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Alex Clark
Do nipples permanently change after breastfeeding? Like, never go back to what they looked like before you had kids?
Therese Dansby
Yeah.
Alex Clark
Oh boy. Why do some babies just seem not interested in breastfeeding right out the gate?
Therese Dansby
There are 5 to 15% of women that can't breastfeed. 87% of women want to breastfeed. Why are so few of them making it to the finish line? When you're in your third trimester and you're like, okay, I'm just waiting for this baby to come out, that's the time to start researching breastfeeding.
Alex Clark
Today's episode is a must listen for any mom navigating the wild, wonderful world of breastfeeding. Or maybe you're like me and you're not a mom yet, but you have a lot of questions about what to expect. I'm joined today by Therese Dansby, a former NICU nurse turned holistically minded lactation consultant who brings equal parts science, soul and strategy to supporting women on their nursing journeys. We're talking nipple changes. Are they permanent? Why breastfeeding feels impossible for some babies, the ins and outs of tandem feeding and even how your menstrual cycle might be messing with your letdown. Terese brings wisdom, warmth and a refreshingly honest take on what it really means to breastfeed in today's world. Watch this episode on the real Alex Clark YouTube channel or culture Apothecary on Spotify and make sure to pause really quick. Just right now. Leave a five star review on Apple or Spotify so you don't forget. Did you know that there is a Facebook group for additional discussion about Culture Apothecary? It's called Cute Servatives. You should join it. We're also on Instagram at Culture Apothecary and then I'm on there at Real Alex Clark. Please welcome lactation consultant and doula Therese Dansby. To Culture Apothecary is fed best or bare minimum.
Therese Dansby
Bed is the bare minimum. Breast milk is the biological norm. And I don't know any lactation consultants who are going to say don't feed your baby. Bed is minimum. And ideally breast milk, human milk for human babies gets us off on the right foot and keeps us growing.
Alex Clark
Tell us about the CDC breastfeeding report card. So it says over 80% of moms start breastfeeding. So then why by six months are we basically just bleeding out? Like, what is actually stopping American women women from meeting their breastfeeding goals?
Therese Dansby
There is a huge drop between even three months. So the breastfeeding report card every few Years it comes out, and it'll break it down by state, it'll break it down by the nation, it'll talk about breastfeeding initiation rates, and then it will tell you six months exclusively breastfed versus ever breastfed. And there's like a 25% difference in that. So, um, you know, 50 some percent babies are still getting some breast milk at six months, but they've been supplemented alongside formula. Only about 26% of babies in the US are exclusively breastfeeding at six months. So to rewind, the WHO and the AAP have breastfeeding guidelines, and they actually did not match up for a really long time. And in 2022, the AAP finally got up to speed, and now they both say that ideally, human babies should only have breast milk for the first six months of life. And then at six months, you introduce complementary solids. And the AAP used to say, and then you breastfeed to a year. And the WHO said, and then you breastfeed to two years. And in 2022, the AAP actually aligned with the WHO and said, actually, two years is the biological norm. And, you know, I don't always agree with the AAP, but their release on that in 2022 was really well written. And it was meant for pediatricians to essentially normalize breastfeeding to age, too.
Alex Clark
Is America setting women up to fail when it comes to breastfeeding? Like, are other countries doing this better? What is America refusing to address?
Therese Dansby
So one big thing is formula lobbying. The same way that other countries don't allow pharmaceutical advertising, other companies don't allow formula advertising. And there is a WHO code for the marketing of breast milk substitutes in the U.S. does not follow it.
Alex Clark
We don't follow the code.
Therese Dansby
We don't follow the code.
Alex Clark
And how. Why?
Therese Dansby
So the code says no promotion of breast milk. So that would. Or, I mean, no promotion of formula. So no ads, no commercials, no influencers, no idealization of formula. So you can't say formula is as good as breast milk. This is what the WHO code says. The WHO code says that you're not allowed to directly contact parents. But now every mom in the US has been sent a free can of formula.
Alex Clark
Dude, I have.
Therese Dansby
Yeah.
Alex Clark
And I'm not even a mom because.
Therese Dansby
You signed up for some random baby thing.
Alex Clark
I got a thing of formula in the mail, and I'm like, what am I supposed to do with this?
Therese Dansby
And it's so much weight because I never used mine. Like, it's. It's such a waste of money, right? And then accurate labeling and then the WHO code says that the local government is responsible for implementing and enforcing the WHO code and the US just blatantly doesn't. The formula companies, the top three are Abbott, Nestle and Mead John. And they are kind of actively lobbying against the WHO code, lobbying against maternity leave. The FDA and the FTC so far have only focused on the truth and advertising and accurate label part of it, but they've just disregarded the rest of it.
Alex Clark
Why does breastfeeding advice seem so inconsistent, especially from medical professionals? Like why do some providers give moms advice that really seems to end up sabotaging them?
Therese Dansby
I work in private practice and people's homes and in the hospital and I definitely have been in both of those consults where people just said, but the last person told me X, Y and Z or this person told me that. And there is also a lot of influencer breastfeeding advice out there too. You know, I've had clients say, well so and so swore by this haka and you know, or somebody said this hands free pump was the best. And it's just really painful. There is a lot of conflicting information and that's probably the biggest issue because breastfeeding, getting breastfeeding off on the right foot is so time sensitive. So, so when you're pregnant, you have this whole cascade of hormones. Your progesterone is really high at the end of pregnancy, your estrogen is really high, your prolactin is really high. Prolactin is the hormone that makes your breast milk. And then when you have the baby, you have the placenta come out, your progesterone and estrogen drop really quickly and the prolactin then kicks in. So the progesterone is inhibiting the prolactin when you're pregnant. So women can start leaking, they can hand express colostrum halfway through pregnancy. The milk's there, but it's not copious until the placenta comes out and you start frequently and efficiently removing milk. So if there's any sort of delay in the first latch, if there's any separation between the mom and the baby, if there's any early introduction of formula, your body immediately starts downregulating.
Alex Clark
Okay, so I have a question because you have experience as a NICU nurse, correct? So you've been in the nicu. I mean a lot of those babies, they're taken from mom pretty quickly and then there's that separation there. So is that one of those instances where you see these breastfeeding problems start?
Therese Dansby
It can be surprisingly I Don't know that it's the most common reason, but you need to be pumping to remove milk, ideally within three or four hours of delivery. If you're separated from your baby and, you know, the circumstances that take a baby to the NICU might prohibit that, there might be other priorities. And sometimes also hospital staff, their priorities are different than the mom's priorities. And the moms don't know what they don't know. And so then, you know, we're six hours, 12 hours later, and we haven't pumped or put the baby to the breast. And the body's like, I don't need this prolactin. The amount of milk, the. The frequency with which you remove milk in the first six days actually sets up your long term milk supply. So it's such a sensitive window that prolactin essentially bathes the cells in the breast that make milk, and they start getting sensitized to it. So we know about things like insulin resistance or, you know, TSH going really high when the thyroid's not responding. Prolactin has kind of a similar relationship with the milk making cells in the breast, and that that tissue is so sensitive to it. And if you don't use it, you lose it, basically.
Alex Clark
Almost all of my best friends now are married with kids or having their first babies. I mean, everyone I know, I'm like the last single one in my friend group. It seems like every other one of them has an experience of like, I had struggles breastfeeding or my baby wouldn't latch or I had to give up because it just wasn't working for me. Is that normal and for young moms across the world, or is this an American phenomenon?
Therese Dansby
I think it's a western phenomenon, just America. Part of it is the sexualization of breasts. I think in our culture, it's kind of taboo here to breastfeed in public. The laws for breastfeeding in public. This is wild. In 1995, it was only legal to breastfeed in public in 10 states. I never even heard that go.
Alex Clark
What?
Therese Dansby
It was included in the public indecency laws. Nebraska, where I'm from, only removed it from public indecency. Lindsay in 2019.
Alex Clark
Okay, that is crazy. I have never heard that. Yeah, but I mean, I feel like, you know, with these friends that struggle, though, it's just like my baby won't latch or like my baby is just flat out refusing the breast. Why do some babies just seem not interested in breastfeeding?
Therese Dansby
Right out the gate, we talk about a cascade of interventions in Birth. And I think that there's a cascade of interventions for breastfeeding too. And I think it actually starts when we're babies. So how were you fed? How are your siblings fed? How is body image and food and health talked about in your house? You know, did your dolls come with a boob? No, they came with a bottle.
Alex Clark
You know what you bringing that up. I never thought about that. You're right. Every baby doll I had, it had a little bottle. But that would be it seem, you know, inappropriate.
Therese Dansby
People would. Yeah, but there are other countries where people will breastfeed anytime, anywhere, and it's just a functional part of your body, like your hands.
Alex Clark
So if the cascade of interventions for breastfeeding starts with how you were fed, what are the other things that happen?
Therese Dansby
You know, there's an old, you know, proverb that says the best time to plant a fruit tree is 30 years ago, and the second best time is now. And I think the same is true with learning about breastfeeding. So, you know, my seven year old has seen me breastfeed. My three year old, that is totally normal to her. Most children do not have that experience. And so you are so focused on getting pregnant, staying present pregnant, having a good delivery. Most people say, I'll deal with breastfeeding when it happens, but because that window is so sensitive, there's something called primary low supply and secondary low supply, primary low supply. There are 5 to 15% of women that can't breastfeed. There is no judgment against that. I don't have any qualms with people giving formula. I have people that I love and know are fantastic parents that have chosen to give formula and that's fine. But I think that the, the problem is the huge gap of the women that start breastfeeding. Clearly, 87% of women want to breastfeed. Why are so few of them making it to the finish line? Primary can be caused by, you know, you had a guest on talking about thyroid health. If you have unregulated thyroid stuff, maybe an adolescent, perhaps you're on birth control pill and you're not cycling. Even in adolescence, when you cycle, the estrogen in the first half of your cycle grows your breasts, and then the progesterone differentiates the breast tissue into like functional tissue. And then you have your period and all dies back and it all starts over again every month. So every month you're essentially practicing putting your breasts to use.
Alex Clark
What do you say to the mom who tried everything, you know, from working with a lactation consultant to you name it and still couldn't make breastfeeding work.
Therese Dansby
Yeah, I have a lot of clients who work with me on their second baby. You know, they're like, I didn't know what I didn't know with my first. I wish I had known you. Not that I'm better than anyone else, but it's just finding a lactation consultant who maybe is like minded and has a similar lifestyle and similar goals and a similar way of communicating because there are a lot of right ways to breastfeed. And I think that's the other thing with the conflicting advice is that something really could have worked for somebody else and not for you or something like that. People are getting lost in the shuffle if they don't get good help either prenatally and go into it knowing what to expect or immediately postpartum.
Alex Clark
So what does that look like? Looking for a lactation consultant prenatal.
Therese Dansby
Taking a local breastfeeding class is a great idea. You will meet a local consultant. They should hopefully have a resource of a resource list of postpartum people in their area. There are for example pediatricians who specialize in breastfeeding medicine who if you're struggling with supply and you've done all the things, they can run a lab panel for you or body workers or ents or dentists. It really takes a full team and a lot of good referrals to make it work sometimes. And if you get started late, it's just a mad scramble to make it work.
Alex Clark
Why do so many moms think that they're not making enough milk when they.
Therese Dansby
Probably are perceived low supply is problematic because partly because of social media. So you see, you know, an ad for lactation cookies or some sort of electrolyte drink like this doubled my pumping output. And you see this bottle with 8 ounces of pumped milk and that's not normal, that's an oversupply. So a mom with a full milk supply who is just breastfeeding her baby is making about 25 to 30 ounces a day. So when you pump, if you pump three hours after the last feeding, you might only get 2 to 4 ounces. If you pump after a feeding, you might only get half an ounce to 2 ounces. And that's normal. But because we're not learning what's normal, then you look at the person who pumped 10 ounces in this ad and you're like quit.
Alex Clark
Why? Could oversupply have its own set of problems?
Therese Dansby
It can cause clogged ducts, mastitis. You're kind of tied to the pump because, you know, a baby's not drinking 60 ounces of milk a day. So you're kind of stuck breastfeeding and pumping around the clock.
Alex Clark
What affects that? Like how come some women would have such an excess amount of milk and some have just average.
Therese Dansby
Some of it can be, for example, some NICU moms who are on top of things and are pumping right away do end up with an oversupply because they're just being very vigilant about it and the pump is effective and they have the right flange size and they're going to town. And the pump, you just pump for 15 minutes. So it's not regulating your supply like a baby would. You know, when a baby gets full, they stop eating. The pump doesn't. So sometimes too, it's people who are afraid of low supply. And so they start pumping after feedings right in the hospital because they don't have low supply. But then they get oversupply. Some of it's hormones. Some people with pcos have low supply, some people have oversupply. Some of it is, I think, some gut health stuff too. So there are a lot of factors.
Alex Clark
Let's talk about gassy babies.
Therese Dansby
Okay.
Alex Clark
How much is diet related? And then, you know, are moms being told like they have to cut certain foods for absolute absolutely no reason?
Therese Dansby
Yeah. And this is probably almost the number one reason I would say to ask for help. And do not turn to social media because it's fine to crowdsource ask in your Facebook moms group. You're going to get 20 different people who have 20 different answers. And then you need to discern those answers, see what feels like the right fit for you, start paying attention to your baby, when is this happening? And then kind of ask for professional help based on what's going on. Because some babies are gassy because they are swallowing a lot of air. So they just have a bad latch and they're swallowing a lot of air. You know, like when you drink a carbonated beverage versus a flat beverage. And then some babies are gassy because they are, they're crampy and they are reacting to a food that mom is eating. And some babies too. That whole cascade of breastfeeding interventions, a lot of it is also birth, how birth went. I don't think there's a lot of informed consent about things like 37 week inductions or C sections or forceps and vacuums and labors under six hours and labor is over 30 hours. Also sometimes the babies come out really kind of stunned and they are not Always going through those cardinal movements of labor. And infant reflexes have so much to do with a good latch. Because breastfeeding takes two people, takes the mom, and it takes the baby and it's 50, 50. And so if the baby is not able to go through those birth reflexes and then go through those reflexes at the breast, they're not latching well. They're also crying. Because you've probably heard of craniosacral therapy. Like there's, you know, tension here from a baby who's my mom's been pushing for three hours and they have a huge cone head, can cause stomach pain, which sounds weird, but anybody who's taken a labor class has probably heard like, you know, tight hips equal to tight lips. If you're in labor and you're clenching down, you know, your doula or midwife should be like, okay, like lower the tone, open up, you know, relax. You know, if you're clenching your jaw, you're probably clenching your pelvic floor too. And babies do that too. And so if their pelvis is tight or, you know, anything in the craniosacral area is tight, they're not opening as wide, they're not extending their tongue as far. And then we've got the air stuff and we've got the tension. So there's not a short answer. Probably Reflux and gas and colic are some of the most frustrating cases. And I've dealt with it myself with my own kids with food allergies.
Alex Clark
Can a chiropractor adjustment right after birth help with breastfeeding?
Therese Dansby
It can help. Sometimes you also need somebody who can do soft tissue work like craniosacral therapy, craniofascial therapy, myofascial release. Sometimes you need both. It just kind of depends on how the birth went. We know about container syndrome in babies, so we don't want to be putting babies in car seats and swings for a long time because they start getting those flat heads. But I think that there's a little bit of container syndrome that happens in western cultures as well in utero, if you're not moving around, how much you move around and are not sedentary in pregnancy. Now, I'm not saying you have to run marathons, really working out walks up, just walking, just not sitting for four hours.
Alex Clark
Okay, Juicy, I've never heard anybody talk about that.
Therese Dansby
Yeah.
Alex Clark
What is the deal with 37 week inductions that women are not being told?
Therese Dansby
So inductions have increased since COVID times. And why? I think for a while they were like, we gotta swab you, we gotta make sure you're COVID negative control of the situation. And I don't think the rates have really gone down that much since then.
Alex Clark
Oh, of course not. They were so overjoyed to be able to get another thing on the schedule.
Therese Dansby
Control. Yeah. And so 37 weakers, we call them the great pretenders, they're late preterm babies, but your OB tells you that they're full term and they are, you know, you get to 37 weeks and all your baby apps, congratulations, you're full term. But 37 week babies, their brains are still like 20 less developed than a 40 week baby. And that matters. When it comes to coordinating the movements required for feeding, when it comes to being awake and alert enough for long enough for a good feeding, or when it comes to simply giving hunger cues, they'll be like, oh, my baby's great. They just sleep all night. Well, they're a 37 week. Or like they're tired. Their cues are not reliable until they're closer to full term.
Alex Clark
Sell us on why breast is best. Why breastfeeding? What is it about breast milk that is so magical, so special? What is it doing for mother's health? What is it doing for baby's health? Why should this be everyone's goal as much as possible?
Therese Dansby
So in 2016, the Lancet had a series on breastfeeding and they said that universal breastfeeding would prevent the deaths of 800,000 children under the age of five every year and 20,000 mothers every year. And people think, oh, well, that's just, you know, globally, third world countries. No, even in the US that is the case. Inadequate breastfeeding rates. In 2019, the WHO said that they actually caused a global economic loss of $302 billion because of the extra health care costs associated with it and the costs of formula.
Alex Clark
That's outrageous.
Therese Dansby
It is outrageous. And then there's plenty of health reasons and people who have heard breast is best, you know, these are amazing things, but they can also be guilt inducing for moms. Like, oh, I didn't, I didn't try hard enough. Like, nobody wants their baby to suffer the ill effects of their decisions. I mean, birth and feeding choices are so stressful because they're so high stakes. But, you know, breastfeeding for 13 weeks decreases your risk of diarrheal illnesses for seven years. So the effects of breast milk don't end. Breast milk colostrum, for example, is more immune modulating than it is nutritional. Colostrum is the milk that they're getting in the first day, it's lining their gut and it's programming their immunoglobulin response and it affects your long term health. So for moms who breastfeed for 15 weeks, their babies have a lower risk of severe respiratory infections for seven years. And then, you know, moms who BreastFeed for just four months decrease the risk of ear infections in their babies for three years.
Alex Clark
Wow.
Therese Dansby
So there's a huge health benefit. And then of course, the moms, you've got the decreased risk of breast cancer, ovarian cancer, cardiovascular disease, osteoporosis. And we all know, you know, everybody's like, oh, breast is best. That's why. Because those numbers do speak for themselves. But I think that what we're missing is at the end of the day, you need a personal why? It doesn't matter what the information is. You need to ask yourself. That's what I ask people in my breastfeeding class. Why do you want to breastfeed? And you need to talk to your partner about that while you're still pregnant. Because otherwise dads are so problem solving. They're like, well, let's just give a bottle at night, like you're struggling. I want this to be easier for you. Let me help.
Alex Clark
This is important because the husband, he's going to see his wife struggling and he wants to swoop in and save the day and he sees, you know, in tears, whatever, things are not going well. And he's like, you know what? I'm going to target, I'm getting the formula. But you're saying just like how you tell your obgyn my birth plan ahead of time. I do want this. I don't want this. It is. So you're setting those expectations so that when things are hard, your husband knows, like, what to do to help you power through it or whatever.
Therese Dansby
Yeah. And, and I think that for me, I did not realize how primal breastfeeding was. When I had my oldest, I had been a NICU nurse and I saw, you know, back in 2007, we were still giving a lot of formula in the NICUs. Now there are donor milk banks that are supporting a lot of NICUs, which is amazing. But back then I saw that the, the micro preemies, like under 28 weeks of age, they were going home so much sooner with the moms who breastfed and the moms who came in and helped them skin to skin. And so I knew intellectually that's why I wanted to breastfeed. But then I had this Baby. And you've been connecting them for nine months and suddenly you're two people. And it's like even hearing your baby cry across the room is like painful to you. Like, I'm tearing up. My kids are not babies anymore. But I was so used to babies crying, you know, I didn't care. Babies forever. Your own baby crying. You're like, like literally, you just want to. Yeah, bring them to you, bring them skin to skin, put them to the breast. And so for me, it was, it ended up being a lot of the emotional connection and a lot of also the self efficacy for having something be hard and getting through it anyways. And I think that that is also a lot of what's missing when I look at all my moms who have made it through really difficult breastfeeding things. That's the common denominator.
Alex Clark
So Therese Dansby hears people being like, women, you need to be doing an ice bath. You need that, like, mental strength. It'll help wake up your day. Like, no, you need to breastfeed. That's what's gonna do it.
Therese Dansby
It's so empowering.
Alex Clark
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Therese Dansby
That's interesting. For example, the rotavirus vaccine. If you actually read the research on it, it is not necessary for babies who are exclusively breastfed and not in daycare before four months of age.
Alex Clark
Wow.
Therese Dansby
Because breast milk has something in it called lactadhedrin that actually binds to rotavirus and inactivates it. And it is so effective that the vaccine isn't necessary.
Alex Clark
Okay, that's fascinating. Write that down. Write that down. Why are tongue ties everywhere now? Like, were we all just undiagnosed in the 80s and the 90s? Why is this like some new epidemic?
Therese Dansby
Yeah, that's the million dollar question. So there are two. It's a Venn diagram. You have something called oral motor dysfunction in one circle, and you have something oral ties in the other circle, and there's an overlap. So some babies can have what we would call an oral tie. So all of us have a frenulum under a tongue that attaches our tongue to the bottom of our mouth. All of us have a frenulum in our upper lip that. That connects the lip and the gums. We have other frenulums in our bodies too, but Some babies have frenulums that come up very close to the bottom gum line. Some have some that come up really close to the tip of the tongue. Some have some that are farther back, but they're really short and thick. To move breast milk effectively, a baby has to be able to move their tongue side to side. They have to be able to extend it, they have to be able to elevate it, and they have to be able to cup it and move it in a wave like motion. So imagine if you had a rubber band between your fingers and you're just trying to like, even do any sort like milk, a bottle or something. Like you just, you can't, you don't have that same range of motion. And so for some babies, they can have the, the physical extra frenulum or anterior frenulum attachments, but it's very flexible and they function just fine. So we have to look at form and function. And then we have other babies who maybe have things like we talked about birth trauma, forceps, C sections and other birth interventions, or genetic things like down syndrome, something that causes low muscle tone. A lot of things can cause oral motor dysfunction. And so then we have this. The middle of the Venn diagram is where tongue ties and oral motor function overlap. And those babies are not removing milk efficiently. They're either causing nipple damage for mom and, or they're not gaining weight. Well, and then when they're not removing enough milk, mom's supply starts to drop and it ends up being a whole big thing to come back from it.
Alex Clark
What are the actual long term effects of mouth breathing and poor latch? Like, is this something that can affect kids years down the line?
Therese Dansby
Yeah, it is. And I learned that the hard way with my oldest. Mouth breathing can cause eventually enlarged tonsils and adenoids, but even in babies it can cause a high arched palate. So, and this is when we go back to even in utero, we want babies moving around. We want them to have a lot of room to move and twist and turn and flip, and we want them swallowing amniotic fluid. And we want them even with a resting closed mouth tone in utero, because the tongue shapes the palate. And so if the baby has had a tongue tie and they're hanging out when you do it with their mouth open, the tongue is not shaping the palate. And so the palate gets really high. Breastfeeding can be painful from the first latch with a high palate because the nipple is getting drawn up and smushed between a bone instead of way back on the soft palate, we have the palatal issues and then it's, it's less efficient, it's more painful. And then babies who are mouth breathing are waking up more often. They, you know, there are studies now about ADHD and, you know, kindergartners and early elementary related to mouth breathing because you're not getting high quality sleep. The other thing is there will be dentists and pediatricians that say breastfeeding at night causes cavities. And the thing is, it shouldn't. There are actually healthy bacteria in breast milk that should to protect your teeth. If we have a really wide lip tie that's trapping milk under the lips against the top of the teeth and then we're mouth breathing, we've got this perfect environment to grow bacteria now because breast milk is very nutritious. The good bacteria love to feed off of it, but so do the bad bacteria. And if we're mouth breathing instead of nasal breathing, we have a different microbiome.
Alex Clark
So what do you think about breastfeeding past two years old? I mean, did you do that with your kids? What did, what did you do?
Therese Dansby
Yeah, so my first two, I never thought I would. Sure, I want to breastfeed, but I'm just going to get to age one and then it's weird if they have teeth, if they can ask for it. Like, it's just weird. And breastfeeding was really hard for me with my first. And so when we got to a year, suddenly it felt like the pressure was off and suddenly we were connecting. Like that was a calm time and it felt like extra credit nursing a toddler. I kept going and it just like one more day, one more day. It didn't feel weird, it didn't feel weird. And somewhere between two and two and a half, both of my older kids, you know, we got down to like just nursing at nap time. And one day it was like, do you want milk? And they're like, no.
Alex Clark
So what do you recommend? First of all, I have two questions. One, I want to know your response to how, what is the proper way to wean? And then the other question I have is how do you handle? Like, both of you are still wanting to breastfeed you and baby, but their teeth are hurting.
Therese Dansby
Breastfeeding a baby with teeth sounds scary. When you have this newborn with.
Alex Clark
For me, who's never breastfed, that sounds terrifying. No thanks.
Therese Dansby
They go, they often go through a biting phase. Around four or five months, they start to lose the sucking reflex.
Alex Clark
Yikes.
Therese Dansby
And feeding is a learned skill and not a reflexive skill anymore. And they start biting and you know, they're preparing to do solids and stuff like that. Usually they don't have teeth at that point. And usually it is just simply behavior modification. They bite you, they don't have teeth yet. You break the latch and you say no biting.
Alex Clark
Okay.
Therese Dansby
And then like you take your nipple.
Alex Clark
Out of their mouth, you mean?
Therese Dansby
And like no biting. And usually it is very short lived.
Alex Clark
Okay, what is the ideal way to wean?
Therese Dansby
So the, we talked about the WHO and the aap. They say up to two years or as long as is mutually beneficial for mom and baby. Some babies self wean sooner. The research suggests that self weaning before age 2 is not necessarily normal. Sometimes there are a lot of things going on. If a baby like weans around nine months or something, there's some other stuff going on. And they're struggling with efficiency or mom's starting to struggle with supplies. So babies are smart, they're just gonna do what they need to do. So after age about 18 months, most moms start setting boundaries like, no, I'm not gonna breastfeed you at night anymore. Like dad's gonna go in and rock you back to sleep. Or you know, no, you can't have milk right now, but you can have it at nap time. And usually it's just a gradual process. This kind, it's kind of a dance between mom and baby. You know, the moms usually when they come to me for a weaning consult there, I ask them what feeding they hate the most. Because usually there's one feeding that they're like pulling their hair out. Why this? Sometimes when your cycle comes back, you start having nursing aversions and it's just.
Alex Clark
Like your tell me more.
Therese Dansby
Skin starts crawling.
Alex Clark
Really?
Therese Dansby
And, and I am. It's very cyclical and it doesn't happen. When I have noticed it happening. It's at a certain point in my menstrual cycle and I think is it luteal phase two? Yeah. When you're like, don't touch me this cursing week.
Alex Clark
Let me tell you, this cursing week, okay.
Therese Dansby
And your milk supply drops a little bit then too. So babies have more like touchy behaviors. Like they're kneading your breast more, they're more interested.
Alex Clark
Oh yeah, that would drive me nuts. See, and I'm not a physical touch person, so that drives me nuts. Boyfriend, baby, like anybody. I'm like, get off me. Yeah, it's like a thing with me. So that, that'll be tough for me. I think one Day as a mom. But I love this. I love this, Therese. I love doing interviews, especially about babies and parenting, where I'm learning new things. And I never knew that there could be an aversion during certain phases of your menstrual cycle to breastfeeding. Like, what incredible knowledge to know ahead of time before I'm in that season of my life. And incredible knowledge for people that are like, there's something wrong with me. I'm a bad mother.
Therese Dansby
Yeah.
Alex Clark
You know what I mean? And struggling with that. Oh, my gosh.
Therese Dansby
I've never heard of, like, tomorrow this might.
Alex Clark
Yes. Yes.
Therese Dansby
Yeah.
Alex Clark
Okay. That is so important. How much does birth trauma or intervention, like epidurals or C sections affect early breastfeeding?
Therese Dansby
You know, it's huge. I had not. I have had really wonderful deliveries with all of my kids, but with my third, I lost too much blood, and I got readmitted, and I remember I got remitted for blood transfusions. And I remember asking, like, do you guys have donor milk? Like, I've never fed my babies a drop of formula, a drop of donor milk, a drop of any. So for me to be feeling so weak and so, like, can I sit up and be this baby right now? Like, really gave me a whole new level of empathy for moms who have been through much worse birth trauma, you know, and of course they're like, we don't have donor milk. And I'm like, just gonna feed this kid. But that was eye opening for me, and it. It gave me a lot of empathy. And that's why you have to decide before. Before your baby is born, how important is breastfeeding? What am I going to do to facilitate this? And what is my why? Because if your only why is they're going to have reduced risk of diarrheal illness, you know, that might not matter that much to you in the moment. And so it can really affect moms, for sure. Breastfeeding is intimate. It's not sexual, but it's intimate. And so to have some. A person all up in your business after birth trauma can be difficult. And so for those moms, there are things like, we can start off pumping to protect the supply. You know, I don't love nipple shields, but sometimes they can be helpful for those moms who have had either a history of sexual trauma or birth trauma that, like, need a little bit of that barrier between them and the baby to make this feel safer for them. And then, of course, there are things, you know, what happened to the baby in this process, and what are their reflexes doing? Are they in shock? Do they have tension patterns from whatever just happened? Do they have emotional trauma? I think babies can have emotional trauma from birth, too.
Alex Clark
Did you do an epidural?
Therese Dansby
No. No.
Alex Clark
What do you. What can you tell us about. Because I've had a few guests talk about this. What can you tell us about epidurals and how that might affect a baby's ability to latch?
Therese Dansby
Interestingly, the research tells us the epidurals can affect babies. It can make them sleepier. I find that it really matters. What else went on in that labor? Did we go into birth naturally and progress normally, and then we just got an epidural at 6cm, or did we get a Foley catheter in our cervix and then get cervidil and then get Pitocin and then get an epidural and then push for two hours? That, to me, changes things. So if somebody just had an epidural, I haven't seen it affect breastfeeding as much as is where all the other stuff, that cascade of interventions go.
Alex Clark
Okay, interesting. And what about C sections? What are women not told about C sections?
Therese Dansby
They don't get to go through those cardinal movements of labor. And so it can affect their reflexes when they're out. Because, like I said, feeding is a reflexive behavior in the first three months, which can be very frustrating to a mom who's doing everything right. But it's kind of like you can lead a horse to water, but you can't make them drink. Like, you are holding that baby. Right. You've got the milk supply, you're feeding them everything, you know, two or three hours or whenever they show cues. And that baby is still 50 of the equation.
Alex Clark
Yeah. So what's going on with them?
Therese Dansby
They are uncoordinated. So the trigeminal nerve affects a lot of the movements involved in feeding. So these can be babies where, like, the nipple is just sitting in their mouth and they're going like this, like, they just can't find it.
Alex Clark
So what do you do with them? How do you fix this?
Therese Dansby
So some of it is some oral exercises for them. Some of it is body work. Some of it is reflex integration with them. There are some body workers that will even help C section babies, like, move through the movements of birth to help them coordinate.
Alex Clark
Weird. They're, like, leaving the vaginal canal.
Therese Dansby
Yeah. Like, essentially. And I don't mean rebirth in a weird, you know, sketchy way, but. But there is a series of. Of tucking and twisting and Rotating and opening. So the fetal positioning is like this. We all know the fetal position, but a baby who needs to breastfeed well needs to be in an open, relaxed position. And so if the baby is stuck in that fetal position, like it doesn't matter that you could technically bend their body in this position if that doesn't feel safe to them. Or for example, the startle reflex, you know, the one where a baby starts to fall backwards and they, you know, flare their arms out and they do it when they hear loud noises and stuff when they're newborns. But if you have an exaggerated one or one that sticks around longer than it's supposed to be, then you try to tip that baby's head back to get a deep latch and they freak out.
Alex Clark
How does breastfeeding impact a woman's hormones, fertility and cycle?
Therese Dansby
Breastfeeding is not birth control. Just gonna say that right now. There is a form of birth control that's affected by breastfeeding. It's called the lactational amenorrhea method. A lot of people will assume that when you're breastfeeding you can't get pregnant, but you actually have to be meeting a bunch of criteria. So things like no pacifiers, no bottles, no being separated from the baby more than three hours, co sleeping, feeding completely on demand, things that most modern women are not doing. And even if they are, they're still not doing it beyond like the three month mark. So even lactational amenorrhea method is not as guaranteed past six months. So it's interesting because some women will get their cycle back super early and it's just like inconvenient and you get some nursing aversions and it can affect your supply as you fluctuate between the phases. But you know, some moms are still breastfeeding their two year old and don't have cycles and they want to get pregnant. And it just, it varies very widely. So there's not really a super reliable way to know which camp you're going to fall in. Except maybe if you have a mom and sisters who breastfed and can kind of tell you when their cycles came back. We talked about the hormones at the end of pregnancy, the estrogen and progesterone and then they drop. They like bottom out five days postpartum. And that's kind of when your milk comes in. Usually you're very emotional that day. You're crying for like no reason. Okay, this is, your milk's coming in today, you're hungry. And so there's that. This Big shift in hormones. And prolactin theoretically can inhibit progesterone. That's why some women just breastfeeding frequently around the clock can keep their cycles from coming back. But some women, it doesn't. And I think there's also just a sensitivity level involved there too.
Alex Clark
What is up with 4 milk and hind milk and why some women make creamier milk than others?
Therese Dansby
There is a company called Lactation Lab and I am just a nerd. And so I got my milk tested this time, sent it in and there again social media you'll see people like, look at this thick layer of fat on my milk. And I would be like, my milk doesn't separate like that in the fridge. If I pump it and leave it in the fridge, like separates a little bit, but there's like this tiny little layer, you know. And I always thought, oh, I must just like make skim milk. And pediatricians will say that to moms, you must just make skim milk.
Alex Clark
Is that inaccurate?
Therese Dansby
Formula is based off of the idea that Breast milk is 20 calories per ounce. Breast milk actually can vary between essentially 18 calories per ounce and 45 calories per ounce. So it can vary so much. And this is just part of nature's design. Why we're, we're watching the baby's cues and it's that two way dance because you're, you're making the milk that your baby needs. So if you feed more frequently, your baby tends to get fattier milk. And that's what some of the four milk high milk stuff is. And we'll get to that. But what time of day it is affects how fatty your milk is, how old your baby is affects how fatty your milk is. Yeah. And over time, one of the benefits of toddler breastfeeding is actually that the breast milk essentially gets concentrated. So you still get all the same benefits of a full milk supply with like a couple ounces a day because the, all of the antibodies are concentrated into the, the two ounces a day that your toddler is getting. And because toddlers are active and they're putting stuff in their mouth and they're around their friends and they're sharing germs and, and breast milk is fattier too. So breast milk in the second year of life is a significant contributor to a toddler's vitamin A stores, for example, assuming mom is sufficient in vitamin A. And so for milk and hindmilk is more physics than anything else. So breast milk is, is fluid. So formula static, it is 20 calories per ounce. Here's the nutritional label. Breast milk is more like blood or bone marrow than it is like formula. And I'm not saying you should feed your baby blood or bone marrow. Breast milk fluctuates the same way. You know, it's like if you get lives drawn in the morning versus the evening, you're gonna have different things in your blood. And the same is true of breast milk. Okay, so foremilk and hindmilk is the thought that it's generally women with an oversupply, first of all. So the baby's not fully emptying the breast because you know, how non homogenized like raw milk. Breast milk is the original raw milk. It separates and the cream rises to the top of our milk ducts. Oh, you know, these tubes. The cream rises to the top, which means it lines the tubes. And so the longer of feeding goes on, physics turbulence starts knocking the fat globules off of the sides of the milk ducts. And so the idea of 4 milk and hindmilk came when researchers tested the milk at the beginning of the feed and it was lower in fat. And then they tested the milk at the end of the feeding and it was higher in fat. Well, it's all the same milk. You're not making different milk. It's turbulence.
Alex Clark
Okay.
Therese Dansby
And frequency. And so if you have an oversupply baby's not emptying the breast. If you have a baby who's a really fast eater, they're just eating for like five minutes and they're done. Like, they might not have time to kind of mix everything in. So you literally can massage your breasts, kind of shake them, like mix the milk up before the baby eats.
Alex Clark
What should women know about tandem feeding?
Therese Dansby
Tandem feeding is kind of two things. One, it can be breastfeeding through pregnancy, and then it is nursing your older baby or toddler while you're nursing your newborn. And the things to kind of keep in mind about it are again, we talked about milk supply really being affected by the hormones of pregnancy. So if you are wanting to tandem feed, ideally you don't get pregnant for the first year, so the baby still getting the full milk supply from you, you're not affecting your current baby with another pregnancy, but it is safe to breastfeed through pregnancy for most women. Some obs will still say, you know, the nipple stimulation increases the the rate of preterm birth. And it really doesn't. So it is true that the suckling motion increases the oxytocin. Some obs will still say, well, if you are breastfeeding Then you are at risk for early labor and. And all that sorts of things. It's. Your uterus is actually not as receptive to that until the very end of pregnancy.
Alex Clark
Okay.
Therese Dansby
Yeah.
Alex Clark
Okay.
Therese Dansby
So it's pretty safe for most people, unless you have a history of preterm birth, and then you just kind of need to monitor closely.
Alex Clark
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Therese Dansby
Yeah, this is kind of goofy, but I have a postpartum cookbook, and it is because there's a fantastic book called the first 40 days. And you know, it's all about postpartum traditions or most specifically Chinese medicine. But this idea of this postpartum period that is set apart. We're resting, we're recovering, we're eating very nutrient dense foods. But people will read that book and be like, I don't have half of these ingredients. I don't know how to make this. And so I have a cookbook of, like, real life healthy recipes. Because postpartum for recovery and milk supply, we do want things like slow cooked meats, broths, soaked grains, things like that that are very easy to digest. Warming, nourishing, cooking with kids around is very stressful. And so in the back of my cookbook, I have this little acronym, like just your dinner time checklist. Like, is everybody losing their mind? HALT stands for hungry, angry, lonely, or tired. And sometimes it just helps to step back. Like, do I need to drink some an adrenal cocktail right now while I'm cooking dinner? Do my kids need, you know, a little glass of milk while we're waiting for dinner? But it can help help bring awareness to postpartum, too, because there are a lot of fluctuations in emotions, and I think neither, neither the man nor the woman is necessarily expecting those. Because you feel so unlike yourself when you're pregnant and then you're like, I'll be back to normal when I have this baby. I should get this baby out and I'll feel like myself again. And your brain goes through synaptic Pruning in your postpartum period whether you breastfeed or not. And it's just, just works totally differently.
Alex Clark
I am curious about the moms who do fall in. Would you say 5 to 15% of moms just cannot breastfeed and do need to opt for formula? I'm curious if there are any do it yourself recipes online that you do like.
Therese Dansby
The hierarchy for supplementation is ideally mom's own milk. And then the second one is donor milk. Donor milk is very safe. Some people are very weirded out by that. But there's a group called Eats on Feats. There's also another group called Human Milk for human Babies. But if you google the Eats on feet for guidelines for safe milk sharing, donor milk is the next preferred supplement if mom's own milk is not sufficient. And then the third choice would be formula. So I have interviewed Sally Fallon about her formula recipe. I do like it.
Alex Clark
What do you not like about it? It.
Therese Dansby
The only precaution that I give women is I'm a little bit hesitant about raw milk under four months of age.
Alex Clark
Okay.
Therese Dansby
I would maybe use like an organic grass fed, you know, non homogenized, low heat, pasteurized milk.
Alex Clark
Why are you anti raw milk before four months?
Therese Dansby
The blood brain barrier is very thin before that.
Alex Clark
Okay.
Therese Dansby
And I, you know, if you are very, very confident in your sourcing, then that's one thing. But if you're kind of scrambling and you've never really drank raw milk before and you're, you know, just finding what you can find, I think that there are some formulas that are less bad.
Alex Clark
What do you think about camel milk?
Therese Dansby
Any non human milk needs to be modified under one year of age.
Alex Clark
Okay.
Therese Dansby
So because like we said, they all have higher protein babies, kidneys cannot handle protein. So I know people will be like, oh, I was fed goat milk and I was fine. Okay. That's not the norm across the world. Being fed animal, non human milk before one year of age is like a significant risk of death because of like malnutrition. So even goat's milk does not actually contain folic acid. So Sally Fallon's recipe is great because it, what you have to do to make formula, any formula, this is the powdered ones, her recipe, everything. You have to water down the cow's milk or whatever milk it is to dilute the protein.
Alex Clark
Okay.
Therese Dansby
And then you have to add back in fat and sugar. So that's where we get the, the, the canola oil, the corn syrup solids, because you have to add those back in. That's in the cheap formulas that we don't love, there are some that are getting a little bit better about that. Lactose should be the sugar that they're adding back in, but it's more expensive to add in lactose. It's cheaper to add in.
Alex Clark
What is your opinion on Operation Stork Speed? President Trump and RFK Jr. Looking into the ingredients that are in our baby formulas?
Therese Dansby
I think that it's a good start. I don't think it's. That's enough. Because we talked about how breast milk is the biological norm and it really should set the standard. So Operation Stork Speed is looking into the heavy metals and the contaminants. It's looking into the labeling, it's looking into that. There has not been a wide, broad study of the ingredients of formula since 1998. So it's time to look into it.
Alex Clark
Yeah, I didn't know that.
Therese Dansby
Yeah. But my concern is that they don't have a pediatric dietitian on their panel. They don't have a lactation consultant on their panel. If breast milk is the norm that we're trying to model formula after, then we need to, like, rewind a little bit more.
Alex Clark
So what you. So your concern is. Because this is important to me, because I'm in talks with all of these people in the MAHA coalition. So I'd love to bring concerns, you know, about these types of things. So what I'm hearing correct is that you want. While what they're doing is noble, there still isn't enough of a push of like. But we need to get, get back to encouraging women to seek breast milk.
Therese Dansby
First, breastfeeding first, and make that, you know, WIC pays for something like $4 billion for formula every year. And I am not saying that low income babies should not be fed. That is not what you're saying. Yeah.
Alex Clark
But you're saying there's not enough education.
Therese Dansby
I'm saying, why are we paying for 12 months of formula.
Alex Clark
Yeah.
Therese Dansby
And not paying for a lactation consultant. Okay.
Alex Clark
I like. I like where your head's at. I would agree with you. So I like that.
Therese Dansby
And Operation Stork Speed and not looking at Chronobacter from what I can find.
Alex Clark
Okay.
Therese Dansby
What's that? Is a bacteria. It's pre. You know, it's present everywhere, but it is in. It can be in powdered formula and it's what caused the recall in 2022 and the formula recall. And so it is neurologically damaging. Like, it kills babies. And it can be found in powdered formula and in 2022, it killed several babies. So they pulled all these formulas off the shelves. Now these people are scrambling for whatever homemade formula recipe they can find, which usually not a good one. They're watering down their formula, like so dangerous. So I think that they need to be looking into Cronobacter. It's not in pre made liquid formula or concentrated formula. It's only in the powdered formula. And people are taking shortcuts. They're not boiling the water and then cooling it. And then, you know, if you follow the directions for making your formula, you should be killing Chronobacter. But, you know, people are just turning on warm tap water and filling up the bottle and mixing it.
Alex Clark
Right. So, okay, that's really important to know. I'm gonna note that. How does maternal nutrition shape the actual composition of breast milk? Like, are there specific foods making a big difference?
Therese Dansby
Yeah, it's hugely impactful. There's a category of nutrients that are going to go to your baby no matter what because they're so important. So things like iron, zinc, copper, your calcium, your body's gonna take those from you if you're not getting them in your diet. So weakening your bones, you know, depleting your liver, stores of vitamin A, things like that. There are other nutrients that your milk is gonna be kind of low in if they're low in your diet. Some of the B vitamins fall in that category. Vitamin C. We don't think of milk really being a vitamin C rich food, but breast milk actually is. It affects baby's health, how well you're eating, but it also affects sex. There's kind of talk of postpartum depletion, and that's generally the cause because your body is going to give and give and give to the baby and you need to be replenishing it for yourself.
Alex Clark
So what, like, ideal meal plan for a postpartum woman?
Therese Dansby
Usually higher calorie. In the first six months of breastfeeding, if you're exclusively breastfeeding, you are burning at minimum 20 calories per ounce. So, you know, 600 calories a day simply making milk milk.
Alex Clark
So then why, if you're burning that many calories or whatever, ideally while you're breastfeeding, how come some women are still struggling to lose like 10 to 15 pounds?
Therese Dansby
Some of it is there is a little bit of a degree of insulin resistance when you're breastfeeding. And some people are going to be more or less sensitive to that. You know, I'm older now, on my third baby. It looks different than My first baby.
Alex Clark
Is there such a thing as a wrong nipple shape for breastfeeding?
Therese Dansby
No, not at all. Not, not for your own breast breasts. There are bottle nipples that are more and less conducive to breastfeeding. So there's again the WHO code. You shouldn't be able to advertise bottles as being more like the breast or pacifiers as being more like the breast. And the ones that are advertised that way are not the most breastfeeding friendly. So for example, pacifiers that are squished, like the orthodontic pacifiers, they're called that because they don't put as much pressure on the palate and create this high bubble palate it. However, the babies just chomp on them. So people who will say, well, my baby didn't take the hospital pacifier, which is usually the avent soothies and then we gave them this nook one and they took it. Well, that's because your baby's not curling their tongue. Yeah, they're not pulling, they're not doing the wave like motion. They're just chomping.
Alex Clark
So what? Who would you seek out for help with that?
Therese Dansby
Lactation consultant.
Alex Clark
Okay, okay.
Therese Dansby
Even if you are just bottle feeding, you can call a lactation consultant. A lot of us have training and bottle refusal and things like that. And again, bottles, it's kind of like you do want to introduce them early. If you are going to bottle feed at all, you need to introduce them before eight to 10 weeks. Because again, feeding is a learned behavior after three months. So if they never taken a bottle before three or four months and then you go back to work, then you're gonna have a baby who's refusing a bottle.
Alex Clark
So what's the difference between like a postpartum doula and a lactation consultant?
Therese Dansby
Yeah, there is a big difference. Some are both. I am certified in both. But there are also a lot of tiers of lactation help, which is kind of confusing for people. So a lot of doulas will get training. For example, CLC is certified lactation counselor. It's like a 60 hour class that you take. And a lot of doulas will have both because they want to at least recognize when to refer to an ibclc. So what I am is an international board certified lactation consultant. And it usually takes most people about two to five years to get there. And they're. There's a national board exam and it's much, it's very different than a CLC or a breastfeeding educator or something like that. So some of it is knowing that, knowing who's local to you too. And what are the letters behind their name and what is their experience? And so postpartum doulas should, when they're doing it well, be helping facilitate a normal breastfeeding relationship. And if there are any red flags, they're referring you right away. Away. They're referring you right away to someone who can help more.
Alex Clark
How do women know if their baby is actually getting enough milk? Are we over relying on weight charts?
Therese Dansby
I was an ICU nurse first, so I was accustomed to. We had to feed this baby, you know, 37 milliliters every three hours. And then there was a cartoon that came out when my oldest was born, and it was a mom at the pediatrician, like, how much is your baby eating every feeding? And she goes, I don't know, a boob full. It's very different in a world that wants to track our steps and our macros and our calories and, you know, our protein grams. And it's like trusting the process. And that's part of the journey from maiden to mother. That's why I just. I think that you can enter the cycle anywhere. But I think breastfeeding difficulties are one of the ways to get to matrescence from maiden to mother and overcoming those difficulties. And so we do want to look at the baby's cues because, like we said, it's that dance between the mom and the baby. So we want to address early cues. Crying is a late hunger cue. Societally, we have this idea that, oh, your baby's using you as a pacifier or your baby's, like, manipulating you. And that's not true. We are so accustomed to moms and babies being separated and being, like, contained, controlled entities that we don't have a concept of what biologically normal infant feeding or infection, infant sleep look like. And so that's a big deterrent to breastfeeding, too. Like, oh, well, my friend's baby's sleeping through the night at three months. I must be doing something wrong. You and I probably don't eat the exact same thing at the exact same meal day in and day out, right? Babies breastfeed because they're thirsty, because they're hungry, because they're scared. The little glands on the areola, the Montgomery glands, actually secrete an oil that smells like amniotic fluid. So babies are attracted to did to it, but also, like, it's home. It narrows their tunnel vision. Instead of this big, scary, bright world, I see my mom, I smell my mom, I hear her heartbeat, I hear her breath. Like it's that in utero kind of feeling to help with that transition from womb to world for the baby too. And so babies breastfeed for all sorts of reasons. And sometimes we're uncomfortable with that. Like you just ate, how could you possibly be hungry? But ideally, we're following the baby's cues. And the babies are usually telling us when something's wrong and we're second guessing it or trusting what somebody else is telling us. Like the pediatrician telling you you're making skim milk or your mom telling you, you know, that baby's using you as a pacifier. And not, I'm not saying my mom saying grandma's generationally too. So in the 1900s, you know, 95% of babies were born at home. By 1950, 90% of babies were born in the hospital. And breastfeeding really started to drop at that point because suddenly the woman was, was a uterus and a cervix and a baby and not a whole person. You know, I love that my grandma breastfed in the 50s. They sent her to the doctor's lounge to breastfeed her babies so she wouldn't make the other moms feel bad.
Alex Clark
Oh my gosh.
Therese Dansby
Yeah. So in 1971, and it started in the 50s, in 1971, only 24% of babies initiated breastfeeding because formula marketing was so prevalent. And formula was the cleaner, the more privileged, the, you know, better, advanced alternative.
Alex Clark
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Therese Dansby
Mastitis is an acute inflammatory reaction. The old school of thought was that it was an infection every time. And so for a long time the treatment was immediate. Antibiotics. Yeah, yeah. And some people have recurrent mastitis. So they're just on all these antibiotics and then they're getting thrushed. The Academy of Breastfeeding Medicine came out with a mastitis protocol a few years ago. That is beautiful. And it's what lactation consultants have been saying for years is you need to treat this as inflammation and not as an infection.
Alex Clark
Okay.
Therese Dansby
Ideally, you're preventing it with frequent and efficient milk removal. So if somebody is struggling with recurrent clogged ducts or recurrent mastitis, probably either. They're pumping with the wrong pump, the wrong pump settings, the wrong Flange size. They're not removing milk efficiently or their baby's not removing milk efficiently. And so the milk ducts come out like little pie wedges. And so if you get inflammation and blockage in one part, it just kind of, you know, you get this whole wedge that starts getting backed up and inflamed. Mastitis is where it turns into not just pain and fullness and lumpy and bumpy, but it turns into a fever. And that's why people thought it was an infection. But it's a fever. It's usually bright red, painful. I did not have mastitis until my third child was almost one. And I still don't know why I got it that day. You just feel like you got pet truck. You were fine one minute and then. So now the protocol is anti inflammatory. So there's something called breast gymnastics, which is such a goofy name.
Alex Clark
But there's cartwheels on the booby.
Therese Dansby
No, there's an lactation consultant named Maya Bowman who is like the pioneer of this. And so you're like rolling your boobs. So it's. This is not harsh, but you're like rolling them up, rolling them to the side, rolling them to the other side. You're stretching out those milk ducks because we want to essentially pump the lymph out of there. There's some normal engorgement in the first few days when your milk is coming in and your supply is regulating. But pathologic engorgement is where it's not improving, it's getting red and warm, it keeps coming back back. Pathologic engorgement eventually turns to clogged ducts, which eventually can turn to mastitis. Untreated mastitis can turn into things like abscesses. And there is a time and a place for antibiotics, but ideally breast gymnastics, ice, lymphatic massage, anti inflammatories like turmeric, ginger. Of course, the ABM protocol is like Advil and Tylenol. Whatever you can do to dial back that inflammation. And usually you can treat it within 24 hours, hours and avoid antibiotics.
Alex Clark
When a baby suddenly out of nowhere, refuses the breast goes on a nursing strike. How can moms power through?
Therese Dansby
This is really stressful and there are a lot of reasons why they might do it. So one would be that the baby has been. We kind of call it like writing off of the letdown. Moms usually have a lot of milk in the first three months and it comes out very freely. And so babies sometimes don't have to do a lot of work to remove the Milk. But again, that cascade of hormones, if the babies have not been doing the work, work, your body's like, well, let's dial back. We don't need so much milk. So then we go from kind of this, a little bit of a normal oversupply to after three months, like my baby's mad. You know, they don't want the breast because there's not enough milk there. So that can be one, one is tension and retained reflexes and kind of the confusion there. Those are probably the most stressful ones. There are certain ages when I see it happen. So like nine months is really common. And at that point you just have to keep offering because your baby is so busy exploring the world that they forget to eat. They're not telling you that they don't want to breastfeed. They're just, they have other priorities. And so you have to keep reminding them, go to a dark room. Sometimes feeding in a carrier at that point helps because they can't like twist and turn and right see the world. And so some of it is just knowing the normal developmental stages too. And some, some of what people call self weaning behaviors are really just normal developmental behaviors. And that's part of the, the normal weaning process that you had asked about. So weaning starts at six months when you introduce solids, whether or not you want to wean from breastfeeding by a year. It's a gradual process from that point on. And so, yeah.
Alex Clark
Do nipples permanently change after breastfeeding? Like never go back to what they looked like before you had kids?
Therese Dansby
Yeah, I think so.
Alex Clark
They do, yeah. Oh boy.
Therese Dansby
There is such a wide variety of what's normal. Okay, so you had asked about that. So. So babies can breastfeed with any nipple shape. The breast is really just fantastic because it's fluffy and pillowy and it just kind of fills the space. Like any mouth shape, any, you know, babies with cleft lips and palate can still breastfeed because the breast like builds those gaps and, and they can still remove milk. And the breast development process that starts, you know, when you and I were in utero and then changes with adolescence. It changes with pregnancy, and then it continues to change postpartum. So the actual fully, like, potentiated developed female breast does not occur until you breastfed and weaned.
Alex Clark
Okay.
Therese Dansby
And that is part of why breast cancer rates are lower, because it is finishing the developmental process that started 30 years ago.
Alex Clark
If you're dealing with elastic tissue and pumping, what are the best ways to still support your supply this is tricky.
Therese Dansby
Elastic nipples and puppy nipples are kind of trending right now. So everybody has a different nipple shape, but we all also have different skin elastic plasticity. And so sometimes it's just a matter of finding the right flange. And you can work with a lactation consultant too. You want to make sure a flange is like at the base of the nipple and not pulling in a lot of areola. Especially if you have more elastic tissue. It can pull some. It can pull the nipple really far back. And so those issues are kind of pumping specific issues. Okay, so if you're primarily breastfeeding, hopefully you're just dealing with that like at work or when you're occasionally pumping and not full time.
Alex Clark
Are there herbs and supplements that are actually dangerous while breastfeeding, even if they're advertised as natural?
Therese Dansby
Natural doesn't mean safe. The interesting thing is that breastfeeding generally you have a little more freedom than when you're pregnant. Your breasts are kind of filtering things and breaking them down and, and making them safer for babies. So there are some herbs that can dry up your milk. So you want to be careful with things like sage or peppermint. Most things that you can buy over the counter at your average health food store are going to be safe. There is a book called the Nursing Mother's Herbal Companion. And that's always my go to if a client texts me, like, hey, can I take such and such treatment? Yeah. And then there's also the Infant Risk Hotline. Most meds are safe to take with breastfeeding too. And unfortunately, sometimes if you're having a dental procedure done or a surgery, they'll be like, you gotta pump and dump. And that's really discouraging. You almost never have to pump and dump. So you can call a lactation consultant. We have books and databases to check. You can also call the Infant Risk Hotline and it's run by pharmacists. And they will ask you, like, how frequently your baby's feeding, how old they are, how big they are, how much breast milk they're getting every day, and tell you, like, exactly how safe a medication is too. So usually needing to take a medication or herb is not dangerous for the baby. An exception would be marijuana. Actually. People think it is safe and natural. It does get through the breast milk in very unreliable amounts because it's kind of fat soluble. No smoking, weed feed, and then cigarettes. Also, they actually can. If anyone's gonna make skim milk, it's a mom who's smoking a lot. It does change Your milk composition.
Alex Clark
If a baby is only using one side per feed, is that a red flag or is that okay?
Therese Dansby
If you are watching your baby's cues and they are gaining weight appropriately, it's fine. A lot of times moms with their first baby are needing to offer both sides every time. Kind of call it dinner and dessert. They'll eat like, like 15 minutes on this side and five minutes on this side. And then the next feeding, you start on this side side. But usually for your second and third babies, you have more milk and then it's more like, I'm fed on this side. Next feeding, I'm going to feed on this side.
Alex Clark
Okay.
Therese Dansby
It's very variable.
Alex Clark
What are your real go to remedies for bleeding or cracked nipples?
Therese Dansby
There is an ointment called Medi honey that's a sterilized honey that is antimicrobial and it's nice and thick and it feels good, but really air drying. There are breast shells or things like silverettes that you can put over them if they're really tender. The biggest thing is figuring out what's causing it. But you can buy all the things in the world, but if you're not working on baby's latch and why they're getting cracked nipples, then you're just going to keep having cracked nipples.
Alex Clark
What are the best tips you can give the mom right now? Listening, who is struggling, breastfeeding and just at her wit's end?
Therese Dansby
I think a lot of times it's kind of to dial it back because you can listen to an episode, be that like this, and think, this is so overwhelming. Like, how on earth am I going to know what to do? So many people saying so many different things. You're telling me that there are lots of right ways to breastfeed, like, what the heck? So it's dialing it back and really tapping into like, what is and isn't working for you and what is the problem? Is your pediatrician telling you there's a problem or do you feel like there's a problem? Are you in pain? Is this bearable? Do you just feel like, oh my gosh, my baby is mouth breathing, so it's. It's like spiral, right? We've all done that, like down the rabbit hole on Google at 3am A lot of it's like, okay, what am I dealing with right now and how problematic is it? And then dealing with one thing at a time. So even when I give my clients a care plan, you know, it's for several weeks, but I'm like, Pick one thing and start there. And then once you're comfortable with that, move to the next thing and move to the next thing and. And it's hard to do that in your postpartum brain.
Alex Clark
Okay, on the other side of that, what encouragement and peace can you offer a mom whose breastfeeding journey is now over and feels sad because it didn't go the way she wanted it to?
Therese Dansby
That's heartbreaking because again, you know, 80% of moms are starting breastfeeding and 20 to 30% are making it to a year. We don't even have data up to two years, even though it was recommended. And so that's a lot of moms, a lot of us as moms. There's just the idea, like, we're gonna do it different next time, like, know better, do better. And it doesn't change the grief. Breastfeeding trauma and breastfeeding grief are actually very real. And I think that that's not always acknowledged. And breastfeeding is a, you know, every three hour boost of oxytocin and you go through withdrawal when you wean, like there's weaning blues and, and it's not just a made up thing. It's not like, oh, I'm sad, we're done. And it's chemically your body is changing. And so moms, even if it's only four weeks out, I mean, honestly, that's a bigger fluctuation. Going from all the pregnancy hormones to being done breastfeeding at four weeks, there's a lot going on. And so I think that your spouse needs to be really aware of your risk for anxiety and depression and your personal red flags and kind of know how to talk to you about that beforehand. There are things, there are perinatal specific counselors, there are progesterone protocols for postpartum depression. But not meeting your breastfeeding goals is actually a huge contributor to postpartum depression.
Alex Clark
How do you know that your lactation consultant is a good one?
Therese Dansby
Some of it depends on the rapport. I don't know if you've ever heard that a counseling relationship almost depends more on the therapeutic relationship itself than your counselor's like style or method or, or whatever they're doing, because you are essentially co regulating with them. And so a lactation consultant is gonna be the same because like I said, there's a lot of ways to meet your breastfeeding goals and some are gonna resonate with you. And some people are like, I just wanna power through, like, I'm just gonna breastfeed with cracked nipples for three months and like, it'll be fine. And then other people, you know, immediately devastated, immediately emotional. It really, you need somebody that you can co regulate with, with. And then it also does matter, you know, what are their credentials? How long have they been doing this? I have a post on my Instagram, like, how to find a holistic ibclc.
Alex Clark
Okay.
Therese Dansby
And it is, some of it is even asking them questions like, hey, how long did you breastfeed? Not that it really matters, but if they're like, oh, I breastfed for six months and then I was over it, like, that's fine. But that's also going to give you an idea of kind of where their threshold is for you wanting to push through. So you have to know yourself and then kind of match up.
Alex Clark
I ask every guest, if you could offer one remedy to heal a sick culture, physically, emotionally or spiritually, what would it be?
Therese Dansby
I think it is this generation of parents tapping into their God given intuition. Because we know when something is going on with our babies and we need to fight for answers and keep going.
Alex Clark
I love that answer. Where can people find you on social media?
Therese Dansby
Yeah. On Instagram, I'm Happy Mama Healthy Baby.
Alex Clark
Oh yeah, it's a lot of happy mama.healthy. baby.
Therese Dansby
Yes. My private practice is called Happy Mama Healthy Baby and I have a podcast called Milk and Motherhood where we talk about breastfeeding and postpartum.
Alex Clark
What's your podcast?
Therese Dansby
It's called Milk and Motherhood.
Alex Clark
Okay. And how often do you release new episodes?
Therese Dansby
Two or three times a month.
Alex Clark
Okay, that's great. That's. That's incredible.
Therese Dansby
Yeah.
Alex Clark
Awesome. And then how can women work with you directly? Exactly.
Therese Dansby
So that's the hard part is that I live in small town Nebraska and so most of what I do, because I'm also a homeschooling mom, I do home visits in my small town.
Alex Clark
Yeah.
Therese Dansby
However, I have a patreon that's called Earbud ibclc. And it's just really affordable monthly podcast series essentially of like, I have cracked nipples. What do I do is kind of like having me on speed dial. You know, it's taking 10 years of experience when moms are asking me about cracked nipples, when they're asking me about mastitis, as you know, putting all my answers in one place. It doesn't replace working with an ibclc. But there are maternity care deserts and there are lactation care deserts. Too scary that you can live miles and hours away from a lactation consultant. So I have that resource for People who just don't have an idc.
Alex Clark
Well, see, I, I think that's important that you brought that up, because when we're in our era, before kids and we're getting married, it's looking at the area of like, okay, who in advance, who would I want my pediatrician to be? If I want a pediatrician, who would I want? My lactation consultant, what midwife you know is around that I would like? And making sure you're moving to an area that has all that if you, if you can help it. I mean, some people, you just can't help it. But, like, I don't know, that's something interesting I never would have thought about.
Therese Dansby
And that's what nobody thinks about breastfeeding until they've already had their baby. And that's kind of the number one thing is you, when you're in your third trimester and you're like, okay, I'm just waiting for this baby to come out. That's the time to start researching breastfeeding.
Alex Clark
Well, I learned a lot in this. I hope that you as the audience learned a lot and love Therese as much as I did. I just can't thank you enough for coming out and, you know, sitting here for an hour and a half or however long it's been, this has been great. So thanks for coming on Culture Apothecary.
Therese Dansby
Thank you so much.
Alex Clark
I know that breastfeeding can be a really sensitive subject. Hopefully this episode was both compassionate and educational, something that I hope you guys will appreciate and really love to share share with others in your life. Please leave a five star review. Tell us what this show means to you, what you thought of this episode. Culture Apothecary releases new episodes. We're on a mission to heal a sick culture. Twice a week, Mondays and Thursdays, 6pm Pacific, 9pm Eastern. We always have new guests, experts bringing a unique remedy to do just that. Subscribe to us on YouTube at Real Alex Clark and follow me on Instagram at Real Alex Clark in the show at Culture Apothecary. I'm Alex Clark and this is Culture Apothecary.
Culture Apothecary with Alex Clark: Episode Summary
Episode Title: Breastfeeding Is Hard—Here’s How to Actually Make It Work
Guest: Therese Dansby, RN, IBCLC
Release Date: June 6, 2025
In this enlightening episode of Culture Apothecary with Alex Clark, host Alex engages in a profound conversation with Therese Dansby, a former NICU nurse turned International Board Certified Lactation Consultant (IBCLC). Together, they delve into the intricate challenges of breastfeeding, offering both scientific insights and heartfelt support for mothers navigating this crucial aspect of early motherhood.
Therese begins by highlighting the significant drop-off in breastfeeding rates from initiation to six months. “There is a huge drop between even three months,” she explains ([02:19]). While over 80% of mothers start breastfeeding, only about 26% exclusively continue for six months. This discrepancy underscores the myriad obstacles women face in meeting their breastfeeding goals.
A critical barrier to successful breastfeeding in the United States is the aggressive formula lobbying. Therese points out, “The US just blatantly doesn't [follow the WHO code],” referring to regulations that limit the promotion of breast milk substitutes ([04:34]). Unlike other countries that restrict formula advertising, American women are inundated with formula marketing, including unsolicited formula samples mailed directly to households.
Therese emphasizes the confusion caused by conflicting advice from healthcare providers and social media influencers. “There is a lot of conflicting information,” she states ([05:50]). This inconsistency can derail even the most determined mothers, making the breastfeeding journey feel overwhelming and unsupported.
Separation of mother and baby, often necessitated by NICU admissions, can severely disrupt breastfeeding. “Pumping to remove milk ideally within three or four hours of delivery” is crucial for maintaining milk supply ([07:16]). However, hospital protocols and other priorities often impede timely milk removal, leading to supply issues.
Therese discusses how cultural attitudes towards breastfeeding impact its prevalence. “It was only legal to breastfeed in public in 10 states” as recently as 2019 ([09:26]). Such restrictions contribute to the overall difficulty mothers face in breastfeeding, making it a less normalized and more stigmatized practice in the U.S.
Finding the right support is vital for breastfeeding success. Therese advises, “Taking a local breastfeeding class is a great idea. You will meet a local consultant” ([13:04]). She underscores the importance of working with knowledgeable lactation consultants who can provide personalized guidance and support.
Understanding milk supply dynamics is essential. Therese clarifies misconceptions, stating, “When you pump, if you pump three hours after the last feeding, you might only get 2 to 4 ounces. If you pump after a feeding, you might only get half an ounce to 2 ounces. And that's normal” ([13:39]). She also discusses oversupply issues, which can lead to problems like clogged ducts and mastitis.
Gassiness in babies can stem from various factors. Therese explains that it may be due to poor latch causing air swallowing or reactions to certain foods in the mother's diet. “It's really painful. There is a lot of conflicting information” ([15:29]). She advocates for professional guidance over social media solutions to effectively address these issues.
Therese highlights how interventions like inductions, C-sections, and epidurals can impact a baby's ability to latch and breastfeed effectively. “They don't get to go through those cardinal movements of labor” ([37:00]), which can affect reflexes necessary for successful breastfeeding.
Breastfeeding offers extensive health benefits for both mother and child. Therese cites research stating that “universal breastfeeding would prevent the deaths of 800,000 children under the age of five every year and 20,000 mothers every year” ([20:08]). Benefits include reduced risks of various illnesses for babies and decreased risks of breast and ovarian cancers for mothers.
Beyond the physical benefits, breastfeeding fosters a deep emotional bond between mother and child. Therese shares personal insights, “It's so empowering” ([24:27]), emphasizing the emotional connection and sense of accomplishment that comes with overcoming breastfeeding challenges.
Breastfeeding significantly influences a mother's hormonal balance and menstrual cycle. Therese discusses how prolactin, the hormone responsible for milk production, interacts with other hormones like estrogen and progesterone, affecting fertility and menstrual patterns. “Breastfeeding is not birth control,” she clarifies ([39:39]).
Therese debunks the myth of foremilk and hindmilk being different in composition. “It's all the same milk. You're not making different milk,” she asserts ([44:19]). She explains that milk composition changes naturally during a feeding session due to physical dynamics, not due to a separate production of foremilk and hindmilk.
Breastfeeding while pregnant or nursing multiple children, known as tandem feeding, presents unique challenges. Therese provides practical advice, “It's pretty safe for most people, unless you have a history of preterm birth” ([45:48]), and emphasizes the need for careful monitoring and support.
When breastfeeding isn't possible, Therese outlines the hierarchy for supplementation: mother's milk, donor milk, and then formula. She critiques homemade formula recipes for safety concerns, particularly with raw milk, and advocates for safer alternatives. “Any non human milk needs to be modified under one year of age,” she states ([51:07]).
A mother's diet directly affects the quality and composition of her breast milk. Therese explains, “Some of the B vitamins fall in that category. Vitamin C. We don't think of milk really being a vitamin C rich food, but breast milk actually is” ([55:36]). She emphasizes the necessity of a nutrient-dense diet to support both mother and baby’s health.
Therese discusses the ideal ways to wean, advocating for a gradual and respectful process. “The WHO and the AAP...say up to two years or as long as is mutually beneficial for mom and baby” ([32:55]). She also addresses the emotional toll of weaning, recognizing the sadness many mothers feel when their breastfeeding journey concludes unexpectedly.
Mastitis, an inflammatory condition, can be effectively managed without overreliance on antibiotics. Therese introduces the Mastitis Protocol by the Academy of Breastfeeding Medicine, focusing on anti-inflammatory treatments. “There is a time and a place for antibiotics, but ideally breast gymnastics, ice, lymphatic massage, anti inflammatories like turmeric, ginger” ([65:18]).
When a baby suddenly refuses to breastfeed, Therese advises persistence and understanding developmental stages. “Feeding is a learned skill and not a reflexive skill anymore” ([67:53]). She suggests strategies like creating a calm feeding environment and being patient as the baby navigates new priorities.
Therese differentiates between postpartum doulas and lactation consultants, stressing the importance of credentials and rapport. “A lactation consultant is gonna be the same because like I said, there's a lot of ways to meet your breastfeeding goals and some are gonna resonate with you” ([76:16]). She encourages mothers to seek out qualified professionals who align with their personal needs and breastfeeding goals.
For mothers who couldn’t achieve their breastfeeding goals, Therese offers compassion and validation. “Breastfeeding trauma and breastfeeding grief are actually very real” ([74:54]). She emphasizes the need for support systems and acknowledges the emotional struggles associated with unmet breastfeeding expectations.
In her closing remark, Therese advocates for parents to trust their intuition and advocate for their children. “This generation of parents tapping into their God-given intuition” ([77:32]). She believes that empowering parents with knowledge and support is essential for healing and nurturing a healthier cultural environment.
This episode of Culture Apothecary provides a comprehensive and compassionate exploration of the challenges surrounding breastfeeding. Therese Dansby’s expert insights and empathetic approach offer invaluable guidance for mothers striving to overcome obstacles and achieve successful breastfeeding. Whether you’re a new mother, expecting, or seeking knowledge on breastfeeding dynamics, this episode serves as a crucial resource in navigating the complexities of nurturing your child through breastfeeding.
Note: This summary excludes promotional segments and advertisements present in the original transcript to focus solely on the informative and content-rich discussions between Alex Clark and Therese Dansby.