World Breastfeeding Week: Interview with Cynthia Epps

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Cynthia Epps, MS, IBCLC, RLC, is known as one of the go-to experts for new moms in the Los Angeles area. She holds a master's degree in biochemistry and is a board certified lactation consultant.  She trained at UCLA, the Pump Station in Santa Monica, Cedar Sinai Health Center and the Lactation Institute in Los Angeles.  Since 1998, she has specialized in home-based lactation consults, transitioning to solids, and gentle weaning.  Her mission is to teach new mothers how to navigate the first year of motherhood while giving themselves and their babies the very best nutritional start in their new lives together. We are thrilled that Cynthia has agreed to let us pick her brain on ways to help mothers reach their breastfeeding goals, from trusting their bodies to avoiding milk supply issues and more.

(1) What are your top tips for breastfeeding success?

The single, most important tip for the aspiring breastfeeding woman is to understand how her body works to feed her baby.  This may mean taking a breastfeeding workshop that includes an overview of the physiology of human milk production, in addition to the various holds for positioning her baby at her breast.  This builds confidence.  Just as she made the baby, her body will make milk for her baby.

Secondly, it is important for the expectant mother to understand that her baby knows how to breastfeed at birth.  The disruptive birth practices of the last century that separated the mother from her newborn post birth are now being eclipsed by the “Baby Friendly” hospital initiatives.  If we respect the newborn’s instinct to find the mother after birth, position the baby on her abdomen/chest, and simply “get out of the way”, the baby will crawl up to the breast and initiate a latch.  “Baby Friendly” practices now honor the sacredness of this post-birth passage by keeping the mother and baby together. 

Third, breastfeeding is not a “911” emergency.  The long-standing commercial infant feeding paradigm is so mechanical, and appears to be so easy, that a mother choosing the physiological human feeding model is taking the road less travelled in our society.  This takes courage, patience, and clarity.  The new mother is often circled by well-meaning clinicians who still favor formula feeding any time there is a bump along the way.  It may help the new mother to understand normal post birth human milk production – that feeding is on demand, the first milk is intentionally small in volume because it is loaded in nutrient quality, and the second milk rises approximately 72 hours after birth, just when one’s courage may be failing. When the baby “wakes up” and begins to cue – cry and fuss – more frequently; this is not a sign that he/she is starving.  The baby is merely announcing the second milk arriving.  Knowing this, the new mother may choose to trust the process and follow her baby. 

(2) What do you suggest to help with breastfeeding problems such as the following?

(a) Sore nipples -- In addressing “sore nipples”, I would first like to clarify that human infant feeding is called “breast” feeding, not “nipple” feeding.  The reason for this is simple – nipples are truly secondary when the baby is properly latched “to the breast.”  Nature does not make a way to feed our babies that is painful.  It is natural to make milk, but the art of the deep latch was passed from mother to daughter through the matriarchy – until this circle of women helping women was ruptured due to aggressive formula marketing in the middle of the last century.  That said, learning to latch a baby to the breast is an acquired skill.  This is where knowledgeable, professional assistance can be very helpful.  If the latch is hurting, one should seek help from a board certified lactation consultant immediately.   

(b) Nipple confusion -- Nipple confusion can result from intruding any tube, pacifier or bottle nipple into the newborn’s mouth during the early days of feeding.  When latched to the breast, the human infant suckles. This highlights the main oral/brain feeding pathway. When an artificial nipple is introduced into the baby’s mouth, the baby sucks.  If there is baby water, expressed breast milk or formula flowing, the baby initiates a “suck/swallow” reflex to prevent drowning.   With repeated practice, the normal human infant suckle pathway to the brain is displaced by the suck/swallow reflex and they can easily take too much milk at feedings.  This may result in the baby fussing and refusing the breast.  Again, seeking immediate help from a lactation consultant early in this process can save the breastfeeding.

(c) Engorgement -- After the birth of my first child, when my second milk came in, I stood in front of a mirror with acutely swollen breasts and asked my mother – who had three children during the 1950s and was openly discouraged from breastfeeding – what was happening.  She did not know. Nor could she help me. Instinctually I knew in that moment that I was not the only new mother to have this experience.  Fast forward to today.  As a trained lactation professional, I can tell you exactly what is happening:  “Engorgement” is nature’s way of ensuring your baby’s survival by providing you with enough milk for several babies.  It is a passage of just two to three days during which the new mother has the first, primal experience of the strength of her body to feed her baby.  By feeding through engorgement, you set your milk production to your baby’s appetite and growth needs automatically.  You will never forget your first engorgement.  But by using hot, wet compresses prior to feeds to soften the breasts, and wrapping them in cold green cabbage leaves between feeds for short periods, you might catch yourself smiling.   

(d) Low milk supply -- Milk supply issues most commonly result from poor breast feeding management after birth, and/or during the first two weeks home.  There might be problems with the latch, or with the baby’s tongue that result in poor milk transfer, having a “sleepy” baby who simply will not wake up to feed, or supplementing after feeds.  The sooner a new mother seeks counsel with a lactation professional, the better the outcome.  Since the breast is dependent upon regular stimulus and milk removal, pumping is the first step in restoring low milk production. 

(3) What is your favorite nursing gear?

Nursing gear has become a big business over the past decade.  Pillows, pillows and more pillows abound! Yet, antique nursing chairs from the 19th century illustrate the “proper” position for nursing one’s baby – sitting upright, feet flat on the floor, and the baby supported by the mother’s arms during feeding.  We’ve come a long way since those days!  The best pillow is the one that feels good to the mother.  If possible, she may try out the different varieties, wait until after the birth of her baby, and then make a decision together.   But she should remember, the pillow is for “her”, not her baby.  She still must bring her baby to the breast supported in her arms, for each feeding.

(4) Any tips for moms who pump?

With the reclamation of breastfeeding, pumping often is presented to the new mother as part of the process, almost mandatory.  Mothers are encouraged to pump to speed the arrival of the second milk, to start bottle feeding within two weeks, and to store as much as 40 ounces of expressed milk prior to returning to employment.  This over-emphasis on the mechanical pump often undermines the new mother’s faith in her breastfeeding, and may have the undesirable effect of causing too much milk production.  Having too much milk puts the lactating mother at risk for breast congestion, plugged ducts and/or mastitis; and may put the baby at risk for colic or reflux, resulting in the use of pharmaceutical medications. 

In my practice, I encourage the new mother to simply follow our ancestors – to use the “first forty days” after birth to simply breastfeed and learn everything about her new role as a mother to her baby.  For mothers intending to return to work, offering one bottle of expressed milk every two to three days from 6 weeks on, simplifies the process.  There is less work when exclusively breastfeeding, pumping intermittently, and offering the bottle to ensure her baby will accept one when she is working.  Plus, the idea that she needs “40 ounces” of expressed milk prior to returning to work counters the physiological logic of her lactating body.  She is “the milk” for her baby.  Over the past decade, national “workplace laws” have been put in place to guarantee the right of each working mother to express milk at her workplace for her baby.  Returning to work does not change the fact that breast milk is a living tissue, and as such, the very best food for her baby.

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