Interview by Editor, Callan
We talked to Beth Iovenelli, an RN & lactation consultant, about breastfeeding as a new mom, the importance of support, and dietary restrictions & supplements.
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: Can you describe the type of breastfeeding support and services that are available for new moms?
A: There are a lot of services available for new moms. I think it's really important for moms prenatally to find support before the kind of craziness of postpartum existence starts. You could locate a lactation consultant that's affiliated with your pediatric practice. There are many hospital-based lactation consultants. Sometimes a mom has a sister or a neighbor or somebody that's had a really good experience with breastfeeding that she feels can offer good support. But if you can't find someone, ask around. Go on a new moms board, Google it, look at the IBCLC website to locate someone in your area.
Q: Why is having support so important when it comes to breastfeeding?
A: Breastfeeding is something that's a natural experience, but it's not so instinctive for a lot of moms. There are moms who can latch and have relatively few problems. But there are many confounding variables that can sometimes muck things up a little bit for some. Maybe the baby was born prematurely. Maybe the mom had some complications. Maybe there is an anatomical disconnect between the mom and the baby and she's struggling. Perhaps mom has a background that is making it challenging for her to produce enough milk. And sometimes even if things are going well, new moms have questions because they've never done it before. We want to be able to have that support so moms don't feel isolated and they can really get their questions answered. And even though they always say this is a silly question, it's OK to ask because if you're a first time mom, you don't know.
Q: Can you go through why some women choose what they do - whether they breastfeed exclusively, choose to pump or just go straight to bottle, whether that be with pumping or formula?
A: There are so many different choices for the way that you feed and nurture your baby. There isn't one right way. I think many women feel that the only way that they can be successful with breastfeeding is if they do 100% exclusive direct breastfeeding. But I find in all my years of practice that there are many approaches to feeding the baby.
Some women may not be going back to work and their desire is to do mostly direct breastfeeding. It'll be easier for her to do that because she's able to stay home. Some women decide they want to do a combination of direct breastfeeding and bottle feeding…perhaps for another family member to be able to offer some pumped milk to the baby to allow the mom to get some extra rest. There are some women that right out of the gate, immediately decide they don't want to latch but they still want to provide breast milk to the baby. And it can be for personal reasons. It can be that she just may feel uncomfortable with it. There may be some history that she doesn't want to share with us. It just may feel icky to her, you know, and that's OK. But she still has the goal of wanting to provide breast milk to the baby.
There's a whole movement of women called EPers (exclusive pumpers). It does create some unique challenges because it's a little bit more work to have to pump and then bottle feed. But if that's the option that suits you the best, then that certainly is a very reasonable way to go. The other option is bottle feeding with formula. Many moms will make that choice for various personal reasons. They may have had a very difficult time with a previous child and they just don't want to go back there again. Sometimes it can be helpful to talk to a lactation consultant to help kind of unwind what may have happened, to see if we could perhaps change her story the second time. In my role as a lactation consultant, I never try to talk a mom into doing anything, but I try to just give her the tools and the education to help her make a good, informed decision.
Q: Are there any dietary restrictions or changes to your diet that you should think about while you're breastfeeding?
A: I remember a story where I was working as a nurse in the hospital and I walked in and a mom was almost in tears thinking that she could only eat rice and broiled chicken because she had so many family members tell her that she couldn't eat salad, she couldn't eat fruit, she couldn't eat all these vegetables because they would give baby gas. And I think if the dietary choices were that limited, I think women would not want to breastfeed at all. You want to be able to, A) eat foods that you enjoy, B) eat foods that are nutritionally dense, that can help your body heal, that can give you energy, and that can help you make milk.
We usually tell moms that there aren't really any foods that are off limits. The things to keep in mind to limit would be things like caffeine, which you can still have, but just in limited quantities. Certainly alcohol can be done judiciously, you know, just with a little bit of timing. But as far as foods in general, unless there is something that the baby is having some sort of reaction to, then that can be explored with someone who is very well versed in understanding how nutrition may affect a baby's gut.
Q: Can you talk more about having a glass of wine while breastfeeding? I feel like there is a lot of misinformation out there about how much you can drink.
A: When moms have questions about having a drink, I usually tell them there are three things to consider. There's quantity, timing and safety. When we say one drink, it’s an average size of either a beer, a glass of wine or a mixed drink. You nurse your baby, you have your dinner with your glass of wine, and then you wait a couple of hours. Alcohol doesn't get in the breast milk and stay in the breast milk. It metabolizes its way out of the breast milk just like anything else does. As a new mom you're definitely tired and a little hormonal. So I wouldn't drink a glass of wine and then go pick up the baby and try to walk upstairs or go lay down with the baby because women are unsure of how the alcohol will affect them. Wait two to three hours after one drink and it should be fine. If you feel the effects of alcohol, if you feel drunk or buzzed, you certainly shouldn't be breastfeeding.
Q: Are there any superfoods or supplements to support breastfeeding?
A: There's a lot of information that is passed around, whether anecdotally or culturally, about different herbs and foods. There certainly is a huge business now with supplements that moms take to help boost production. I will say before moms invest in tons of different tinctures and all those things, that the most important thing to make a full or robust milk production is thorough, frequent removal of the milk from the breast. This can either mean the baby's nursing well and efficiently or she's pumping because you can take herbs all day, but if the milk isn't being removed from the breast efficiently and effectively, then your body will not respond the way that you think it will.
Fenugreek is a kind of tried-and-true one that has been used for centuries. Blessed Thistle is another one that has good results for some moms. You know, a lot of moms will have oatmeal for breakfast and certainly oatmeal is high in iron. So if your your iron is low, then that's going to be something that would be a roadblock for making a good milk supply. Aim for foods that make you feel good and give you energy. Talk to someone who's got a good background in it to understand what your reason is for taking something in the first place.
Q: Is there anything that might negatively impact your supply that you could be taking or eating?
A: One important thing to avoid if you get a cold is antihistamines. Anything that has Sudafed in it is a complete no-no. Pseudoephedrine can really affect a milk supply. The other thing is mint in large quantities, which can actually have a little bit of a drying effect on your milk production. An occasional cup of tea, if you enjoy mint tea, isn't going to tank your milk supply. But mint is something that we will use in large quantities with moms that have something called oversupply or hyper lactation where they're making too much milk, which sounds like a good problem to have, but I promise you, it's not.
Q: Nipple balms and butters - how do they help and when are you supposed to use them? And then cabbage leaves? I heard people using them, but what's that about?
A: There's a lot of different balms, butters, ointments, and creams that can be used when moms have sore nipples. The most common one that moms come into contact with in hospitals, every hospital in the country seems to give out, is lanolin. Keep in mind, if a mom is vegan or she has issues with wool, she should stay away from it because lanolin is made from the oil in sheep's wool.
The areola actually secretes its own oils, those little dots that are on the edges of the areola that become more prominent during pregnancy actually secrete an oil that helps to keep your own areola and nipple naturally lubricated. There are some great nipple butters that do actually have some herbs in them that have actual healing properties such as antifungal/antimicrobial properties. If you have cracks, that can prevent the nipple from getting infected and they feel very soothing. You can also use a basic coconut oil that you can literally take out of your cupboard. But I think the bigger thing is to make sure that you're working with someone that can help you figure out why did your nipples get cracked in the first place. Because just slathering the ointment on isn't going to fix the latch if there's something going on with the latch.
Q: Someone told me about…I think they're called Silverettes?
A: In my practice, personally, I haven't recommended them. But over the last several years, a lot of moms have come to me saying that they use them. They say they feel really good and that they do have some healing ability to them. So basically, if you find something that helps your nipples feel better as they're healing, I think use it. There are some cases where moms may need to take a break from direct latching if their nipples are really injured and they may need to just pump and feed for a few days to allow the nipples to heal. Because if the baby continues to reinjure the nipple, then breastfeeding is just going to become more painful. And you put yourself at risk for mastitis or clogged milk ducts. If they're causing you pain, then the milk removal process is a little bit more effortful for the baby than it probably ought to be. So sometimes it's important to just say, timeout, nipple vacation!
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