“Breastfeeding: The Role of a Lactation Consultant” – with Melissa Kotlen RN, International Board Certified Lactation Consultant

Dr. Fox interviews Melissa Kotlen, a registered nurse and certified lactation consultant. In the first part of this two-part episode, they discuss why Melissa chose to become a lactation consultant, why coaching mothers through breastfeeding is 80% about “the psychology of it,” and more.

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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. All right. I’m here with Melissa Kotlen, who is a registered nurse. Congratulations. 


Melissa: Thank you. 


Dr. Fox: Working on the labor floor at Mount Sinai at nights, but also a lactation consultant for the past 17 years. 


Melissa: I am. It seems like minutes ago. 


Dr. Fox: So thank you for coming on. It’s so great to have you. 


Melissa: So happy to be here. 


Dr. Fox: In our little chit chat, we also just learned that our daughters are actually classmates at Barnard together. 


Melissa: Crazy. 


Dr. Fox: So we’re gonna have to figure that one out. Although it’s I guess now virtual classmates they would only see each other on a Zoom session, I imagine. 


Melissa: But they could still be best friends, you never know. 


Dr. Fox: We have no idea, we’ll find out. We willl find out. 


Melissa: Zoom besties. 


Dr. Fox: We’re gonna talk today mostly about breastfeeding, although who knows where it’ll take us? And just so our listeners understand, tell us your story. Like, you know, where are you from? How’d you get into lactation consulting and to nursing? 


Melissa: I breastfed my first baby back in 1997. I was the first of all my friends to have a baby so I had no one to tell me the ropes other than my mother who would probably breastfed us for three weeks. 


Dr. Fox: Okay. While she was smoking? 


Melissa: No, I think the baby nurse that took care of me apparently there are pictures of her with a cigarette. 


Dr. Fox: Amazing. Amazing we all survived childhood. 


Melissa: And no car seat, nothing in the front seat in her arms coming home. 


Dr. Fox: Right, with no seat belts. 


Melissa: None. And so I breastfed my first baby just sort of blindly. I had taken a class actually at Mount Sinai, but I probably didn’t remember anything. 


Dr. Fox: Did you deliver at Mt Sinai? 


Melissa: I did, I did. 


Dr. Fox: Really, who delivered you? 


Melissa: Becky Brightman delivered two of my… 


Dr. Fox: Serioulsy. Oh, Becky Brightman is a wonderful OB-GYN. 


Melissa: Best ever. I always laugh at the old ladies who sit in there, you know, and I’m like, “Why are old ladies going to this practice?” And then I realized I am that old lady now, like, “I’m not giving up.” 


Dr. Fox: It’s like at the family party, if you’re like, I don’t know who the weird cousin is, it’s you? 


Melissa: I kind of breastfed him blindly for the first year. And then I had another friend who had a baby and then she was always asking me lay questions about breastfeeding. And by the time I had had my second, she said to me, “You know, I feel like I wouldn’t have breastfed for so long if you hadn’t supported me and told me what to do.” And I was probably telling her the wrong information to just, whatever worked for me, I didn’t know anything. She said, “I really feel like you should look into this and maybe go into it.” And I wasn’t working at the time and for fun without Google or anything like that way back then I just started to crawl around and I caught Mount Sinai because I knew they had lactation consultants to see if maybe they had a course I could take or a program, and they did. And I was the only non-RN in the seven-week didactic course that we had to take. And then it took me two years of sending paperwork down to a woman in North Carolina who would sign off on my, you know, experiences. So I did two years of clinical work at Mount Sinai to become a board-certified lactation consultant. 


Dr. Fox: When you say that you were the only non-RN, meaning, everyone else turn-taking it was actually a nurse. Was this because these are nurses who are working like in postpartum or labor and delivery and needed to know this information or they wanted to get extra training or certification? 


Melissa: Yeah, the certification, especially this was in 2000, it was becoming kind of hot. Lactation consultants were sort of, you know, this was like the profession to start to go into, it’s become even hotter now. I think that they were just adding on their certifications to the already existing, you know, RN license NPs. And it was very easy for them to do because they just had to sort of, you know, log particular hours with breastfeeding moms and then take the board exam but I had to see about 500 different things that I had to sign off on paper and do before I could even sit for the exam. 


Dr. Fox: Is the requirements to get certified similar now to what it was then? 


Melissa: I think there are more pathways now depending on your background and so I’m not quite sure actually. 


Dr. Fox: So when you did those you said it was seven weeks of just like of course work? 


Melissa: Of course work. And now they have these comprehensive weekend-long classes that you could do which are great and you can even do them online but back then you showed up. 


Dr. Fox: And then it was two years of clinical experience extensively? 


Melissa: Exactly. 


Dr. Fox: And that’s, you have to shadow another lactation consultant essentially like work with her? 


Melissa: Yeah. So essentially you start out observing for a certain period of time then they go in with you and work with you on certain skills and then they send you in to watch over you while you’re doing it. And then they say, “Okay, go see this patient and then I will check in later just to make sure that everything’s okay.” And then they sort of signed off on you, but it was everything. I had to see babies in the NICU, sometimes it was tough to find certain babies like babies with down syndrome. There aren’t a lot, it was hard to sort of wait around until one was born that was going to attempt to breastfeed, like there was a lot to do and a lot to check off that just wasn’t possible at a certain point. Every Friday I would have a meeting with my one woman in North Carolina and I had to FedEx my little reports down there because there was nothing online. So now I think it’s a lot easier. 


Dr. Fox: Right. And so it’s sort of like, that’s the whatever American or International Board of… 


Melissa: So I’m an IBCLC, so I’m an International Board Certified Lactation Consultant. 


Dr. Fox: IBCLC. Okay. 


Melissa: And that was through the International Board of Lactation Consultant Examiners that I had to, it was crazy job. 


Dr. Fox: And when you were doing it in 2000, and you said it was the hot thing, was this board certification something that was new or had it existed for a long time but maybe fewer people did it? 


Melissa: So I think that the designation started in the ’80s but breastfeeding, you know, that was when breastfeeding just sort of we were learning more and more about all the benefits. And again, even though, you know, maybe our mothers did it way back, you know, in 1970, there’s just so much more research on all of these benefits and that didn’t exist in the ’80s, like, well, yeah, we know it’s good for you but not what we know now. And so I think as the years have gone on, we’ve learned so much more, every day we learn more and more. 


Dr. Fox: Is most of the training or that didactics, is it physiology and anatomy and benefits or is it more like these are the tricks of the trade? 


Melissa: Everything. 


Dr. Fox: Both? 


Melissa: So it started off with the physiology of the breast that was like an entire day of just the boob and then really went into sort of the production of milk and then went into latching techniques. And we went into, you know, the troubleshooting of all the different issues that can come up, rash and mastitis and engorgement and all of these very common issues that moms run into if they always feel like they’re alone and they’re the only one that went through it, so this is where we step in. But it was also learning about just a little bit of, you know, compassion earlier, just compassion, understanding that moms think they come into labor and delivery. And having the background in both is interesting for me because they come in and they think that, “Oh my God, the labor, or even a C-section, this is the hardest part of this entire thing.” And then we’re like, “You know what? That’s nothing.” We realized like… 


Dr. Fox: Traversing this kid? 


Melissa: Exactly. Now I have to sustain this baby, you know, if I’m choosing to breastfeed again, no pressure, but if I’m choosing to breastfeed right, then now I actually have to sustain her, you know, or him through just this, this is ongoing. Like the labor, the delivery, the recovery that’s sort of over, that’s nothing, it’s piece of cake. 


Dr. Fox: Right. I got to get this kid into college. 


Melissa: Exactly, exactly. 


Dr. Fox: No, it’s I think that, and I say that a lot with, you know, when I’m talking to women, to my patients and they’ll say, “Oh, you know, when we get to the deliver because frequently if I’m taking care of them, they’re having difficult pregnancies not because I’m a bad doctor but, you know, all right, all right, I hope everyone understands what I meant by that. But finally the finish line, when I deliver, I’d be like it’s actually the starting line, you know, we’ll get you to the starting line, but then, you know, you’ll have to raise this kid. And so one of the things that you said, and I think that it actually ties to what you said before about when you helped your friend. And that you said that you didn’t really know anything other than your own experience but just sort of being supportive, and I was curious how much of lactation consulting is technical, meaning, “Oh, you’re doing this wrong, do this better, you can do it differently, here’s how I’m gonna help you,” versus just, “I’m here to support you, this is hard, I’m gonna make it easier, it’s okay,” like that type of difference, I guess maybe between like coaching and teaching, like how much of it is each of those? 


Melissa: Oh, my God, I would say it’s 80/20. 


Dr. Fox: 80/20 with the support? 


Melissa: The psychology of it. 


Dr. Fox: Which is why you’re so helpful with your friend even though you claim you didn’t know anything? 


Melissa: I didn’t feel like I did anything, I feel like I walk out of so many of my private consultations with moms who in, they say they’re in dire straits when they call me, they’re telling me they have all of these issues. And let’s say, it’s a latch issue, “Baby is not latching, baby is not latching, I’m about to hang this up. ” Okay, fine. I make my visit. I sometimes don’t do anything other than just reposition her hand. Baby latches has a beautiful feeding, “Wait, she’s never done this before.” I’m like, “I didn’t do anything.” Like we sat and talked for a little while beforehand, calm her down. A lot of it is just knowing that my body is physically better and knowing what I do is what I do and that they have the support, the ongoing support. I always offer, you know, part of what I give to them because mainly what I am doing is just doing private consults because in the hospital I’m sort of latching them quickly and that’s the end. I always say to them, “You have me for unlimited phone calls, texts, FaceTime, whatever it is for the duration of this baby’s breastfeeding experience,” because it doesn’t just end when I walk out the door, it’s too hard. So for them to know that they can just call me or text me or email me or FaceTime me at any point and know that I’m there for them, it helps them to succeed because you’re just not giving up. Part of what people always say, oh, sort of, you know, “What sets you apart?” I’m like from the very beginning, from 17 years ago when I started this, I was like I’m a lactation consultant but I wanted to be like the friend that just happens to know a lot about breastfeeding that they can call. And while I keep forgetting that I’m getting older, I keep thinking I’m still in my 30s. I’m like, “Oh my God, we’re peers.” You know, I’m no, I’m like their mother now. But it’s the psychological part of it, the support is huge. Sure. I mean, they really do have issues but the latch issues which are the majority of when I get those phone calls are usually just something so small that we can tweak. But even when they’ve gone through milk supply issues and an awful bout of mastitis or thrush, any of these issues, we fix them. And then just knowing, “Okay, this is normal, this is how many moms go through this.” When they hear me say, “I get this phone call every single day,” it takes them down a level. They’re like, okay, “Wait a minute, I’m not alone here.” 


And I always tell them they cannot Google anything because, oh, my God, it makes me crazy, they’re gonna hear a million different stories. And also I tell them not to call their friends about things too because it’s always gonna be, you know, the frustration of different levels of advice really starts to play with their heads a little bit. And even in the hospital that the frustration of, “;h, but the nurse told me to do this but then the pediatrician told me to do this, my OB told me to do this, then I saw a lactation consultant, but she said that,” you know, it makes their heads swim, they’ve got so much to sort of unpack. They just had a baby, whether it’s their first or their 10th, there’s still so much for them to sort of wrap their heads around. And when you get different types of advice from so many different people it’s just so overwhelming. 


Dr. Fox: There is so much you just said there that’s awesome and we got to unpack all of that. But before we do that, just so everyone understands because what you’re saying is at the hospital just latch and they go it’s because you are first a lactation consultant and doing your private practice of lactation consulting and home visits every year talking about, and then you went to get your degree in nursing and in RN… 


Melissa: Yes. We forgot to… 


Dr. Fox: All right. And now you work at Mount Sinai as a labor and delivery nurse. And so the reason you’re not doing all of the breastfeeding, you know, teaching, helping us because after the delivery, you helped them initially but then they go to a different floor during the postpartum floors and you’re not a part of that… 


Melissa: Exactly. 


Dr. Fox: At the hospital, there are other people who do that. 


Melissa: Exactly. 


Dr. Fox: It’s almost like coincidentally, you do lactation consulting and so you’re very helpful right after birth but that’s not? Okay. So just explain how that process works? 


Melissa: And especially I had to wrap my head around that because I’m like, okay step out of this role because there’s so much to do after the delivery, and I have to get them upstairs. A lot of times, you know, when I say, “Are you breastfeeding the baby? Okay, let’s latch the baby on.” I love doing it, but I can’t sit there and actually go through an entire consult. And I start sometimes finding myself starting to chat a little bit like, “Okay so let me give my little rundown of how big the baby’s stomach is right now and how much milk it actually needs to feed. And yes, you have colostrum.” And then I’m like, “Oh, I don’t actually have time for this, so let’s latch the baby quickly, let’s position the baby, boom.” I miss that part and I wish that they could hang with me a little bit longer on an L&D. But I also trust that upstairs, you know, on postpartum that if they’re having any issues they will see one of the lactation consultants there who can kind of go through it and have a little bit more time with them but, you know, it’s a little bit of a bummer. I have nurses call me and sometimes when they have a mom who’s, you know, desperate to breastfeed babies having a little bit of latch, I could run in for two seconds, you know, latch them on. And like, “I’m so sorry, I have to go back to my patients,” and, you know? So that’s the only sort of a little bit of a bummer there. 


Dr. Fox: But you’re still doing the consulting lactation? 


Melissa: Yeah. 


Dr. Fox: And one of the things you said which was it just struck me because I say the exact same thing when I’m talking to patients in ultrasound, which is the line, I have this conversation every day. When I’m trying to, you know, talk about things and let people know that there’s something I’m looking at and I’m talking about but it’s common and I’m not trying to freak them out and worry them, I always say, “Just so you know, I have this conversation every day, this is a third time I’ve had it since lunch.” So it’d be like, “Oh, okay, like I get it.” And then I always say the same thing. I used to tell people, “Don’t go on Google,” but I found that it’s not successful because everyone is on Google. 


Melissa: Then they do. 


Dr. Fox: So what I tell them as I pre-Google them, I say, okay…” 


Melissa: You can look at this site. 


Dr. Fox: … I say, “When you go on Google, you might find A, B, and C and this is why it’s not what I’m talking about. And if you get there, hit that back button, back button, back button, back button, and then go the other direction and there is where you need to go.” But the same thing, I’ll say like “Your friends are gonna tell you something different, everyone has a different experience, they may have a similar diagnosis, but it’s not the same.” It’s literally the same strategies because like you said, people ,their heads are spinning because the information is so vast and it’s so wide, there’s just so many options if we don’t tell them exactly what’s going on and so for you, you’re saying, no, this is normal when everyone has this, like don’t take this to a dark place. 


Melissa: Exactly. And you physically see their shoulders sort of drop when you say, “This is what I see every day.” Like there’s a physical, like, “Oh, okay, I’m not so alone in this even though I have mastitis and I feel horrible right now, I’m going to feel better.” You promise, “You’re going to feel fine. Thrush, it takes a little bit longer to get rid of but you’re going to be okay,” and they sort of relax. And so I think it goes back to the point of just having someone say to you,”This is normal, you have my support all the time.” Lactation consultants, we’ve seen it in movies, we’ve seen it on TV. Like sometimes they have really nasty reputation of being like the nipple Nazis and all that. And it’s upsetting because we’re not all like that. To have somebody who you sort of feel like I can call at any time just to bring me down a level, just to say, you know, of course, I work nights, so it’s great because they can text me at three in the morning and I’m like, “Yeah, I’m up.” If I’m on break then I can call you, just to know that they have that. And, you know, of course, I wish the media would take the awfulness away. 


Dr. Fox: It’s hard because some people focus too much, and, I mean, with the lactation consultants, the ones who you’re describing who maybe have given your field a reputation it doesn’t deserve, I think it’s just people who are very focused on the task like our goal is to get you to feed, you need to do A,B, C and D and we’re gonna be very regimented. Whereas what you’re describing is a much more like you’re taking two steps back and you’re looking at the overall, you know, wellness, the overall like mother-baby bonds, the overall, how is she doing situation? And so breastfeeding is obviously a big part of that and that’s the expertise that you’re bringing to the table, but it’s not just that, right? It’s the whole person and the whole unit of the mother and baby that you have to look at and what does she need at that time. And it’s not necessarily specific instructions it might be but it’s not necessarily that. 


Melissa: Exactly. And also what you just said when you’re looking at the whole entire picture, I don’t have a script and I think the problem is there are many who sort of have their like laundry list of things that they are going to do and clinically that’s what they’re supposed to be doing. But everyone there’s no textbook answer for this mom to this mom, to this mom, and I never go in saying these are my expectations for you because this is what the AAP says or like I ask them always what their goals are. Sometimes the goal is to get out of the hospital and having breastfed three times. Sometimes I have these moms who say, “Oh, I want to breastfeed through my next pregnancy so I don’t know when this is going to end.” And I always sort of go back to the movie but nobody ever remembers this, “What about Bob” with baby steps? Let’s take it in baby steps. So let’s get you out of the hospital first, let’s get you home, then let’s get to two weeks when we have that first growth spurt. So when it’s broken up according, again, to whatever their goals are, we always talk about that first, you know, what are your goals? What do you expect from this entire experience? And then I sort of formulate the plan from there. So you can’t just go into it like, “Well, the AAP says that let’s breastfeed for six months exclusively and then up to a year or, you know, mutually agreeable.” That’s what they say. But this mom, I’d also rather have a mom who’s happy doing this than being stressed out because she supposed to be, and then have her, you know, on antidepressants because she’s feeling the stress of that. 


So you have to look at the whole picture and you have to just sort of make these goals, tailor your plan to what the mom wants. And then the way that I end every conversation with all of my moms is, “This is fine for now. We can always tweak it. So call me if this isn’t working, we tweak again and we tweak again.” And I get these phone calls, some moms I hear from them every day for months, some of them like I have my consult with them and then three weeks later they call me for a small question and then I hear it from them, you know, again in a year and they’re ready to wean or over that. So it really depends. And when we were talking just about sort of that reputation and the, you know, this is what you have to do, I think there’s a show, I think it’s on “ABC,” “A Million Little Things,” one of these friendship, you know, 40s friendship kind of shows, like “This Is Us” or something, and the season opener, I think of the second season was that one of the women has a baby and there’s an entire full-on scene with a lactation consultant and she’s yelling at the pregnant… I was mortified and I was like I can’t believe this is what they’re making us look like. And I posted something, I think on Facebook about how disappointed I was like I might’ve tagged “A Million Little Things” if I even did it right. And there were a few clients of mine who were friends of mine on Facebook who said, “This actually is accurate, like I know this…” 


Dr. Fox: This happens. 


Melissa: “…this happens and this is why we called you,” you know? I’m like, “Oh,” like I’m trying not to have my head in the clouds about it but it was an awful scene, everybody should Google that scene, it will come right of it. 


Dr. Fox: You’re talking to a gynecologist. We sometimes get things said about it. 


Melissa: The wording. Thta’s true. You do it worse than I did. 


Dr. Fox: On TV, we’re represented differently from how life is. It’s what we’re talking about also points to a bigger, I don’t say issue, but sort of a bigger topic, which is in general after birth for a while, mental health of the mother is so critical and it’s also tenuous. There’s so much going on at that time and it’s people really don’t appreciate that. And by people, I don’t mean like, oh, people don’t have babies or their husbands or their friends. I mean, the women are about to get into this, right? They’re pregnant. And they don’t realize, you know, what’s gonna happen after birth. And I think that picture-perfect story you see on Facebook and Instagram of, you know, “Had a baby two weeks ago and I’m perfect and everything’s great and my baby is beautiful and I look wonderful and then I lost all my weight and I’m gonna…” Right. And it happens for some people, and God bless, that’s awesome but that is really, that’s the exception. And it’s very hard because, you know, you’re physically recovering from delivery which is not a piece of cake, like that is hard to do and you’re not sleeping well, and now you have all the stress over, whether you’re feeding or not, and it’s not going well, and your hormones are up and down or, you know… 


Melissa: You haven’t showered. 


Dr. Fox: Right. People aren’t happy about, obviously, they gain weight in pregnancy and people want to lose it and it’s just a very difficult time for people, and it’s incumbent about all of us to help them, you know, get through this whether it’s our friends, whether it’s our family, whether it’s our patients, whether it’s people who you’re coming to see, it’s about the whole person and the whole unit and the whole family. It’s just so critical and you can’t divide it up into little pieces. And when people do it ends up usually causing worse problems than it fixes. I think it’s exactly what happens with them just with the main lactation consultants. We actually had a bad experience when we had our twins. 


Melissa: Oh, see. Maybe you called into the producers at “A Million Little Things.” 


Dr. Fox: You know, so my wife is trying to, considering or hoping to breastfeed the twins which is very difficult obviously, and just the people who were assigned to help us at the hospital were quite mean to her, to me. They literally accused me of shaken-baby syndrome because I was like rocking the baby, and I was like, I was a med student until I was like, I actually told them to get out of the room. I said, “You’re out, goodbye.” And it was crazy. You know, but then you see all the people now, they’re wonderful, they’re unbelievable, they’re so helpful, they’re so lovely. And I think, you know, occasionally like anything there’s doctors who are terrible also, I mean, there’s a lot of people in a lot of fields that are awful and not kind, but that’s not the goal and that’s not who they mostly are, and I think that, you know, what you’re describing is really what people are looking for. 


Melissa: And you’d have to find your fit. There are some women who love that sort of hardcore, “Give it to me,” not give it to me straight, but “Just tell me what to do. I don’t need the coddling. Tell me what to do,” and that’s fine for them. But the majority are not like that. The majority want, they want their non-stop support and it’s what’s gonna make them successful. Yeah. 


Dr. Fox: That’s great. When you are working with the mom or a mom-to-be as the lactation consultants when do you start? Is it during pregnancy? Is it always after birth? Is it depends on the situation? What’s typical, number one, and number two, what’s ideal if they’re not the same? 


Melissa: Ideally, I love it when moms call me and they just, you know, took a pregnancy test, “I just wanted to see how you work.” “I’m like, “Call me in about seven months.” But ideally, about eight weeks before their due date, I always recommend taking a prenatal breastfeeding class. And while it might seem weird to not have the baby there and not be, and you’re working sometimes with a doll and a fake breasts, you know, just practicing positioning and all that, just knowing everything from A to Z going into it helps them to become much more successful. 


Dr. Fox: And you don’t have to learn it when you just had a baby? 


Melissa: Exactly. 


Dr. Fox: You don’t feel lost. 


Melissa: Exactly. That whole element is taken out. So if they have the knowledge and it’s the correct knowledge, I used to teach prenatal breastfeeding classes at the 92nd Street Y, and the classes were always packed. I had couples there, I had singles, it didn’t matter. Some came alone, some came with partner, but half the time the partner would be the one that would retain most of the information. 


Dr. Fox: Right. They’re taking notes, they’re like yeah. 


Melissa: And be able to be like, “Remember she said this?” They’re taking their notes. Then at least you can go into it knowing, for example, what the expectations are. And I talked about everything from the entire labor and delivery experience all the way through postpartum and weaning, but at least they have a sense going into it of what to expect. If they don’t get around to doing that, then obviously calling as soon as they can afterwards. 


Dr. Fox: Are there options for that, to get that information without having a personal lactation consultant? Are there good books? Are there good websites? Are there good seminars? YouTube? Like what can people do if they don’t have the time or the wherewithal or the money or whatever? What resources are available, again, while they’re pregnant just to read about it or learn about it? 


Melissa: Sure. I mean, one of sort of the go-to websites that I love is kellymom.com. 


Dr. Fox: Kelly with a K? 


Melissa: Yes. 


Dr. Fox: Okay. 


Melissa: And Kelly Bonyata is an IBCLC as well. And she’s sort of the go-to even for LCs to be like, “Is there a new updated information to sort of…?” She has a very comprehensive website? 


Dr. Fox: Okay. kellymom.com? 


Melissa: kellymom.com. K-E-L-L-Y-M-O-M.COM. 


Dr. Fox: Okay. 


Melissa: kellymom.com. I have a series of, you know, about 50 videos on every single aspect on howcast.com, they’re two-minute-long videos that talk about every single topic. 


Dr. Fox: If people can just liike google on YouTube will find you under your name? 


Melissa: Exactly. 


Dr. Fox: Okay. 


Melissa: And again I’m so not techie that I don’t have them all in one place, so they’re there. If people are physically picking up books these days, I mean, there are so many breastfeeding books out there. 


Dr. Fox: You’ve seen them during pregnancy, or you spoken to them during pregnancy, and now they’ve had the baby. So then when are you being involved with them as a lactation consultant not as a labor nurse? 


Melissa: If I’m not seeing them within like 30 seconds that I can latch the baby on. If they’ve been organized enough and have gotten in touch beforehand and prepared then they’ll call me usually right after they deliver saying, “Okay, I’m going home on such and such day.” It used to be, they’ve called me to come into the hospital, now, you know, visitors camp it’s so tricky. 


Dr. Fox: We’re gonna take COVID out of the equation for now. 


Melissa: Taking COVID out, sometimes if they can’t see somebody in the hospital, maybe sometimes there’s non-LC on they’ll call me, like, usually it’s within the first couple of days after they come home. 


Dr. Fox: Do you find that it happens frequently that the nurses or the lactation consultants at hospitals like messing up for you where you’re like, “Oh, they touch you all wrong,” or do people do it similarly you find that it’s helpful? 


Melissa: The problem is that they’re too rushed. So they have a laundry list of people that they have to see, they sort of organize it according to who’s being discharged first and sort of get them out, but they’re not spending an hour and a half with them. They’re checking to see if everything is okay and they can chart that everything’s okay but there’s not a lot of time spent. It’s not really the LCs that are messing things up, sometimes if they can’t see an LC and it’s the nurse who actually hasn’t had any formal training that is when I have to sort of undo things. And it’s actually funny because one of my sort of projects right now being new on labor and delivery in a nurse residency program, we had to create a project, and the project is actually educating, there are four of us that are working on it, actually educating nurses on labor and delivery to be able to sort of disseminate the proper information and to be able to work with them on the latch and all of that kind of stuff so that they go upstairs to postpartum already in a good place. Because, with so many different stories, I mean, you might get a nurse that is older, there have been some I’ve walked in on and I’m like, “Oh no, don’t tell them to do this, like with the latch,” and I kind of wait, and then I kind of fix it. But there are nurses that have come from completely different backgrounds where maybe this is what they learned but it’s kind of not the right way and it is gonna make a little bit of a mess for me upon their return home. So this is when I get those phone calls saying, “Well, I did with the nurse told me to do but right now my nipple’s angling this way,” or, you know, whatever the issues are. I have to fix a little bit. 


Dr. Fox: In that when you said it’s like 80/20, you know. In the 20% where you were talking like technical things, what are the common things just so women get a flavor of what types of things might be difficult for them or things they’re doing it and technique helps. So what kinds of things do you address with them or, you know, help them work with? 


Melissa: So the majority of the time like the technical stuff is usually the actual latch, and then half the time it’s really how they’re just holding the baby and positioning. Half the time, you know, we want the baby up at the breast so that they’re not sort of hunching over them, we want mom sitting up straight, comfortable pillow on her lap, a boppy in my breast nipple whatever it is, the baby is right there so they can’t fall anywhere. I want her hand properly positioned, if she’s in a cross-cradle, I want her coming around and holding her breast and ain U to make a little sandwich. If she’s in a football hold, I want the breast in a C. They’re like these tiny little tweaks to things they’re so small yet they make the biggest difference. And so the latch, the positioning, those are all such small things that take 10 minutes for me to teach somebody, but even other nurses, just to be able to teach their patients then we avoid sore nipples, we avoid so many different issues. So technically those are the things that we can work on. I mean, milk supply-wise, if we have a mom who’s baby is in the NICU and she can’t directly breastfeed the baby, let’s talk about proper pumping technique, let’s talk about, do not turn that suction up suction highest speed because your body knows it’s not the baby and that it’s gonna shut down and sort of diminish your milk supply. There are all like, these small things, but this is, again, goes back to why I love the prenatal breastfeeding class because then we can teach them all that beforehand. Things come up. If the mom had the yeast infection during vaginal delivery, yeah, we might end up with a baby with thrush and, you know, but we’ll see this week’s down the road. If a mom has unrelieved engorgement, it might turn into a mastitis, but we can avoid that. If a mom is having recurrent plugged ducts, there are things that we can do to sort of avoid that. So it really is just 20%. If we can teach them everything to start with, we can kind of avoid that. But things do come up. 


Dr. Fox: And how often do you have to interact with maybe her doctor? Like you say, okay, there’s an infection and you obviously, you’re not prescribing. So do you speak to her doctor directly or tell your doctor, I said A, B and C? How does that normally work? 


Melissa: Really, it depends but a lot of the times, a lot of my referrals to a lot of patients they’ll come from, for example, OBs or pediatricians that I already know. They trust me and so a lot of the times they’ll say, “Oh, so if you want, I can call so and so.” But a lot of times they’ll say, “No, no, I’ll just call, so what is it that exactly what I’m asking for?” I’ll tell them exactly what we’re asking for. And I can’t remember the last time I got a phone call from an OB saying, “Wait, what are you doing? Like, what is that?” They know me, they trust me, they know… Exactly. 


Dr. Fox: That’s the thing. We’re very thankful. No, because I think it’s, you know, we’re not there with them and so it’s, number one, you obviously have more experience in this than I would. The only time I could even think that maybe it’d be an issue is if does she have an infection? Does she not have an infection? Which is hard sometimes to know, okay, fine, whatever. But any two people could disagree with that because I get called sometimes either directly by a lactation consultant or, you know, through the patient or whatever and I’ll be like, “Okay, great.” And I’ll say like, “Do you have those symptoms?” “Yes.” “All right. Let’s do it.” That is interesting and I guess that makes sense that you get a lot of referrals from OBs and pediatrician. And of course, you, as you are the lactation consultant to the stars, it’s not a HIPAA violation because I was told that, you know, from Milcah that you were hers. 


Melissa: I was. 


Dr. Fox: She’s also, you know, doingn a podcast on breastfeeding, and that’s how we got connected. And I was like, “Oh, you two have to talk.” 


Melissa: It’s so funny. I know, and I’m always very quiet. Like, if she said it and she brought it up, then great. 


Dr. Fox: Yeah, I know her because… 


Melissa: I’m usually, people are like, “How do you know her?” I’m like, “Oh, we’ve been friends for years.” 


Dr. Fox: There is definitely lactation consultant confidentiality that exists. 


Melissa: She is the biggest star. I mean, you know, I love that. 


Dr. Fox: Milcah, Milcah, she is absolutely. When do you stop working with them? You said, you’re always told her until they wean. 


Melissa: Until they don’t need me anymore. So there are some that ride right into the next pregnancy, sometimes I’ve seen somebody once and then they don’t need it again. But for the most part, I develop true relationships with all of my client ,and I remember everybody it’s been 17 years, you know, sometimes I’m shocked that I forget that they’re, wait, how is this kid 16 now? They’re still stuck in my mind as a newborn. I’m sure, they’d say the same thing for you is, “What do you mean? Didn’t I just deliver you?” 


Dr. Fox: I’ll be like wait, is that the fourth birthday of your life? No, he’s 17. 


Melissa: It’s so crazy. 


Dr. Fox: It seems like just recently how mature? 


Melissa: It does, they get stuck in your head I’ll typically as often as they need me until they’ve weaned, they’ll call and then they’ll start up again with the next baby. 


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 H-E-A-L-T-H-F-U-L-W-O-M-A-N.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. 


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