In the latest installment of our occasional conversations with Fort Worth newsmakers, and a nod to National Breastfeeding Month, North Texas lactation consultant Amanda Alvarez addresses common breastfeeding concerns she hears from new moms. 

This conversation has been edited for length and clarity. For the unabridged version, please listen to the audio file attached to this article.

Alexis Allison: OK Amanda. What is a lactation consultant?

Amanda Alvarez: Yeah, so lactation consultant is a really general term. And there are lots of ways that people help with breastfeeding and with lactation. We teach prenatally, like, while someone’s preparing for a baby to come. We provide education and support. And then, among lactation consultants, there are some of us who have the credential IBCLC, and that’s International Board Certified Lactation Consultant. All that means is, in addition to providing education and emotional and moral support, we also have some clinical skills that allow us to be part of a care team when there’s a clinical concern about how a baby is eating, or how somebody’s body is producing milk.

Allison: Great, and I know that you work with the Mothers’ Milk Bank of North Texas. Can you tell us about that work, and about the Baby Cafe?

Alvarez: Yeah, absolutely. You know, nonprofit milk banks exist all over the world. But especially here in North America, we exist to provide safe milk for medically fragile babies. But we know in milk banking, that feeding a baby is just one piece of it, and so when there’s a baby who needs to be fed, and needs donor milk, we fill that need. But we also know that that family and that team needs breastfeeding or lactation support as well. And so my role for the milk bank was to develop a support program that helps connect people not only to donor milk, but really to help reduce their need for donor milk over time by improving breastfeeding, or improving lactation or the volume of milk someone’s needing.

Allison: In a Baby Cafe meeting, what do you typically do or discuss? 

Alvarez: I love that it’s different every time. Baby Cafe is a breastfeeding support group, and those exist in lots of different ways. But, what makes Baby Cafe really unique is that it’s peer-to-peer support. So you’re in community with other parents, other families, other support people who are kind of just in the same place as you are. They’re having those same sleepless nights, or they’re having those same bits of self doubt, or that same pain, whatever it is that they’re working through. So you’re there with other families to help one another. 

But Baby Cafe adds the layer of having a qualified lactation consultant there as well. And so rather than somebody saying, ‘Yeah, that’s a problem, you should see somebody,’ I’m there, right, or the lactation consultant is there. And so immediately, if there’s something that can be improved, we’re able to step in and give that level of support immediately. So you know, solving latch pain, or concerns about milk production, answering questions about breast pumps. It just shortens the amount of time between finally finding a way to express that concern and getting help for it. It happens all at once. But you know, they’re drop-in, they’re casual and so we never know for sure who’s going to come or what questions they’re going to have. But it’s great, because we can listen through other people’s questions and answers and learn through other people’s experience all in the same room.

Allison: Who can come to these Baby Cafes?

Alvarez: We see all kinds of people at these events. Some people will come while they’re pregnant. And we’ve had some who came routinely throughout pregnancy just to listen and learn, and maybe ask questions. Maybe they took a breastfeeding class, but it left them with some questions. Or maybe they started talking to other people about breastfeeding, and it raised questions. So people will come during pregnancy. Most people who come are here with a newborn, like they are pretty fresh from the hospital from the birthing center with a concern or problem that may be presented outside of that 24 hours or so that they were in the hospital. And then we do still see people come back with older babies, maybe they’re getting ready to go back to work and they have questions. Or maybe things are going well, and they just want to be around other parents who get it. So it’s not always problem-solving and crying and pain. A lot of times it’s just being in community with other parents.

Allison: Some solidarity. Well, August is National Breastfeeding Month. Can you tell us what breast milk actually is?

Alvarez: Breast milk is what makes us mammals, or one of the few things, right? It just biologically makes us mammals that we create milk for our young. Everybody kind of has gotten the message that breast milk is the best thing you could feed a baby. I think we spent the past 20 years or so spreading that ‘breast is best’ message. But we haven’t necessarily spent the last 20 years giving people the support they need in order to be successful with breastfeeding. Things like workplace policies or just accepting community standards or even paid family medical leave, some of those things that just help make breastfeeding realistic. 

Those are the things that we talk about a lot in the lactation world now. Because I think the word is out, right. And most people start off wanting to breastfeed. And really, that’s what the statistics show in the United States, almost everyone starts off breastfeeding. Are they able to maintain it? Are they able to sustain it and meet their own goals without support and the kind of care we add in the community?

Allison: Can you talk a little bit about some of the common challenges that you hear about when it comes to breastfeeding?

Alvarez: In a typical Baby Cafe session, we hear a lot about latch pain, you know, like it hurts when the baby attaches to the breast. Nine times out of 10, that’s a simple enough fix with just adjusting technique — just the act of learning how to do this. You take a parent who’s never done this before, and a baby who’s just getting the hang of it and there is some learning involved. It’s completely natural, but it’s also learned behavior. 

Lots and lots of concerns about milk production, even when it’s perfectly average. You know, I think the perception of how much milk we have, or how much milk we need, is again something that we have to learn through experience. 

Allison: Can you talk a little bit about the timeline of milk production? 

Alvarez: Human bodies are fascinating. And in most cases, most bodies are capable of making breast milk. If you can grow a baby, you can typically make breast milk. It starts about halfway through pregnancy. And what’s really interesting to me is that, when babies are born prematurely, the colostrum that their parents are already making is what’s suitable for premature babies. And so it’s kind of the age of gestation, and the nutritional qualities in the breast milk match, even before delivery, which I think is fascinating. 

Once the baby’s born, it can take anywhere from, we say, two to seven days for milk to really increase enough for a person to notice it. Colostrum is there in the beginning, really small, really concentrated, really powerful. It’s great for teaching babies how to nurse, because it’s not an overwhelming volume. And typically, that increases almost always on the third or fourth day. But there’s a lot of variables that can make it happen early and kind of delay it a little bit. But somewhere in that first week is when the milk really increases enough that you feel it before you feed, you feel it after it’s been drained, you start to notice it more.

Allison: I appreciate you bringing up some of those common problems. Are there any common misconceptions that you could address with us?

Alvarez: Oh, for sure. So many people feel like they need to start pumping immediately. So they’ve just delivered a baby, they’re just getting the hang of how to read their baby’s cues, how to latch the baby, learning how to breastfeed, recovering from pregnancy and delivery. And then they want to immediately start pumping as well, because ‘If you don’t pump, your milk won’t come in.’ 

And we see those families, and it’s hard because they are exhausted. They’ve completely worn themselves out by breastfeeding full time and pumping full time. Or it’s complicated things to the point where they’re trusting the pumping piece more than they’re able to trust breastfeeding. 

There are families who definitely choose to simply pump and pump exclusively. But more often than not, I see people — that wasn’t their intention, that wasn’t their goal. But it’s where they ended up because things got so complicated. So, I’ve really spent a lot of my time reminding people: There’s no need to go home and start pumping. Unless something’s going on, that tells us we need to start doing that. But that’s not something that needs to happen automatically for everyone. 

Allison: Thanks for addressing that. If there are some new moms or some pregnant moms out there listening to this, do you have any words of wisdom for them?

Alvarez: Connect to some trusted resources, so that when you do have doubts or questions about feeding your baby, you already know where to go for that information. When we’re looking for information in the middle of the night, because we’re in pain or because we’re scared, or because we just heard something confusing or concerning at the pediatrician’s office, that’s the worst time to find good qualified help. It’s great if you can spend some time asking your circle of friends, like, who has had a good experience? Who can recommend a lactation consultant? Or, you know, even just identifying like, who are the women in my life who succeeded at breastfeeding, who I could go to if I had questions? Planning that ahead of time makes all the difference.

Allison: Do you have any local or online resources that you would recommend?

Alvarez: The milk bank actually put together a great resources page that has links to some trusted lactation resources. Also, anytime you’re reading an article about breastfeeding, or you’re looking for advice to solve a problem about breastfeeding, you want to make sure that’s from a qualified source. And so if it’s written or published by an IBCLC, which is that lactation credential I mentioned, then you know you’re getting information that’s evidence-based and not just someone’s experience or opinion. 

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....