New mothers can get help, advice on nursing their baby
[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with a podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Upstate's Breast Health and Breastfeeding Medicine division has expanded its services with a public phone number dedicated to lactation assistance. I'm talking with the director of the division, Dr. Jayne Charlamb, along with nurse Michelle Dwyer. Dr. Charlamb is an associate professor in internal medicine and obstetrics and gynecology at Upstate, and nurse Dwyer is a nurse with more than 30 years experience in maternal child healthcare. Both are international board certified lactation consultants. Welcome to "The Informed Patient," both of you.
[00:00:46] Jayne Charlamb, MD: Thank you. It's a pleasure to be here.
[00:00:48] Michele Dwyer, RN: Thank you, Amber.
[00:00:50] Host Amber Smith: Why is it important to have a phone number that anyone can call to get answers about lactation, ...Dr. Charlamb?
[00:00:57] Jayne Charlamb, MD: You know, I think for a long time our medical community promoted breastfeeding but didn't do enough to support our families who wanted to breastfeed. And it's difficult sometimes for families to know where to go for help. Their pediatrician may not be available 24/7 or may not understand some of the aspects of breastfeeding not directly related to the baby, and the obstetrician may not have that specialty training on how breastfeeding works in terms of the baby.
So we felt that it would be great to have a one number place that would be easy for families to reach the breastfeeding support they need.
[00:01:42] Host Amber Smith: So the number -- (3 1 5) 4 6 4 - milk, or 6 4 5 5 -- during what hours is that available for people to call?
[00:01:52] Jayne Charlamb, MD: That's available 24/7. You are not going to get a live person on the other end 24/7, but there is a recording explaining where you can go for help during normal business hours. And if you do need help during the off hours, if it's an emergency and it can't wait, there is a number that we give that you can talk to a live person anytime, day or night.
And so this is for anyone. They don't have to be a patient of yours, or a patient of anywhere at Upstate. Do they have to have insurance to call?
Not at all. This is for any family. We really encourage families, regardless of where they delivered their child, to call and get support. We take all the insurances that Upstate takes, and that's never even a question on the phone, what types of insurance. If a family needs to be seen in person, then we make it work.
[00:02:57] Host Amber Smith: How often do people who call end up having an in-person appointment?
[00:03:03] Jayne Charlamb, MD: I think I'm going to let Michele answer that because she is our best go-to as far as responding to phone calls.
[00:03:11] Michele Dwyer, RN: As far as the percentage, I would say at least 50%. Many times I can triage on the phone, and it's a quick question; it's a quick answer. Maybe I'll be on the phone for 15 minutes, and I will literally be just helping that mom so she can put the phone down and go back and take care of herself and her family. If it gets to be a little bit longer than 15 minutes, I can kind of feel it out that to best help you and best serve you, let's make an appointment. Do you feel like you could do that, and come with a support person?
So a fair answer would be 50%. I would like it to be 70% because it would be easier to evaluate a problem in person for sure.
[00:04:02] Host Amber Smith: Well, Dr. Charlamb, if I understand correctly, this number existed before, but it was just for physician use to call you, because you're one of a few physicians in New York State to be an international board certified lactation consultant. So what sorts of questions would you typically get from your physician colleagues about breastfeeding?
[00:04:24] Jayne Charlamb, MD: Very often physicians, honestly, would use that number to call us to say, "Hey, how can we get our patients to you?" And that's when we realized, wow, we really should establish something for the general public.
But physicians often have questions. I think most of them revolve around procedures and medications and whether or not they would be safe for their patients to use in a situation in which mom is breastfeeding and may need a certain antibiotic or a certain type of surgery, and how would that imp impact breastfeeding? And we're still very happy to answer those questions either from a family or from a pediatrician or a surgeon and whatnot. I do receive calls fairly frequently from our emergency room or from various people at Upstate and even other hospitals. I'm very happy to support that.
Interestingly, the vast, vast majority of medications are actually very compatible with breastfeeding, and I think there's a lot of concern -- rightfully out there; we never want to do any harm -- but I am very often able to reassure a medical provider or a family that that medication is just fine. And usually the answer is, it's just fine, or we can find something that is a safe alternative.
[00:05:35] Host Amber Smith: Well, let's talk about the benefits of breastfeeding for the baby...nurse Dwyer?
[00:05:42] Michele Dwyer, RN: A multitude. Coming off of the recent pandemic that we had, breastfeeding -- and we knew this was going to happen; Dr. Charlamb and I talked about this early on in the pandemic -- that early immunity and protection is most likely going to enter into the breast milk. And what better way to bolster up our civilization is to pass along the immunity via the breast milk, to the babies that were being born, coming into this situation.
And that did happen. The antibodies were found in the breast milk. I believe babies, they had immunities. I believe that was also found as well, babies that were nursing at the breast. That would be the first situation, I would say, that you're just passing along all of your good things to your baby.
And I tell my mothers that every time your baby gets any drop of your best breast milk, just like you are inoculating them to all of the situations that are out in the world. And that is a very empowering and very helpful piece of knowledge for a mom because she does put a lot pressure on herself.
Another benefit would be just that you're able, you made this baby for nine months, and now this baby is born and you're going to bring this baby to the breast and give the most perfect food that has been specifically made for your infant, as opposed to if you were going to nurse another infant that was not yours. And it's just a full circle. And you're going to nurture that baby and provide nutrition. And essentially your baby is going to grow with the milk that you're providing. And it's a very empowering thing for a mom to see.
It just brings the whole maternal child full circle, I believe. So many, many benefits. Those would be my two biggest, is that you're just bolstering your baby to face the world and everything that is in it, and you're also nurturing that bond with your baby.
[00:07:51] Jayne Charlamb, MD: I think building on that, looking at the results of that type of relationship, we look at the immune function that Michele mentioned is huge. We know that the baby's immune system is immature when that baby is born, and this helps the physiologic growth and development of the immune system, protecting against infection.
We know that babies that are breastfed are less likely to get chest infections, ear infections, diarrhea. Over the longer term, even when we're talking in terms of months of breastfeeding, we know babies will be having a significantly lower risk of dying of SIDS (Sudden Infant Death Syndrome,) and that's something that I think every family is very fearful of. And if they want to do everything possible, that's a very empowering, good way to reduce risk of SIDS.
Certainly we see reduced risk of leukemia in infants. And getting older even, there are some indications that infants that are breastfed for at least one year, when they are older, less likely to develop obesity, which in our current atmosphere of concern about this epidemic of obesity, to be able to set up one's child to have less likely to have problems with that is a really wonderful thing.
[00:09:15] Host Amber Smith: Are there benefits for the mom?
[00:09:18] Jayne Charlamb, MD: Oh, 100%. As Michele mentioned, I think the bonding is a big part about it. There's the ease relative to having to wash bottles and sterilization in the early days.
From the medical standpoint, though, we're starting to have a growing understanding of benefits to mom that we didn't really acknowledge or understand years ago. We know that women who breastfeed are less likely to develop breast cancer, are less likely to develop ovarian cancer and even heart disease.
That seems to be a growing acknowledgement in the medical community that, of course, I think the general medical practitioner at this point understands fully that breastfeeding is good for baby, but we're now starting to get a better understanding that, wow, this is really important for moms as well.
You spend, as Michele mentioned, nine months growing this human inside of you. And there are many, many changes that go on in a pregnant person's body, including laying down fat stores and changing the way our glucose, our sugars are stored, and our metabolism works. And all of that really is nature's way of preparing this adult body to breastfeed.
And if we halt that, after delivery, if we say, OK, we're just going to get formula and not go through that lactation stage for that woman who just delivered an infant, that's not the physiologic norm. That's not what her body was set up to do. So there are repercussions to that which we can see -- that women that have a pregnancy without breastfeeding, for example, those women are more likely to go on to develop diabetes years down the road. So I think as time goes on, we're recognizing this isn't so much about what's best for the baby, but what is best for the family.
[00:11:21] Host Amber Smith: Do you have an estimate for what percent of women who give birth are choosing to breastfeed now, in 2023?
[00:11:28] Jayne Charlamb, MD: The best tracking in the United States is done by the C D C (Centers for Disease Control and Prevention.) And their data that came out in 2022 showed us really a nice number of families start out breastfeeding their infants. Over 83% of infants born in the US have been receiving some breast milk. Now that might be one day in the hospital. It might go on longer. And as we see, although the vast majority of babies start out receiving some breast milk, that number, that percentage goes down gradually. By the middle of the first year, only about 55% of babies will be getting any breast milk, and only about one in four babies will be exclusively breastfed at six months.
And as many of your listeners know, I'm sure, the American Academy of Pediatrics and the C D C both recommend exclusive breastfeeding for our infants to six months. So we're really meeting our goals, I think, at the beginning. But over time it wanes down. The number of families that are either wanting to or able to continue breastfeeding with a recommended amount at that six month period.
[00:12:44] Michele Dwyer, RN: Amber, I'd like to add -- not to belabor the pandemic -- but I personally, on the ground, saw many mothers who would not, and were not going to choose to breastfeed, choose to breastfeed because of the knowledge that they knew that they were passing along immunity and supporting that immune system in their baby.
Also, there was a (infant) formula scare and a shortage, and I had many mothers, and so I saw an influx, and I think our numbers will be higher just from that. A lot of mothers actually reevaluated how they were going to feed their baby, and that was a positive thing. So we ran with that in the breastfeeding medicine program and just capitalized on the fact that these mothers inherently knew and we just reinforced, "yes, you're right. This is the way to feed your baby. It's the safest way.".
[00:13:37] Jayne Charlamb, MD: I think Michele's right. We may see a nice tick up in the percentage, also because with the pandemic, many of us were home more, and there were opportunities for virtual work. So I think it made it be a cultural shift in the situation with moms and babies being in close proximity. A lot of the difficulties we see in families in the long-term breastfeeding, I think, are related to our culture and the separation that moms that are in the workforce faced.
So the pandemic, one of the silver linings, I think Michele is right, that our cultural shift was to keep moms and babies together longer.
[00:14:19] Host Amber Smith: Do you know how breastfeeding in the US compares with breastfeeding or formula usage elsewhere in the world?
[00:14:28] Jayne Charlamb, MD: So it's very variable in the world. The US is pretty comparable to most Western countries. It's interesting when you look at other countries, one might expect, oh, the most advanced countries have higher breastfeeding rates. And that typically is not the case, because those same countries that we think are so wonderful and advanced and developed, they separate moms and babies. They don't necessarily have great maternity leave.
Very fortunately, we do have safe alternatives. We know our families have access to clean water and to regulated formula products. When you look at other countries, that's not the case.
Surprisingly the country with the highest breastfeeding rate would be Croatia. There, they likely don't have alternatives. It's the cultural norm to breastfeed because that absolutely is the safest option, and for many families, the only option.
The lowest in the world is actually in Ireland. It's not easy to predict which country. I think a lot of it has to do with availability and resources and education. But some of the countries, I think we in the US sometimes wrongly look down upon as far as their resources and their education. I think we can learn a lot from them, and they know how to breastfeed. So it's really variable, I guess is the word I would give you.
[00:16:01] Michele Dwyer, RN: I will add that, personally, I think that in the United States we overthink breastfeeding. And as Cr. Charlamb had mentioned, I have had patients who come from other countries, and they don't understand why there is not more breastfeeding here. They don't understand how anyone can consider another form of nutrition for their baby. And, it's just understood. And it's a really refreshing kind of a mindset.
[00:16:29] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Jayne Charlamb, who directs Upstate's breast health and breastfeeding medicine division, and Michele Dwyer, who is a nurse with more than 30 years experience in maternal child health care. And before we get back to the interview, let me remind listeners that the number to call for lactation support is (3 1 5) - 464 - m i l k, milk, or 6 4 5 5.
Well, let me ask you a little about the history of breastfeeding, because before formula was developed, nursing was the only option, right?
[00:17:11] Michele Dwyer, RN: That was the only option, and that's an excellent, excellent question because I will have mothers here in the lactation support center, and they are really anxious. They want this to work. They have a lot on their mind; they're just trying to get in the way of a successful breastfeeding relationship with their baby. And I bring them right back to the beginning. That civilization, as we know it, would not survive. We would be extinct by now if breastfeeding did not work. That was the only way, or else you died, that was it.
So when I make it that stark for a mom, it's somehow easier for her because she now does have lots of support. It's not a life and death situation. You have support that is available to you, we'll meet you at where your goals are because every family is different. But that was an excellent question because it's the truth. Without a mother, a female, being able to able nourish her infant, we would be extinct, and we wouldn't be having this conversation. We wouldn't be here.
[00:18:25] Jayne Charlamb, MD: In times in the past, certainly, and I think now, too, biologically, we estimate about one in 20, perhaps, about 5% of women are not able to -- for various reasons -- physically breastfeed their baby. Just as there are some women that have issues with infertility, there are some women that have issues with developing the milk supply. And I think we have ability now to support those families and fix some of the issues that they did not have thousands of years ago.
Before modern medicine, breastfeeding was the preferred choice of feeding infants, just as it is today. So in the past, what would've happened is you would get what we call a wet nurse. It would be another sometimes related, sometimes unrelated woman who would breastfeed that baby. And this was very common. And if you look at Europe in the 18th century, and even in America, in the colonial period, very common to hire a wet nurse who would potentially live with you. Or sometimes they would even send the infants out to live at the home of the wet nurse. And in Europe there was a huge demand for this service. And it wasn't just because women couldn't breastfeed. They would choose not to. They were thoughts that it wasn't good for her figure, or she was too busy with her social calendar. And so if you could afford it, you would hire a wet nurse, and the government in Europe actually regulated. There were laws mandating that the wet nurses have routine health examinations, and there were set guidelines.
This fell out of favor over the next couple hundred years and at that point sort of coincided with the development of infant formula. But it wasn't really until the early 19th century, or late 19th century, actually, that we had commercialized formula here in the US.
[00:20:17] Host Amber Smith: Well, among the moms who breastfeed today, what are some of the most common difficulties? And how are they fixed?
[00:20:24] Michele Dwyer, RN: Well, the most that I see now, it really comes down to the latch. I think there's a misconception that once the infant is born, you're just going to bring that baby to the breast, and it's all going to just all to work out.
It does, many times, all work out, and I don't see those mothers. But, many times it does not. There's pain. There's a little bit of fear. There's anxiety. There is worrying about your baby's weight. Am I feeding the baby enough? Can I just come in and get like a number there? There's a lot of being wrapped up in the numbers, like the weight of the baby, am I making enough milk?
So what we do is, I always say that the easiest thing that I can do is to show the mother, yes, you do have enough milk, as far as the volume, as far as the number. Yes, your baby's weight is absolutely fine, and we talk about the number. But more importantly, what I try to do is to support the doubt. There's a lot of doubt. Am I doing it right?
Mothers will hear a conversation, regarding their baby and how much milk they're making, and they will take the negative parts. They will hear it in a negative fashion. I'm not doing enough. I'm not making enough. My baby doesn't weigh enough. My baby's not as big as this baby over here.
So the majority, again, the details are easy for me to take care of. I can show them that everything is OK. Then the more extensive part of the visit will be to offer that emotional support. You can do it. You're doing a fantastic job. And I usually will not see a mother just once. It is a process. I'll see them two or three times in a month, in the early weeks of their infant, to get them through that one to four weeks of age for their baby, till they're really getting their sea legs, that they feel like, OK, I think I can do this. And I will hear from them, which is so heartwarming to me, throughout the whole year. They will call me. My baby's going to start eating complementary foods. How do I go about that? My baby wants to wean. My baby's 11 months old. How am I going to do that?
So it's a relationship that we formed way in the beginning and it is one of the highlights of my job, I will say that.
[00:22:53] Jayne Charlamb, MD: Right now, the families having babies, when they themselves were born, breastfeeding was not as common, and so they were not raised seeing breastfeeding among their siblings, among their friends. And so I think what Michele provides is what would be naturally provided if we lived in a culture in which 98% of babies were breastfed. We would see our siblings, our cousins, our friends. Then we'd have a bunch of supportive women who have been there and experienced these problems surrounding our new families and helping them to breastfeed successfully.
And we don't have that established in our culture. Very often, the connection is just through Facebook to friends. A new mom may live thousands of miles from her family, may not have connections to other families who have successfully breastfed. So the basics of supporting a new young family really go back to personal support, and that's what our program strives to provide. And that's what Michele is so good at.
And there are medical issues as well. And so that's when I end up getting involved. But again, those are relatively rare. I'd say 90% of what comes to us on these phone lines is handled very quickly and very easily with some real basic support.
[00:24:21] Host Amber Smith: Do moms who have twins and triplets, do they automatically have more of a challenge breastfeeding?
[00:24:28] Michele Dwyer, RN: They do, just because of the sheer number. It can be overwhelming. And so I always say thank goodness we get nine months or so to realize that we are going to be breastfeeding two babies or three babies. But it's easily managed.
The beautiful thing regarding the lactating female -- her body will accommodate two, or three babies. It can be extremely overwhelming. So that comes back to the support. But the female body is a beautiful mechanism, that it just will kick in. It will take a lot of time. But it is absolutely doable. And again, I'll say it again, it will take a lot of time.
And so that goes to the emotional part, to the mother and the family, the family as a whole, because we have a support person who is involved, who is very caring and doesn't want to see their wife or mother of their children getting exhausted. So there's a whole dynamic that does expand when there is more than one baby that you're trying to keep alive. But it can be done. It absolutely can be done. So we do like to offer that support.
[00:25:49] Host Amber Smith: Well, the theme for this year's World Breastfeeding Week was "Let's make breastfeeding and work, work." So I'd like to talk about the difficulties, in 2023, for women in the US who want to breastfeed while working outside of the home. Are there things being done to help make that available as an option for women?
[00:26:10] Michele Dwyer, RN: It is getting better, Amber. Much better. I have been doing this for over 30 years, and 30 years ago, not to be very specific, but I remember pumping in a bathroom, with a hand pump, and trying to get it done so I get back to work. And of course, I worked for maternal child, and I'm in the department of maternal child, and I had to cram it in to pump. And it was very stressful, very, very stressful.
But we have come, thankfully, a long way. We here at the breastfeeding medicine program, with Dr. Charlamb and other lactation support that is out in the community, have got together in recent years to advocate that businesses locally, because they legally have to provide a spot for a mother to pump where she's comfortable, and there will be privacy, and she is allotted time to do that, so that we can support the breastfeeding.
So there are many rooms that I know of that have been incorporated into local businesses. We here at Upstate have them in almost every facility, actually every facility that I can think of now. And you have to have an electrical outlet. You have to have a sink would be nice, basic things, a chair, privacy.
So we have come a long way. We do have a little bit further to go. I know my teachers that are out there that go back to work, I would say they have the most difficult time. School systems try to find room, but I think space, there isn't a lot of it, from what I'm hearing in general. So they have a hard time. I would like for that not to be. And, again, in the restaurant, the customer service facet of employment. Those mothers have to fight very hard to continue to provide breast milk for their baby for a full year if that is what they want to do. We're getting better, but we have a little bit ways to go, to answer your question.
[00:28:25] Jayne Charlamb, MD: You know, looking historically, I'm very proud of New York State. We were the first state in the United States to enact any legislation protecting breastfeeding. Back in 1984, they took breastfeeding and made an exemption from the public indecency offenses. And about a decade later, there was New York Civil Rights law giving a breastfeeding mom the right to breastfeed in any location she's otherwise able to be, private or public.
And more recently, like Michele alluded to, New York State labor law gives all employees in New York the right to express breast milk in the workplace, regardless of the size or the nature of their business.
But there are still challenges, especially in the industries Michele mentioned. I think the next place we need to go with this is to say, great, we now have the time when the lactating parent is separated from the baby. We're allowing pumping. But I think we need to start having a cultural shift looking more at longer parental leaves, because while it is great to be able to pump, it is not the same. And to expect a new parent six weeks after a delivery of a baby, to go back into the workforce and pump and come home and do laundry, and do diapers and do bottles is an awful lot. At that point, breastfeeding is just beginning to, you're just kind of getting your groove.
So my next push now that we're doing great with a pumping while at work, my next push will be to advocate for parental leave. And I think we in the United States are behind on that. Frankly, when you look at the opportunities for being home with one's family after the delivery of a baby in the EU (European Union) and at various other countries, we're way behind.
[00:30:22] Host Amber Smith: Well, I want to thank both of you for making time for this important discussion.
[00:30:26] Jayne Charlamb, MD: It was great being here.
[00:30:28] Michele Dwyer, RN: Thank you so much, Amber.
[00:30:30] Host Amber Smith: My guests have been Dr. Jayne Charlamb -- she's an associate professor in internal medicine and obstetrics and gynecology at Upstate -- and nurse Michele Dwyer, who has more than 30 years experience in maternal child healthcare. Both are international board certified lactation consultants. And the number to call with infant feeding issues is (3 1 5) 4 6 4 - m i l k, or 6 4 5 5.
"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please rate and review "The Informed Patient" podcast on Spotify, Apple, YouTube, or wherever you're listening.
This is your host, Amber Smith, thanking you for listening.