Got milk?

Providing milk for infants and babies is the primary function of breasts, so you really can't talk about breast health without talking about breastfeeding.

And this is one topic that Meredith Pollaro knows a lot about. She’s an International Board Certified Lactation Consultant (IBCLC) who operates a private practice at the Nurturing Nest, is co-chair of the Northern Nevada Breastfeeding Coalition and a coordinator and educator for the Women, Infants & Children (WIC) state Peer Counselor Program. Pollaro is also a licensed and registered occupational therapist as well. At the Nurturing Nest, Pollaro leads a free breastfeeding support group on Mondays at noon and also offers private appointments.

“A lot of moms come in for varied reasons,” Pollaro said. “It can be anything from postpartum engorgement, plugged ducts, recurrent mastitis—which is a breast infection. They could have concerns about their breasts, their nipple shape, their body size. They could have concerns about their milk supply and if they’re making enough milk for their baby. There can also be concerns with how baby is sucking, is baby sucking effectively to remove mom’s milk? Sometimes they come in and someone has told them that there’s a concern with a lip tie or a tongue tie, and they want to come get another opinion.”

Pollaro said lip ties—a tight attachment between the lip and gum—often don’t cause any issues, but tongue ties—varying tight attachments between the bottom of the tongue and the mouth—are more likely to cause issues with breastfeeding because they can cause the baby to have an “inefficient suck.” Because Pollaro is also an occupational therapist, she has worked with many babies with different kinds of oral motor dysfunction and is very comfortable evaluating these situations and, if necessary, referring moms to pediatric dentists, ear, nose and throat specialists, chiropractors or craniosacral therapists for lip or tongue ties causing issues.

There are many benefits to breastfeeding, both for mom and for baby.

“One of the big benefits to breastfeeding right after delivery is that when baby is at the breast and suckling is that we’re getting uterine contractions, so it helps the uterus go back to pre-pregnancy size,” Pollaro said. “So moms are looking at weight loss. With breast feeding, you’ll burn more calories. Some people see a benefit of getting their weight back down. Other benefits are a reduction in different types of cancers [for the mother].

“For baby, reduction in colds, ear infections, illnesses because of the protective nature of breast milk. A lot of times people feel real strongly that breast milk be the first food that babies receive so that they can coat their tummy and keep all the bad germs out that babies are exposed to when they’re born. Other benefits would be reductions in diseases and other illnesses later in life, such as Crohn’s disease, has been documented. … There’s lots of studies on IQ that say the babies who breastfeed have higher IQs, too.”

In addition, the breastfeeding mother has a lower chance of postpartum depression.

“When baby’s at the breast—more so when baby’s at the breast than when it’s a pump or some of the other devices that people use to remove milk—mom is releasing oxytocin, so it is relaxing mom and it’s kind of a euphoric feeling and mom is happy and feeling comfortable,” Pollaro said. “Even some moms when they actually later wean their baby, they might have some of those baby blues at that point that they didn’t experience early on with breast feeding.”

And, of course, breastfeeding often helps with uncomfortable or painful breast engorgement, which is very common. Pollaro said mothers should breastfeed eight to twelve times in 24 hours when the baby is first born not only to help with engorgement but also to make sure their milk supply is sufficient. The more milk a baby demands, the more milk a mother produces, so it’s extremely important to get the baby to the breast quickly after delivery—ideally, within an hour or two of delivery.

Frequent feeding or expression of the milk by other means is also important so that the breasts are emptied, which helps to prevent plugged ducts and infections.

Lactation consultants like Pollaro work with mothers to achieve whatever breastfeeding goals that particular mother has and to educate mothers about breastfeeding. Pollaro said that those goals vary greatly. Some moms want to breastfeed for two weeks, some for three years. Others choose not to breastfeed at all—opting for pumping or for formula.

“As an IBCLC, our job is not to pressure moms to breastfeed,” Pollaro said. “Our job is to educate them on the benefits of breastfeeding and then our job is to support them in their choices. … If their goal is not to breastfeed and they walk in the hospital saying they do not want to breastfeed, most of the time they’ll get a brief information about breastfeeding, but it really probably shouldn’t go beyond that if that’s their choice. But I have seen several cases of moms having that feeling going in, but once they’ve had the baby, they become interested. The baby is looking for the breast naturally, and they sometimes will decide that it might work for them.”

One of the biggest issues Pollaro faces as an IBCLC is when mothers have been given bad advice or false information or believe myths about breastfeeding, like the myth that you can’t eat spicy foods while breastfeeding. A balanced diet and staying hydrated is important, but you can still eat almost anything. And many medications are totally safe to take while breastfeeding.

Also, women with breast implants usually have no issues breastfeeding. Some women with breast reductions, especially those done years ago, may have issues with producing a sufficient milk supply if milk ducts were damaged in the surgery, but not always. But a very common reason that women believe they can’t or decide they won’t breastfeed is because of poor advice or stories from older family members.

“Just because your mom couldn’t breastfeed, it doesn’t mean anything about you or what you can provide for your baby because our body is designed to make milk for our baby, and in most cases, it works that way,” Pollaro said. “What’s really hard is that my mom was told formula was best, why bother with breastfeeding? It ties you down to the home. And so I think I was breastfed about two months, and that was pretty common. So it’s kind of about changing those cultural norms. Back in the ’50s, breastfeeding was for people who didn’t have money, who were low income and people who had the finances were going to buy the formula. It was more convenient. But a lot of moms that breastfeed actually find out that it is easy. … It’s always there. It’s always ready. It’s less supplies. It’s less packing. It’s less things to worry about, especially in the first six months or so until they start eating solid.”

As a private lactation consultant, Pollaro sees mothers typically when a mom is having some kind of issue after birth and decides she needs additional help. Most mothers see a lactation consultant when they’re in the hospital to deliver the baby, but not all will remember everything taught to them at that time because of how tired or overwhelmed they might be. Mothers with home births often get help from their midwives or doulas, and many midwives and doulas are lactation counselors that can assist the mother and baby. Pollaro recommends that mothers take a breastfeeding class while still pregnant in order to be prepared for when the baby comes.

“I get this question a lot—what’s the difference between a lactation consultant and a lactation counselor?” Pollaro said. “A lactation counselor—there are different versions. There’s a CLC, a CLE, a LEC, and all of them in the end are 20 to 40 hours of education for lactation counseling. So you might see these people employed at a doctor’s office and helping moms with getting breastfeeding started and things like that. The difference with a International Board Certified Lactation Consultant, which is my credential, is that you have to have 90 education hours and 1,000 or more—depending on the pathway you take to become an IBCLC—of hours working with moms and babies for lactation before you can even sit for the test. And you take an exam that’s offered once a year around the world on the same day.”

In Northern Nevada, there are many places mothers or expectant mothers can go for information and help with breastfeeding, including the Nurturing Nest, Lactation Connection at Renown, A Nurturing Space, La Leche League of Northern Nevada, WIC (if you qualify), Renown Regional Medical Center, Ron Wood Family Resource Center, Carson Tahoe Regional Medical Center and Saint Mary’s Regional Medical Center. Pollaro added that Carson Tahoe Regional Medical Center is the only Baby-Friendly hospital in Northern Nevada, and it’s one of two in the entire state at this time. (The second is in Southern Nevada: St. Rose Dominican Hospital San Martin Campus. St. Rose Dominican’s Siena Campus is in the process.)

“There are ten initiatives to be Baby-Friendly,” Pollaro said. “It’s just more supporting the mother to having breastfeeding success, and they’ve shown that implementing these ten things in the hospital actually leads to higher breastfeeding rates and success. It’s getting the baby to the mom quicker, delaying bath, avoiding pacifers, formula, bottles. It’s interesting, too—to get formula, it’s actually prescription to the doctor when you’re in a Baby-Friendly hospital. … The coolest thing about Baby-Friendly is that all nurses [on the OB unit] have to go through 20 hours of training on breastfeeding. So the nurses are more empowered with this information to help moms, so if it’s nighttime and the lactation consultant is not there or maybe early morning, they feel more comfortable to help the moms.”