“Breastfeeding: Myths, Misconceptions, and Advice” – with Melissa Kotlen RN, Lactation Consultant

In the second part of her interview, Melissa Kotlen, RN and lactation consultant, explains why giving women the choice not to breastfeeding is liberating, misconceptions about dietary restrictions, exercise and breastfeeding, and more.

Share this post:

Dr. Fox: Welcome to today’s episode of “Healthful Woman”, a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and Maternal Fetal Medicine Specialist practicing in New York City. At “Healthful Woman”, I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. 


How do you talk to women if they come to you for advice or you’re meeting with them and they don’t want to breastfeed? How does that go? You know, in a conversation someone says, “Am I wrong? Am I crazy? What do you think? What should I do?” How do you approach that? Because, I mean, on the one hand, you’re there to, like, help them breastfeed. 


Melissa: Sure. 


Dr. Fox: On the other hand, they’re saying, “I don’t want to do or it I’m not going to do it,” whatever it is. 


Melissa: I’ve had a few different combinations of that. First is the mom who…it’s few and far between, but the moms who don’t want to actually…they want to give breast milk to the baby, but they only want to exclusively pump and don’t want to put that baby near the breast, then we just work with that. You know, I have it a few times a year. But then there are the moms who call me in, and there’s sometimes, you know, an interesting dynamic, maybe with the partner. You can see she’s not happy with this, but he’s saying…or sometimes the mother-in-law is sitting there. 


Dr. Fox: Right. Interesting dynamic is such a nice way to put it. 


Melissa: Yeah, I’m so kind. 


Dr. Fox: It’s an interesting dynamic. It’s a disaster. 


Melissa: It’s awful. God, this family sucks. 


Dr. Fox: Like someone dropped Anthrax in the room, yeah. 


Melissa: It’s true. And I always have to sit there and smile like, “Oh, no, this is all good.” But get out of here. Get the mother-in-law, who’s hovering and standing over my shoulder. And I always…F.Y.I., I always want the family in there. I want as many people in there because I want other ears and I want this to be a family thing versus just the mom and me. So, if she’s willing to have everybody in there…but sometimes you can tell it is not in her at all, and she’s zoning out a little bit while I’m talking, and I just…there are no questions, and I put the baby on and she… 


Dr. Fox: And her mother-in-law is paying you. 


Melissa: Exactly. Exactly. And the mother-in-law is saying, “Well, you know, when I breastfed Brad…” I don’t know how that name came up. 


Dr. Fox: Right. Brad is 45. 


Melissa: Exactly. You know, “I just want you to know, I did…” you know. “Okay, okay.” This is, you know, Jennifer. 


Dr. Fox: Right, right. 


Melissa: Sometimes, if I can get them out of the room or if they are alone, just saying, “Be straight with me, be honest with me. How are you feeling about this?” “I don’t know, I don’t really want to do this. I just feel like my husband keeps telling me I have to, you know. My mother keeps giving me the guilt trip that she breastfed my four sisters and me.” You know, it’s like, “Okay, but let’s work with what you want to do because this is you, this is your baby.” Again, what I was saying earlier, this is your happiness. I would a million times over have a mom who is formula feeding and happy, and the whole family, everything is going swimmingly and everyone’s smiley, and she feels like she can get up off of the couch. She feels like she has a break, she feels like she can go take a shower, and she’s not falling into a depression. 


Dr. Fox: Right. 


Melissa: That, to me, I have to look at, you know, their mental health too. 


Dr. Fox: Right. That’s a win. 


Melissa: It is. I’m like, “I just want everybody to be happy here. If breastfeeding is not for you, it’s not for you, and I’m not going to sit here and stress you out. And so, do you want to try, maybe, to pump one time a day? Would that work for you? You know, just to be able to…you can mix it with the formula if you want.” And a lot of the times, the second you lighten that up and just say…they’re like, “I’d be willing to do that, maybe, once.” And then all of a sudden, they call you and they’re like, “I think maybe I can do it twice a day. I’m thinking maybe morning and evening.” Great, okay, fine. But then if there are the moms that say, “I hate this. I hate it. It stresses me out. I dread every moment.” And it’s not even, like, putting aside any kind of pain. She doesn’t have an infection, her nipples are fine, everything’s fine, it’s just not in her, then forget it. Let’s hang it up. Let’s find some other way that you feel like you’re going to bond with the baby, then, if this is not it. 


Dr. Fox: Right. 


Melissa: That’s when I sort of become the friend who had kids. 


Dr. Fox: I think when you change it from a mandate to a choice for women, that’s very…it’s liberating because then they’re making their own choice. 


Melissa: They made their choice. 


Dr. Fox: Like everything in life, you know, this is… 


Melissa: Exactly. 


Dr. Fox: …you know, liberty, freedom, all of these things… 


Melissa: Exactly. 


Dr. Fox: …that we, you know, say that we love. This is a woman’s choice. 


Melissa: Exactly. 


Dr. Fox: She should do what’s right for her. I think, like with all things, sometimes, people have misconceptions, and, therefore, they’re not making, like, an informed choice. So, yeah, it’s up to us to make sure they understand, like, you know, “What are your reasons? Just so we understand that you know the facts, and fine, then make a choice. It happens all the time in medicine. What is it that you would just want everybody to know? Like, this is a myth, this is a misconception, here’s the truth. Here it is. Here’s your chance. Say whatever you want.” 


Melissa: The first thing is, always get the sort of small-chested moms who went from flat to maybe an A-cup during their pregnancy. They think that they’re not going to be able to breastfeed because they’re small-breasted. Not true at all. All it has to do with the amount of tissue, I mean, like, the actual glandular tissue. If they’ve developed something during their pregnancy, then most likely…they’ve never had any breast surgeries, traumas, anything like that, which I always ask, then they’ll be able to produce. 


Dr. Fox: Okay. 


Melissa: Sometimes I have the mom with the, like, guzunta huge boobs that actually are producing less. So, breast size has nothing to do with how much you’re going to produce. That’s the first thing. The second thing is always about food. I get it a lot with baby nurses. Not baby nurses in the hospital, but actual baby nurses who are telling their moms what they should not be eating. 


Dr. Fox: Oh, “Don’t eat this, do eat this, don’t eat that because the baby will taste it…” 


Melissa: Yeah. Or… 


Dr. Fox: That always sounded a little fishy to me. 


Melissa: I say eat anything and everything. Fishy. 


Dr. Fox: I didn’t mean it that way. I was thinking, you know…I would always be, like, “Really? Seriously?” 


Melissa: Eat anything and everything that you want. 


Dr. Fox: That doesn’t make sense to me. 


Melissa: Not at all. 


Dr. Fox: You never question anybody who’s nursing, like, ever. Really, “Yeah, yeah, yeah, of course.” But seriously? The baby knows you have broccoli? I don’t think so.” 


Melissa: No, I’ve had so…and for some reason, it’s always the baby nurses that say, “Oh, you know, I told her no broccoli, garlic, onions, strawberries, citrus.” I’ve heard it all. I say eat anything and everything. And if the baby starts to have a reaction to something, typically it’s going to be cow’s milk protein, and everybody says dairy. I’m not putting that in quotes because goat and sheep is a very different…it’s a different bird. 


Dr. Fox: They’re actually not birds. 


Melissa: Oh, they’re not. That’s right. 


Dr. Fox: Okay. Yeah. 


Melissa: It’s usually the protein in cow’s milk that is…if a baby is going to have some sort of… 


Dr. Fox: Right. But it’s not typical. Yes, eat what you want. 


Melissa: Eat anything and everything. Eat spicy food, because guess what, at six months, those are going to be the babies that are going to have a more interesting palate than the ones that…moms that cook, like…I always say, like…my mom cooks. My ex-husband always says, like, “Your mom’s recipe for chicken was take chicken out of package… 


Dr. Fox: Put in oven. 


Melissa: Put in oven, take out of oven, like, not one, like…” my mother will probably end up listening to this and being like, “You think I cook like that?” It’s awful, you know? That, and I had, like, a mom who ate that kind of chicken with just boiled potatoes for so long because she was too scared to eat anything else. I’ve had baby nurses say to me, “Oh, you know, I’ve told her not to eat this, this, and that because look at the baby’s diaper.” And I open the baby’s diaper, and if you…and I see, like, sort of a green salad-y-looking poop, that just means that there was more foremilk in the prior feeding than…we want those yellow, mustard-y, seedy poops, which means they got to the fat. But if sometimes, you know, they only had a little bit of the…like, they had more foremilk than hindmilk, we’re going to get that green salad-y-looking poop. And I had one baby nurse who once said to me, “Look, I told her to stop eating salad, because look at that…” I’m like, “How does that work?” 


Dr. Fox: Hold on. Take one step back. 


Melissa: It comes out through the milk. 


Dr. Fox: This didn’t come up before. Part of your lactation consultant services is poop inspection? 


Melissa: Oh, I love it. I’m obsessed. 


Dr. Fox: You’re like the guy, the tour guide who, like, picks up the poop and says, “Oh, because of this, it was this type of animal which means that… 


Melissa: [crosstalk 00:07:59] 


Dr. Fox: …this is this agriculture and you’re that…” 


Melissa: It’s the job. 


Dr. Fox: Wow. 


Melissa: I love poop. 


Dr. Fox: Oh. 


Melissa: Since my own kids, I’m like, “Oh my god.” 


Dr. Fox: There’s a lot of information in there. 


Melissa: Look at this, like…right? 


Dr. Fox: Most people don’t want to do it, but that’s…okay. 


Melissa: [crosstalk 00:08:11] 


Dr. Fox: So you’re really into this. You’re rolling up your sleeves. 


Melissa: It is, like…I see the carrots, I’m like, I’ve got…you know, once they start really eating solids, I’m, like, “Look at that.” 


Dr. Fox: Amazing. 


Melissa: That seed in there. That’s great. That sesame seed. 


Dr. Fox: That’s good for the moms in labor. I’m sure they appreciate that. 


Melissa: Oh, they do. Sometimes, though, I’m happy for that N95. 


Dr. Fox: Yeah, all right. 


Melissa: It’s not possible, if you’re eating a lot of salad, for it to actually somehow reconstitute in the breast… 


Dr. Fox: Right, it doesn’t come out of salad. 


Melissa: …and come out as green again. Like, it doesn’t make any… 


Dr. Fox: Right. 


Melissa: So, it doesn’t make any… 


Dr. Fox: That would be magic. 


Melissa: Right. It would be magic. And so sometimes they’re getting this information from what are supposed to be support people like the baby nurse or something like that, and it’s just not right, to put it lightly. So, one of the myths and misconceptions that I hear all the time is always about the food. I always like to just say, “You just eat anything and everything that you want.” 


Dr. Fox: This is gold. This is good stuff. 


Melissa: Right. 


Dr. Fox: All right. Two point five billion people are going to be better educated now. All right, keep it coming. What else you got? 


Melissa: I mean, there are so many. Exercise. 


Dr. Fox: Please say it’s good. Please say it’s good. 


Melissa: I’m a huge fan. Are you kidding me? I’m a marathoner. 


Dr. Fox: Otherwise, Malca [SP] would come in and beat you with a baseball bat. 


Melissa: No, I know she would. We’re on the same page. I loved her whole entire podcast on exercise. There’s been this, sort of, sad research done, which I put that in air quotes too, about these babies who were rejecting the breast. This was quite a few years ago, I’m probably dating myself, but about how lactic acid builds up when you’re breastfeeding, so you should not be exercising and then breastfeeding the baby afterwards, because babies were “rejecting the breast” after this. 


Dr. Fox: Protest the breast. The breast protest. 


Melissa: Yeah, only after…breast protest…like, pushing away. Supposedly, you know, the research had shown that it was because of the… 


Dr. Fox: The mother’s fault. 


Melissa: It was the mother’s fault. 


Dr. Fox: Of course, yeah, yeah. 


Melissa: Lactic acid built up, “You cannot work out.” And what follow-up research showed was, “Wait, hold up. It’s not about that. It’s that these moms were going, working out, running like crazy, doing whatever they’re doing, sweating, putting the baby right to the breast, and it’s salty. 


Dr. Fox: Too salty. Too salty. 


Melissa: And the babies are pushing away saying, like, “No.” So, this is what you do. You take a shower and then breastfeed. The only thing with exercise, like, I’m more concerned about your hydration, because that’s what’s going to dip your supply. 


Dr. Fox: Sure. 


Melissa: So, you best be taking your, you know, spy belt with your containers on there and just…and drinking. The exercise, critically important, especially for mental health. And so, if they come back, even if the baby is screaming for the breast, the second they walk into the door, at least just wipe them down so that they’re not salty and sweaty, and the baby is not, like, ugh. 


Dr. Fox: Yeah. 


Melissa: That’s a huge one as well. I probably have somewhere out there that I have written something about all of these misconceptions and the myths. 


Dr. Fox: Those are good ones. 


Melissa: Those are the ones that I hear all the time. 


Dr. Fox: A few other, sort of, big pictures items. If you had to give advice, right, so they’re not going to meet with you, you’re just telling them over a podcast. So, someone is pregnant, she’s expecting and she wants to breastfeed. What advice would you give her, I’m going to say, right now when she’s pregnant? I’m going to ask you the same question right after she delivers, and the same question when she goes home for the baby. Stuff that, again, you just think everybody should know before they get into this. 


Melissa: Just as far as the preparation, I mean, and the planning? Just, like… 


Dr. Fox: Anything. Preparation, planning, if there’s something that, you know, “Ugh, I wish every mom knew this before she started,” something like that. Same concept. 


Melissa: So, I mean, obviously, you know, while pregnant, 100% take some sort of prep class. Whether…it’s not going to be in person these days, but again, online, just read up a lot. Prepare yourself, but don’t go too wild buying all of these accoutrements like, you know, buy your Boppy pillow or whatever it is. You can hold off on buying a pump. You don’t have to do that at first, because, like, I would rather, if a mom is breastfeeding and obviously going to go back…or not obviously, but going to go back to work or just wants a relief bottle or whatever, I get it that they want the pump, but let’s hold out for two weeks. Get your supply established and just know that the baby’s latching well and all of that, and then around the two-week mark let’s start to introduce maybe one bottle a day or something like that. They don’t need the pump to bring to the hospital. I’ve seen this so many times. 


Dr. Fox: Right. 


Melissa: You don’t…maybe if you want to bring the Boppy, great, but just to be able to prepare, just the information before having the baby is the best thing. So, again, they know everything A to Z, they have a few things that they can bring, but don’t go wild on all of these special things. We can buy them afterwards, and Amazon delivers in one day anyway. 


Dr. Fox: Right. The first two days, let’s say, the day or two in the hospital, what are things that you would want women to know, sort of, entering into that situation? 


Melissa: Okay. So, entering into that situation, yes, you have milk. If you haven’t had any breast surgeries, traumas, anything major happen to the breast… And, as an aside, as far as surgeries go, I’m not worried about implants, but more so breast reduction surgery because it sort of kills a lot of the ducts and takes tissue out. The implants are put in behind the muscle, so we’re not really worried about that. The colostrum is enough for the baby for the first couple of days. Their stomachs are the size of a marble. It’s all it has to fill, and it’s a teaspoon’s worth, but it’s very rich and thick, and it’s filled with all the immunoglobulins and everything that that baby needs for the best kickstart. I hear too often…like I did last night with my patient who was 19 years old, but, you know, she tried to breastfeed. I put the baby on, the boyfriend kept saying, “No, no, no. She doesn’t want this, she doesn’t want this. We’re just going to give it a try.” 


Dr. Fox: She, the baby or she, the mom? 


Melissa: She, the baby. 


Dr. Fox: Okay. 


Melissa: “She’s not going to want this, you don’t even have anything.” And I try doing my 10-second-long lecture, but nobody is listening. But, you know, just knowing you don’t have to fill, you know, a 60-milliliter bottle into that baby’s stomach right away. And your body produces…it’s an issue of supply and demand, so your body is producing as the days go on, so the more the baby is at the breast, the more you’re going to produce. And all it has to fill is that little tiny marble. On day one, it’s a marble. Day three, it’s the size of a shooter marble. Day 10, we’re looking at a ping pong ball. So, Mom’s supply actually will exceed what the baby can actually take, but at least we’re working together to sort of build it together. 


Dr. Fox: Right. And that latch, as you said, it is the stimulation. 


Melissa: Critical. Exactly. 


Dr. Fox: There’s a loop where it stimulates the brain to tell the breast to make milk, and also the let-down so the milk comes out in both of those. 


Melissa: Exactly, exactly. 


Dr. Fox: Trying it, even if very little or nothing is coming out. Number one, there probably is and it’s enough. But number two, you are starting the process. 


Melissa: You’re starting the process. 


Dr. Fox: So, that’s going to work as you continue forward. 


Melissa: Exactly, exactly. And that’s why, also, that latch is so critical. Like, if we’re talking just the immediate postpartum, that’s why having someone there to assess that latch, we want those baby’s lips flanged out, we don’t want them gliding onto that nipple, because that’s not giving any stimulation. They’re breastfeeding and they’re not nipple-feeding. So, if they’re nipple feeding, you’re going to end up with the sore, chopped-up nipples. If they’re breastfeeding, I don’t care what kind of nipple you have, which actually goes to another myth and misconception, to go back a step, which is, I hear so often that, “Oh, well the nurse said I have great nipples for breastfeeding.” I’m, like, “I don’t even care if they’re inverted.” 


Dr. Fox: Yeah, I wrote on my paper, “The nipple question.” 


Melissa: See? I didn’t even see…I don’t even have my glasses on, here. I can’t even look over the table. 


Dr. Fox: Right. 


Melissa: You could have an inverted nipple, and the baby has to get, you know, a half an inch to an inch beyond the nipple. They’re not on the nipple at all. They’re just sort of creating this teat with the tissue and drawing it, sort of, where the soft and hard palates meet. It’s really far back, so that’s the stimulation. When we let them glide onto the nipple… 


Dr. Fox: Right. If they gnaw on the nipple, it’s going to be painful, yeah. 


Melissa: That’s it. Exactly. It’s going to be painful, we’re not giving any stimulation, and then we end up dealing with sore nipples plus milk supply issues. It’s critical. 


Dr. Fox: Right. And then what about when they go home? 


Melissa: When they go home… 


Dr. Fox: I’m going to say that the big lesson that I got from this is, like, don’t beat yourself up. 


Melissa: No, it’s true. 


Dr. Fox: Yeah. 


Melissa: Don’t beat yourself up. 


Dr. Fox: And get help if it’s not working. 


Melissa: Get help. There are so many lactation consultants wherever you are. You know, if you go…I know everybody’s in New York, you’re listening… 


Dr. Fox: Right. It’s a lot of New Yorkers. A lot of New Yorkers. 


Melissa: There are people all over the world, again, 2.5 million people listening to this, you know? If they go to the ILCA website, ILCA.org, there’s “Find a lactation consultant”. You type in your ZIP code and they’re all going to come up. So, find a lactation consultant. A lot of them do take insurance. 


Dr. Fox: Oh, I didn’t know that. 


Melissa: Yeah. 


Dr. Fox: They participate in health insurance. I would assume the health insurances cover it. They probably have to. 


Melissa: Most companies are covering it. So, even if… 


Dr. Fox: If for only political reasons, they’d be, like, terrified if they didn’t, what would happen to them. They cover breast pumps, they cover all the…what do they cover? 


Melissa: Exactly. And great breast pumps. 


Dr. Fox: It’s less expensive to cover a lactation consultant than a breast pump. 


Melissa: Yeah, no, it’s true. Depending on the area you live in, but yeah. Yeah, and they offer beautiful, great breast pumps. I mean, the best. And so, I’ve had clients who have told me that their insurance companies will cover three consultations with a lactation consultant, or, you know… 


Dr. Fox: It’s a lot. 


Melissa: …something like that. It’s a lot. And it’s great. 


Dr. Fox: Three hours. 


Melissa: Yeah, or more, because it depends on…yeah, it depends on how they work. It’s pretty important. And again, going back to much earlier, you know, this all comes back to the support and knowing that you can call someone. But coming home, there is the whole “Don’t beat yourself up” thing. “Sit down, take a deep breath, know that, ‘Okay wait, I can get help,’ and this is going to work out.” 


Dr. Fox: Right. 


Melissa: One way or the other. Again, whatever their goals are. 


Dr. Fox: Right. Now, let me ask you a question. Who would you recommend enlist the help of a lactation consultant? How would a woman at home or at the hospital know, “I need a lactation consultant to help me”? 


Melissa: Usually they know. A lot of them that are the sort of hyper-successful, type A personalities that are not going to not be successful, so they’re calling no matter what, even if everything is going perfectly. They just want that check-in. They want a little breastfeeding check-up to say, “Okay, yes, everything is perfect.” 


Dr. Fox: That’s good for you, for business, yeah. 


Melissa: Which is beautiful. Like, no complaints. 


Dr. Fox: Right. 


Melissa: Then there are those… 


Dr. Fox: Then you just get paid to be their friend. 


Melissa: Yeah, yeah, besties, you know? “Of course, FaceTime me any time.” And then they send me down to their friends, so that’s good. But then you have those who, even in the hospital, they already know the baby is not opening this mouth wide enough, their nipples are already sore, they’re bleeding, they’re, you know, lipstick shaped, whatever the issues are, they know already that something is off. 


Dr. Fox: Right. So within a couple of days, if the latch isn’t right and you just know there’s something off, that’s…because obviously not everyone’s going to have it correct the first time, the second time. But within a couple of days, for many women, it does work out, and if it doesn’t, it’s really time to call. 


Melissa: Yeah. If they’re leaving the hospital and still things are, like, just it’s too painful, they feel like just something is off that, you know, the baby is just crying nonstop, never content. I mean, the baby could have issues, like, we could have a tongue tie or a lip tie that should be assessed. It’s missed a lot of the time. 


Dr. Fox: Yeah. I just saw one this morning. 


Melissa: Did you see one this morning? 


Dr. Fox: Just this morning. Absolutely. 


Melissa: It was so tight? 


Dr. Fox: Yeah, I mean, the pediatrician was examining the baby, I was in the nursery, and she goes, “Oh, look.” And I said, “Oh, yeah, let me look.” And she said, “Yeah, it’s just like this morning.” 


Melissa: I’m so glad that she actually caught it. A lot of times, they just don’t look in the mouth. Like, they’ll look to see… 


Dr. Fox: The good ones do. 


Melissa: Yeah. The good ones do. Exactly. Sometimes the exams are a little too fast and sometimes I’ve had a mom who’s, you know, had problems for two weeks, I go to see her, it’s, like, screaming at me. I’m like, “Why did nobody pick this up?” 


Dr. Fox: How much do you just want to fix that yourself? 


Melissa: I do. I just want take a little snip. 


Dr. Fox: Just take a little scissors and snip… 


Melissa: I do. 


Dr. Fox: You’re like, “I saw them do this. You don’t need a medical degree to do that.” 


Melissa: It’s nothing. But now they’re laser. Now they laser. They don’t snip it off anymore. 


Dr. Fox: Oh yeah. Well, they do that so that you don’t do it. “I have a laser.” 


Melissa: Exactly, with my dirty Kellys that I carry around with me. 


Dr. Fox: Right. That’s probably better for the baby in the long run. No, but it’s interesting, because I think a lot of, you know, women may not know, like, “Okay. I’m going into this, I’m planning to breastfeed. I don’t expect it to be a breeze. I expect there to be, you know, some learning curve.” At what point is this not normal? Right? “At what point am I beyond the learning curve and I’m just sort of…I’m setting up for a situation that’s going to fail because it hasn’t worked out yet. And so, if that point is sort of, when I’m going home, it’s still not basically going okay, that’s a good time.” I think, number one, it’s just a good, easy-to-remember benchmark. Like, “All right, I’m on my way home.” Number two, logistically, that’s when you’re going and there’s no one there, necessarily, to help you anymore. You’re not in the hospital, the situation is different, and so if it’s not going to get worked out while you’re in the hospital, there is a real chance it won’t get worked out when you get home. So, that seems like a reasonable time to start, you know, calling in help. 


Melissa: The stress hits when they get home, for sure. And I think there is sort of this odd sense of security when they’re in the hospital, because there are so many people who technically should be able to help. But the second there’s, like, this little bit of this panic of, “Wait a minute, I’m on my own. Oh my god. Wait, I can’t just ring a bell, a call bell? Or, nobody’s just going to come in to help me. I can’t put myself on a lactation list.” You know, there’s that moment. 


Dr. Fox: “Can I leave the baby in the nursery tonight?” 


Melissa: Exactly. And now, of course, they won’t even have the nursery open. 


Dr. Fox: I mean at home, like, what’s that, our kitchen? 


Melissa: At home. 


Dr. Fox: We don’t have a nursery at home, sorry. 


Melissa: “So, they’re in the room with me all night?” Yeah, there’s no other hands. So, I think that that’s usually when most of them, it hits them a little bit earlier rather than later. We have moms with very high pain tolerance. They might think that’s normal for a while. And I always say, like, the initial latch, for example, the first week to 10 days, that initial latch for that first 7 to 10 seconds was like, “Oh, wait. Okay, it’s better.” But if it continues, let’s say it’s going on for minutes and they’re not getting any relief and they have a high pain tolerance, they might think that that’s just how it’s supposed to be, and it’s not. Breastfeeding is not supposed to be painful. 


Dr. Fox: Right. 


Melissa: But again, I go back to my longstanding, you know, recommendation of just having that prenatal breastfeeding class so that you know that that’s not normal. 


Dr. Fox: Right. 


Melissa: And you know, “Okay, wait. I remember this was said, I need…” 


Dr. Fox: “My partner took copious notes. Page 12.” 


Melissa: Exactly, “And now where are they?” 


Dr. Fox: Yeah. Page 12 says this isn’t supposed to hurt. You wrote that down. 


Melissa: You wrote it down. She was stern about that. 


Dr. Fox: Yeah, wow. And then just so also women understand for their expectations, so they come home, they realize this isn’t going well, and they do, you know, call on a lactation consultant to come, how long does it typically take for you to quote, unquote, fix what’s going on? Is it 10 minutes, like you said, because you know right away, or is it 2 sessions, or is it 3 weeks? What should they expect when someone comes that it will sort of start improving for them? 


Melissa: Sure. With the technical or clinical issues, the latch issues, for example, it’s usually why we’re called. Again, you know, a check-up, but still includes checking the latch. That is…usually, it’s one session. 


Dr. Fox: Right. 


Melissa: I mean, I will sit there for an hour and a half watching the entire feeding top to bottom. I mean, and that’s undressing them, they pooped in the middle, you know, again my favorite thing. 


Dr. Fox: Right. They, the baby. 


Melissa: What’s that? 


Dr. Fox: They, the baby. 


Melissa: No, the mom. I go and wipe her. Yeah. Your poop is great right now. 


Dr. Fox: You are a labor nurse so that is a possibility. 


Melissa: I’m a little obsessed with poop. Yeah, like… 


Dr. Fox: Yeah, it is a possibility, yeah. 


Melissa: Usually, like, the average session will be about an hour and a half. And usually we’ve gone through everything. I’ve watched the feeding. I’ve corrected what needs to be corrected. I’ve assessed the baby, assessed Mom. Few and far between have I had to go to a second or third time. Maybe once or twice in my entire 17 years have I gone to see somebody 3 times. 


Dr. Fox: That’s great. 


Melissa: Usually it’s the one time, it’s very comprehensive, but then they get to call me. 


Dr. Fox: Yeah. The ongoing feedback. 


Melissa: The ongoing stuff is the stuff. I mean… 


Dr. Fox: Is that typical? Do most lactation consultants do that, or is that atypical? What’s your sense out there? 


Melissa: I think it’s atypical. I’m weird. You know, it’s like… 


Dr. Fox: Right. Listen, you can understand, it’s a totally different way to engage with people. It’s harder. And okay, so… 


Melissa: I know a lot…like, mine, you know, I just charge one flat fee, “This is what you get for, again, the entire time this baby is breastfeeding.” A lot of others, I think, do it by session. I’ve had phone calls of a lot that have called me after they’ve been with somebody else because a friend recommended it after they had not known about it the first time, and are thrilled when they know that they can call me at any point. And so it sort of is…it’s all about the relationship, too, and the trust and the support and so, it’s hard. If they’re having clinical, technical issues, you need to go back. But, usually, once all of that is fixed in that first session, all of the follow-up issues, they sort of come later. “Oh, I’m starting to…I’m feeling this little ball in my breast, and I think it’s a plug.” Like, that’s the stuff that I actually don’t need to go and see you again, I can tell you exactly what to do right now. I try not to clink dishes while I’m doing it. My kids can answer a lot of the questions at this point. They’re like… 


Dr. Fox: My son is always like, “Ask her how far apart the contractions are.” You know? 


Melissa: What’s the duration, the frequency? 


Dr. Fox: Yeah, and he’ll be like, “Oh, there’s no way she’s in labor. I heard that call, yeah.” 


Melissa: She’s just latent. 


Dr. Fox: No, they have that. But I think it’s also reassuring for people that it’s not like going to therapy where you’re like, “I know I’m signing up for twice a week for six years before we even, like, scratch the surface of my problems,” right? 


Melissa: Exactly. 


Dr. Fox: This is like…it’s going to work. And if it never works, then fine, maybe it’s not right for you. But just about everybody, the things that are going wrong will get corrected very quickly. I think that’s encouraging that they’re not signing up again for weekly lactation consultant sessions for the next year. It’s, hey, one, two…I don’t know, it’s something in that range. That’s amazing that all the people who maybe are finding difficulty doing it, and they really want to do it, that this is a way that, you know, one thing and they can do it. It’ll help them. 


Melissa: Yeah, yeah, yeah. 


Dr. Fox: That must be very satisfying for you. 


Melissa: One of the other nurses who’s pregnant on the unit last night…I have, like, my initials on my fleece, and she was like, “You’re a lactation consultant?” I’m like, “Yeah, yeah.” I always think everybody knows that for some reason. She’s like, “Oh, I’m going to have to keep you in mind soon enough.” I’m like, “You’re going to be fine.” But she’s like, “Do you still see private clients even working full time?” I’m like, “Yeah, on my days off, you know, after my morning nap, whatever. My days off, I’ll go and see them.” Because it is such a satisfying part of my life, and it’s such…I don’t want to say it’s a routine part of my life, but it has been the majority. It has been my career up until now. 


Dr. Fox: Part of your identity, in a sense. It’s who you are. 


Melissa: It is, it is. When we were talking much earlier in the very beginning when you were asking me about my background, I actually left out the part…after I had become a lactation consultant, I don’t want to ever say it became a little bit easy, but I’m always one that has to keep my braining working, and part of the reason why I ended up where I am now as an RN on L and D, I actually had gone back to get my Masters in midwifery in 2011, and then life happens, and in the middle of my birth clinicals, I ended up getting divorced. My kids were younger at the time. I had no one there, even though my ex lived a minute away from me, he sleeps through his phone, 2:00 a.m. calls, it just wasn’t working. Like, it was just very, very hard. So, I ended up having to withdraw, sort of, at the bitter end. So, where my path was supposed to be, like, “Oh, I’m crossing over from lactation, I love women’s health so much, I’m going to do midwifery.” And then, boom, that ends. 


Fast forward to my kids being older, they’re basically out of the house. It was actually my ex-husband’s wife who said to me, “I think you should go back. You love the whole labor and delivery. Midwifery would be tough, anyway, just to go back to. If you went back to nursing school, got your BSN, got your RN…” you know, “got our RN license, and went back to labor and delivery, you’ll have regular hours, you’ll have shifts.” I’m like, “This is true.” So, everything sort of wraps up, like, women’s health is the only world that I’ve ever been in, and I’ve been obsessed by it since I was, you know, probably at least six years old. My aunt had all these pregnancy and birth books when she had my cousins, and I used to sneak to the room and just, like, read through these books. I was always fascinated by it. My mom made me, in 1976…the show…I was six years old, it was like an after-school, “My Mom’s Having a Baby,” it was on. I was, like, fascinated with it then. So, everything…like, I should have known way back then that this was sort of where I would end up. 


Dr. Fox: Right. For our younger listeners, by the way, books are those things with pages on them… 


Melissa: You go to a library. 


Dr. Fox: …that are on shelves. 


Melissa: Yeah, they have these little… 


Dr. Fox: Yeah. You can Google it, what a book is, and it’ll show you a picture, and maybe you can even see a video. 


Melissa: Sometimes it’s hard, sometimes it’s soft. You know, you flip through pages and not click on something. 


Dr. Fox: Right. 


Melissa: Everything sort of comes together and sort of makes sense in that world. I love L and D, but I will never, ever give up the lactation because it’s just…it is part of my identity. It’s part of, you know, where my whole entire career began, and it’s not ending any time soon. So… 


Dr. Fox: That’s amazing. 


Melissa: Here I am. 


Dr. Fox: That’s awesome. Wow. Melissa, thank you so much for coming on. 


Melissa: Thank you so much for having me. 


Dr. Fox: That was amazing. 


Melissa: It was so much fun. 


Dr. Fox: This was great. And I think that it’s so helpful. Obviously, so many women are thinking about this either in the past, their own experiences, or in the future what it’s going to be like, or even in the present, they’re pregnant, they just had a baby, and I think just to know that there’s options and there’s help and there’s ways, you know, to help women breastfeed. And like we said, it’s not for everyone, but if it’s something that someone wants to do and is choosing to do it, they share all the available help, and for most women, they’re gonna be able to do it. 


Melissa: Yeah. 


Dr. Fox: I think that that’s fantastic. So, thank you again for coming on. We’re going to have you again. 


Melissa: Oh my god, I would love to come back, because I have diarrhea of the mouth. 


Dr. Fox: There you go, always go back to the poop. 


Melissa: It’s always the poop. 


Dr. Fox: Wonderful. All right. 


Melissa: Thank you again for having me. 


Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 


The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.