Interview by Editor, Callan
In part two of our series with Beth Iovenelli, an RN & lactation consultant, we dive into postpartum mental health practices & tools, breastfeeding in public, and what you can expect when going back to work.
Beth Iovenelli is a Registered Nurse and Board-Certified Lactation Consultant with nearly 27 years of experience in the field of maternal child health. She has worked as a labor and delivery nurse, postpartum nurse and patient educator in the hospital setting and as the coordinator of newborn services and lactation in a pediatric office. Beth has taught thousands of parents and provided staff training and development for nurses, doctors and nutritionists.
Q: When I was breastfeeding my daughter in the newborn stages, she started cluster feeding like every half hour. Is that normal?
A: Cluster feeding can happen if babies are going through growth spurts. It's a normal thing that at certain times of the day, your baby may be a little bit hungrier and want to eat more frequently. The increased latching shouldn't be painful. Increased feeding for growth spurts or for cluster feeds shouldn't increase your pain. Sometimes it's just as simple as correcting the latch and encouraging a wider mouth. Sometimes there's something going on with the baby's mouth. Is there an undiagnosed tongue tied? Does she have a tight jaw maybe from the delivery or are the muscles around her mouth extra tight that she's really clamping down?
Q: Someone mentioned that they had a baby who had a bad latch, and it was recommended to them that they do baby massage before to sort of relax them?
A: Sometimes people will do that before bed or if you have a baby that seems like they need it. But if I feel that there's some real tightness - there can be neck tightness, jaw tightness, and usually they're all kind of related - oftentimes I will make a referral to an OT or a PT or someone that does something called CST, which is cranial psychotherapy. There's so many different people or professionals that can evaluate even more what's happening with the mouth, sometimes it's just that everything is tight. Maybe the baby had a really long, tough delivery and the baby's head was scrunched down, and they just are very tight, and they just need some loosening up.
Some of it can be easy mommy home stuff that you're doing, like gentle range of motion back and forth. But it just depends on what the baby's particular issue is. I will say that as a lactation consultant, I think in the last probably five years or so, there's been a bigger focus and a lot more awareness that that some babies really do need that support after delivery. If it's been a rough delivery positionally, then they might come out with a tight jaw. And many times, that could be the reason moms have a painful latch. It has nothing to do with the mom.
Q: How do you recommend that moms take care of their own mental well-being while breastfeeding?
A: I would say the first month is really challenging for moms. I've observed over the years that for the first couple of weeks, you're kind of running on adrenaline because there's all this excitement with having a new baby and everything is new, even though you're tired and sore. But around week three, I feel like moms really hit the wall because the fatigue is starting to pile on. So, I think it's very important to find connections and support for the nuts and bolts of latching. Find someone that you can talk to about how you're feeling.
Moms that have a history of anxiety or depression - you have to be even more vigilant that you're getting the care and support that you need. If you've seen a therapist prior, it's important to check in with them. If you've been on medication, it's important to check in on dosing and it's important to prioritize rest because sometimes it's just getting a longer stretch of sleep. And that's when doing a little pumping and having some milk available in the bottles so that you can sleep a little bit longer can be very helpful. I've seen some moms very tearful and overwhelmed, and we'll strategize ways for her to increase sleep. If there are worsening symptoms, it's really important for mom to check in and to have her partner help her, because if a mom is really in the thick of it, whether it's feeling anxious or depressive, sometimes it's hard to advocate for yourself. I think it's community, it’s rest, and it's professional mental health support when those other things aren't working.
Q: Do you screen your clients for postpartum depression? What are the warning signs that you look out for?
A: It’s an ongoing screening process that we're doing as we talk to moms. We're looking at things like the mom's appearance - I mean, obviously, all new moms look exhausted - but there's a difference between a tired postpartum mom and a mom that just looks you know…we look at eye contact, we look at mood, we look at how she interacts with the baby. How is she? Is she crying all the time? Tears are certainly a part of the new mommy landscape, but is it happening all the time? Is she canceling appointments? We don't just let a mom cancel an appointment with no kind of communication. And one of the first things we talk about when we're going over medical history is does she have any history of mood issues, anxiety or history of depression? Even if it was when you were in high school and now you're 32 years old, if you've had anxiety or depression in your history, things can crop up with hormonal changes, life changes, or lack of sleep. So, we always want to be aware of it.
There are formal screening tools. One is called the Edinburgh screening tool that moms fill out. There’s a rating system where if you hit a certain number, you're at a higher risk. And we would insist that you connect with someone. A lot of what we do is an ongoing visual, virtual, conversational, and observational assessment of what's happening. And I think it's important to have someone who says, how are you feeling mood wise, like what's going on? Because I think a lot of people are afraid to open that can of worms. I can sense that you're feeling a little bit anxious or you seem a little sad today. Can you talk to me a little bit about what's happening? And then sometimes just that little, tiny opening makes a mom share. Just having that conversation can make things seem less overwhelming, less big, and less crushing.
Q: Breastfeeding in public. Any tips on becoming comfortable with this? Because it's awkward at first.
A: The US culturally is so different than other parts of the world. I've facilitated new mom groups where there's women from Europe, South America, Asia…places where it's no big deal. And I literally had some mom from Europe say in a group, what is the deal with you people? I don't understand. Why is it such a big deal? Sometimes if I see a mom nursing in public, I want to go up and say: “Good job!” Go to a new mom's group where there's other moms in the room and you can get comfortable with sitting down and getting yourself situated. Sometimes if you're having somebody over to the house that you're comfortable with, you don't have to run to your bedroom. I think wearing the right kind of clothing is super helpful, so it’s not a big production. I think most moms say once they do it a few times, they become less afraid to do it and less wary of it. But there is a lot of emotion related to that. Unfortunately, there are stories of women having issues with it where people might make comments. But I encourage women to completely ignore it because feeding your baby is important, and if they're hungry, they're hungry and they need to eat. It’s nobody else's business how you feed your baby.
Q: I think a lot of moms get stuck in their own heads about breastfeeding publicly, because it isn’t as common to see. My mom did not breastfeed, so she was pretty uncomfortable at first with me breastfeeding because it was foreign to her. And I realized I had never really seen anybody breastfeed.
A: That’s the thing too, is that there was this sociological study that was done a long time ago where they had children from different countries and they had baby dolls, baby bottles, and toys and they basically said: your baby's hungry, you need to feed your baby. There were children that were four or five years old that were in the experiment from other parts of the world, and they would pick up their baby doll and put it to their breast like they were breastfeeding it. Children from the United States would pick up a bottle.
In the United States, babies cry, and they get a bottle in public because women are afraid because of it. But like you said, your mom didn't breastfeed, so she felt uncomfortable, which made you feel uncomfortable. It’s being willing to kind of just be brave and say, look, I'm feeding my baby. It’s none of your business.
Q: How should you prepare for the transition back to work? I didn't know when to start pumping. Should I be building a freezer stash? How do I even know what supplies I need?
A: It depends on where you work. Do you work in an office? Do you work as a nurse, a teacher, a physician, or do you work in finance? I think it's important to talk to other moms if you're in the office setting who kind of paved the road before you. I think that can save you a lot of reinventing the wheel. The other thing that I think is important is talking to HR about your intention to be pumping and looking at how that might impact your day.
Do you have the kind of job where there's appointments that you need to book and you need time blocked out? Is someone else scheduling your appointments or meetings and how can you work with them? I think it's helpful to speak to HR and/or another woman that's done this as well. It is federal law that they have to allow you the time to pump milk for your baby, so they can't tell you no, they can't tell you to go pump in a bathroom - they have to try to help you make some sort of accommodation. For smaller companies, that could be more challenging, but many larger companies will even have lactation rooms that moms can use. It’s about sorting out those challenges ahead of time.
As far as what stuff you need, I tell moms, if you're bringing the electric pump back and forth, keep something like a little non-electric pump in your desk. That's a good backup to have available for you. I think right now, unfortunately, I call it the Instagram phenomenon because a lot of accounts that are promoting breastfeeding and all these other things will show a deep freezer full of milk. And moms think that's what they need in order to be successful at breastfeeding. Really, you only have to have enough milk available for maybe one or two days, because if you think about it, you're going to still be breastfeeding in the morning. You're going to be breastfeeding when you come home, in the evening, at night, and on the weekends. By the time a mom goes back to work, she needs in the neighborhood of 15 or 16 ounces to leave for the provider. So, if you get two ounces each day for two weeks, you would have 28 ounces of milk. And so that's almost 30 ounces and that's about two day's worth. It’s not as overwhelming as moms make it out to be. Some moms will start a little bit sooner just to have a little extra.
Q: What are your tips for staying consistent and focused on pumping while at work? I feel like that is a big challenge, once you're back at work, things come up and you get busy.
A: I think your breasts are going to remind you that it's time. I don't think you have to be so strict with it. Usually if a mom works a typical eight-hour day, usually she'll nurse the baby early in the morning before she leaves for work, then she gets to work at maybe 8:30, then usually she'll want to pump at 10 or 11 o'clock, because her breasts at that point are asking to be paid attention to and then one other time in the afternoon. Some moms will do like an early lunch break, like at 11. You might take your lunch early and pump and have your lunch at the same time. It just really depends on what your schedule is like. But I don't think you have to pump as often as you think. Usually, two pumps are adequate for moms. Some moms who have their own office can throw in another pump because they can. You may have a day where you're stuck in a meeting an hour and a half longer than you thought, and you're starting to feel really uncomfortable. And those days are unfortunate, but it depends on the work culture. But I think it's also very reasonable to say, excuse me and leave and or just let your manager know, or maybe you're the boss and you can end the meeting!
STAY TUNED FOR PART THREE OF OUR INTERVIEW
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