Bonus: Baby-Friendly Hospitals, Extended Breastfeeding and More!

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Shanna Micko: Hi. Welcome to Big Fat Positive with Shanna and Laura. Today we have a very special bonus episode with more of Laura’s conversation with Jessica Claire, IBCLC lactation consultant. They had so much to talk about in the last episode that we just couldn’t fit it all in, but we wanted you to have that great content. So we put it all together in this little bonus episode for you. So sit back, relax and enjoy Laura and Jessica’s conversation on Baby-Friendly hospitals, common issues that Jessica wishes new moms knew going into motherhood: when’s a good time to wean breastfeeding and more. Enjoy the show.

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Laura Birek: Actually, we just wanted to know a little bit about you and how you got started as a lactation consultant. What inspired you to even go down this path?

Jessica Claire: Fabulous question, because I was doing something completely before. I was completely different. I was an actor, I was a teacher of actors in all my early twenties and I had my first child 15 years ago and I was fortunate enough to be able to stay home with her basically and that was my plan: work a little tiny bit, but really, really stay home with her. I fell in love with breastfeeding. I really, really connected with my baby that way. I felt like it was not just a way to feed her, but also to connect with her emotionally and physically in all the ways. Then I had been attending my local La Leche League meeting and I really connected with the woman who was leading that meeting and she approached me and she said, “You love breastfeeding and you love helping the other moms who come to this meeting. Would you be interested in becoming a leader?” I said, “Oh my gosh, well, I guess. Okay.” I went through that whole training process, which took me a couple years actually, because you have to go through mostly communication training, technical lactation training, but it’s not a consultant. You become just a peer counselor. So I spent a few years just really casually helping other families in the community, but not in a clinical way and then I realized, okay, I really, really love this and I want to pivot my work life into something that feels more meaningful to me. So I went back to school, got a lot of background classes, a lot of lactation specific education, a lot of clinical training and sat for the board exam eight years ago and became an IBCLC at that point and then from there I opened my private practice. I work in a hospital as well.

Laura Birek: Okay.

Shanna Micko: So it really shifted from just doing kind of casual peer to peer support to something more clinical. In my private practice, I help families who are having a lot of difficulties. Like not just your average, like, you just need a little bit of help and support.

Laura Birek: I had a question actually, because you work here in the Family Room in San Marino. They have a new location in Toluca Lake.

Jessica Claire: Yes, we are opening a Family Room in Toluca Lake where I’ll be teaching prenatal breastfeeding classes once a month and I’ll be leading a weekly support group. We call it the breastfeeding hang, Tuesdays, 1 p.m. to 2:30 p.m. in Toluca Lake and on Mondays in San Marino Family Room 11:00 a.m. to 12:30 p.m.

Laura Birek: They can find that information on the Family Room?

Jessica Claire: Yeah, on their website: familyroomcenter.com.

Laura Birek: Great. You work at the Family Room, obviously, you host these groups and I think you also have people who come in and make private appointments with you.

Jessica Claire: Yes, I have a private office. I see people in my private office. I also do home visits if needed and then I work in a hospital setting too in the NICU postpartum in our clinic there. That’s separate, but very complimentary.

Laura Birek: So you do the whole…

Jessica Claire: I do everything.

Laura Birek: Since you work in a hospital, Shanna actually had this question, She texted it to me and was like, “Make sure you ask this question,” which is, so there’s this trend towards this Baby-Friendly hospital designation and I think when I was pregnant I didn’t really know much about it and then I was told, “We’re a Baby-Friendly hospital.” I was like, “Great. I don’t know what that means.” What do you think about that? What’s going on with that? Is that something that pregnant women should be looking for?

Jessica Claire: Sure. The Baby-Friendly initiative was started, oh gosh, I think probably 20, 25 years ago by UNICEF and WHO, the World Health Organization. Basically, what it is, is it’s a certification process that a facility can go through and they have to do all kinds of steps. They have to train all their staff on lactation education: their nursing staff, their lactation staff. They have to have policies in place that protect breastfeeding. So they’re not going to be routinely giving formula just for no reason. There needs to be either maternal choice like I’m planning on formula feeding my baby. It’s not banned in Baby-Friendly hospitals at all. I work in one. Or there needs to be medical necessity for formula supplementation and a policy surrounding that and there are other pieces to it, but basically what was happening before the Baby-Friendly movement is people were given formula as samples as they left the hospital. There was a lot of free advertising happening to parents from the formula companies and part of what Baby-Friendly is trying to do is to get that commercial interest out of the hospital so that parents really have free choice to breastfeed their baby and get the support that they need to do so. I don’t know if that makes any sense. There are quite a few hospitals in LA County that are Baby-Friendly certified. I do think it’s a good certification. It’s a good thing for a hospital to have pieces in place making sure their staff is trained, but that’s not the only path. California has a law. By 2025, every single hospital in California that has birthing patients is going to have to have a model hospital policy that protects breastfeeding that’s very similar to what Baby-Friendly is trying to achieve.

Laura Birek: Interesting. Because I feel like I’ve heard some pushback from people who wanted to use formula or their babies weren’t latching and they were having trouble or their milk wasn’t coming down in the hospital and they had bad experiences asking for formula.

Jessica Claire: Right. I’m sure that happens. I believe parents when they tell me things like that. That’s really unfortunate, because what’s supposed to happen in a conversation like that is the nurse or the lactation consultant is supposed to explore reasons for either wanting or needing formula and to respect the wishes of the parents. So I can’t vouch for any particular person or experience, but I would say when Baby-Friendly has done well, it increases breastfeeding rates, because at least in my hospital, 95% of our patients coming in want to exclusively breastfeed their babies.

Laura Birek: Wow. Cool.

Jessica Claire: But not that many leave during that, because we have jaundice issue, all kinds of issues that might come up during the hospital stay and so basically a hundred percent of formula feeding parents coming in get to leave with their goal intact and that’s what Baby-Friendly’s trying to do is protect the right of the parents to at least pursue the goal of breastfeeding.

Laura Birek: Okay.

Jessica Claire: But it’s not about not giving formula if it’s being requested or denying the baby food if they’re clearly not feeding well. That means it’s being implemented poorly I would say.

Laura Birek: Good to know. What’s one of the most common issues you see as a lactation consultant that you wish new moms knew about going in?

Jessica Claire: I feel like one big issue is just unrealistic expectations of newborn behavior. Meaning I think some people, they’ll read a book or they hear from a friend with a slightly older baby about this like every three hour schedule and it’s really not typically like that in the very beginning if we want to establish breastfeeding really well. The amount of skin to skin time that helps to promote a lot of breastfeeding and establishing that milk supply can be overwhelming if people aren’t really ready for it and so I feel like that’s one piece. Your baby is going to cue you to feed not necessarily every two to three hours. Sometimes it’s going to be cluster feeding for a few hours, especially in that first six week period of life. That’s one thing. Just the amount of body time that you’re going to be spending with your newborn is something that I wish more people were aware of because it can be overwhelming.

Laura Birek: I remember we had a lot of cluster feeding.

Jessica Claire: Yes, it’s completely exhausting and especially if you have like a mother-in-law there who formula fed her kids like, well, I just gave a bottle and then the baby slept three or four hours. Breastfeeding doesn’t quite work that way, especially in the beginning. So that’s one thing that I try to educate people about in my prenatal classes and that’s not to say if a mom’s feeling really overwhelmed and she needs some time alone, it’s okay to hand the baby off to somebody else or swaddle the baby and put it down. But really that newborn is expecting a ton of touching and a ton of body contact and a lot of cluster feeding and comfort nursing and feeding nursing and that’s just the way a newborn human is wired.

Laura Birek: If the mom is overwhelmed and just can’t handle it anymore, if the dad does or the non-breastfeeding partner does skin to skin, is that a good substitute?

Jessica Claire: Yeah, that’s fabulous. Nils Bergman is this neonatologist researcher of skin to skin. He’s in South Africa and he recommends at least an hour of skin to skin time with the non-birthing parent.

Laura Birek: Okay.

Jessica Claire: So to prioritize the breastfeeding parent, because it helps with milk making hormones, lots of skin to skin, lots of touching and holding. But for a certain period every 24 hours, the other parent if we’re talking about a two parent family, it’s great for them to be doing skin to skin to help bond with that baby too.

Laura Birek: They are so cute. I miss it. I just want a little baby.

Jessica Claire: I miss it.

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Laura Birek: So when we’re talking about working towards no longer breastfeeding, is there an ideal time to do it or do you have any…

Jessica Claire: Like an age?

Laura Birek: Yes.

Jessica Claire: Oh gosh. Breastfeeding is such a culturally prescribed behavior. So in the US, we have relatively early weaning ages in general that has to do with the fact that our maternity leave sucks and also cultural ideals. I think Americans in general really value independence and so this idea that the kid is going to be on the breast for… A number of people have their hard stop numbers and so in the US we definitely wean babies much earlier than in some other places in the world. But we can talk about public health recommendations if that’s helpful. So World Health Organization has a recommendation of exclusive breast milk feeding, breastfeeding, and or milk and bottles, six months start solids and then you continue to breastfeed along with complimentary foods for two years or beyond. That’s their recommendation for babies worldwide and it feels really long to most American families, especially before they’ve even had a baby. I don’t know anyone who did that and so I think a couple things to remember that the benefits of breastfeeding for maternal health and child health, both immunologically nutritionally and also sort of socially and psychologically don’t ever end. There is no really like, okay, after 12 months the milk is Mountain Dew. Do you understand what I’m saying? The sort of baseline benefits continue for as long as you want to do it. That being said, I think it’s really important for parents who are breastfeeding to really be honest with themselves as they go along this journey like, is this still working for me too because this is a relationship? Especially if we’re talking about nursing a toddler, it’s a very different activity than a little baby who’s just sitting there and looking up at you. A toddler they want to have a little snack and then they’ll be at the breast and then they’ll go play with their trucks and then they’ll come back and they might try to climb all over you and although technically speaking nursing is really beneficial to both mom and baby, I think it’s important. I always advocate for moms or breastfeeding parents to really be like, okay, do I need to put limits around this? Am I still okay with how this is going because it’s my body too?

Laura Birek: No, that’s a great way. I’m still nursing.

Jessica Claire: Cool.

Laura Birek: It’s definitely a different experience. I don’t know if you’ve ever looked up the #gymnursesticks on Instagram.

Jessica Claire: Oh, yeah, yeah, yeah. I’ve seen stick drawings of toddler nursing and it’s true. It can be intense. Some things to think about, a lot of times toddlers between 12 and 18 or 12 and 24 months are not the best eaters. Meaning they can be really spotty with their nutrition and a lot of times I have moms who never thought they would nurse past a year. Oh my gosh, I’m so glad at least they’re nursing 3, 4, 5 times a day, because I know baseline nutrition my milk is still super nutritious, has tons of immune properties in it and even though if you only ate a rice cracker and a chicken nugget today, at least there’s I know some good nutrition getting into my toddler. So like I said, it can be a real plus for the parent too to feel like, even though this is hard and it’s taking up my time, I know that at least I have some of the nutrition covered for my toddler. So there are benefits for the parent too.

Laura Birek: That makes sense. My mom tells anyone who expresses a passing interest that I nursed apparently till I was three. I don’t even know.

Jessica Claire: That’s a very deep memory for her and she’s proud of it like, wow, I provided this for my daughter and it was a big part of our life when she was little and I was a young mom. I don’t know. How does it make you feel? Does it make you feel embarrassed?

Laura Birek: I used to be very embarrassed, because she would tell people when I was a teenager. No one wants to have their mom talking about how you were breastfeeding until you were three. But now I think it’s sweet and also I’m, “extended breastfeeding” my baby, because he’s passed a year in American terms. So I definitely understand what she was going through. I think it’s sweet now, but also, I used to be embarrassed by all these things I did as a kid and a baby that she would tell me about and I realized I didn’t have any control over that I was a baby.

Jessica Claire: Yeah, you were just doing what you were doing.

Laura Birek: But it’s definitely an outlier in the US at least.

Jessica Claire: Absolutely. Although I will say at the hospital we see pretty wide variety of people from all walks of life. I’ve been surprised and I’ve worked there for four and a half years, because I always get a little bit of a history, did you breastfeed your older kids and for how long? How many people have nursed for two years or beyond? So I feel like a lot of times you just wouldn’t know, because there may be only nursing in the morning and the night.

Laura Birek: Sure.

Jessica Claire: That might go on for a year or longer.

Laura Birek: I definitely find that when I’m nursing in public now, because my baby is moving all around that there’s definitely a bit more. I never got the judgment. When he was a newborn, no one ever even looked badly at me.

Jessica Claire: I love to hear that.

Laura Birek: I never heard anything bad.

Jessica Claire: Good.

Laura Birek: People would say, “That’s beautiful,” but now I definitely see people being like, what is that big kid doing? Maybe I’m projecting, but I definitely notice some looks of scan from people.

Jessica Claire: Why is she nursing that older kid in public or at all? Again, it has to do with the fact that in general, culturally, it’s a little out of our frame of reference for most folks to be nursing past a year. But it’s been eye opening in that job in particular, because I was surprised. I thought we’re going to see six months, a year. But I know quite a few people and often when they tell me, “I nursed for two years,” they’re a little embarrassed and I always say, you did your kid a solid. That was amazing for both your metabolic health and other cancer prevention for you and also your child’s immune system and nutritional baseline. So I try to shore them up so they don’t feel so embarrassed.

Laura Birek: It’s so interesting how people feel embarrassed if they can’t breastfeed.

Jessica Claire: I know.

Laura Birek: There’s the very narrow window of what’s socially acceptable.

Jessica Claire: Oh my gosh. There’s so much feeling and emotion and judgment that surrounds infant feeding in general and I’m making the best effort I can to really try to be very open and we’re in this together and not everybody who wants to breastfeed gets to do it and then some of us choose not to for whatever reason, none of my business. But I would say most American women at this point definitely want to breastfeed at least in infancy and then as you probably have already seen some of your peer group people are either weaning or the baby stopped breastfeeding on their own.

Laura Birek: Shanna’s talked about it. I think her first daughter breasted till six months and then transitioned to formula and I think CeCe her younger daughter was eight months. Shanna, don’t hate me for not remembering, but they had a really hard path. She had a lot of problems with production and weight gain and so she really took that as a big win.

Jessica Claire: Absolutely.

Laura Birek: Okay. We have one final question, which is actually about food. It’s from a listener from the UK unnamed on Instagram. They’re wondering when you should start introducing nuts. This is not necessarily your realm, but I bet you know.

Jessica Claire: Yeah, you ask 5, 10 allergists and they’re pediatric allergists, they’re going to get a lot of different answers. There was a study or two out of Israel showing that kids introduced to peanut protein early, like four months, five months had a lower incidence of peanut allergy later in life and so there was a bit of a push to introduce peanut butter early. I don’t have a pat answer. I think you need to look at your families. Do you have allergic people in your family in general? Then of course there’s the choking hazard issue too. Are we giving it as a paste? Are we giving it as whole nuts? Nuts to me are a healthy food, but again, peanuts in particular are highly allergenic for a certain amount of the population and the research flip flops, so I don’t have a pat answer to that, but I would ask the pediatrician. I think traditionally most people are introducing nuts around 12 months, but there are some pediatricians that recommend a much earlier introduction to peanuts and maybe other tree nuts. But again, I would ask your doctor about that because you may have particular health history.

Laura Birek: Sure. I know that infants with eczema worry a lot about that sort of thing too. That’s the end of our listener questions. I just had one final question for you, which is, do you want to tell us again like how we can find you, people need your help or want to join in your… What do you call them?

Jessica Claire: Breastfeeding hang. Yes, okay. So my website is lactationconsultantla.com and my Instagram handle is jessica.claire.ibclc. Let’s see. Every Monday I’m at the Family Room San Marino starting in March 11:00 a.m. to 12:30 p.m. and that’s a drop in, come with your questions and your baby: breastfeeding hang. Then the Toluca Lake breastfeeding hang is going to be every Tuesday from 1 to 2:30 p.m. So I’d love to see some folks there, because we’re just ramping up that space. That’s a brand new location, guys.

Laura Birek: Very exciting.

Jessica Claire: Yes.

Laura Birek: All right. Well, thank you again so, so much. You’re a great resource and we’re so happy to have you help us.

Jessica Claire: I’m so happy to be here. Thank you for having me again.

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Shanna Micko: That was so great. I really wish I could have been there in person and I definitely need to meet Jessica one of these days. Thanks Jessica again for joining us on the Big Fat Positive Podcast. Listeners, if you love our show, please spread the word. You know that we love word of mouth. If you know someone who’s trying to conceive, who’s pregnant, a new mom, let them know about Big Fat Positive. You can find us on all the social medias at BFP Podcast. We have a website, bigfatpositivepodcast.com, and if you want to join our conversation or tell us what you think about us or our show, or have any questions for us, whatever’s on your mind, shoot us an email. You can reach us at [email protected]. Big Fat Positive is produced by Laura Birek, Shanna Micko and Steve Yager. We love you guys. Thanks so much for listening. Have a great weekend and we’ll see you on Monday. Bye.