When it comes to feeding infants, support is best [PODCAST]

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“What really is best and first when it comes to infant feeding: support. Support is best. Whether we are talking about infant feeding or frankly anything else related to postpartum or the fourth trimester, support is critical.

The other slogans just fall short.”

Michelle Haggerty is an integrative family physician and breastfeeding medicine specialist.

She shares her story and discusses her KevinMD article, “When it comes to feeding infants, support is best.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today’s show is with Michelle Haggerty. She is an integrative family physician, and her KevinMD article is titled “When it comes to feeding infants, support is best.” Michelle, welcome to the show.

Michelle Haggerty: Thank you so much for having me. I’m so excited to be here today.

Kevin Pho: We’ll get into the article a little bit. First off, briefly share your story and journey to where you are today.

Michelle Haggerty: Yeah, absolutely. I grew up in the Twin Cities of Minnesota, where I’m at currently now, and I went to school in Madison, Wisconsin, and studied infant nutrition and global health at that time. I did an internship over in Uganda studying infant nutrition, HIV, global health, and sort of the intricacies of that. Then I went on to get a master’s in public health at the University of Minnesota, again studying global health and nutrition, going along those same lines. Then I moved on to medical school and went to Midwestern University just outside of Chicago. I say I did the Midwest tour.

Then I went on to go into family medicine and did my residency in St. Paul, and I moved on and went to a federally qualified health center in northern Minneapolis, and I’ve been working there for the last seven years. In that time, I have grown my family. I have three boys now. After having my first child, I realized that the postpartum period is very underserved and undersupported, and after having my second child, I realized that there’s something I wanted to do about it. I got fellowship-trained in integrative medicine and found the world of alternative options for medical care.

And so I dreamed up my private practice. I started a practice called Fourth Trimester Doc after the birth of my second child, and it provides home care visits for families postpartum, so for mothers or birthers and their infants in the home. I’ve also become an IBCLC, which is a lactation consultant, and I have been going along the lines of learning more and more about breastfeeding medicine. So at this point, I’m very immersed in this postpartum world and in the fourth-trimester space, and I’m very passionate about supporting families during this time.

Kevin Pho: So you mentioned that the postpartum period, you said, was undersupported. Talk more about that.

Michelle Haggerty: Yeah. So think about the standard medical system. You know, families or birthers have their visits every week or even a couple of times a week going up until the very last days of their pregnancy, and then all of a sudden there are no more visits. They are sent home after the birth, and they are, you know, planning the follow-up visit at six weeks postpartum. There’s a lot of stuff that happens in those first six weeks, you know, initiation of breastfeeding, mental health concerns, even core and pelvic floor issues. And so there are a lot of things that are missing, and by the time that six-week visit comes around, it’s almost too late. There’s already so much that’s happened, and either people are thriving and doing well, or they’re just stumbling along and barely making it through. And so it’s very, very underserved.

The other piece of that is that, you know, families are bringing these infants into their pediatricians’ offices, and so those infants are getting a lot of care and a lot of support, but really the maternal or the birther, the birthing person, is not getting that same sort of care and support. So this is where we really should be taking care of the whole dyad, the mother or the birther and the infant or infants. And, you know, we are having them come out, leave their homes, carry the car seats, and do all the things, when for anybody else who has had a major abdominal surgery, we would say, “Stay home, you know, take care of yourself, have family and friends take care of you.” But instead we say, “Nope, nope, the infant is more important. We need to make sure that you bring the infant in. We need to make sure that the infant is gaining weight,” and all these things, and we are really not addressing, you know, what’s happening with that birthing person.

Kevin Pho: So during that immediate six-week postpartum period, what’s the role of the lactation consultant during that time?

Michelle Haggerty: Yeah, the lactation consultant is critical. Even in the hospital system, a lot of hospitals have lactation consultants that sort of help with initiation, with addressing latch, and with making sure that families are well informed about what to do once they go home. And then in those visits following up, lactation consultants are really important for encouraging and supporting that breastfeeding or body feeding relationship.

For a breastfeeding physician, we kind of take it maybe a step a little bit further and evaluate the whole patient. So what’s going on with the maternal or the birther, the mother or the birther? Are they having issues with mental health? Those are things that we need to be addressing, and that also very much coincides with lactation. Or, you know, are there issues with the family dynamics, or, you know, is the baby healthy? So we kind of address that whole picture and go a little bit beyond the latch and the breastfeeding relationship specifically.

Kevin Pho: All right, let’s talk about your KevinMD article. You talk more about these issues. It’s titled “When it comes to feeding infants, support is best.” Now, for those of you who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Michelle Haggerty: Yeah, well, I see, you know, over the past several years, there have been all these different slogans that have come out about breastfeeding. Whether it be breast is best, and we know that, you know, breast milk is optimal nutrition for an infant, but it’s not necessarily best in the grand scheme of things as far as, you know, again, maternal mental health, the whole family dynamics, all of the other things that make up the whole picture.

You know, informed is best. Well, sure, you can inform somebody and give people education around breastfeeding and why breast milk is optimal nutrition, but if they don’t have the support needed to be able to do the actual action of breastfeeding or lactating, or their bodies aren’t capable of doing it for whatever reason, informing someone doesn’t help, you know? So sure, informed is good, and it’s important, but it’s not the best thing.

The other one is fed is first. Well, sure, you know, fed is first, but, you know, we want babies to be fed. Like, that’s required. Babies need to be fed to be able to survive. So that is not first; that is required. It’s automatic. So to say fed is first feels like you’re really, I guess the best way to describe it is, not really caring for the goals of the breastfeeding individual. So if that person wants to breastfeed or body feed and they’re not meeting their goals for whatever reason, just saying, “Oh, it’s OK, you can just formula feed, it’s fine,” is just, you know, negating all their dreams, desires, and wishes and not really addressing what’s going on. So that’s not best either.

And so to me, support is best. Support is, or, so there’s one more slogan too: fed is first. So fed, you know, yes, that is first, but maybe it’s not best. But, you know, we again want to address that it’s important to feed the infants, for the same reasons why fed is best, I think. But in general, support is best. We really want to be supporting families, and support goes beyond just having a lactation consultant. Support is, like I said, maternal mental health support. It is family leave. It is having care providers or physicians who look like the people that they’re treating. It is, you know, having the general society be aware of and support families who are breastfeeding in public. So there’s way more to the story than just saying, “We just need lactation consultants,” or, “We just need people who are aware that breastfeeding is good and healthy.” We need more than that. So that’s where that article came from.

Kevin Pho: When you talk about some of these other slogans, breast is best, fed is best, informed is best, fed is first, in general, who are the groups that come up with these slogans? Do they have any agendas, any conflicts of interest?

Michelle Haggerty: Yeah, so let’s see. Breast is best comes from the World Health Organization, and, you know, I don’t know that they have any agendas beyond just sort of helping, encouraging families toward optimal infant feeding. But I do think that, again, the breast is best slogan or campaign is really overlooking the whole picture, and so it’s a little bit blindsided, I think. So that’s where that one comes from.

Fed is first comes from the Dr. MILK group, which is just a Facebook group for physician moms who are breastfeeding or lactating, and it’s a great group for that support system. I think they do a great job. I don’t think that there is an ulterior motive on their end besides just really trying to encourage people to reach their goals, and so I don’t think that there’s a hidden agenda on that side.

Let’s see, informed is best. I don’t know where that one comes from. I think that’s just, in general, what is sort of out there in the general, you know, childbirth education space, and I don’t think that there is a hidden agenda in that. And I think in general, we want to encourage, you know, information for our families and our patients, and so information is key. It’s really important, but I don’t think it’s the best.

And then the last one is fed is first. So that one comes from, there is some underlying controversy with that organization. The founders had some issues with, or the founding physician had some issues with, breastfeeding and wasn’t well supported, and there were some medical issues that had happened, and that infant wasn’t well cared for, unfortunately, by their physicians, and recognized that there were concerns going on. And I think that there’s more to that space than what is sort of out there right now. So that slogan can be a little bit controversial because of that, you know, where that is initially coming from.

Kevin Pho: So if you’re a new mother and you’re going through this immediate postpartum, fourth-trimester experience and you’re bombarded by all these slogans, what kind of advice do you have in terms of navigating all that? What should that new mother do?

Michelle Haggerty: Yeah, I mean, I think it’s reaching out to people who can be supportive for them. We have this whole movement of physicians specifically who are really becoming more and more passionate about the fourth-trimester space and wanting to support and figuring out ways to do that, so starting businesses that do support this. So I would definitely find family members who are willing and able to support, care physicians and lactation consultants who are able to support, so setting up your team. Postpartum doulas are fabulous. They come into the home and help with all sorts of the care and support needs that the family needs. And then just really, family friends.

I mean, and then going beyond that, I think, even advocating in society. So making sure that your employer is supporting you, and what are some things that you can do, if you are going back to work, to ask for and advocate for yourself in that space. So there are definitely ways of finding that support and getting, you know, prepared for the postpartum.

For me, I always say that if you’re not planning for postpartum, it’s like you’re planning for a wedding and not the marriage. So if you’re planning for birth and not postpartum, you really are missing a huge part of the picture. We have to be planning for this space. And so if you can do that during the pregnancy, get all the team members lined up, and get that ready, then, you know, you’re off to a great start.

Kevin Pho: I’m a primary care internal medicine physician, and we have other primary care doctors who listen to this podcast as well. If I see someone who’s in this fourth-trimester period, what are some of the issues that I need to keep in the back of my mind?

Michelle Haggerty: Yeah, I think, one, I think all physicians really need to be better aware and more trained in the breastfeeding space. I think that we need to be asking the question, “Are you breastfeeding?” Even, you know, you may not know: If they have a child that’s three or four, they may still be breastfeeding. So you want to ask those questions when you’re treating. Saying things like “pump and dump” without actually having knowledge of what you’re talking about is not helpful. There’s actually a new website coming out called trashthepumpanddump.org. That’s a great resource for physicians to go to, to be able to know: Is this something that families can still breastfeed with, or is it something like the medication or whatever that they can continue?

Kevin Pho: So for those who aren’t familiar with pump and dump, what is that?

Michelle Haggerty: So pump and dump means that you’re recommending that somebody pump the breast milk. So if you’re giving a medication or recommending a medication, you recommend that they pump the breast milk and dump it, so throw it away and not feed it to the baby. That can be hugely detrimental for the breastfeeding relationship.

One, you don’t even know if that person has tried pumping before. So does the pump even work for them? Number two, do we even know that the infant will take a bottle? So then, you know, you don’t even know if they’re going to be able to take whatever it is. Do they have backup? Do they have backup stores of breast milk? A lot of people haven’t stored any breast milk, and so they don’t have anything else to give. So now you’re basically telling this family that they need to introduce formula. And is that really necessary when 99 percent of the medications that we give families are compatible with breastfeeding and can be given? So there are very, very rare cases where we don’t recommend continuing breastfeeding when medications are involved.

Kevin Pho: We’re talking to Michelle Haggerty. She’s an integrative family physician. Her KevinMD article is titled “When it comes to feeding infants, support is best.” Michelle, what are some of your take-home messages that you want to leave with the KevinMD audience?

Michelle Haggerty: Again, support is best. I really, I mean, we really need to be working as a society to encourage supporting families who are breast or body feeding. This includes legislation. This includes family leave. It includes pumping support in the workspace. Again, it includes training providers and physicians in these spaces who are of various ethnicities, backgrounds, and cultures to be able to provide that support for people that look like them. And just being supportive of people who are out in public and breastfeeding or body feeding.

I think it’s really important to acknowledge somebody who is out in public, and you see them, and they are breast or body feeding their child. Say something like, “Congratulations, nice work, good job, you’re doing awesome.” That can go so far for so many families, because it’s so hard. It’s so hard to be out there and doing all the things. We put a lot of pressure on families and especially mothers these days, and I think the more that we can do to support and acknowledge the fact that it’s hard, and not undermine that relationship, is really important.

Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for being on the show.

Michelle Haggerty: Thank you so much. Pleasure.

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