 We begin tonight with advice for helping newborns get off to a great start in life. Joining us for this week's Your Health segment are Jennifer Fahey, assistant professor at the University of Maryland School of Medicine and certified nurse midwife at the University of Maryland Medical Center and Cheryl Holden, senior nurse, clinical nurse and lactation consultant University of Maryland Medical Center. Thanks to both of you for being here. So when it comes to breastfeeding rates around the world, if you look at the developed countries, the United States lags but it's getting better. Is that what you're seeing in your practice? Yes, we're working very hard to initiate higher breastfeeding numbers with the moms and that's starting by getting babies skin to skin as soon as they're delivered. So we have we have 10 steps that we're following because we're working for baby-friendly but every hospital in Maryland is all pursuing the same thing, more exclusive breastfeeding babies. What do you see in terms of the receptiveness of new parents to that? I think it's definitely improving as word gets out about initiatives such as this as we learn more and more about the health benefits of breastfeeding. I keep learning new things and I've been doing this for quite a while and it's amazing breast milk if it were a medicine we'd be required to give it to all newborns so we just need to get the message out that this is something that moms can give to their babies. And it's more than food? Oh yes much more than food. Tell me more. It's an active substance. The reason I call it a medicine is because it gives antibodies that help baby that particular baby at that particular age in its life. It's perfectly made to give it what it needs nutritionally, what needs to fight infections, what it needs to learn about its culture even. We get tastes from the breast milk that help us learn to be in our community. It's really an amazing substance. For the mom, for the new moms that you work with, is it is it more work to breastfeed or get formula? Great question. How do they perceive it? They don't have to get up in the middle of the night to warm up a bottle if they're breastfeeding. They don't have to prepare bottles of formula and it's definitely good for the environment not throwing formula cans away. There's this idea that sometimes parents have that they're gonna have to work more if they breastfeed because it's something that the mom's doing. But as it turns out on average a new study found that breastfeeding moms sleep 45 minutes longer than moms who have formula feeding. Well that's important. Yeah so the sleep is extremely important. I think the really difficult time for moms comes when they're trying to return to the workforce or reintegrate into the other aspects of society and that's where it's really important for the rest of the community to come in and help them because it can be very difficult to return to work and pump and do all the work of continuing to provide this wonderful food source to their babies when we're back as working moms for example. I experience that myself the challenges and so I think that's where the challenge of the work comes in and where everyone can help new moms. In terms of of right off the bat within the first day or two is there some degree of difficulty I mean maybe it maybe it works naturally immediately the baby knows what it's doing for the most part but but the mom may need a little help. It's a learned behavior right like any other learned behavior. It is for both of them and I think by getting babies on mothers chest as soon as possible after delivery and then allowing them to find their food source and to eat with the support of all the staff it's working out very well. How soon after delivery do you try to do that? Right away if we can within minutes of being born. We're drying the baby off and putting the baby on mom's chest. We call it skin-to-skin and you weren't doing skin-to-skin 15, 20 years ago. We were not. We were not. Baby got wrapped up, swaddled. That's right and you could see their little face and that's it. How did the change come about? With a lot of education actually about 15 years ago there was a nurse that started what she called kangaroo care and I think it's kind of run along since then so we know that the baby on mom's chest the baby feels secure the baby's heart rate will drop if the heart rate is too fast if they're cold the mother's going to warm them up it's just it's perfect between the two of them. So from a hospital standpoint I mean we're just talking about to take the baby dry the baby off and plop. Mothers got to love it you would think must might be in some discomfort otherwise but well they know about it ahead of time part part of this whole improvement is at every prenatal visit the nurse midwives OB doctors are talking about all the benefits of breastfeeding and what to expect so it's not a shock and a lot of our moms take classes too and I think they really enjoy it and the baby immediately goes looking for something immediately but those first one of the things when you wrap them and put them away as we miss those first cues that baby gives to mom and mom also misses those things she needs to hear and feel her baby helps her start not only be safer right after delivery less chance of bleeding but it also starts letting her body know that her baby's here and so we were missing a lot of those cues from baby we were missing that opportunity for mom to hold and feel baby and to get her hormones in her brain that will tell her to breastfeed and so you know not all babies can do this but a majority of them can and we can put them right on and then we just watch them and see when they're showing a signs that they're ready for that first feeding. Let me remind our viewers if a question about breastfeeding the movement towards more breastfeeding as opposed to bottle feeding you can give us a call we'll have the number up on the screen you can also email your questions the email address is live questions at mpt.org so typically how long do you want somebody to continue breastfeeding the baby sir a certain number of months but when are you supposed to wean these days the American Academy of Pediatrics recommends that every baby received breast milk for a year but World Health which is a bigger body would like every baby to receive breast milk for two years it's a living fluid and forgot before we call it the first vaccination the first time the babies feed it's their first vaccination they get all the amenities from mom in that first feeding you mentioned one of you mentioned that modern society isn't totally in sync with this if you're going back into the workforce any improvements in in the you know the systems for pumping storing and all that we saw some big improvement come with the Affordable Care Act put a lot of measures in place to help support breast pumps for moms so that when moms were going to be going back to work some lactation support lactation consultation and a lot of those have stayed in place and that has helped a lot there's also Maryland has regulations so do a lot of states about supporting women giving them breaks to breastfeed and so doesn't apply to all employees and some women that are working certain jobs might not benefit from those but there's definitely a lot more now than there used to be to support women as a society how do we feel about it do society feel about this the way that you would like I think there's a lot of discomfort with the act of breastfeeding and I think it's probably from lack of knowledge and we have grown up in a society that is a bottle feeding society so we have everything prepackage branded yeah definitely definitely so people know that that's what the norm is for them and they are uncomfortable around mothers that are breastfeeding sometimes right and we've seen that there was some picture going around on Instagram today of a celebrity who was was breastfeeding so there was the issue with the exposed partially exposed breast which makes some people uncomfortable but she was also holding a glass of wine which is something I wanted to ask you about if you're a breastfeeding mother do you have to be more careful about what you eat and drink and smoke perhaps than otherwise definitely if you read that article they quoted American Academy of Pediatrics and they said that they would like you to not drink that glass of wine one to two hours before feeding the baby so exactly exactly and I like to say to women that they often there's a lot of things they can't they can have very full diets you know one glass of wine is different than some other things that we could fit in so it's all about making sure that you're in communication with lactation experts or with your pediatricians to know what's safe women don't have to have perfect diets they don't have to be in perfect shape yes we need to create drugs and certain substances have to be out of the milk is those could be dangerous including ones that sometimes we prescribe we have to be careful to make sure we know among select patient status but I like to remind women that they you know this doesn't have to change their lives as much as they might think to be able to successfully and safely breastfeed their babies the other point worth making in in support of breastfeeding is on the other end of the digestive system that that breast milk digests almost perfectly I mean it's designed the both systems are designed for that and when you do change the formula or certainly solid food put this simply the diapers get a lot smellier yes they know and there's a lot of things talking about that and about our gut flora that we've learned and so that's one of the things we've known breast milk is the best food but we're still learning about why and one of these things that has emerged is from breast milk baby gets about a third of its gut flora and we're understanding that now has impact on risk of getting diabetes obesity even hypertension and so what we call the microbiome of the gut is seeded in great part by breast milk in a way that it's not with formula so that end of the gut is also stinky diapers and let's grab a phone call Prince William County this is Holly Holly thanks for the call go ahead. Hi I have a question for the ladies I'm interested when a child or newborn is not taking breast milk properly like they get very bloated very gassy very stinky smelly diapers possibly slight hives does this mean the child is allergic to breast milk or lactose is it an early sign or signal of a lactose intolerance in the child and should I be maybe moving to like alternative Holly thanks for the phone call how often do you see that pretty pretty I can't think maybe 5-10% of moms may experience something like this and a good recommendation is to go back to your pediatrician and possibly even see a Peds GI doctor because it may not be lactose it might be dairy products but the pediatric doctors will help you figure out what it is but definitely not going to a soy formula that's just as allergic as as dairy what are the top issues that a lactation consultant sees I mean I see the same it must be a lot of new mothers I'm guessing yeah first-time mothers first-time mothers inability to latch sorenipples or babies are biting when they get a little bit older and women fear that they're not producing enough milk to feed their baby because it's perfectly obvious when the bottle is empty exactly so we developed a really beautiful way of showing how small the baby's stomach is on day one day three and day seven and we show those to the moms to reinforce that they do have enough milk Jennifer what happens when when a child needs to go to the the NICU I mean and or maybe it's a premature birth or those things impediments to breastfeeding well they can be impediments to direct breastfeeding if the baby is needing to be helped to breathe and there might in being separated but it's actually these babies who are premature and who are going to the NICU who are having cardiac we were talking about cardiac surgeries earlier for complex heart disease those are the ones that need this the most and doctor teams all over the world and all over the country are realizing how important breast milk is to the well-being of these babies so it's now becoming one of our staunchest advocates are some of these pediatricians and specialists because they need that breast milk to help make those babies better and the best place to get that is from the moms themselves there's banks and other things but the ideal source is the mom and then as quickly as possible getting them together as well and hopefully eventually breastfeeding directly but the milk is essential for these babies I guess there's a feeling in society that we can improve upon anything we have the the science we have the the technology to do it and maybe that was part of the the big movement away from from breastfeeding but but now maybe we know more and there's the move towards natural foods of all kinds does that help I believe so it but it's just the perfect food for human babies there there's no argument at all it it's just the right food I laugh because every time I read a new article about breast milk I realize it is breast milk that makes me realize that how much we think we know but how really little we know about how our systems work all our systems work in sync with each other and so I think that's part of the big push is as we're realizing more about the immune system about microbes about all these things that we're learning about breast milk that's helping reintroduce it I guess getting back to basics Jennifer Fahey and Cheryl Holden both University of Maryland Medical thanks for spending time with us thank you your health segments are a co-production of Maryland public television and the University of Maryland Medical System