to slow down production. Milk storage capacity has nothing to do with breast size and more to do with how much glandular tissue the breast has. Women with very large breasts can have small storage capacities and vice versa. There is an article called “The Magic Number” with more information about milk storage capacity how it impacts supply and demand. 

When do you recommend starting to pump?

Barb shares that some women worry about creating an oversupply problem by pumping too soon but she recommends starting whenever you feel like you want to or have the time. In the interest of storing milk, you can also use the Haakaa, a silicone breast pump that suctions onto the breast you aren’t nursing on and passively collects milk. 

In terms of daily milk removals, does it matter if it is pumping or nursing?

No, it doesn’t matter as long as you are removing milk enough times in a 24 hour period. 

When do you recommend seeing an IBCLC?

Barb recommends seeing an IBCLC if you have a non-latching baby, nipple damage, or any questions about breastfeeding.

Sore nipples. Is it normal? When is it a concern?

Barb emphasizes the need to differentiate between nipple soreness and nipple damage. Nipple soreness can be normal in the beginning. Many moms report a stinging feeling when their newborn first latches. That feeling should dissipate as the feed progresses. If you have nipple damage, like scabbing or bleeding, that would be a reason to seek out more help. Barb recommends nipple creams with healing properties, like Motherlove or Earth Mama Angel Baby. 

How do I know if my latch is good?

Barb recommends not obsessing about the appearance of the latch. If mom is comfortable and baby is getting lots of milk, that’s a good latch. 

Alcohol and caffeine, are they okay?

Alcohol—If you’re safe to drive, you’re safe to breastfeed. If you’re not safe to drive, you still need to remove milk but dump it. Coffee— The literature says that it’s perfectly fine. Some babies do have a negative effect, but that’s not the rule and in general coffee, consumption doesn’t need to be worried about too much. 

What is the difference between a Lactation Counselor and an IBCLC?

An IBCLC will have received the most comprehensive education. A lactation counselor is still a good option. They are very knowledgeable and can help you find an IBCLC if they can’t help you. There is a scope of practice for each type of education. For the more complicated breastfeeding problems, you would want to see an IBCLC. 

How to go about getting a breast pump?

Aeroflow is an online resource for moms. They do all the backend work for your breast pump. They work with tons of insurance companies and if they don’t work with your insurance, they can likely direct you to who can help you. It’s free. 

Nutrients and immunity. When is it okay to wean?

You can choose to breastfeed or not. It’s okay to wean whenever you want to wean. But looking at nutrients and immunity, WHO says babies should be breastfed for two years and beyond. AAP recommends a minimum of 12 months (6 months exclusively). The benefits extend beyond those time periods and it also doesn’t have to be all or nothing. Any amount of breastfeeding is great. 

We finished our chat by discussing the #fedisbest movement. Barb shares that from the heart of it, it comes off as being supportive to all moms. But it is problematic in that it’s not addressing the need for additional support for moms who want to breastfeed but have roadblocks. The phrase “fed is best” is nonsensical. Fed is expected, whether formula or breast milk. Saying #fedisbest doesn’t help a struggling mom to meet her goals. It can actually undermine the fact that there is a very real need for support for women who do want to meet their breastfeeding goals. Barb ended our conversation by emphasizing that every mom should celebrate her breastfeeding journey. Whether it is one day, one week, one year, or beyond. Celebrate all of your hard work, your journey is important. 

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