Last week I had the opportunity to sit down and chat with Melissa Kotlen Nagin, a certified lactation consultant and About.com’s Breastfeeding Guide. In particular, Melissa and I connected to talk about the dad (or partner) factor when it comes to breastfeeding. We had a fabulous time chatting; read on for highlights from the interview (a Boston Mamas first!), where we cover role shifts, dad/partner involvement, pumping, nighttime feeding, baby nurses, co-sleeping, bottle feeding battles, postpartum depression, the supermom syndrome, and re-lactation:
Christine: So, parenting obviously is very different these days. Can you talk a little bit about how parental roles have changed, and what factors you feel have contributed to this shift in involvement?
Melissa: Yes, things have changed so much. Years ago dads weren’t even allowed in the delivery room and now they’re cutting umbilical cords. And when it comes to parenting, dads are spending a lot more time at home now…there are more cases where dads take paternity leave while moms go back to work. It used to be that it was all mom and that, save a diaper change here or there, the dads weren’t involved until later when the baby was old enough to play… Now things have shifted so much that they’re doing the feeding, diapers, he’s taking baby out for a walk while mom sleeps…even making decisions. Couples are going together to register whereas it used to just be mom.
Christine: Do you think this is due to general societal change? Or the working mom factor?
Melissa: There’s just so much more information out there, even as far as the breastfeeding. Dads actually are going to the classes instead of it just being moms. And dads are often the ones who are pushing the moms to breastfeed. I’ve had clients who have said, “I’m not into this but he really wants me to do it.” Because there’s so much more information on the benefits, dads are more involved and informed – both in breastfeeding and in hands on parenting in general.
Christine: What do you think are some of the key ways that a dad or partner can get involved in breastfeeding? What are the major points to take away?
Melissa: Well, it starts at the very beginning – going to a prenatal breastfeeding class with the mom is the best start because the dads actually retain so much more information than the moms at that point since, obviously, the moms are preoccupied with pregnancy. And they’re much more supportive on that end. And obviously helping with the bottle feeding and being hands on. Even having dad as the go-to or go-out guy – he’s the one going out for diapers, for everything…even major purchases like the pump.
Christine: Seriously? Dads are going to the store to buy the pump? Are they actually picking the pump? My husband – hands on as he was – just would have been paralyzed with a task like that.
Melissa: Yes, they’re actually picking the pump, unless they’ve already registrered together for one. What I see is that they usually grab the most expensive pump because they assume the quality is better, not realizing that the Playtex Embrace Double Pump is under $200 – it’s not the most expensive but it’s the most fantastic pump. Actually, it’s the only hospital grade pump on the market under $200. Oh, and the dads…they go to the store and buy everything…everything!
Christine: So back to the helping. There’s getting water for mom, helping in general…
Melissa: Yes, yes, and I’ve actually had dads doing massaging for the mom to help with breastfeeding. I’ve seen hundreds of women in New York and 99% of the dads have been the most hands on, interested, and concerned guys. They remember so much more and become such great advocates for mom. I had one mom who was on bed rest and she couldn’t come to the prenatal class and the husband came and took all the notes and called and emailed afterwards. It’s so nice to see…for so many years it was hands off.
Christine: OK, this is a little off the dad/partner topic but one of the common issues – especially for moms getting ready to go back to work – is the issue of having to nurse around the clock and squeeze in pumping to build up a supply. What do you suggest here?
Melissa: I always recommend this: your milk supply is highest in the morning, between 1 to 5 am – that’s not to say you should wake up to pump if your baby’s sleeping. So I suggest that the best time for pumping is after the first realistic morning feed. So let’s say the baby wakes up at 7am – you have so much milk that if you feed on one side, you would still have enough left on that side to double pump for 15 minutes. If you get in the routine of doing that every day you build up a really nice stash. And the general rule is milk can be out fresh for 6 hours, in the fridge for 6 days, and in the freezer for 6 months, unless you have a deep freezer in which case it’s 12 months. So you always have milk ready to go. And the nice thing about the Playtex Embrace I mentioned earlier is that it comes with the drop in liners that you can pop into the bottle or put in a Ziploc in the freezer to build up a bank. If you’re going back to work, start a month before, and then you’re in the routine of pumping, and it just becomes part of your day. The one thing is that unless you’re at work and in a regular routine of pumping at this time, I would never recommend on a random day pumping around 4-5pm when your supply is down…you’ll be disappointed because there just won’t be much. So it’s optimal to pump to build a bank in the morning; if you’re double pumping, pump for 7 minutes, stop for 1 minute and massage, and then pump another 7 minutes and you’re done.
Christine: Related to this, do you have any recommendations for how nighttime feedings could be shared? I know a number of moms with very supportive partners but they feel that as the food supply, they’re it.
Melissa: After the first couple of weeks, once the supply and latch are established, you actually can go 4-5 hours once in a 24-hour period without nursing. So let’s say mom wants to get a good stretch of 5 hours of sleep – dad could use a bag of pumped milk for the middle of the night feed. Mom might wake up uncomfortable, but then she can pump, and if she does sleep through that stretch, great! Also, at the very beginning with the actual feedings, you can actually zone out and close your eyes – the hardest part is actually getting the baby back to sleep. So, the feeding isn’t the hardest part, it’s the getting them back to sleep. So if the dad can step in then, that’s great.
Christine: Interesting… I guess I always felt that as the food supply since I was already awake I just needed to do it all. Meaning, if my husband was still sleeping, I didn’t want to wake him and just felt like I needed to see it through.
Melissa: I know, and people ask all the time, “I’m going to have a baby nurse, what will I have them do?” And I always say that it’s the best thing in the world! If you have a baby nurse, tell them to bring the baby to you when he/she wakes up – and usually the night feeds are pretty quick – and then hand baby back to the nurse once you’re done and let the nurse work on getting the baby back to sleep.
Christine: I can’t believe I never thought of that! Actually, I have another question about the night feeding… the highly debated co-sleeping issue. So what if a mom really wants to co-sleep to make nighttime feedings easier and the dad/partner is really against it. Do you have any myth busters? Or suggested cutoff times?
Melissa: It’s a very personal decision. I would recommend those co-sleepers that hang off the mom’s side of the bed. So if a dad isn’t happy having a baby in the middle, this is a solution. And lots of people worry about rolling over, but unless you’re in a heavily sedated state, even in your deepest sleep you actually have a sense of your boundaries. It’s why we don’t fall out of bed – and this is especially the case with the sixth sense you have after you have a baby. The rollover factor isn’t really the issue. On a personal level, people are going to do what they’re going to do. But if it’s disrupting your relationship with your partner – especially if you feel like co-sleeping is ruining your sex life and marriage, then that’s another story. You have to come to an agreement with your partner – such as if it’s just for the initial weeks where you need to do what you can to get some sleep at night. And then usually around the 6 week mark people start feeling better and maybe that could be a transition point. But it’s hard to say one way or another that people should or should not co-sleep. It’s a very personal decision, but I’d say that the cutoff for me is when it starts affecting your other relationships.
Christine: OK, so let’s talk about the bottle thing. One of the issues I have heard from moms is that if you’re the one home with the baby all day it’s frustrating to also have to wage the bottle battle. And of course they don’t want to take it from you. And then there’s the issue of creating resentment – you’re feeling bitter about having to do the bottle battle during the day and then if the bottle isn’t working he’s feeling left out because he can't bond via feeding. Suggestions?
Melissa: First, assuming supply and latch are established, I always recommend starting between 2-3 weeks because they’re more apt to taking a bottle. After 6 weeks it becomes more difficult. I would always suggest attempting on a weekend when it’s a more relaxed time – always try earlier in the day than later. You could attempt when they’re slightly hungry but not when they’re starving and screaming. So if they’re somewhat satisfied from a small breastfeeding then try. And I always recommend warming the nipple. And also getting a bottle that actually mimics the breast. The Playtex Nurser is actually designed like mom and the bag collapses just like the breast does so there’s no air, you’re not going to have a baby with reflux, or one who will be crampy and uncomfortable. It’s the most natural transition.
Christine: So that’s your top bottle recommendation?
Melissa: Absolutely. There are a thousand different bottles out there but it’s been the tried and true for so long, moms trust it, and it just flows best for breastfeeding, so I’d definitely recommend it, especially with the drop ins because it’s so easy…And with the resentment factor – let’s face it, baby is not going to want to take a bottle from mom. They know what we smell and sound like, and even the way we hold them. But when they’re relaxed and comfortable and you have the time to be consistent and persistent, like on a Saturday or Sunday where dad or partner can try a bottle each day. The key is to be consistent and persistent. Even if they lick the bottle twice, fine. Tomorrow, maybe they’ll do something else. But being persistent with baby is everything.
Christine: Tell me about it. We started Laurel on the bottle late, at 3 months, and it was a nasty battle and I was pretty bitter about trying to get her to take it during the weekdays. She eventually took it and that worked fine for a couple of weeks and then we got lazy about presenting every day and dropped off in consistency and then that was it. It was the point of no return.
Melissa: Exactly! So then did you keep pumping and trying? Did she take the bottle from your husband?
Christine: She took a bit from him and also one of my sisters and my mother – the crying and the fight did not bother my mom one bit after raising 7 kids of her own! We were also lucky with the way we managed to set up her care when I went back to work and she didn’t go to day care until 9 months and only a couple days a week at that, so she was already eating a lot of solid food by that point. It was both sad and hilarious – the daily report would say, “took a sip of milk…or 1 oz. of milk.” And it was hard for me because you’re taking the time out of your day to pump and you just know that all that liquid gold is going down the drain.
Melissa: You just said something important. When moms are pumping they should bank in small increments: only 1, 2, 3 oz. increments. If they’re using a 6 oz. bottle, for example, break it up for exactly that reason. If you put in an ounce and baby takes that, fine. But if you or dad put the whole 6 ounces in and they take only an ounce or two the rest has to go. You can always add but you can’t hold onto that milk.
Christine: Right. For that reason, we really liked the Mothers Milkmate system. It rolls down like a soda can dispenser so the freshest milk is always in the back and the containers are nice and small. I used the Ameda Purely Yours pump and it attached right onto the Milkmate bottles.
Melissa: Yes, it’s great. Exactly. Small amounts.
Christine: OK, just a couple more questions here. I want to go back – you mentioned earlier having some moms who weren’t into breastfeeding… what do you do if you’re a mom who’s not enjoying it and feels tethered by it, but the dad or partner is really pro-breastfeeding?
Melissa: So, she’s ready to be done and he’s a little rah-rah about it. I think the main factor is giving him facts. First of all, we all know that a sane mom makes for a happy home life. And really, whatever a mom can do is great. Let’s say she gave just colostrum in the hospital - at least the baby got that. The problem is that yes, we do know that the longer breastfeeding goes on, the more benefits. But at the same time, if you have a mom who is absolutely cooked, she’s ready to be done, she’s not happy anymore, and she feels like you said, “tethered,” then that’s it. It needs to stop right there. For the dad, just giving a little knowledge - again, looping back, going to a prenatal class to get the right info. A happy mom is everything. I know moms who have talked to me about postpartum depression and the breastfeeding was not helping. And the second they took the baby off the breast and they were able to put the baby on formula and mom could start taking medication, they were just happier. And they felt like, “If I had only known this from the beginning I wouldn’t be such a wreck right now.” And for the dads - just to have a little knowledge and know the importance of mom being in a good space… it’s so critical. And the baby will benefit from any breastmilk that they got.
Christine: You know, I’ve also found that, perhaps as a function of being in Boston where it’s a highly educated population, a lot of moms go to a year or beyond and I think that can be tough on a mom-to-mom level. One mom may feel like, “Oh, you made it that long?” and feel bad if she can’t or doesn’t want to go that long. That pressure can really mount up, especially because people are so achievement oriented - then the mom feels like a bad mom if she can’t get to that year mark.
Melissa: Yes, definitely, one issue is that there’s a lot of hard core information out there, and then add into the mix very successful, driven societies - in a bright community moms are going to feel that pressure. But the mental health issue is huge…and too many moms lapse into severe depression because of that pressure and it’s just not worth it. If the baby had 2 days of breastfeeding in the hospital, their systems are already built up from that. Same thing as when people ask me whether they can do formula and breastmilk at the same time – it’s just a very personal decision. If you’re going to do that, you’re going to do that, but the point is that baby will benefit from whatever breastmilk they get.
Christine: Right, anything is better than nothing. And whatever you can do is great.
Melissa: Yes, absolutely. And worst case scenario and mom decides to wean early and 3 months later they change their mind, there are options. I had a client who started formula at 3 months and after a lot of trial and error it turned out that the baby was allergic to both soy and cows milk. So here they were, 3 months off the breast and we had to help her re-lactate.
Christine: Really? I had no idea you could do that!
Melissa: Yes, there’s so much that can be done. It’s not dead in the water. It’s a little work but we can do it… herbally, with medication, there are many different ways. I actually have a whole section on re-lactation at About.com. But in general, I would start the natural way with herbs, and you have to pump 8 – 12 times a day to get things going. And worst case scenario we could use medication that increases prolactin levels. There actually are no side effects and it turns out that it’s great to treat heartburn too!
Christine: Wow, you learn something new every day!
Melissa: Yes, and circling back …if a mom wants to induce lactation, that’s why the hospital grade pump is so important. It’s the most efficient and strongest. You obviously don’t want to use a hand pump to do that sort of work!
Christine: OK, one last question… do you have any book recommendations for getting partners involved in breastfeeding?
Melissa: Actually, the one book I love in general – a very easy read and written in a fun way with great information is Mama Knows Breast.
Christine: Oh, yes, I love that book – I actually
reviewed it here on the site.
Melissa: Yes, it’s a great, great book. An easy read, not daunting, very honest, fun, and just the way she writes is really great. I highly recommend it.
Christine: I know…we got a couple of the Sears books and they offer great information and I recommend them to friends, but always with the caveat that they’re very attachment oriented. That you should take from it what you will but need to do what’s right for your family. Actually, the breastfeeding book inspired panic in one of my dad friends – once he and his wife read all the stuff on the benefits of breastfeeding, even as she really struggled with nursing, they felt like they couldn’t turn back or their baby would suffer major consequences.
Melissa: Yes, it’s great that there’s so much information out there, but parents really need to do what works for them.
Christine: OK, so do you have any concluding thoughts for our readers?
Melissa: I just think that with dads, the involvement today is fantastic and the feeding part is always the most daunting but these days it’s such a pleasure to have dads be such a big part of the process. And getting them the right information is key - go to the classes and get them involved. A lot of moms want to be supermoms and do everything themselves, but they need that help. And the baby needs dad to be involved too.
Christine: Absolutely, and I also recommend therapy to all my friends! The transition can just be so difficult in so many ways – especially the shift in priority from between-partners to mom-baby. Even if you’re intellectually prepared for this change, it can steamroll new parents. So for my parent friends, I recommend all of my favorite books and…therapy! And even after you survive the “boot camp” phase of early parenting, I recommend therapy “tune-ups.” Thanks so much Melissa. It was really a pleasure to chat and gain your insight today.
Many thanks to Melissa Kotlen Nagin and to Z-Square in Harvard Square for letting us sequester their space for the interview. For more information from Melissa on all things breastfeeding, visit her at About.com. Or New Yorkers can connect with her via her private practice.