The Sad Moms Club

34. Feeding your Newborn: Lactation, Latch, Positioning, and Pumping with Holly Hill, RN, IBCLC

• Joni Lybbert • Season 2 • Episode 34

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Holly Hill teaches us the biology of lactation, tips for latch and positioning your baby, and the correct flange size when pumping.  She is a wealth of knowledge, and if you are new to breastfeeding or you're having trouble figuring it out, listen to this episode for guidance and to learn the value of an IBCLC. Holly works as part of the Breezy Babies Team, but you can connect with her directly via her Instagram @light_up_lactation or her email holly@breezybabies.com.

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Joni Lybbert:

Hi, welcome back to the sad moms club. This is Joni Lybbert your host, and, today we're talking to Holly hill. She is a. Oh, the letters are so hard. I B C L C international board certified lactation consultant. She is amazing. She came highly recommended from so many different people. I had a lot of people reach out to me who hired her shortly after they had their baby. And just other people who work in this field who have a lot of great things to say about her. She works with a company called Breezy Babies. I'll be sure to link their website in the show notes. So that if you're looking to work with Holly or one of their other lactation consultants, you can look on there. We talk about all sorts of things on this episode. We talk about. Her story a little bit and how she went from being a nurse to lactation consultant. We talk about latch and positioning and other tips for breastfeeding or chest feeding. She shares tips for pumping. And we discussed formula feeding a little bit. Talk about reasons for low supply reasons for oversupply, how to stop breastfeeding. Holly's a wealth of knowledge and she really taught me a lot. And my guess is she could teach you something too. So if you're struggling with breastfeeding or if it's something you're concerned about with your baby, that's on the way. Or maybe, you know, someone who's struggling right now then definitely listen to this episode or send it to them. I think that's all I've got. So let's talk to Holly.

Welcome to the sad mom's club.

Joni Lybbert:

you'rE a nurse as well, right?

Holly Hill:

I am. Yeah,

Joni Lybbert:

how long have you worked as a nurse for? How did you get from like nursing to lactation and what was the journey like?

Holly Hill:

yeah, so I will start at the beginning. I always knew it going into nursing school, signing the application and all those high hopes that come as you're applying to nursing school and the envisioning. I knew that I wanted to work in women's health care. I knew that was it. That was just like a soul calling, if you want to call it that.

Joni Lybbert:

that. Yeah.

Holly Hill:

then I also told myself I know this is what I'm interested in, but nursing school is going to show me lots of different types of ways I could be a nurse. And I did stay open to it, but really, my heart is in women's care. And pregnancy, and birth, and babies, and all of that. My first job out of nursing school was on a postpartum floor. And I thought I would go on to labor and delivery from there, but I loved postpartum.

Joni Lybbert:

Cool.

Holly Hill:

loved it because that's when I realized everybody prepares for labor. There's a lot of focus on birth. There's a lot of focus on labor. There's not a lot of focus on postpartum time. And then I also realized how much I love to teaching parents just how to take care of their body, the things to expect. Nobody tells you really that. And the more babies you have, the crampier your uterus is afterwards. And so those after pains get a little more intense. So I loved being in that position to describe that even more.

Joni Lybbert:

Yeah, like educate and help them know these like little nuanced things that they wouldn't have learned elsewhere. That's cool.

Holly Hill:

exactly. So I graduated nursing school in 2005 and have always worked. Postpartum.

Joni Lybbert:

Where'd you go to nursing school at? Just

Holly Hill:

oh, I went to OHSU in Portland.

Joni Lybbert:

Oh, okay. I've heard of OHSU. So wait, did you work out there first when did you come to Utah?

Holly Hill:

I am from Utah, so grew up in Kaysville, and went to college on a music scholarship, so not like medical world at all. And that's how I met my husband. We met at the Weber State Symphony.

Joni Lybbert:

Oh, like you're both in the symphony or you both were watching the symphony?

Holly Hill:

we played in the symphony together for two years,

Joni Lybbert:

What do you guys play?

Holly Hill:

I play the viola and he plays cello,

Joni Lybbert:

Wow.

Holly Hill:

To actually take that further, it's also piano and guitars and singing and I'm in my basement here of my house and we have a room dedicated as a music room. There we have the drum set, and the banjo, and the harmonium, and the handpan

Joni Lybbert:

The hand fan. Don't know what that is. I love that. this is a huge part of your life.

Holly Hill:

It is. It is. And I actually use that as I am teaching families. And it may sound silly that I sing to babies. I do that as like a modeling if we're talking about oral stretches for baby's mouth. I say, make it like a sing song and, have a smile on your face and bright shiny eyes. And it comes across a whole lot easier. So I've been able to incorporate what I do naturally into my passion of getting to help people. To finish the backstory. We met at Weber State. We moved up to Portland because we both said, I like the rain. It rains more in that part of the world than it does in northern Utah. That's where I started I did nursing school, started working on a postpartum floor there. We bought a house, had a baby, and then there was postpartum depression that was very, very challenging. And then the 2009 recession as well. So my husband at that time was a teacher and job security was not secure.

Joni Lybbert:

Oh, wow.

Holly Hill:

So that's what brought us to Utah. All of those reasons.

Joni Lybbert:

Gotcha.

Holly Hill:

that's how I started to work in Salt Lake and then that's where the lactation piece comes in.

Joni Lybbert:

Can I ask you a quick question before we get to lactation now that you mentioned something else?

Holly Hill:

yeah, of course.

Joni Lybbert:

Were you expecting the postpartum depression? Had you did you know about it because you were on the postpartum floor? Did it take you by surprise?

Holly Hill:

It blindsided me. Absolutely. And I feel like I should have known but I was still so unprepared. I also went through pretty intense hyperemesis with her, where I loved my midwives, and they said, Holly, you're like a step away from the pick line, so let's Let's try to avoid that. And I have the best coworkers where they're like, oh, I have had a PICC line, or this is what doesn't hurt when you throw it up, or just like really good support. So I have two kids and with my first one I labored for so long was ruptured for over 24 hours. And in the nursing world, we just know that is a high risk of infection. So she came out not healthy. And Had she been born here in Utah in the Intermountain system, she would have been in an ICU. But how it was at the hospital that I worked at and delivered at in Portland they did like a secondary care in the nursery. So she could still stay on the postpartum floor with me, but would go to the nursery for antibiotics and assessments and whatever they were doing. I also skipped over I had an emergency cesarean delivery with her.

Joni Lybbert:

That makes sense with what you were saying about risk of infection. Yeah. Wow. That's a 10. Welcome to

Holly Hill:

It, it's a lot, right? So going from a difficult pregnancy, really long labor, unplanned cesarean Sick baby. Latching didn't go well. And postpartum mental health did not go well. So, We struggled with a nipple shield and formula in the tube and syringe. It's where you have like, an oral syringe and then attach a feeding tube on it. And so baby latches onto the breast, and then you slide the tube into the baby's mouth. Or the tube is just held near the nipple, so then the baby will latch onto breast and tube at the same time.

Joni Lybbert:

Gotcha.

Holly Hill:

There are more fancy ones, those are called supplemental nursing systems.

Joni Lybbert:

Okay.

Holly Hill:

And it gets really intense from there, but the tube and syringe is like, starting level.

Joni Lybbert:

And you guys had to do that?

Holly Hill:

We had to do that. So when I'm helping my clients, with needing to give supplement and they're trying not to do bottles. I can say, oh I've been there.

Joni Lybbert:

Yeah. It is nice to have some of that personal experience, but I know this is super hard and frustrating, especially when you're not even feeling well.

Holly Hill:

exactly.

Joni Lybbert:

Regardless it's hard. And then if you're not feeling well and you're recovering from abdominal surgery and you've been throwing up for nine or whatever, like it. It's just hard baseline and then people typically have something else that happened.

Holly Hill:

there's always a lot. I remember going to my 6 week checkup and it was a group of midwives that I was going to, and there was one in particular that I just had this great connection with, and at that six week checkup she gave me pamphlets about postpartum depression. She said, Holly, I care about you, I really encourage you to get connected with somebody. And I flat out denied it, because I'm a nurse. And I'm strong and I'm, I can overcome mental health challenges and I can't be in postpartum depression. I definitely had a mental block against that.

Joni Lybbert:

Did you end up finding help eventually or just suffered through it for a while?

Holly Hill:

when my baby was a year old is when I finally admitted that I had been struggling all that time and needed help.

Joni Lybbert:

That's a long time to struggle.

Holly Hill:

It's too long. Looking back, kiddo of 16, so it's been a while. But there, there are things that if I could go back and hold my hand of my younger self and say, These are why these challenges are happening, and it doesn't have to be that way. That applies to mental health, that applies to healing from a cesarean. Oh my gosh, the things I know now that would have helped me then. Like, how to roll out of bed, how to stand up, how to easily get into a car.

Joni Lybbert:

just like Moving! just simple moving thing. Yeah. No,

Holly Hill:

Yeah. All of that. And then extending that to, here's how to use a nipple shield easier. Here's how to, do bottles easier. Here's how to pump easier. So that is the place that I come from when I approach a family as a lactation consultant. I've had those struggles. I don't want to superimpose my story on other people, but I do say I, I get how the struggle can be.

Joni Lybbert:

Definitely. I think There's absolutely power in that. And that's one reason why, at least for people like you and me, who feels like women's health is a calling, there is this element of I just want to be able to support you and hold you in this space. And I get it cause I'm a woman. I think it is powerful to be able to do that. When did you start your lactation training?

Holly Hill:

That happened in 2015. So I'd been a nurse for 10 years already. And I saw a flyer about an upcoming lactation conference. And I thought, Oh, that could be really interesting to go to. And then I so naively thought, But what more could I really learn? I've already been a nurse for 10 years. oh my gosh, that first day blew my mind. And that first day, it was a three day conference, so three eight hour days. on the first day, they talked about anatomy and physiology. So just getting down to the cellular level. Talking about the mechanics, but why the mechanics are the way they are and why things match up and what happens in the brain like the pituitary and how the hormones work and how prolactin and oxytocin have to talk together. It was so amazing and I drove home that first day and I stopped at the mall on the way home and I bought some new clothes because I told myself on the drive home, I'm going to be teaching this. And so I'm going to get those clothes so that I can show up tomorrow and look legit.

Joni Lybbert:

You knew.

Holly Hill:

I knew! I did. And I came home and I was just like, talking at hyperspeed to my partner about how incredible that first day was. And he was like, Okay, so we're doing this. And then, fast forward years later, I then ended up teaching at that conference.

Joni Lybbert:

Oh, wow.

Holly Hill:

Yeah.

Joni Lybbert:

Full circle.

Holly Hill:

Right.

Joni Lybbert:

So do you start with more like education and then you can, you work towards your IBCLC?

Holly Hill:

Those are all the letters.

Joni Lybbert:

I've heard that's like quite the certification, it's like a graduate degree.

Holly Hill:

It is. And I wish that it's seen as a graduate degree because there are 95 hours of education for it. And that's not even including the one on one hours that you need for it. To become a, an IBCLC, there are three different pathways for it. There's Pathway 1 for those who are already health professionals. There's Pathway 2 for people who Already have a bachelor's degree. And then take specific college classes. Like I'm mentoring a person right now who she has a bachelor's degree in biology and she's in a master's program for human lactation. So that's what qualifies her for pathway 2. And then pathway 3 usually comes from volunteer work like La Leche League. Meetup groups or like a milk hotline something like that.

Joni Lybbert:

Gotcha.

Holly Hill:

So all those different ways to get there But it's the same education like you have to take very specific classes about Anatomy and about lactation and then the Contact hours are different. Because I wanted to hit this goal so quickly I The 95 hours really shakes out to be more like 100, cause there's just so much that you put into it, so I did all of that in just over a year.

Joni Lybbert:

Wow.

Holly Hill:

It was so intense! And then I looked up what an MBA takes, like, how many hours does it take to get, that master's in business. 60 hours over 3 years. And I was like, are you kidding me? And I don't get title of masters after my name after this? Okay. But that really is what it is. A graduate degree in human lactation.

Joni Lybbert:

Wow. Yeah, that's so impressive. One of the questions that people brought up on Instagram was how do I become a lactation consultant? So thanks for mapping out those three different ways. That's helpful.

Holly Hill:

And it's so important. And I love being in this space right now where I can be that mentor for other people. To say these are the things that we think about, you're doing your education hours, but here's how to be a lactation consultant. Here's how to do the charting. Here's what it needs to look like to send a care plan back to the client or to the provider. I find that really fun.

Joni Lybbert:

Awesome. I think that is one cool thing about nursing is I started nursing school and I hated it. I thought this is not for me. And then I found something that I truly love. So it is a cool career in that. It opens your eyes to so many other opportunities to learn and people always say there's something for everyone, but I think there kind of is because like floor nursing not for me, but talking to people all day long. That's for me.

Holly Hill:

There you go!

Joni Lybbert:

it's very cool. Okay, so you told me a little bit of an outline of what you can teach us today. And unless there's anything else you want to add, I kind of wanted to get into that.

Holly Hill:

Now let's jump right into it. Here's what I love to talk about to break it down. Because when you approach latching or the idea of pumping, it can feel so clunky. So I think that's even the word that I wrote to you. And so I like to make it sound easier and insert the details in there. I'm definitely a detail person. I can get the long term vision, but I really feel like the more you understand the details of how something comes together, the easier you can see the big picture. If we think about a baby latching, like taking a bite on a hamburger. So it's not a hamburger for us, it's a hamburger for the baby. And that's a lot of when I see parents try to position their hand. Do that right now. Put your hand on your breast. And What direction is it?

Joni Lybbert:

I don't know. Mine might be hamburger, but I don't know

Holly Hill:

Okay, well, your thumb is typically on top, and your fingers are typically on the bottom. So that's like hamburger for us, but if you're holding a baby across your chest, actually making a taco shape to them. So, when we take a bite on a taco, we don't just nibble on the outside, right? We tip it, and then we even tip our heads, so we can open our mouths really big, and then get a big bite on. So.

Joni Lybbert:

that's interesting.

Holly Hill:

That and the next thing that I'm going to share, positioning, are my number ones of here's how we make latching happen. I'm so conscious of the parent's body posture as well. Because if I see that her shoulders are all the way up her ears, and elbows are flying high and everybody looks really tense, latching is not going to happen very well. So, I Want that parent to check in with their shoulders, drop their elbows. Then bring their baby close to them. And when your elbow is low, then it's so much easier to scoop your hand underneath and hold your hand in a U shape. Rather than high elbow and high shoulder and your hand is out to the side like a C.

Joni Lybbert:

Okay, so U shape and like grabbing from almost underneath your breast instead of to the side

Holly Hill:

exactly. And all of this is a position where a baby would be across the parent's chest.

Joni Lybbert:

right. right. So it can change depending on baby's position. Okay.

Holly Hill:

So the biggest thing here is the thumbnail of the parent needs to be directly across from the baby's nose. If that lineup is happening, then the right shape is happening.

Joni Lybbert:

Okay. So like across the nose towards the ear almost of the baby. Is that kind of just so people, I can see you, but

Holly Hill:

right I'm thinking about how to say that. If the baby was across the parent's chest, and then the parent's hand is scooped under the breast and holding in a U shape, then

Joni Lybbert:

then the thumb will touch the baby's nose.

Holly Hill:

I'm realizing that this is a podcast where it's all audio, and I realize a lot of what I do is body language When I teach parents I do a lot of mirroring. So, There's some hands on that I do because I think hands on are so important, but I bring a baby doll to me with each visit, so that I can say, I'm going to mirror you and show you what I see. And then I'm going to tell you how we're going to make it different, and then we'll take baby off and make it different.

Joni Lybbert:

Yeah. That's so helpful because you don't actually know what you're doing, especially if you don't know what you're doing, you don't know what it looks like. But when you see a mirror image of it, you're like, Oh, that looks awkward. I understand what you're saying now. That's cool.

Holly Hill:

Yeah so, modeling and mirroring. Okay, that's for the beginning of latching. Now the next part of latching is that I always see parents line up their baby's mouth to their nipple. And that is not how We latch babies because if you can put all this in your mind's eye, if the baby's mouth is lined up to the nipple, then they only need a teensy tiny mouth to open up. And then their gums chomp on the tip of the nipple and chew, right? Everybody should be cringing in pain when they hear this. That is not a good latch. So from the outside, it's going to look like the baby has kissy lips, like kissy narrow lips. But what we want instead is for the breast and the nipple to be tipped up and pointed at the baby's nose. So their mouth is actually aimed on the areola, that darker part that is around the nipple. And it's off center. And so what this means is that the baby has to open their mouth so much wider than they latch on. The purpose here is that we're trying to get that nipple to land pointing at the roof of the baby's mouth. Not at the front where the gums are chewing, but deep and high in the mouth where there's a ton of space. And then those gums are actually pressing on the glandular tissue, not nipple chomping. Does that make sense?

Joni Lybbert:

Yeah, how often do you, when you're helping people, how often is that like, a key part that needs I mean, I'm guessing these two are the main ones,

Holly Hill:

Yeah, every single time.

Joni Lybbert:

I totally get it That's where it comes out. you more think of like, a straw. Like, you're just sucking on a straw and it's gonna come out, but you're saying it's more the whole breast needs to be engaged, almost.

Holly Hill:

Exactly. Exactly. And I've made a few of videos on my Instagram where I've even said, It's not nipple feeding.

Joni Lybbert:

Mmm, that's a good point.

Holly Hill:

it's breastfeeding.

Joni Lybbert:

I'll definitely have to share some of your videos because you do such a good job of illustrating what you're saying.

Holly Hill:

Oh, well, thank you.

Joni Lybbert:

I'm understanding it a lot through being able to see you. So there is a disadvantage to this. So go look at Holly's Instagram because you have a lot of props to show what you're talking about, which is so great.

Holly Hill:

do. And when I worked in the hospital system, I would bring those props to classes that I would teach. Or leave a crocheted boob in the break room like, here's what we're doing and here's how.

Joni Lybbert:

I love it. That helps me learn so much. So I think that's fantastic.

Holly Hill:

I think so. And on that note, I just opened an Etsy shop so that I can sell these sets of crocheted boobs.

Joni Lybbert:

For like other lactation or just for decoration,

Holly Hill:

however anybody wants to have that, but I started learning how to make them because I was seeing that the hospital that I was working at that time didn't have a lot of budget for anything extra. And so I thought breast models are so helpful to learn from, so I'm just going to make my own. And then I showed up to one of our corporate meetings and I plopped them on the table. And I said, here's our table decoration today.

Joni Lybbert:

it's fantastic that they love it.

Holly Hill:

they did. I get a whole lot of, Holly.

Joni Lybbert:

Oh, yeah. I love it so much. Okay. So those were like the two main things. Are there other main things you like to

Holly Hill:

yes. That was all about Latch and then sidetracked to talk about crocheted boobs. I tend to talk in circles, and I tend to repeat but I actually use that to my advantage as well, because if you are an exhausted new parent, and you're trying to learn new things, the more you hear it, the more you're going to remember it.

Joni Lybbert:

Definitely.

Holly Hill:

So I talked all about latch the next part is positioning. Really, we can't talk about one without the other. Latch in positioning, just go hand in hand. So the biggest thing that I want everybody to remember of positioning is to keep the baby's body in a straight line. Now, that sounds really simple, but you forget in the moment. Because when we're holding a sleeping baby, they're usually on their back. And yeah, they're in a straight line on their back. But when we are latching babies, we have to roll them onto their side. And then, that puts the nose to nipple and the baby's body into alignment from ear to shoulder to hip. Now, why we want that is because if the baby is on their back and they need to turn their face to then latch on, then it closes off their throat. iT's in the same way that you take a drink from an open cup. When I'm in person with people, and I did this a lot in the hospital as just teaching this small piece, I would say, do we hold a cup to our shoulder and then turn our chins to try to get a drink? No, it doesn't work very well.

Joni Lybbert:

Looks weird too.

Holly Hill:

it does look weird. Again, as I'm doing this into the camera. But then I also say, Do you hold it low on your chest and tuck your chin down to try to take a drink? No, cause that's not going to work either. We keep our bodies in a straight line and we lift our chins as we tip up an open cup and then we can swallow comfortably

Joni Lybbert:

Gotcha. So you said keeping them in alignment, you said from ear to shoulder to hip

Holly Hill:

Exactly. And chin lifted up off the chest.

Joni Lybbert:

and chin lifted. That's helpful. So there's latch, there's positioning. Are those the two main pieces or are there other things too? Just for my own like organization in my brain.

Holly Hill:

Yeah, so latch and positioning, but what comes next is how to know that the baby is actually eating. that's always every parent's biggest question. How do I know that my baby's getting enough? This is the order that I go in. Latch and positioning, just let's get the body mechanics. And then, let's look into some of the details. When a baby latches on, they do a very classic sucking pattern. First they do fast and light sucks, and then a slow, strong pull, and then that's when you listen for the swallow. When babies are latching onto a bottle, they do this exact same pattern, they just tend to do more of the slow, strong. pulls and louder swallows. If a baby is latching a breast, you can't see it because breasts are not see through. So you follow the sucking pattern and you listen for those swallows. in the very beginning, we look for the number of diapers. First day that a baby is born, It's just the birthday. It's the celebration. Everything is brand new. So we're just looking for the fact that a baby can pee and poop. That's it. The next day starts the count. So that's called day one. And at minimum it's one pee and one poop. Or more. I overachievers in this category for sure. Like more diapers is better than less. Less just means that the baby needs to eat more frequently, or maybe eat more efficiently. That goes hand in hand. By day 2, it's 2 peas and 2 poops. Day 3 is 3 peas and 3 poops. Do you get the pattern? Day 4 is 4 and 4, and then 5 and 5 and then 6 and 6, and then it usually averages after that to be about 6 to 10 diapers every day.

Joni Lybbert:

Okay.

Holly Hill:

When I'm meeting with clients in their home, then it's usually when I get to see them days after delivery. And this is when I also bring in talking about baby poop. Because if a baby eats every day, they should be pooping every day. It's been common that people hear that Breastfed babies can go days without pooping, but that doesn't mean it's normal. So just like adult humans, if you eat every day, you should have a bowel movement every day.

Joni Lybbert:

Gotcha. good to know. you said if they're not producing enough pee and poop, they're either to be eating more frequently or more effectively. Now the effective part of it, how do you how do you do that?

Holly Hill:

So that comes down to the latching and the positioning. Because as I was saying, if the baby's chin is turned to the side, if it's a shallow, narrow latch and the baby's just chewing on the nipples, those two things right there mean the baby's not getting enough milk.

Joni Lybbert:

Got it.

Holly Hill:

Or there's the potential for baby to not get enough milk. That right there is huge. And then I also add in the skill of using hands to compress the glandular tissue while the baby is eating. In that way the parent is able to push out more milk. Then the baby is able to get more milk with less effort in those days when they're working on building up their effort.

Joni Lybbert:

They have like a, must have some kind of reflex to know how to do it, but also are they learning how to do it too?

Holly Hill:

Oh, absolutely. Oh, yeah. Yeah, for sure. This is when I, I love an analogy of learning how to ride a bicycle. We as, older folks know that if we're to ride a bicycle, we have a body, there's the bicycle, and then we're gonna put the two together. Just because you put your body on a bicycle doesn't mean that you automatically know what to do. It takes practice and practice. And even when you got it, you still wobble. That's how it is with learning how to latch. A baby has those sucking instincts. A baby has rooting instincts. But then it's putting it together of a baby learning. to come forward with a wide open mouth and then use their tongue correctly. For a parent to hold their baby in a position and then relax their own body and then just really bring those two together, Parent and baby.

Joni Lybbert:

If they have learned bad habits for the first however long, how long does it take to kind of reteach them how to latch appropriately?

Holly Hill:

Ooh, that is a really good question. And it really depends on what the habits are. But usually people ask for a consult because they're in Pain, or stress, or frustration. And usually the habits have been a shallow latch and painful nipples. BUt that, that could also be a baby that's just really tense, or has oral restrictions. Or the parent never had their nipples measured, so maybe they're using the wrong flange size. And then pumping's not working. I guess what I'm saying is that I don't have just one answer for that.

Joni Lybbert:

Sounds like that's where you come in.

Holly Hill:

Yes.

Joni Lybbert:

what are some common challenges that people face when they're either first learning how to breastfeed or maybe also if they breastfeed breastfed, chestfed fine before, but now they're struggling with this baby. Two different

Holly Hill:

Yeah. Those are two different questions. Number one, I've already talked about it, and that's sore nipples. And often I see that like, if this is not the parent's first baby, then sore nipples happen because they're holding their baby too high above the nipple. Or maybe they're just smushed the nipple into the baby's mouth. Oh my gosh, I can't tell you how often I see that. Where, just as I said, it's not nipple feeding, and so it's not allowing the positioning or the space for baby to open their mouth wide and get latched on better. Sore nipples. That also happens if baby has oral restrictions that were not seen earlier. And sometimes it's not necessarily a restriction, it's just that baby is holding so much tension that their tongue can move fine, but they're clenching their jaw so tight. It's a thing that happens. Babies need time to uncurl and relax, and this is usually when I'm calling in other specialists people who specialize in bodywork the massage therapist, the chiro, the craniosacral therapist, I see myself as part of a team modality, not just hi, I'm lactation, and that's all there is. It's, I'm a piece of your puzzle, I'm a part of your team.

Joni Lybbert:

The oral restrictions, that's like a tongue tie, or

Holly Hill:

Oral restrictions. So this is something that as a nurse and as a lactation consultant, I'm not at the level of being doctor trained, so I cannot diagnose any of that because it is a medical diagnosis. But I can see when the tension of it is stopping a baby from latching well, or the tension of it is creating these shallow latches and then the parent has nipple wounds, which. So that's also when I come in and say, okay, this is how much I can do for you in this moment. And then I want you to go on and see another provider and then get all of the opinions on the best care for the baby.

Joni Lybbert:

Any other common challenges?

Holly Hill:

yes. So the next one after that would be engorgement. Cause think about if you are experiencing sore nipples. You're not going to want to latch as often because then it's that tension and that fear of that pain coming back. And then the milk floods in, and when milk really floods in, then breasts and chests are tight and heavy and lumpy and warm and uncomfortable. My whole approach to everything is gentle and soft. If I'm checking a baby, it's gentle and soft. If we're doing latching, gentle and soft. If we're talking about engorgement, gentle and soft. And getting some breast massage, when you have a lot of engorgement, there's a lot of swelling. So think about a swollen ankle. It's achy, it's tight. What you want to do is be very gentle with it and get some elevation to try to drain off a lot of that extra fluid. So that's how I approach engorgement is gentle breast massage and working in some lymphatic drainage.

Joni Lybbert:

THis is just a personal curiosity. If someone has engorgement and it's hurting to breastfeed, but they need to breastfeed to get it you just have to suffer for a little bit or is there something you can

Holly Hill:

no, not at all. There is this amazing lady. Her name is Maya Bowman and she has coined the term breast gymnastics.

Joni Lybbert:

Okay.

Holly Hill:

So I've made a video on that too, on my Instagram, and it just makes me laugh every time. she has described it as also the kindest, most gentle touch. So you start with the breast gymnastics, and it's a way of just loosening structures within the breast. It's a way of getting rid of that extra fluid. So that there can be softening happening in the breast and then milk can flow. But sometimes when a breast is so full and so engorged, sometimes the nipple flattens out. So in that situation it may make sense that the parent would use a pump for a couple minutes. Just to get off a little bit of milk, soften the breast enough to the point where baby can latch onto it. So baby's not trying to latch onto a a wall. nobody has to suffer through. There, there's always something else that can be done.

Joni Lybbert:

Okay.

Holly Hill:

That actually leads into oversupply and undersupply. Because those are also common challenges. I see undersupply happening in two different ways. One is called primary low supply. And that would be somebody who didn't have a lot of breast growth during puberty, didn't have any breast growth during pregnancy, and so just do not have the glandular space, like the glandular ability to make a full supply of milk. Definitely frustrating.

Joni Lybbert:

Is that the one called, someone wrote in about IGT? Is that an example of that?

Holly Hill:

that's it. So insufficient glandular tissue. Another medical word for that is hypoplasia,

Joni Lybbert:

Hmm.

Holly Hill:

Not enough cells.

Joni Lybbert:

I'll just like read her comment in here real quick, If that's okay. She just said, I wish more people would talk about true low supply, like IGT because it's a real thing, but so many people, including healthcare professionals act like it's not. And that makes the experience so much harder. And she talked about in like my DM, feeling lots of guilt around it guilt around having to formula feed instead of breastfeed. And, yeah, just like hard things that other healthcare professionals said to them, saying that's not a thing. And just some really painful experiences with it that she was obviously not anticipating when she first started having children.

Holly Hill:

right. Absolutely. We don't know all of the reasons exactly for why IGT happens. And it's varied from a lot of people. I often see that comes in when somebody has a history of polycystic ovaries, PCOS. And PCOS is a tricky beast. Like that can swing an oversupply or an undersupply. So that in and of itself enough to say here's a direct cause. Sometimes infertility. This is something that I do see a lot. And. when I approach my consults I like to look up the history so I'm prepared of what's happened in the past to know how that's influencing what's in front of us currently. And I am seeing that with a lot of infertility. If hormone treatments were needed to get pregnant, like to create enough stability to create a pregnancy, sometimes that means that there might be low supply. Because if hormones weren't there to get pregnant on their own, the hormones aren't always there to create the milk. Now, that's not an always statement. That is a sometimes. I've had many clients who didn't have any breast growth during pregnancy and then had a great supply and we were all shocked about it. I've had others that didn't have a lot of breast growth during puberty. Didn't have any breast growth during pregnancy. Did fertility treatments for X amount of time. And then have low supply. So those are just two examples of things that I consider. But again, infertility doesn't necessarily equal low supply. So it's all person specific. But gosh, my heart is so there for people who struggle with low supply. Because it does seem like they're so caught off guard. When they expect the baby to just latch easily and then life is sunshine and rainbows and it doesn't. And then that guilt over giving formula. So I do not come with any judgments. I show up to a house and if they are giving formula, great. Let's talk about how to mix it safely, prepare it, store it, how much the baby actually needs. Batch preparing. So at that's how I approach that as well. And I like to leave my clients with a full list here's what we talked about so that you can come back to it. Because if that's what they're either needing to do or choosing to do, they don't need me to come in and judge them for it. They need me to be there to say Here's how to do it safely.

Joni Lybbert:

Absolutely. Well, I think at least from my experience talking to people, the judgments, they're going to hear it from somebody. They don't need it from, the person that they hire. I think that's really important to bring up. You said before that there's primary and then there's, was it secondary?

Holly Hill:

Secondary, yeah. And then within that is also perceived low milk supply. In the lactation world we call it PIMS. Perceived Insufficient Milk Supply. So that would happen when a parent just doesn't think that they have enough. Through a consult, then we can say, actually, you're doing great. but then The secondary low supply, that comes in from a baby not latching well, or a parent not pumping enough, or the pump isn't working for them because they don't have the right flange size, or it's not settings that are doing much for them. So then that becomes more of a management issue. But even saying that, I also take into account, if the parent is doing all the management, they're doing all the things, then what else is going on? Do they have gut inflammation? How is their diet? Are they eating enough? What kind of rest are they getting? If they're really running on empty, then the body is just not going to put its energy into making milk. It's going to put its energy into just standing upright for the day.

Joni Lybbert:

Oh, that makes sense. And then what about oversupply? Where does that come from?

Holly Hill:

Yeah, that one, lots of different reasons for why somebody could have oversupply, and that could be from pumping too often. Let's say there's a parent who started with an undersupply and then got on a regimen of latching and then pumping to build it up, but then they kept on going and then built it up too much, that would be an oversupply. Some people are genetically predisposed. to have a lot of glandular tissue. And now I'm not talking breast size or chest size. I'm talking about the glands and the ability to make the milk. Because a small chested person could have an oversupply. A large chested person could have an undersupply. Size has nothing to do with this here. Some people tell me, Oh, I have a history of overproduction. So I'm like, great, let's talk about it and figure it out. So those who have experienced undersupply or those who are what we call just enoughers. I'm doing air quotes for these. Just enoughers. They think that people who have oversupply should be on cloud nine and that they'd never have any problems in the world. But oversupply can lead to more pain. It can lead to more congestion in the breast. And I say congestion because we used to say clogged milk ducts. We have new science and new information and clogged ducts are not necessarily a thing. It's more about the surrounding pressure. So like the extra cells, the extra fluid, the extra milk puts so much pressure on those milk tubes. And so the milk tubes get pinched off. If you can think about a kink in a garden hose. pressure like that. So if there's congestion, then there's more likely to have mastitis. Or maybe that parent with the oversupply is leaking all the time and it's uncomfortable and they feel soggy and then that can be a drag on mental health just as much as low supply.

Joni Lybbert:

your baby if you have oversupply? noT a thing?

Holly Hill:

it, yes and no. So there's oversupply and then there's also a fast milk flow, like the velocity of how quickly the milk is coming out. I guess every single one of my answers is it depends, and then here are some examples of how it depends. If there is so much milk, and it's just showering the baby, and the baby's like trying to take a sip on a, like a fire hose, that, that's a baby that's gonna get too much too fast, and then they're gonna spit up half of it.

Joni Lybbert:

Gotcha.

Holly Hill:

But let's say it's just everything has been going fine. Parent is latching their baby. That's when we say you can't overfeed a breastfed baby. Because they'll come off when they're done. That's not necessarily oversupply If I'm coming into a consult with somebody who has oversupply, then I'm talking about positioning, like oversupply and fast flow. We position in the parent to lean back, and so the baby is more above, so they have to suck up against gravity. And that will slow down the milk flow.

Joni Lybbert:

Interesting.

Holly Hill:

But if we're talking about, right? All of these things!

Joni Lybbert:

details.

Holly Hill:

If we're talking about just an oversupply, but a flow that the baby can manage, then I work with that parent to make a plan to gently, slowly downregulate to a milk volume that matches their baby.

Joni Lybbert:

Because it's like a positive feedback loop, right?

Holly Hill:

Oh, it totally is! And that's totally drawing on your nurse brain for that. cause

Joni Lybbert:

what that means.

Holly Hill:

It is. So what happens is, the baby latches on, or maybe the parent is pumping, because I work with exclusive pumping parents too. But the mechanism is the same. So the stimulation on the nipple goes up the nerve pathway and it talks to the brain, specifically the pituitary. And so then the pituitary says, Oh, I'm going to make some prolactin. Here we go. So prolactin is the hormone that makes the milk and then oxytocin is the hormone that pushes the milk out. So it acts within that glandular tissue to then have a letdown. In the lactation world, we call it milk ejection reflex. For everybody else, they call it letdown. That just means that the milk is flowing. So then the more milk is removed, the more the signals keep going up to the brain to say, Hey, keep on making milk. We're still flowing. But if We're talking about oversupply and gently down regulating, then we intentionally pump a little bit less or nurse just a little bit less, so some milk is left in the breast, which then that sends a signal to the brain to say, Hey, you made too much, so time to cut back and slow down just a little bit.

Joni Lybbert:

Is that uncomfortable to leave a little bit in?

Holly Hill:

it can be. So that's when we talk about breast gymnastics for the comfort. There's a lot of different tools and techniques that we use here. But ice would be appropriate in this situation too. I like true ice and no more than 10 or 15 minutes at a time cause then it's too cold for too long. And by this I mean like, put maybe a half a cup of water in a baby's diaper and then put it in your freezer.

Joni Lybbert:

Oh.

Holly Hill:

cheap, it's what you have on hand.

Joni Lybbert:

Oh, that's smart. And kind of like you can wrap it around a little bit.

Holly Hill:

right? And you break it up just a little bit, but it's soft cause it's the baby's diaper.

Joni Lybbert:

Yeah, that's a good, that's a good tip. and then I was gonna ask about people who pump or are bottle feeding. You talked about flan, phalange size, and

Holly Hill:

Yeah, not phalanges like fingers.

Joni Lybbert:

Okay, that makes more sense.

Holly Hill:

I've seen it written that way. So not phalange with a PH, but flange with an F. So that means the diameter of the tunnel on the breast pump parts.

Joni Lybbert:

The outside or the inside diameter?

Holly Hill:

the inside diameter where the nipple goes into the tunnel of it. So that's what a flange is of a breast pump. Almost everybody will get a breast pump that comes with either size 24 or 25 millimeters. But the most common nipple size is 17 millimeters.

Joni Lybbert:

Oh.

Holly Hill:

So that's why I talk about measuring nipples to use the correct flange size.

Joni Lybbert:

So if you have one that's too big, what symptoms might, you experience?

Holly Hill:

Oh that could be not a lot of milk coming out, that could be areola swelling, because if it's too big, then it's pulling in lots of extra areola tissue.

Joni Lybbert:

Got

Holly Hill:

But what we really want is just the nipple going down that tunnel. I'm almost always sizing people down.

Joni Lybbert:

That's weird that it comes with 20 who, who are they made for?

Holly Hill:

I don't know,

Joni Lybbert:

human women?

Holly Hill:

no, I, nipples do come in true 24 25 size, even up to 30 that does exist, but the majority of people are smaller than the 24 25. I direct them to buy inserts, and they're just like soft silicone pieces that slide into their 24 25 flange and narrow down the tunnel to their nipple size. And then I also lubricate that tunnel with whatever a parent has on hand. And nipple cream, olive oil, coconut oil. Whatever it is, make it smooth and slidy. So correct fit plus smooth and slidy equals better experience and better milk output.

Joni Lybbert:

Why does this smooth and slidey help? Just makes more of like a better suction or?

Holly Hill:

It's friction. Not to be crass, but think about sex. You're not gonna have dry sex because it's friction and it doesn't feel good. And then the outcome afterwards is not positive. APplying the same idea, you lubricate the tunnel, and then there's less friction, which means there's less pain.

Joni Lybbert:

Gotcha. Cool. aNd then what about bottle feeding? Are there tips you offer to parents who bottle feed?

Holly Hill:

Yes! And it's called Paste Bottle Feeding Method. think about what you see in the movies. A baby is flat on their back, in somebody's arms, and then the bottle is vertical. Upside down. Gravity is gonna help that baby get too much too fast. And then, that's more likely for them to spit up or overeat. Paced bottle feeding means that a baby is sitting upright in the parent's arm and then the bottle is horizontal, so think flat to the floor. Maybe tipped up at the end ever so slightly, just enough to keep milk in the nipple tip. And then that way the baby can control the speed and the amount. And then they slow down so it's not as big of a stretch to their belly. anD then it's less likely that they're overeating or too much too fast. And then I always like to take a bottle out pull it out, at somewhere in the middle of the feeding, pick baby up and give them a burp. Because burping always needs to happen with bottle feeding. There's just always extra air there. And then I do recommend switch arms. Just like babies who latch will switch sides, babies who bottle feed should be switched in the parent or caregiver's arms. So that their neck isn't always turned the same direction for every single feeding.

Joni Lybbert:

Okay. That's helpful. I've heard people before say that when their baby went to the NICU, they were bottle feeding and then they really struggled with breastfeeding because maybe they lost their supply entirely depending on how long they were there or they just feel like the baby got used to the bottle and that they now struggle with breastfeeding. Do you hear that? Is that common?

Holly Hill:

Oh yes! Yeah, it really is. And that has to do more with a flow preference and how much the baby has to work for it and often that firmer feeling on their palates.

Joni Lybbert:

Is it something you can like, if it's really important to someone, is it something that they can. their supply, I guess that it's probably not an

Holly Hill:

So remember back at the very beginning of our time together when I was talking about my own personal experience of using a nipple shield and having to use formula through a tube and a syringe? That's the idea of what we do. Often nipple shields are the right tool and trick to get a baby from a bottle to latching. Maybe not. It's all dependent on the baby. Sometimes we're able to do this bottle trick where We have the baby eat from a bottle for a few swallows, it just takes the edge off their hunger. And I explain this to parents like, think about when you're in a class, or you're in college, or going to school, think about when you're learning something new. Can you learn on an empty stomach? No. If our stomachs are empty, we're like, oh, when's lunch, or what am I going to make for dinner? You're not paying attention to what's happening in front of you. Use the bottle because that's what's familiar for a baby and then take the bottle out and then try to quickly latch them on breast. So it is a bottle trick. Sometimes it works brilliantly, sometimes not at all. That's something that definitely takes time and I often say tincture of time. I think that's not a phrase that's very common anymore,

Joni Lybbert:

I've never heard it.

Holly Hill:

Okay. It's also like the song by Bonnie. And I use that when I'm teaching body movements for babies. Okay, you're looking at me like you have no idea

Joni Lybbert:

understand now. Sorry.

Holly Hill:

that's okay.

Joni Lybbert:

feel like, I was thinking I know the song my Bonnie flies over the ocean or lies over

Holly Hill:

That's it. My body lights over the ocean. My body lights over the sea. So I do that when babies are just holding a lot of tension. I'll raise up one arm. Like I'll raise up the right and then lower their left. And then on the B's. I'll switch the arms, so then left arm goes up, and right arm goes down. And this is just to, very gently, very slowly, to release any tension that they're holding on in their chest, or in their back. Yeah, that is not a common song anymore, I'm realizing.

Joni Lybbert:

Yeah, I'm sure, I, mean, I knew it, but I didn't obviously get the words right. I was like, I think that's what she's saying, but I'm not sure why she's saying it. I

Holly Hill:

yup. So just changing on the Bs my bonnie, then right arm goes up, flies over the ocean. My bonnie, then left arm goes up. And then Bring back my Bonnie to me. I told you I sing to babies, right?

Joni Lybbert:

Yeah, that's great. Good song.

Holly Hill:

So Then I do share this with families and then I say, whatever song comes out of you, it doesn't even have to be a song. It can just be whatever you want to say to your babies. But for me, it comes out in song.

Joni Lybbert:

That's fun. Any other tips on bottle feeding, pumping, transitioning from bottle to Breasts or chest, I mean, I'm sure there's millions, but do you have any like big ones that are coming to

Holly Hill:

so many. Gosh, the biggest one there I would say is work with somebody so that you're not doing it alone. Because all these things that I'm saying, sure, a parent could muddle through it, but if you have somebody there to say, let's trade this, or let's trade that, but specifically when we're talking about bottles to breast for a baby that's not been latching at all, that is very slow and very progressive. And then we utilize the tools, maybe Nipple Shield, maybe not. Maybe at Breast Supplementer. Maybe not. I don't just stop at one try. I guess that's the bottom thing that I want to say, is that there's always another answer to keep on trying.

Joni Lybbert:

So if it's something that's important to them, you can keep working with them for a long period of time. And if it's not or if they say you know what I'm done, then you can support them in that way too.

Holly Hill:

Absolutely. And then on that note of being done, I see stopping a milk supply just as important as starting a milk supply. We never stop cold turkey. so, it's a very slow, supportive weaning time. And that's another one where parents don't have to figure that out alone. That's why my job exists. I can help people through that time, so they're not in painful breasts. They're not suffering through. they have a very solid plan that they can look to.

Joni Lybbert:

Well, That kind of dovetails into where do people find support? Like now they know you, but what's the best way to connect with someone who can help them?

Holly Hill:

Googling, honestly, Lactation Consultant Near Me. Often, and especially around here in Utah, I want to say nearly every hospital will give something of a breastfeeding resource list. So that's a place to go as well. La Leche League is an amazing organization and they are all over the world. So there's La Leche League International and that would be a good place to go to find some answers, get connected with a lactation consultant. I I'm my own business of Light Up Lactation, like as Holly, but I work with the Breezy Babies team. We are three of us here in Utah and one of us in Iowa. Between us all, we've got Northern Utah and then telehealth anywhere. That's me to get contacted with me. But a family can always Look to the resources that they got at the hospital, or if they had a birth center birth, then maybe their midwife will have a contact list. They can talk with their doulas. So the client that I saw today was referred to me from her doula. So Lots of different ways to go about that.

Joni Lybbert:

Yeah, it's good to know that this is a resource and you have some people you can ask. There was one question on Instagram. Someone asked, why are there such terrible resources for breastfeeding in hospitals?

Holly Hill:

my gosh, I don't know. I worked so hard when I was in hospitals to make that easier and make that attainable because I think breastfeeding and lactation and chest feeding, it can all feel so heavy and stressful and I want it to be light and approachable and accessible to everybody. I am sorry for somebody's experience where it feels like it's not accessible and why there's a lack there. I don't have the full answer to that one.

Joni Lybbert:

It's a bummer.

Holly Hill:

Yes, but keep on trying because when I was in the hospital system, I taught prenatal classes. I was an inpatient lactation consultant. I did their outpatient clinic. Not every hospital has that, but there are a lot that do, so that's a good place to start. But then, community. I love being in private practice right now because I can have that long term follow up with people. So it's not just like a, one and done and that's it, but it's progress over time.

Joni Lybbert:

Can they request like when you were in the hospital, I've heard someone say this before, so I have no idea if this is just one hospital's policy, but they said like they never have lactation come the first day. They usually have them wait 24 hours or something like that. I'm wondering if that's true and can you request them at any time or do you have to wait a certain period of time before you start?

Holly Hill:

That is such an excellent question. I have heard some lactation consultants say that they don't want to be there in the first 24 hours. Which, that boggles my mind. I was never that kind of a person. Hospitals have lactation people, but that doesn't mean that they're scheduled every single shift or every single day. So that is one of the challenges. Yes, a parent can request a lactation consultant, but, and I'm just drawing on my own experience here, that maybe I had so many families on the floor that I couldn't get to them that day. Because then there's the constraint of how many hours They can have a lactation person scheduled,

Joni Lybbert:

Gotcha. Sometimes it's helpful just to know the why, even if it's frustrating. OnE other comment that was posted on Instagram was she just said navigating the need for time to sleep or self care versus the guilt of using supplemental formula. you speak to that?

Holly Hill:

Navigating the need for self care. Yes versus the guilt of supplementing with formula. Now before I go any further I have so many questions of what else is going on In a situation like that what does the milk supply look like? the baby situation? Do they have restrictions or body tension? What else is going on? So that, that would be where I would figure things out first. And then it is going to be family specific here, sometimes I do say, there is a time and place for formula. It exists for a reason. And I am not going to formula shame. And I'm not gonna throw any judgment on families who need to use that because it does exist for a reason. If you need to, know that self care is so important and sleep is so important. So let's say it's maybe one or two bottles of formula in that time so that you can get a solid chunk of sleep. And if that's what it takes for as a parent to then be like, Okay, now I can pick this back up and handle it again. Then I think it's all worth it. I was saying to some of my mentees earlier this week that I don't think that formula itself is bad. I think the way it's marketed and parents feel this such strong guilt. That's where the problem is. It's food for babies and it does have a place in life. Now, am I going to not help a person latch and just say, Oh, formula's fine? No, of course not. I'm going to say, let's look at the whole situation and figure out how it works in best. Let's figure out how your partner can support you. Let's figure out your breast pump so that maybe that looks like you're actually pumping a little bit longer than you would usually and you leave a bottle with your partner. Or family member, or friend, or doula, or whoever's there to help out, and then get a good, solid, maybe four hour chunk of sleep, and then re approach. Does formula enter that situation? Maybe. Maybe not. I don't know. I realized that this question was very specifically about the guilt of using supplemental formula, but I see it as, if this is what you are needing in your family, then take it as that. It's needed to help both you and your baby, and then what if that helps you springboard to better rest, better self care, means a better latching situation, or a better pumping situation.

Joni Lybbert:

it might also mean a better attachment with your child because you can connect with them because you can be present because you're not as anxious. You're not as depressed. When I see this question, I'm not thinking from like your lens. I'm thinking oftentimes when moms are having These mental health struggles, they're prioritizing everyone else, like up here, high up. You can't see me right now, but they prioritize themselves last. And so I'm not saying prioritize yourself over your baby, over your family, just like equal. Just like you also matter and you actually have to be healthy to be able to give. And so I think there's I understand where the guilt comes from and also if you can step away from it for a second, being like, I actually matter too, and I need to be well, great, baby's fed, that is what matters.

Holly Hill:

Yeah.

Joni Lybbert:

I love what you're saying though, and I think that there's ways to problem solve around it, and that's where it's like very personal, and family oriented, and It's hard to give a blanket answer to that, but ultimately if everyone's fed at the house and sleeping the best you can, that's great. that's that's surviving at that point. That's

Holly Hill:

Exactly.

Joni Lybbert:

everyone's looking for.

Holly Hill:

Absolutely, and it's navigating that path of how would the parent like this story to be, and then what's reality, and then how do we best blend those two?

Joni Lybbert:

that's something we talk about is like, what was your imagined baby and what's your actual baby? Because they're not always the same. Often they're not. Just exploring what expectations you had around this versus what your reality is and how you can radically accept that a little bit and come to terms with it and then do what you can to support yourself, support your child, support your family within that context.

Holly Hill:

yeah, for sure.

Joni Lybbert:

I have one last question, just when should someone contact you? So if they're like, let's say they're pregnant and they're like, I'm worried about breastfeeding. Is it, when do you initially start visiting with people? How often, what does that look like?

Holly Hill:

So I really love this question and it's also based on, How much the insurance will cover and how much a person can financially afford if their insurance doesn't cover it. Let's say we're in an ideal world where everybody's insurance covers as much lactation support as they want. Which I do have those unicorns, so that does happen. I would say at least one prenatal visit. At least one. Because then I, and I'm not saying just I as me, but I as all lactation consultants, if this is possible, check the health history, figure out that person's individual story. And help them prepare for when things go perfectly planned. And then navigate some potential issues. If somebody does have risk factors in their health history for low supply, let's talk about that. And Make a plan of some breast milk and some formula. So like that's when that would come in so beautifully. Or in prenatal appointments I also talk through how to support your milk supply if your baby unexpectedly ends up in the NICU. Which, I was that parent with my second baby. She was in the NICU. And so I was just a pumping parent until she learned how to eat and breathe at the same time. I Had those skills just because I was already a postpartum nurse, but I know not everybody comes with those skills. Pumps are intimidating and they're awkward at best. So I love to talk through that with a parent and just that anticipation of what could happen. So there's the first part of my answer is if you can have at least one prenatal appointment, if not two, because I do love to see somebody who's about a month. From their due date and they have their breast pump and then we can actually set it up and they learn how to use their own specific pump Before it becomes a have to or a need to or the want to so after that it would be As soon after the hospital as they feel ready or birth center or home birth, but wherever they've birthed I say hospital just because that was my own experience So I want to make sure I'm honoring all the other families out there, too so I I love that check in just to make sure that everything is going fine. And then if there are challenges, then there are more frequent visits. That is going to vary for everybody. For some of my clients, frequent visits looks like once a month. For one of my clients, I saw her every other day for the first week of her baby's life. Great! That was awesome. For others it looks like a week here, or two weeks there, or however the calendars make sense. I would say at least one within those first two weeks, just to make sure that everything is looking great. That the latch is fine, or we tweak it, or you're using the right size flanges, and here's how to use your breast pump in the way that makes the most sense.

Joni Lybbert:

Very cool. Do you take insurance? How often is lactation covered

Holly Hill:

Yeah. That is going to be a little bit different as well. In our Breezy Babies team, we bill insurance through the Lactation Network. And, so we don't assume on anybody's insurance, so we ask everybody to just check with Lactation Network. And, oh my gosh, can I just say that they have changed the landscape of providing lactation services. Because they have started to partner with so many more insurances that it's through them that families are able to get free lactation visits. And so this is how I've been able to see one family ten times. And it's been delightful to see them on their path. Or another family. Today was the fifth time that I've seen them and just navigating their story. My ideal world is that as many lactation appointments are given to everybody in the world as often as they need them. that's how it should be. Like, yes, I have this training and yes, I went to school for this. Literally I went to lactation school. Literally there's a textbook for it. jUst cause I like to talk about it, I know that doesn't mean that rings true for everybody. Sometimes I do see clients just once, and their insurance covers it, and they're like, I'm good, thanks. And that's fine. I forgot the initial question. I feel like I went on a rant

Joni Lybbert:

I asked about insurance and do they cover it? It sounds like sometimes they don't though.

Holly Hill:

Yeah, sometimes they don't. And I describe that as if they don't and you need to pay out of pocket, then if you have a health savings account or a flexible spending account, you can use that toward it. There are some clients that I've worked with that have said, I know my insurance isn't covered, so I saved up and I planned for this. we see each other once, maybe twice.

Joni Lybbert:

The Lactation Network, you said, is something you can call and you can say hey, does my insurance, do you guys partner with my insurance? Okay. Do you mind sending me just like the resources that we've chatted about

Holly Hill:

Oh,

Joni Lybbert:

email?

Holly Hill:

feel like I should write these down.

Joni Lybbert:

You can also just send me anything. Whatever just

Holly Hill:

Yeah.

Joni Lybbert:

that's like the big one that I think, and then the breezy babies website I'm aware of. people can contact you through Instagram. Is that the way they contact you

Holly Hill:

I get a lot of messages through Instagram and that's great. So I am LightUpLactation on Instagram or families can go to BreezyBabies. com and at the very top of that website is a banner to say, check your insurance, see if you qualify for free visits. So that's a great one. And then they'll see on the next page, it connects them with Lactation Network. And then I want to say like halfway through the page, it says, I want to be connected with Breezy Babies.

Joni Lybbert:

That's the best way to work with you is to

Holly Hill:

yeah,

Joni Lybbert:

website or your Instagram. Awesome. Okay. I will say as I've posted about getting to interview you, so many people have been like, we love Holly. So you saw a couple of those on like the questions, but so many people have messaged me like, Oh, we love Holly. I'm like, wow, she must I think

Holly Hill:

much. And just, as I've shared from my own story and then just through my career to get to this point, this isn't just oh, lactation, I help babies eat, whatever. I'm really passionate about this because I know there's such high emotions that go into it and because there are so many complexities that are just inherently a part of it. The parents history, the baby's history, the pregnancy history, how the delivery went. I love knowing all of that, but then bringing in that piece of softness I know I use that word a lot, but I think that everybody needs that approach of softness and understanding and then they feel validated and supported. That's always my goal for families. And if you don't remember me, that's okay. But if you feel like I helped you feel more confident, and that you feel seen and heard, that is my goal.

Joni Lybbert:

that softness is something that at least in the therapy side of this world, we talk about holding the mother, like a mother's holding and caring for the baby. We're holding the mom, like we're the one that's being gentle with them and supporting them through this emotional high expectation time. And so I think that's a perfect word to use.

Holly Hill:

I love that. Thank you. I usually say holding space.

Joni Lybbert:

Yeah. There's a book called The Art of Holding the Postpartum Mother. I'm getting the words wrong, but it's Karen Kleinman. Anyways, might be something you're interested in.

Holly Hill:

Oh, I'm writing it down.

Joni Lybbert:

I'm going to, I'm getting it wrong. So The Art of Holding, let me just record. Let's see. The Art of Holding in Therapy, an Essential Intervention for Postpartum Depression Anxiety. Yeah. But I think it, it was beneficial for me to read as well. So,

Holly Hill:

Nice. I'll put that on my list.

Joni Lybbert:

Yeah. And There's too many things to learn, but it can be on the list one day. Thank you so much for your time, Holly. This has been so great and I've learned a ton and definitely realize how valuable you and other lactation consultants can be. So thank you.

Holly Hill:

Wow. You're so welcome. Thanks for saying all of that. And thank you for having me on the podcast and for inviting me to be here. Bye. This was so great. Such an honor.

Joni Lybbert:

Good. Yeah, it was so fun. It's always fun to meet someone new and learn something new.

Holly Hill:

Although I've got to say, because I listened to Betty DeLass, I was able to remember some of the things that she was talking about and share that with my client today. Like what you're doing is so fantastic. And on this side, I can pick up other health professionals or other areas that can help the people that I see.

Joni Lybbert:

Yeah, I've thought about, I wonder how much it helps professionals versus, the audience is just like your everyday parent. But I've heard that from professionals that they're like, Oh, I didn't know about this resource. Find it very helpful in my own practice just to be better connected and about people we have in our community that I've. Never heard of, of maybe

Holly Hill:

Absolutely. And I love going to networking events for that very reason. And just like we're taking this word of birth workers and applying it to so many different areas. And I love it. And I see that I'm here to collaborate. I'm not in competition. I'm like the least person you will ever find. I just want to play nice with everybody.

Welcome to the sad mom's club.

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Joni Lybbert

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