CONVERSATIONS WITH… A Lactation Consultant

Getting help from a breastfeeding expert can make your nursing journey a much smoother one. Here are her tips.

Babies-CONVERSATIONS-WITH-A-lactation-consultant-1
If you have ever encountered challenges while breastfeeding ― whether it’s a low milk supply, a painful latch, cracked and sore nipples, or engorgement ― you’d probably have called a lactation consultant in desperation during your baby’s early days.

Lactation consultants, who troubleshoot any problems, offer latching and positioning guidance, as well as encouragement, offer breastfeeding mums valuable support and advice.

Valerie Ng has been an IBCLC (International Board Certified Lactation Consultants) certified lactation consultant with Mumsfairy since 2011.

Her passion for working with breastfeeding mums stems from her having had to wean her own child prematurely at 8 months because she was going through a divorce. “My supply plunged and I felt discouraged that I needed to supplement with formula,” she shares.

“I was not emotionally well to continue breastfeeding and I didn’t know where to seek help,” she says. Regretting her decision to stop breastfeeding, this now fuels what she does. “Working with mothers heals me,” she says.

Valerie tells us more about the work she does, including common breastfeeding problems women face.

Hi Valerie, care to share with us what a typical day is like for you?
I am a lactation consultant in private practice, so I am not employed by any hospitals. My working hours are rather flexible, and I plan my appointments around my son’s school timing. I do a lot of WhatsApp support for mothers that I see, too. I see a maximum of four mothers a day.

My nipples were damaged in less than a week from having a shallow latch and I had to stop latching as the pain was excruciating.”

What kind of training did you need to be certified as a lactation consultant?
I was certified in 2011 and recertified ― this is mandatory every five years ― in 2016. I did 1,000 hours of supervised clinical experience with breastfeeding mothers and babies at the National University Hospital, and I completed an online learning course of 10 lactation-specific modules. These include topics like human milk composition and function; anatomy and physiology of the lactating breast, positioning and latch, and breastfeeding initiation.

Could you tell us more about your own breastfeeding experience?
My son Rayden is now 12 years old. I was breastfeeding well in the hospital but the latch became painful when I got home. My nipples were damaged in less than a week from having a shallow latch and I had to stop latching as the pain was excruciating. Because I wanted to breastfeed exclusively, I started pumping. My milk flow was relatively slow and I remember having to massage, pump and squeeze for an hour each time, just to have sufficient milk for his 3-hourly feeds. Once, I even expressed blood! I managed to latch my son exclusively when the confinement nanny left after a month. I’m glad my pumping efforts paid off as I had sufficient milk to satisfy my boy. My favourite position was the side-lying one, since I didn’t have to wake up, especially for the night feeds. Going out with him was a breeze ― I just needed a nursing cover, a sling, extra clothes and diapers.
Babies-CONVERSATIONS-WITH-A-lactation-consultant-2

What do you usually advise mums to do if they have a low milk supply?
It depends if it’s a perceived or real low supply. Many mothers perceive their supply to be low for the following reasons:

• Their baby is not sleeping, and often seen rooting or crying;
• There’s the maternal stress having to “catch up” with the baby's consumption every three hours;
• Comparing their milk yield with other mothers.

For a perceived low supply, I would usually teach the mum to identify when milk is being transferred during a latch, and explore comfortable positions to better manage their baby’s demands. I’d also discuss the mother’s and baby’s sleeping schedule. A well-rested mum would have more energy and patience to handle a baby.

There isn't any ‘best’ way to breastfeed, only the most suitable way.”

For real low supply issues, where formula supplementation is needed, I would show the mum effective milk-removal methods to maximise the milk yield with the right cycle and suction controls on the breast pump.

Advice can vary for each mother. It depends on mother’s expectations, energy and motivation level, so I would usually discuss options with her. There isn't any “best” way to breastfeed, only the most suitable way.

What other common breastfeeding problems do mums call you about?
Some mums have a painful latch ― I would teach the “flipper” method, which involves getting the most amount of areola into baby's mouth by a simple “flip” and “shove” action. Many mums have good success with this.

Many mums also experience engorgement and blockages: It is important to focus on the “doorway” at the nipple and areola area. If the nipple pores are not open, massaging aggressively can result in a painful bruise.

What kind of breastfeeding preparation should mums be doing before they give birth?
Mental and emotional preparation is important. A good support system helps too!

How do you involve dads in the breastfeeding journey?
In the hospital, dads can help to remove colostrum by hand expression. Colostrum is thick and sticky, so it is easier to remove using hand expression instead of a pump. At home, dads can do syringe or cup feeding if supplementation is needed. They can also help to burp the baby and even position the baby for the mum. Simply being around and cheering her on provides the best support for a breastfeeding mummy.
Babies-CONVERSATIONS-WITH-A-lactation-consultant-3

What are some items that breastfeeding mums should buy?
Most breastfeeding mums will have their breast pumps, milk bags, bottles and nursing pillows ready. I’d also recommend mothers to get a silicone milk saver, to collect the letdown (milk ejection reflex) from the other side while latching.

What are the common mistakes that new mums make with breastfeeding?
Some mothers wait for their supply to come in before they start latching or removing milk. It is important to have sufficient stimulation in the early days. Frequency and effectiveness of milk removal affects the long-term milk yield. Removing colostrum effectively prevents initial engorgement, too.

Some mothers wait for their supply to come in before they start latching or removing milk. It is important to have sufficient stimulation in the early days.”

Would you advise supplementary feeding, and under what circumstances?
There are three things to consider: First, does the baby produce sufficient urine and bowel movements? Second, is the baby crying most of the time, or is he relatively calm and settles well after a feed? Third, do you observe any milk transfer during the latch?

During my sessions, I will teach the mum how to watch for the milk transfer. Simply seeing the baby latch on is not enough ― it is necessary to see that the baby is transferring milk well. Supplementary feeding is not necessary if the baby feeds at least eight times a day, settles well in between feeds and has a sufficient urine and bowel output.

For mothers who have difficulty latching on and are exclusively pumping, supplementation may be needed if her breastmilk yield is less than baby’s consumption.

Could you share some of your most memorable patients/clients?
I saw a mother with the biggest milk blister, resulting from too strong suction and a not-too-ideal latch. The milk blister was around 1cm in length going across her nipple. I needed to prick it several times in order to remove the milk stuck underneath the skin layer.

I have also seen a well-endowed mum with a fully engorged breast, roughly the size of a melon. I felt like I had gained hand muscles after helping her to hand express for an hour!

Photos: Valerie Ng and iStock

Like us on Facebook and check SmartParents regularly for the latest reads!

Elsewhere on SmartParents.sg…

Buyer’s Guide: 6 best nursing bras [Photo Gallery]

MUM SAYS 7 things I miss about breastfeeding

10 sure signs you’re done having babies