135 - 10 Things We Wish You Knew About Breastfeeding with GP and IBCLC Dr Eliza Hannam

0:00We acknowledge the traditional owners of the land on which we work and live, the Awabakal and Wurrimei people, and pay our respects to Elders past and present. We celebrate the stories, culture and traditions of Aboriginal and Torres Strait Islander Elders of all communities who also work and live on this land. You're listening to Boob to Food, the podcast with Luca McCabe and Kate Holm.

0:31There is so much noise in the parenting space and we don't mean the tantruming toddler. We understand it can feel confusing, conflicting and overwhelming. That's why we are bringing our years of experience as a midwife, nutritionist and naturopath and of course mums so that you can confidently navigate the roller coaster of motherhood from boob to food and beyond. Each week you'll hear practical wisdom, expert advice and inspirational stories of other mums in the depths of this parenting journey. Let's dive in. Today's episode is brought to you by Chief Nutrition. Welcome back to Boob to Food, the podcast, and welcome back to the podcast, lovely Eliza.

1:09We are really excited to have you here with us today to celebrate World Breastfeeding Week. But for those who haven't come across you before or heard your previous episodes, could you just let listeners know a little bit about who you are and what it is that you do?

1:22Dr Eliza Hannam:Sure. Hi, thanks so much for having me back. I'm Eliza. I'm a GP and a board-certified lactation consultant and I'm also a Possum's NDC accredited practitioner. I'm a mum of three and I'm also very excited that I have newly joined the Boob to Food team as an advisor. So that's something that's just officially been announced in the last few days and I'm so thrilled to be joining the team. We are more excited. We are more excited than you. It's such a blessing to have you as part of the team. You honestly are such a wealth of knowledge around so many topics of just health in general, women's health, mum's health, children's health, breastfeeding, all of the things.

2:01So we're excited to pick your brain once again. But I guess just starting with breastfeeding, because obviously World Breastfeeding Week and we want to help support families everywhere should they wish to breastfeed. I think it's something that, you know, it's often portrayed as breastfeeding is like really natural and really instinctive and like something that everybody can do. But in reality, a lot of women find that it's actually not that easy. Can you just speak to sort of those early days and why it can be so challenging?

2:33Dr Eliza Hannam:Yeah. And you're right. You would assume kind of from a biological perspective that it would be easy and natural and intuitive. And actually more often than not, it's not at least initially. and I still kind of can't get my head around that really. But I guess you've got this kind of perfect storm of recovering from pregnancy and birth and you're trying to get to know this little human and learn how to parent and both of you are ultimately learning an entirely new skill. And even if it's your second or subsequent baby, it's new to this little one and the way that you fit together or your baby's temperament might be different.

3:09Dr Eliza Hannam:And actually for me personally it was my second baby after I'd had a really like unusually straightforward first journey that I had so many issues that I just did not expect. And so I guess common challenges might be nipple pain and damage or concerns about supply. And actually one of the biggest challenges is just navigating often quite conflicting advice from postpartum healthcare professionals. And so I guess in terms of what can make a difference, education in pregnancy, which we'll come to, does make a really big difference. And I think if nothing else it also will help you just to connect with hopefully a trusted care provider whose approach resonates with you and really you know continuity of care always makes a difference in postpartum in the perinatal period you know at my clinic in Sydney we will often follow up families for weeks and sometimes even months on end and that might be checking in every week or two weighing the baby reviewing the feeding plan but even just kind of checking in is this still feeling okay and manageable and sustainable and you know what can we do to make it feel that way if it's not?

4:15Dr Eliza Hannam:But I think also, and we'll, I guess, maybe come to this later, but I really want to kind of emphasise that for anyone who's in the thick of that, it usually gets easier. And so if you can hang in there, if you can get the right support to give it a bit of time, time will tell, but most of the time it gets easier. Yeah. And being on the other end as a midwife, looking after fresh postpartum women, It is really hard to give good education, one, because, you know, we often have seven patients who we're trying to plus babies. So there's just not a lot of time. But two, you know, like you said, the new mother is recovering, is in pain, is so tired, has visitors visiting all of the time and trying to take in new information can be really, really tricky because you're not in a very good space, headspace, I guess, to take in new information.

5:08Everything's just like so overwhelming. And so getting this education when you are in a good headspace when you're pregnant is so, so important and so much more valuable because you're actually going to take in what someone's telling you. But it can be hard, you know, to prep for breastfeeding, I guess, to learn about it. I feel like I used to teach parent education classes and there's so much emphasis on the labour and the birth, which is great and we need to learn about that, absolutely. but you know that's one day hopefully hopefully one day maybe two maybe three but breastfeeding you know is a long time thing and so even though yeah like we said it should be natural and instinctive it's not a lot of the time um and there is lots of like things that we can learn and things that we can do so what would you recommend that parents do during pregnancy to actually prepare for breastfeeding what steps would you recommend that they do i guess so there's sort

6:04Dr Eliza Hannam:two parts of it but really it's like education about how breastfeeding works about optimal latch and positioning obviously that part is easier when the baby's there but I'll often in an appointment like get a woman or mum to like hold the baby and a doll rather and sort of show them what these different little micro movements and adjustments can feel like we talk about prevention and troubleshooting of common issues and a point of call for postpartum but I also spend quite a bit of time, we do an hour long antenatal breastfeeding appointment and I spend quite a bit of that time talking about newborn sleep and behaviour, about what to sort of expect in that first couple of months postpartum and how families might prepare for that just based on I guess their individual supports and situations and values and all of these are linked with the success of breastfeeding because I think if you don't know what to expect in terms of sleep and you haven't thought about the support networks that can support breastfeeding, it's a lot harder to hang in there through those potentially trickier early days.

7:08Dr Eliza Hannam:So there are courses, there are online and in-person courses kind of for a group setting where they can talk about breastfeeding rather than necessarily, as you say, just focusing on birth, which is really important, but ideally both. It's also, I know I'm sure quite a few IBCLCs would offer sort of one-on-one education in pregnancy. And I think this is particularly important for people who might have an increased risk of breastfeeding difficulties. For example, if you've had previous breast surgery, who have a history of inverted nipples, you've had previous breastfeeding difficulties, but it's arguably helpful for everyone, and maybe especially if it's your first time.

7:46Dr Eliza Hannam:And I guess otherwise, in sort of preparation, it might be helpful to talk about your goals and preferences with your pregnancy care providers or with your midwife or your obstetrician or whoever you're seeing for pregnancy care. And if you don't kind of have the space or time or capacity to do one-on-one appointments or even a group appointment, just even finding out about what your local breastfeeding support options are. There might be private clinics, there might be home visit options, there might just be community health clinics, so that it's not kind of something you're trying to scramble to find out in the middle of the night in those early few days after birth.

8:20Totally. You don't want to be googling at three o 'clock in the morning when you're sleep deprived and stressed and you know trying to then connect with a lactation consultant that was actually something that I did before my eldest was born and I recommend to all of my patients too to connect with a lactation consultant and get that education and I really do I mean obviously can't look down the parallel path like what would have happened if I hadn't done that but there was so much that when I then got handed this baby it wasn't like oh like what do I do because like you said, they're learning and you're learning.

8:51And so just to have a few like techniques and some understanding of what exactly to expect, it really helped me to feel confident. And then we did have a really successful breastfeeding journey. I think it's just such good advice. You know, we don't need another swaddle. We don't need 50 blankets. We do need this support and to have a network. And like you say, if it's not accessible to you, at least find out what, you know, your local resources are so that if you do find yourself in that situation of needing extra help, you're not doing the 3am Dr Google trying to figure out where to go and what's normal.

9:29Dr Eliza Hannam:It's actually a great present or even group gift from family. I've had a couple of people who've reached out asking if they could organise an appointment either in pregnancy or after birth for their like friend or loved one. Often women who've had their own difficulties and thought, gosh, that would have been great. But even, yeah, I guess that's something if people do want to buy something, as you say, rather than stuff, meals and education can be great gifts. Yeah. Yeah, and I think too a lot of people probably think, oh, I like teaching and consulting that if I'm having issues or when I'm having issues.

10:02But, yeah, it's great to, I don't know, I don't know what that, like probably some cool word about this, you know, sort out the issues before they come, you know. Yeah. Preventative. Yeah, but there's probably some cool, like, I don't know, saying about this that I can't think of right now. But you know what I mean? Like, don't let it become an issue. Like, get the education beforehand so that you're equipped and ready. And I do think, like, you know, being a midwife myself then when I was handed a baby, yes, I'd never breastfed before. But because I had all the knowledge there, you know, it was easier.

10:34Like, it was still – there were still issues and, you know, oversupply and all of this stuff. But the knowledge of what was normal and what was not and what were my support options and what could I do about things was really, really handy and I was really thankful to have that knowledge that other people can get from, you know, speaking to a lactation consultant before they have the baby. Can you talk a little bit about antenatally expressing and if that's helpful and when someone can start doing that and why?

11:03Dr Eliza Hannam:Yeah. So I guess for those who don't know, that means when you start hand expressing for colostrum, which is the early kind of precursor to mature breast milk. And you can usually do that from pregnancy. So we know that most women will be making colostrum in the second half of their pregnancy. What I think before I go on to how to express, I think it's just important to note that colostrum production is inhibited by the placental hormones. So about 6 % of women can't actually express in pregnancy because those placental hormones are so strong and that that doesn't necessarily indicate any concerns about supply and usually those women are still making colostrum it's just that it's being inhibited but basically we sort of found out really about the benefit I think it's been done forever and midwives would have been teaching women to do it since you know eternity but there was a really big study of babies with mums with gestational diabetes called the DAME trial that showed that those babies who had low blood sugars or who needed supplementing when breast milk was available or colostrum rather was available, those babies were more likely to leave hospital exclusively breastfed than the ones who were given formula or glucose.

12:14Dr Eliza Hannam:So I guess we extrapolated from that, that if it's available, that it sort of predicts success. Importantly, as I said, there's no correlation between sort of being unable to express antenatally and having low supply later. and there are times when it's just not possible. But I guess if you've got colostrum, you might as well try and collect it. It's usually safe from 36 to 37 weeks, but I always would just recommend checking in with your pregnancy care provider. There are some contraindications. And they can also usually show you how there's some great YouTube videos, but nothing really replaces kind of hands-on help.

12:50Dr Eliza Hannam:And that's something we always do in our antenatal appointments at the clinic. That's something that Luca did for me. I videoed it. Did I ever make it to Instagram? We were going to post it on Instagram. I was like, I feel like this is too far. I love that. I think that's so great. I actually not so much demonstrated myself, but yes, showed women on their bodies how to do it. But I kind of, I guess, with my doctor hat on, I always have to think about plan for worst case scenarios. So even if your baby, even if you don't have gestational diabetes, is I kind of think the worst case scenario being if you and bub had to be separated after birth if someone you know ideally if you've got a partner or support person can go with the baby they can do skin to skin they can give that colostrum you can hand express until you're together um that's you know such a wonderful thing to be able to do if it's an option um again acknowledging it's not always um but I also think just like practicing the technique hand expressing such a handy tool it's a great way to help with engorgement um it's a great way to help if the bubs just having difficulties attaching when the breasts are really full.

13:54Dr Eliza Hannam:It's, you know, if you're having sore nipples in those early days, it can be a way to have a little bit of a rest. So even if you're not getting much colostrum, just literally practicing the skill, I think, can be helpful. I think some people are just to totally normalize, kind of freaked out the first time they do it and something comes out of their nipples. So just kind of feeling okay with that and getting used to like touching your breasts and nipples in that way can all be quite helpful to do before you're kind of recovering from birth and meeting your baby and trying to do it then potentially.

14:21And if you are exploring this for the first time, like when you express colostrum,

14:25Dr Eliza Hannam:it's teeny tiny amounts that you get, like, you know, meals would be the maximum. Like it's usually like a very, very small amount. Yeah. So don't be alarmed if you're like, oh, nothing's really coming out. Like baby's stomach when they're born is so small and the amount of colostrum that they'll actually be consuming is very small. So even these tiny amounts that you can express are really, really helpful. And then great to have in your freezer, like colostrum is so rich in immunoglobulins like I'm always a bit sad when my freezer stash of colostrum dries up because I like to give it to the kids when they're sick yeah and some people like might use it in the bath if the little ones have um dry skin or yeah absolutely and yes great point like sometimes it will take women three days to collect half a meal and that can be totally totally normal yes and even if you don't get enough to collect just practicing and seeing that little bubble you You can rub it on the nipples as well if they're kind of feeling dry or anything, yeah.

15:19I still remember, I remember clearly when I was pregnant with Flynn and I was sitting on the lounge and I was 16 weeks pregnant and I was eating honey on toast and then I looked down and I was like, I spilled honey all over myself, how weird. And then I looked down and it was leaking out of my boobs. 16 weeks. 16 weeks and leaking, like just pouring out. I wasn't even touching them. It was the funniest thing but that was a good indicator maybe of my oversupply issues.

15:44Dr Eliza Hannam:but but also it is that honey color it's so kind of yellow honestly I thought I like clearly have this memory that I just felt honey for myself but I do find that yeah it I do think it was really helpful for women whose babies did require top-ups that it just took a lot of pressure off when they had that colostrum already there it was like you know they'd get in this cycle of triple feeding where you're pumping and you're trying to feed and trying to you know build your supply at the same time and you're also trying to sleep and you're also trying to recover and having this little bank you know even one feet ahead was just so handy for them just to even be one feet ahead of your baby um to have that coming into the hospital or you know if you have a home birth was just so helpful and I feel like it just took a lot of pressure off women so definitely speak to your health care provider about that and most hospitals can offer like a kit which has all the The syringes and labels.

16:38The syringes and everything, yep, and instructions on how to do it. And then remember to take it with you to the hospital when you're in labour as well. But don't do what I did and take your whole freezer stash because it will potentially get wasted, which is very sad.

16:51Dr Eliza Hannam:Yes, I always kind of say if you've got a partner or birth support person, it's their job to both remember to take it and to hand it to someone at the hospital and ask them to put it in the freezer. And make sure it's labelled or they'll chuck it. Yes, and labelled absolutely if you're having a hospital birth for sure. Yes. Well, talking about partners, like I feel like a supportive partner is really, I mean, if you don't have a partner, then no, it's not vital. But if you do have a partner, having a partner who is supportive of your breastfeeding journey is vital. What, like, can they do, what conversations would you recommend that a couple has?

17:25What, you know, what can a partner do to help in this time? Because often they do feel quite helpless and that they're not really doing anything. And so, you know, sometimes they'll say, oh, we'll give them a bottle so that we can help. But there's so many other things that they can do that isn't them actually feeding the baby.

17:42Dr Eliza Hannam:Yes, absolutely. Yeah. So studies do show that having a partner who supports and values breastfeeding increases the likelihood of success. So I do, I think like the very first thing is to have that conversation in pregnancy. I think for, you know, in hetero couples, for a male who's not pregnant, like it's, they can't necessarily be thinking about those next steps during pregnancy, but it all feels a lot more physical for the person carrying the pregnancy. And so telling them that if it's something that feels really important, flagging that actually can intuitively, it's often not that easy. I would say ideally involving them in appointments in pregnancy or any education in pregnancy.

18:23Dr Eliza Hannam:I always encourage, if it's possible, to bring their partners along to that pregnancy appointment. And I guess like really, you know, part of what they can do in pregnancy as well is like planning for that postpartum again and protecting that time in that space. I think we've sort of talked about it a little bit, but, you know, seeing the partner is, I guess, a bit of a gatekeeper in terms of who's coming and when and knowing about the importance of like giving feeding time, having skin to skin, you know, really making sure that people who come into your space after birth are people you feel comfortable being topless around and so the way they support feeding might be kind of gatekeeping around visitors and that's like such a helpful thing to be able to do and I think you know a lot of families I see now you know partners are taking more time off they're being involved and I totally understand it often feels like an easy way to share the load would be to share the feeding and down the track that absolutely works well for some families but in the really early days when you're trying to establish feeding I guess it's kind of taking care of everything else so that you can just prioritize getting feeding working and so that might even just be like bringing the baby to you for feeds doing the changing and settling doing the bathing and showering so like sorting out your own meals and other kind of postpartum supports and then later if it still feels like something that's important or going to work for your family absolutely they could be involved in doing a feed with a bottle.

19:50Dr Eliza Hannam:But I think that's like kind of a later down the track way and there's lots of ways they can support feeding earlier on. We'll be back after this short break. Today's episode has been brought to you by Chief Nutrition. We've been talking a lot today about breastfeeding, being World Breastfeeding Week. And one thing that breastfeeding mums really, really don't often do very well, but should do is eat and keep up their protein. But it can be really hard when you're breastfeeding because you realise you only have one hand. So one-handed snacks are key and also things that don't perish, I have found.

20:26True. I remember when I first had Jude, I did a huge order of, the Chief had actually just launched their beef bars and I had boxes of them at home because I knew, because I'd been working in this space, that it was going to be tricky to feed myself and to, you know, maybe not be able to make a proper lunch or anything like that but I still wanted to have snacks that were good for me going to be giving me that protein and other nutrients too and that actually tastes really good I know it sounds weird to have a beef bar and I know that you were a bit dubious when you first tried them they're actually so yummy they are they're delicious my husband keeps stealing them now I'm like stop stealing my beef bar this is annoying but I do find yeah their beef bars their collagen bars even their jerky they're also handy just to have you know like lying around the house where you might need it It's always that precariously placed, you know, can't reach the remote kind of vibe.

21:15You need like a little breastfeeding box of snacks. And yeah, they're really great to keep up your protein. And then that in turn is going to help your milk supply as well. You can use the code boob2food for 15 % off their products online. And you can actually get some of their products in Woolworths too. Yes, which is so handy. It's so nice to see more and more of their range appearing in Woolies. And some fuel stations randomly. Yeah, it's always good on a road trip. You can check out their full range of products and their stockists at wearechief.com. Now let's get back to today's episode. Cleaning the house.

21:49Yeah. Taking care of older kids.

21:52Dr Eliza Hannam:Or organising a cleaner if that's kind of the next best option. Yeah. Yeah. Well, I think honestly like taking away all of that other – because I think that's the thing when you're breastfeeding off and you're just trapped and you feel like I've got all this stuff to do. I can see the house getting so messy around me. like you kind of have this mentality like I need to do things but if everything else is being done for you then you can just enjoy that time and relax yeah yeah just lean into it yeah someone to feed you yep yeah rub your feet make sure you're drinking water yes yes bring your water bottle yes my husband knew like as soon as I'd start feeding I'd always look around I used to get this really intense thirst with a letdown and so like oh my gosh the thirst I know yeah Yeah.

22:33And I think too, like you said, having a partner who understands what's normal and what's not is really important because one thing that we'd hear all the time is, you know, the woman would say, oh, like, but this is normal. They're like, it's not normal. You have had the baby on you all day. It's not normal. And then that would feed into that negative spiral of, is it normal? Because they're saying it's not normal and, you know, you kind of need someone who's like, yeah, actually remember when Dr. Eliza said that when we were in this appointment and it is normal. And sometimes when you're tired, you need someone to remind you that what you heard is correct as well.

23:04Dr Eliza Hannam:Having someone else hear that information for sure. Yeah, for sure. Something I like to really reiterate to women is that breastfeeding should not be painful but I think there is this myth along with, you know, the very like real reality that some women can find it challenging that breastfeeding is going to hurt. Can you just speak a little bit to that and what is considered to be normal or when women should be looking for help? yeah look it it really just shouldn't hurt it shouldn't be painful I see like I'm always blown away by the strength of women who have been doing feed after feed where they're curling their toes and they're just feeding throughout it really it shouldn't be something that you're dreading because of the pain it shouldn't be something that you're curling your toes or gritting your teeth through um it is like it's a different sensation and I think also when the breast so when the milk first comes in if the breasts are quite engorged things like attachment can feel trickier then and when the babies like have little mouths and they're still learning to breastfeed certainly it can feel different it might attachment not uncommonly feels a little bit uncomfortable in the early days but that should very quickly subside as the baby's sort of drawn the areola and breast tissue into their mouth and is feeding and and it definitely shouldn't be pain that persists throughout a feed or in between feeds and that usually tells us that the latch and positioning isn't great or occasionally it's something like a tongue tie and so I think if you have pain that is severe or persists beyond attachment or is happening between feeds that is absolutely a time to get help and I think something that really gets to me is when women might be experiencing this and someone will come in and say, well, the latch looks good.

24:52Dr Eliza Hannam:So it's not that. And it's usually not like a latch, a good latch is not something you can see. It's something that the person who is breastfeeding feel. And if it is, especially if it's kind of a pinching or tugging or tearing sensation, it usually means that that positioning could be optimized and it's just worth kind of troubleshooting that. And even with things like nipple damage, like I've seen so many women persist and persist like literally their nipples are like shredded or I had one patient whose nipple actually was like hanging off and it's like oh like no no no no like that is not in the realm of normal and I think like you described some discomfort as it's like a different sensation and as bubs kind of you know positioning themselves appropriately discomfort yes but like if you're noticing that you've got nipple damage even things like if you're starting to think you want to use a nipple shield like don't do anything like that without seeking support from a lactation consultant because there is more that can be done to make breastfeeding you know a more than tolerable experience it shouldn't just be tolerable definitely and as you say I think if you're seeing damage then that's not that shouldn't be considered normal or something that you have to just endure yeah yeah and seek a second opinion if someone has said to you that's fine you're like oh it's really not like don't you know everyone has a different perspective and a different level of education and I do think this is something that can be confusing in those early days in the hospital when there's maybe a lot of voices giving you advice that you just like you said earlier having that continuity of care with a known provider can really really help with those outcomes.

26:30I had the most painful letdown. Me too, yeah I used to call it dagger boobs.

26:35Dr Eliza Hannam:That's a good point, that's true I also used especially in the early days, I think, yeah. Mine continued for the whole few years. Just like that. Yeah, interesting. You'd brace yourself. You'd be like, okay, I can feel my milk's coming. Yeah. Like you can actually, some people can't feel a letdown, but a lot of people can. It's just funny. I can feel like I'm going to have a letdown. Oh, I know. I can still feel it now. I feel like I am and I only think it was a lot months ago. I know. Visceral reaction. Yeah. But, yeah, it's like all I can explain is like this very quick, intense pressure to your boobs and then it's gone.