Well Wisconsin Radio

The information in this podcast does not provide medical advice, diagnosis or treatment. It should not be used as a substitution for health care from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.  

Katie:   Hello and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host, Katie Lovell, and today my guests are Molly Peterson and Ashley Richmond. They are owners of WISCO Lactation based out of Madison and Milwaukee and are both international board-certified lactation consultants, which is the gold standard when it comes to lactation care. They believe lactation care is a human right and feel that babies deserve human milk, and their parents deserve support in giving it to them. They meet families where they are at and support them in a judgment-free way that puts their mental health first. At their clinics, they assist with numerous infant feeding issues, including latch issues, oversupply, breast refusal, flange fittings, and more. Thank you so much for joining us today, ladies.

Molly: Thanks for having us. We’re excited to be here.

Katie: Well, we are just going to dive right into our first question today. Can you tell us what an international board-certified lactation consultant is, and why is it considered the gold standard in lactation care?

Molly: Yeah, so in lactation, it’s kind of like an alphabet soup. There’s a lot of different types of credentials out there, but an IBCLC is an international board-certified lactation consultant. So, we have the most advanced training in lactation and clinical care. So, we certified through the International Board of Lactation Consultant Examiners, and there’s a lot of backend work that you have to do before you can become an IBCLC. You have to have a certain number of college courses. You have to have between 500 and 1,000 hours of clinical practice, so like working underneath a currently certified IBCLC. You have to take, um, at least 95 hours of, like, lactation specific education and then take a comprehensive exam. So, it’s considered the gold standard because it’s the only globally recognized credential with consistent evidence-based standards across all the countries. And we’re trained to handle both routine feeding support, but also more, complex situations. And so just having that advanced level of training really helps in our day-to-day practice.

Katie: Yeah. That sounds like a very extensive training process.

Molly: It is, yes. But, for good reason, right? We’re supporting moms and babies, and we’re one of the few professions that have two patients and two clients in every visit with us, or most visits with us. So, we’re not only looking at history for mom, but we’re also looking for history with the baby, too. And then if you had twins or triplets into the mix, there’s a lot of people in the office or in a visit, but you have to take them each as their own individual.

Katie: Yeah, that’s amazing. What advice do you give to expecting mothers when they’re about to start their breastfeeding journey?

Ashleigh: Yeah, so usually we talk to them about learning before their baby arrives. So, if they can take a class, we have a class that we offer, but there’s other classes available. Or to meet with an IBCLC prenatally, we love to do prenatal visits. Just kind of answer all the questions, go through all the basics, and get everybody sort of in the mindset of what to expect after baby comes. We talk a lot about the first hour after birth, just making sure you’re getting that skin to skin, and that early feeding really matters, and how to troubleshoot if, for medical reasons that can’t happen. Really understanding that breastfeeding is a learned thing. There’s a lot of talk of, “Oh, it’s natural, it’s just going to be easy, it’s going to be natural.” Well, it’s actually a learned behavior, so it can take some time. And surrounding yourself with supportive people, supportive partner, lactation consultant, just kind of get your team, there for you and ready so that after baby comes, you have the support that you need. And just really, I guess, being a little bit flexible and having some patience, letting go of that, you know, this situation, this feeding situation has to be perfect. I talk a lot about that.

Molly: That was a hard one for me even. I was a lactation consultant first, but then mom after that and letting go of that perfection, I think is a big one to hit home on.

Katie: I was just going to say that. I have been going through my own breastfeeding journey and, yes, letting go of that perfection was the biggest thing for me as well. There is a fascinating phenomenon when a mother’s milk composition actually shifts in response to a baby’s infection or illness. Could you explain this process to our listeners?

Molly: Yeah, it’s so cool to me. I just think breast milk is such an amazing thing. So, breast milk is a living fluid, and it actually responds to babies need through this biofeedback loop that happens. So, I always joke with clients, if you’re at Target and a little old lady coughs in your face, or you’re pushing the cart and it’s sticky and you’re like, “Why is this so gross?” You’re taking in that information. And so, then the next time baby nurses or if they’re exposed to, some specific pathogen, they nurse and their saliva actually interacts with a nipple during feeding. So, they kind of backwash into our nipples a little bit. The same thing can happen when you’re exclusively pumping and you’re kissing your baby or if you’re doing skin to skin with them. And so that signals to the parent that they need to produce those different targeted antibodies to protect the baby from getting whatever they were exposed to. So, then the milk increases protective components, immunoglobulins, white blood cells, all the amazing things to be protective to help the baby not get sick. It’s really cool how it’s so personalized and responsive, not only from a composition perspective, yes, it changes in fat, protein, carbs, but also to protect that little person from getting sick. It’s just wild and fascinating.

Katie: So fascinating. I loved being able to do that research a little bit and look into different ways. It’s so amazing.

Molly: Every time I explain it to parents or we’re in a visit and we talk about that biofeedback loop and that backwashing of the nipples, most of the time it’s like, “Oh, no way. I didn’t know that. ” Or the partner is all of a sudden, like, “This is really cool. Your body’s amazing.” And it just helps set them up for, “Wow, I really am doing something kind of neat.”

Katie: The breastfeeding journey is so insane. It’s so amazing.

Molly: It is, yes. And so nuanced. Yes. And, the ups and the downs and the wins and the hard days. But just knowing if you can breastfeed or pump or provide that milk, it’s doing cool things for your baby, which I think is awesome.

Katie: Definitely. Awesome. Thank you for that. All right. So breastfeeding is much a mental game as it is a physical one. So how do you support the mental health of a patient who is struggling with that guilt or pumping fatigue?

Ashleigh: Yeah. We try to normalize it. Feeding challenges, they’re really common, more common than people think. It’s not, you’re not failing. I have a lot of moms that sit in my office and I say, “you’re not failing.” Your baby is fed, they’re supported. It’s more than just having the perfect milk supply or the perfect feeding situation, just kind of reframing those goals, sometimes is necessary. And simplify, I try to really meet people where they’re at. And what I mean by that is, I’m taking into account everything that’s going on in your life. I’m not going to give you 12 things to do if you’re telling me, “I’m already overwhelmed.” We’re going to take things out of the feeding equation then. We’re going to optimize your pumping schedule maybe or your pumping equipment with the flange fitting and just talking through expectations and making sure that parents are resting because resting and sleeping is huge when it comes to mental health, making sure that their bodies are also nourished, that they’re eating. I have a lot of people that say, “I’m eating once a day.” And I’m like, “That’s not going to work because you’re trying to heal. Your body needs those nutrients.” Sharing responsibility, I touched a little bit about your team approach in the last question that I answered, but it’s really important to find your village because you can’t do it all on your own. Even though as women, I feel like we always try to do everything on our own. We cannot do this on our own. So, that’s a huge thing that I talk about for mental health. We do screen all our clients for postpartum mood disorders. We refer out. We use Mom’s Mental Health Initiative, which is a great resource in the Milwaukee and Southeastern Wisconsin area. It’s really a huge part of feeding. If mom’s mental health is not in a good place, then the whole family is impacted. So, just making sure that that’s priority.

Katie: Great. I love that. So, what are some of the more complex clinical issues that you handle that people might not actually realize fall under or in your scope of practice?

Molly: Yeah. Like I mentioned, we see two plus people most of the time. And so, we’re kind of trying to decipher issues with the parent, but also issues that could be going on with the baby. So, we see a lot of either low milk supply where mom’s not producing enough or oversupply and regulation issues where the baby is trying so hard not to choke all of this milk, but it is a lot coming at them. And so, we see that as sometimes a big challenge. We see infant feeding difficulties that can range from, a premature baby, whether they were born at 24 weeks or 37 weeks, there’s challenges with any range in there. Oral restrictions like tongue ties. All of our team has taken a lot of specialty training on oral function and tongue ties to be able to really assess what’s going on with that dyad because it impacts both mom and baby. And so, making sure we’re not missing some of those things that can really be fixed by doing some oral exercises or some body work is really important. There’s things like mastitis or a breast infection, plug ducts, nipple pain, nipple trauma, pain inside of the breast. We also can support relactation or inducing lactation. So, if you decided at two weeks old, “Hey, I don’t want to breastfeed anymore.” And then at two months you decide, “Actually, I do miss this, and I want to be nursing or pumping.” We can help with those types of things. There’s a lot of medically complex situations like NICU babies, if they spent a lot of time because they were premature. Multiples, it’s hard enough trying to nurse one baby, let’s throw two or three or four into the mix. And it can just make things a little bit more complicated if that lactating parent or the baby has any sort of chronic illness. And I’ve seen lately a lot of mommy thumb. But, things like that where it’s those random things where it’s like, my thumb hurts and I can’t hold my baby. Okay, how do we troubleshoot that? And then we also deal with a lot of medication safety during breastfeeding. There’s a lot of really amazing information out there through the Infant Risk Center, but there’s a lot of providers who may not know that it exists, so we can kind of help troubleshoot, by saying yes, this medication is safe, or no, maybe we need to have you talk to your provider about a different medication. And at our practice, we’re really fortunate because we have an amazing IBCLC who is also a nurse practitioner on our team who specializes in a lot of these complex clinical issues. So, if it’s something that we’ve been trying to manage and it’s just something that’s above my pay grade all of a sudden, I have a wonderful person I can just text and be like, “I’m referring her to you. We need her to see you pretty quickly.” She deals with low supply, can order labs in- house and interpret those labs and prescribe medication or, whatever we need just to kind of take it to that next level. So, we’re really grateful and fortunate to have that option on our team, but all IBCLCs can manage complex clinical issues at the same time.

Katie: That’s amazing. I just never realized how many things happen with breastfeeding or pumping or just the journey of motherhood. It is insane.

Molly: Yes, it absolutely is. And it’s amazing and beautiful and awesome, but at the same time, exhausting. It’s hard work.

Katie: 100% can agree with that.

Molly: Yeah. And I don’t think our society really sets us up well either. We’re back to work so soon and a lot of people don’t get paid leave. Their partners are back to work after the weekend, you know? So, I think to Ashleigh’s point of finding and creating your village. So, if your partner is going back to work three days after delivery, somebody else can come in and kind of step in to do the dishes. Your job is to just hang out with your baby in your bed and get that breastfeeding relationship established.

Katie: Definitely. Can you tell us what type of advice you give to a mother who is looking to maybe start that weaning process to conclude her journey of breastfeeding?

Ashleigh: Yes, definitely. So going gradually is best just for mom’s own breast health, dropping about one feeding at a time, just to protect that comfort and regulate that supply slowly so we avoid clogged ducts or mastitis or anything like that. With older kids, it’s a little bit different than with younger kids, so it kind of depends on the age of the child, but just following the child’s cue if they’re older. Also keeping in mind, the mom’s readiness, the parent’s readiness. So, sometimes baby’s not ready, but mom’s ready and we’ve got an, a, a toddler and it’s a situation where mom’s driving force here. Sometimes it’s the opposite where baby’s the driving force. So, just kind of going slow and figuring out along the way what works best for that family. It’s a very nuanced situation, very dependent on how many times a day are they feeding and what the age of the child is. But replacing some of the feeds with connection, so whether that be snuggles or books or like a bedtime routine or something like that, just to maintain that bonding experience and watching out for the engorgement and things like that and managing that. But also, being aware that there’s some emotional mixed feelings that can happen. A lot of parents are telling me, “Oh, it’s just bittersweet.” It’s kind of like, “I want to be done because I’m touched out, but I don’t want to be done.” There’s a lot of feelings that come up because there’s a lot of hormone changes in there too. So, it’s a little bit tough to manage sometimes, but just going slow and figuring out what works best for your family.

Katie: Yeah, that’s great advice because I’m starting personally that journey for myself right now. So, I appreciate that advice. Yes, but I can understand the connection and the bittersweet feelings. Yeah, because there are days where I’m ready to be done, but then there are days where I’m like, “No, I can’t.” This is our connection moment; this is our bond. So, yes, I understand that bittersweet.

Molly: For sure. And it’s interesting also trying to comfort them when you normally would comfort them at the breast. When I weaned my daughter, she was two and a half and the first time she fell off her scooter or something and she was hurt and she was crying and she wanted to nurse and I was like, “I don’t know how to comfort you. I don’t know what that means for us now.” So, it’s a really unique experience of finding that new bond and that new way to kind of connect outside of breastfeeding.

Katie: Yes, definitely. I always use that excuse of, “Oh, here’s the breast, you know? Here you go. ”

Molly: Yep. When in doubt, boob out. We say that constantly around here.

Katie: I love it.

And now we’ll just take a quick break to hear about some of Well Wisconsin’s program offerings.

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Katie: And now we’ll head back to the Well Wisconsin Radio interview.

All right. So, instead of the common last-minute panic over building a freezer stash, what is the most or more realistic timeline for preparing a milk supply? And what specific strategies can working mothers use to maintain that supply once they actually return to work?

Molly: Yeah. I love talking about returning to work because it’s stressful, it seems. And there’s, again, we’re not set up for a lot of success in our current society. And I think social media also plays a big role in some of the anxiousness that gets associated with all of this returning to work. The biggest advice I give clients is Instagram isn’t real, and you don’t need to be pumping 12 to 15 ounces at a time in one shot. That is not realistic. You also don’t need this huge freezer stash by the time you go back to work. Usually a couple day’s worth, at least enough for that first day back, so maybe 10, 12 ounces at most. Maybe having a little bit of a cushion, of a couple extra days in there can give a lot of peace of mind, but we don’t need to be having tons and tons and tons of milk because that can come with its own problems that we don’t want to have to worry about. About two to three weeks before going back to work and some families choose to start a little bit sooner, but that’s when we would really be figuring out, okay, when am I going to be pumping to make that milk supply for my little freezer stash? So, like once a day, put the pump on after a feeding, just to have a little bit of milk stored up, but again, we don’t need to go gangbusters here. And then once you’re at work, usually we want to be pumping about the number of times your baby would be getting a bottle. So, if you’re normally nursing and they’re getting a bottle about every two to three hours, okay, then we want to be pumping about every two to three hours. It can be a little flexible. We’re shooting for typically in the early stages of lactation, at least eight times a day to bring in a full milk supply we’re nursing or pumping. And then once we’re back to work about six to seven times in a 24-hour period to maintain that milk volume. So, a good rule of thumb is about every time your baby gets a bottle, but there is a little bit of flexibility there. And I think that’s one thing that a lot of parents don’t realize is we want it to be doable, not adding a ton of stress as the day goes on. The other thing that we talk a lot about with our returning to work clients is what type of pump are you using? Is it going to be effective at removing milk? Is it going to potentially harm that milk supply? I love wearable pumps in theory, but in practice, a lot of times they’re just not effective enough at generating the right amount of suction to remove milk effectively. So, we can see supply issues if we’re not using an effective pump. Flange fitting, making sure that the flanges that you are using are appropriate for you. I mean, there’s so many different sizes out there, and most women are much smaller than what comes with the pump. That 24 millimeters, I think I fit one person in my life for that. So, knowing that we probably need to figure out what size flange you are makes a big difference as well. Hands-on pumping are you using compression when you’re back to work versus just that strike suction from the pump, those types of things can be really, really helpful. And it’s also important to rest and hydrate and eat under appropriate amount of calories in a 24-hour period while you’re trying to do all of this because breastfeeding and pumping burn calories. And so, we need to replenish those back within ourselves so we’re not just this milk machine shell of a human trying to produce all this extra milk for our baby. And then we can use the fresh milk that we pump today at work for the milk that we used yesterday when they were at daycare or with grandma. So, getting creative with what’s going to work best for you and your family versus, “Oh, this is exactly what I have to do, ” I think is the overarching theme of today. There’s flexibility, let’s make this doable, let’s make this reasonable, and hopefully that’ll help.

Katie: Yeah. I love your advice that Instagram and social media is not real. I love that because it is very influential.

Molly: It is. And it can be damaging. You know, if you see somebody pumping 12 ounces and you’re pumping three, which is totally normal, that’s going to really get in your head, and then that’s going to make it even harder to have let downs and be able to express appropriate amounts. So, yeah, don’t listen to the influencers on Instagram.

Katie: Great advice. What specific laws protect a mother’s right to pump once returning to work? And how do these laws define the actual pumping space to ensure that it is more than just that restroom stall?

Ashleigh: Yeah, so in the US, we have a few laws that protect us. The breaktime for Nursing Mother’s Law and the Pump Act. So those say that employers must provide reasonable break time for pumping. In some states, like Illinois, I know specifically, they have to be paid for their time pumping, but in other states, that may not be the case. So, there’s some state-by-state laws to consider. They have to provide a private space that is not a bathroom, shielded from view, and is free from intrusion. So, basically the door has to lock. And the laws, they apply to most employees, and they were expanded with that pump act in recent years to cover more workers. So, kind of digging into those laws, basically Googling them and seeing how they apply to your specific work situation, and then having a conversation with your employer early on before you return to work, just so you have a plan in place. Those are pretty much the laws. I do talk to people about certain situations and if there’s someone else pumped at your job before. What worked for them and kind of troubleshooting that way. But I mean, to be completely honest, sometimes we kind of have to put our foot down and be like, “Hey, I need to pump. This is for my own health. It’s for the health of my baby, so how can we make this work?” So having that conversation is kind of tough sometimes with the employer, but got to do what you got to do to take care of yourself and your baby.

Katie: Definitely. Thanks for diving a little deeper into those laws. Hopefully that helps some of the listeners with a little bit more of a conversation that they can bring to their employer if this seems to be an issue. So, thank you. If you could debunk one single piece of well-meaning breastfeeding advice that you hear constantly in your practice, what would it be and why?

Molly: It’s such a good question. And I feel like there’s so many myths out there that we’re constantly debunking, trying to figure out just one is so hard, but probably that if you’re not pumping enough, you don’t have enough milk. Because pump output is not a reliable, clear indicator at all when it comes to milk output, especially if there’s other factors going on. We typically think that babies are more efficient than the pump, and there’s going to be situations where that may not be true, but overall, the baby is using suction and compression, and they’re cute, and they’re cuddly, and your pump is not. And so, how much your pumping doesn’t always indicate where your supply is at. There’s going to be factors for pumping, like what’s your stress level like, if you have high cortisol levels when you’re trying to pump, that stress hormone is high, oxytocin, that hormone that literally lets the milk down gets blocked, so you’re not going to be able to express very much milk. How long has it been since you last nursed when you’re trying to pump? If you just fed your baby five minutes ago and your breasts are pretty much drained, of course you’re not going to get very much when you’re pumping. Again, going back to an efficient pump with efficient flanges that are working for your body, those are going to make huge differences. It’s amazing when we do flange fittings in the office and the parents are always like, “I don’t pump very much. I don’t think I have very great supply.” We fit them for the right flange, and we get them set up with a pump that is effective and it’s like, “Oh my gosh, I do have milk. This is so exciting.” So, it’s like those aha moments that we’re constantly supporting, which just makes me so happy. I think this myth really creates a lot of unnecessary anxiety and undermines a lot of confidence for a lot of people. And so, knowing that there’s things that we can do when we’re pumping to help with our output and it’s not just, “Oh, I pumped one time and I got drops. That must be all I have for my baby.” That’s probably the biggest myth that I would try to debunk today.

Katie: I feel like that’s a very common myth. I feel like a lot of mothers, specifically myself, I went through that too, when I was comparing myself to others. That social media influence.

Molly: Yeah. It’s a hard one, I think, because with breastfeeding, you don’t get to see how much you’re making and how much your baby’s transferring. Like there’s no gauge on the breath. So, then you throw the pump on and, “Oh my gosh, you know, this influencer, she pumped 12 ounces. I only got four.” Okay, four is amazing. We don’t need to be pumping oodles and oodles of milk.

Katie: Yeah. And four, I guess, is really healthy too, right?

Molly: Absolutely.

Katie: The baby only needs four ounces, so your breasts only supply four ounces.

Molly: And that’s four ounces total. So then that’s two ounces on one breast and two ounces on the other. So, if you’re staring down the barrel of the pump and you’ve got two ounces, but the bottle holds eight, of course it’s going to look like not enough. But in reality, it’s more than enough. Absolutely perfect.

Katie: Yeah. Are there any services typically covered by insurance? And if any of our listeners are interested in your services, how can they find out more information?

Ashleigh: Yeah, so that’s something that I work very closely with trying to get as much insurance coverage as we possibly can for our practice. And we do have them all listed out on our website at wiscolactation.com/insurance, all the insurances that we take. Coverage does vary by insurance carrier, so if you just check that website, you can see or you can contact us, and we can let you know. Our biggest barrier is that because Wisconsin does not license IBCLCs, we’re not allowed to be covered by the state insurances like Badger Care or Medicaid. I’m really hoping that this changes. It’s going to take a lot of work, that I’m just starting to dip my toe into, but we don’t want finances to be a barrier to care, so we do offer payment plans or reduced fees for our Badger Care Medicaid clients, should they need it. We also have a student clinic that is very reduced rate, that our students can help as, as we oversee the care as well. So, we try to give as many options as we possibly can. So yeah, our website has more information on that, or you can obviously contact us, and we can help figure it out.

Molly: And I have to say, like, Ashley’s put in a lot of work to get insurance coverage. She’s done an amazing job. It doesn’t come easily, but it’s been an important part of our practice. We don’t want somebody not to get support because they can’t afford it. So, Ashleigh deserves a little round of applause, pat on her back, because she’s worked incredibly hard.

Ashleigh: Well, thank you. It’s been quite the fight. I spend many, many hours fighting with insurance companies every week.

Katie: Well, kudos to you, Ashleigh. Way to go. And thank you for that information. I hope that will help our listeners as well. Well, thank you, ladies for your time today.

Molly: Absolutely. It’s been fun. We love talking about all things lactation, so we’re always happy to chat.

Ashleigh: Yeah. Thank you so much for having us.

Katie: Thanks for listening to Well Wisconsin Radio. I hope you enjoyed the show. We love hearing from our community, so please take a moment to visit the Well Wisconsin Radio card under the benefits tab in your Well Wisconsin portal to share your feedback or suggest a guest for a future episode. You can find our transcripts and previous episodes all at www.webmdhealthservices.com/wellwisconsinradio. If you’re listening to this podcast on your platform of choice, be sure to subscribe so you can never miss an episode.

Molly Peterson and Ashleigh Richmond are owners of Wisco Lactation and board-certified lactation consultants (IBCLC). An IBCLC is the gold standard when it comes to lactation care. Their mission is to help support the lactating mother by providing unique, evidence-based support to families so that they may make their own informed choices in infant feeding. They meet families where they are at and support them in a judgement free way that puts their mental health first. At their clinics, they assist with numerous infant feeding issues, including latch issues, oversupply, breast refusal, flange fittings, and more!

The information in this podcast does not provide medical advice, diagnosis or treatment. It should not be used as a substitution for health care from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.

Resources referenced during the interview:
Mom’s Mental Health Initiative – www.momsmentalhealthinitiative.org
Infant Risk Center – https://infantrisk.com
Wisco Lactation – www.wiscolactation.com