Podcast: How to Feed your Newborn Baby

It's a long time dream to have my own podcast where I can freely educate about parenting issues dear to my heart without being limited by the 30 second watch time of Instagram reels. And I'm so glad that I have launched the Modern Indian Parent Podcast to do exactly that. 

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In this episode, we have a very special guest, Dr Zinal Unadkat, a paediatrician and an IBCLC! We had an insightful conversation about how to feed a newborn. We touched on some important topics, such as how to ensure a good milk supply, oral ties and much more. So if you are a parent to a newborn, don’t miss out!

Prefer to read? here is the transcript of the episode: How to Feed your Newborn Baby

 

INTRODUCTION

Sanchita (00:00)

Hello and welcome to another episode of the Modern Indian Parent Podcast, which embraces modern approaches to Indian parenting. I'm Sanchita Daswani, a pediatric nutritionist.

 

Rinie (00:11)

and I'm Rinie Gupta, a pediatric sleep consultant. Every week, we bring you episodes in which we redefine Indian parenting and help you own your modern parenting choices, even if Nani or Dadi do not agree with them.

 

Today's episode is very special because we are welcoming our first ever guest on this podcast, Dr. Zinal Unadkat from Mumbai. She's not only a pediatrician with 25 years of experience, but also an IBCLC with 14 years of experience.IBCLC stands for International Board Certified Lactation Consultant.

 

And this is the highest qualification a lactation professional can achieve worldwide. And just to put it in perspective, all over India, which is a really big country with a huge population, there are only 200 lactation consultants who are IBCLCs. So, you can imagine the amount of expertise that she has. She has helped thousands of mothers have a thriving breastfeeding relationship with their babies.

 

As an expert in solving feeding concerns like oral ties and low milk supply. So, it's a great opportunity to have her on this podcast today. In this episode, we're going to be discussing so much about how to feed your newborn, how to initiate a great milk supply, when to feed them, how to deal with a low milk supply, how to deal with oral restrictions and so much more.

 

So stay tuned for this episode if you're an expecting mother who's planning to breastfeed or you are a parent who is already breastfeeding.

 

Rinie (01:53)

And here we have today Dr. Zinal. She's joining us all the way from Mumbai. Dr. Zinal, hello, how are you?

 

Dr Zinal (02:00)

Hey, I'm excellent, how are you doing?

 

Rinie (02:02)

doing great as well. Actually ever since I started following you on Instagram, like I saw your credentials and your work and your advice. I was telling Sanchita we have to have Dr. Zinal on our podcast and you won't believe it. You're actually our first guest.

 

I want to start off this conversation by learning more about your journey. So can you tell us about your journey into pediatrics? And then how is it that you came about to super specialize in lactation?

 

Dr Zinal (02:21)

So when I started doing my pediatric practice, I was feeling that there is something missing. And then, at that time, I was working as an assistant. I'm talking of way back in 2004 I was working as an assistant with Dr. Prashan Kangal and then sir was making a video of breast crawl in Nandurbar. And I was amazed to see

 

Because being a paediatrician, though I breastfed my baby, I did not know that a baby can crawl and find its way to go and latch on the breast on its own. I was fascinated and I'm like, OK, I have found the purpose of my life and that is going to be breastfeeding and I'm going to work more towards it.

 

So many mothers in Mumbai are not getting help. And I realized that so many pediatricians are giving formula. So many pediatricians are not doing initiation. And initiation is the most important thing.

 

And that is how I said that now I'm going to focus only on breastfeeding.

 

Sanchita (03:16)

I really appreciate that you're doing this because there's so much for us as parents to learn like I have twins. So when they were born, I was like, someone help me. Do I have to latch on both at the same time? Is it OK for me to, you know, use the bottle and use formula? And as you mentioned about initiation, what are the steps

 

that moms can take at the hospital itself to initiate breastfeeding.

 

Dr Ziinal (03:40)

So you know what, I would like to just correct your question a little bit here that more than the hospital, I feel that this knowledge has to be given when you're pregnant. Because if anatomically, like suppose if I tell you that when you're pregnant and you know that as soon as I'm going to deliver my baby, the first thing is that I have to do is keep the baby in skin to skin and I have to give the baby my breast milk. Unfortunately, most of the parents do not have this knowledge or awareness when they are ready for delivery.

 

Sanchita (03:49)

right.

 

Dr Zinal (04:09)

Some of them do have, but some of them don't have. So I think the first step is you knowing what is coming next and you being ready for it when the baby arrives. So when you know that as soon as the baby is going to arrive, your breast and your body is the habitat for the baby because the baby has listened to your heartbeat, the baby recognises you. So as soon as the baby is kept on you, skin to skin, the baby feels more welcomed, more loved, and emotionally more secure.

 

And at that point of time, the babies, all five senses are working. And when all the five senses are working, they immediately go and latch on on their own. So I have seen even where probably the mother's nipples are not that well formed, or probably even if there is an oral restriction or if there is anything if initiation is done, the baby latches on very well. So I think for a parent in the labour room, it is important to understand how much of pain you are in, even though you're going to deliver, you're going to be in pain.

 

And even though it's going to be a task because you're not ready for it. And let me tell you, it is really overwhelming for a mother to be in a labour room where there are so many people around her, and people are just telling her to push, push, push. At times it becomes embarrassing, and they get into too much of fear. Preparing yourself for this before you enter the labour room, you go through the process in a much better way

 

Sanchita (05:29)

oh.

 

BREAST CRAWL AND NEWBORN INSTINCTS

Rinie (05:30)

Wow. Can you tell us more about the breast crawl? Because the breast crawl that you just described is what, got you into this path. So Can you describe what the breast crawl is for us?

 

Dr Zinal (05:40)

Imagine you're going on a holiday, right? It's like I was in Singapore in January. So when I was going, I was excited, right? I was excited to see the gardens of the Bay. I was excited to go and see things around. Why? Because I wanted to explore something new—the same way the baby had just arrived in this new world.

 

There's a transition of the baby from the intrauterine environment into an extrauterine environment. So the baby in the first one hour, you notice the eyes of the baby; the baby has a sparkle in the eyes and the baby is very excited. Where am I? What am I doing? Who are my people? Okay. How are people treating me? How is this new world? So, the baby uses all his five senses. So when you place a baby on the mother's abdomen, that is skin-to-skin, so the baby gets that. When the baby is crawling,

 

the baby is following the breast. So, the smell of breast milk, one particular component, is precisely the same as that of amniotic fluid. So that is why when the babies have amniotic fluid on them, they follow that smell. The baby is seeing the mother's nipple. Now, if you all have noticed and you all will agree with me that in pregnancy, there are a lot of nipple changes which happen, right? The nipple turns from pink to black. And a lot of time, mothers ask me this question: doctor, now my breasts don't look the same. But that...

 

Sanchita (06:48)

Hmm.

 

Dr Zinal (06:52)

colour change has happened because the baby can see because newborn babies can only see black colour they can't see pink colour

 

Sanchita (06:58)

Yeah, right.

 

Dr Zinal (06:58)

All right. And the baby is listening to the mother's heartbeat. OK, because that's what the baby has heard all these nine months. The baby is trying to salivate, or the baby's tongue comes out with the smell of the mother's milk. And that's how the baby crawls. And believe me, it's a wonderful thing. I must have worked with.

 

more than 5000 mothers in my life to work with breast crawl till now. We just have to support the baby and on its own the baby latches.

 

Rinie (07:27)

That must be so magical to experience.

 

Sanchita (07:27)

That is, I can't believe it. I had twins, and because they were born early, I actually couldn't even hold them in the beginning. And they went straight to the NICU at that point. it was a very different experience. But, for so many parents who have this opportunity for the moms, it's beautiful. And when that baby can latch on,

 

Dr Zinal (07:40)

It's Beautiful 

 

Sanchita (07:50)

and just start the whole process. For so many moms, they start getting a bit stressed out. My God, is my milk supply coming? And they're not sure if it's enough. So, could you tell us a little bit about how to make sure that we, as moms, get a good milk supply?

 

FREQUENT FEEDING AND NIPPLE STIMULATION

Dr Zinal (08:07)

Research has proven that if the initiation is done within the first four hours, then the amount of milk that the mother will produce is going to be very high because you have stimulated the right chemicals to start making it.

 

But unfortunately, as it happened in your case, that probably because the babies went into a NICU and, you know, they were maybe preemies or probably sometimes mothers have some complications. So in those situations, definitely because of the other things going on, OK, the milk-making hormones don't work that much. But let me tell you, having said that, that does not mean that the kind of a mother also will meet enough. So for.

 

What is important in making milk is the frequency of feed. So it's like the milk-making process is a pituitary-based process. So milk-making hormones are pituitary hormones. So whether a mother is pregnant or not pregnant, if we stimulate the pituitary to do the milk-making process, the breast will make milk because it works on demand and supply, demand and supply, demand and supply.

 

DISPELLING THE MYTH OF LOW MILK SUPPLY

Dr Zinal 

The breast needs to be frequently emptied, which means there has to be enough nipple stimulation for the milk-making process to start.

 

Or to continually happen. And milk making process is very dynamic. That means it works 24 by 7. So, the more you feed, the more your body produces milk.

 

Rinie (09:29)

Dr. Zinal, can I ask?

 

Dr Zinal (09:29)

So this is what

 

Sanchita (09:29)

Yeah,

 

Rinie (09:30)

Dr. Zinal, can I ask about nipple stimulation and breast emptying? Does the same principle apply to pumping as well? If you are separated from the baby, let's say, you know, as for Sanchita's case, the babies were taken to the NICU. And if you pump, does that provide a similar kind of stimulation and give us a good basis to get a milk supply off to a good start?

 

Dr Zinal (09:51)

See, there are some situations where you have to start using the pump. For example, if her mother has delivered the baby as 26 weeks or 28 weeks, she knows it's going to be easily another 60 to 90 days before she can latch her babies because maybe the babies are on the ventilator or perhaps the babies are in some kind of a situation that the babies are incapable of latching.

 

Rinie (10:10)

Mm

 

Dr Zinal (10:11)

So for a baby, it's a process to learn to coordinate the suck, swallow, breathe, suck, swallow, breathe. So that sucks, swallow breathe coordination usually comes in only after 34 weeks, between 34 to 36 weeks. So if a baby is too preemie, yes, pumping does work because you have to stimulate the breast to keep up the supply. So, I'll give you an example of one of my patients when I was working at Seven Hills Hospital.

 

Sanchita (10:23)

Okay.

 

Dr Zinal (10:32)

So I had this mother who delivered triplets at 26 weeks and her babies were 600, 650, 700. That was their weight. And I counselled her on the second day of her delivery and I told her, okay, you know what You can pump.

 

So this is 2011. In 2011, the awareness of pumps in Mumbai was very, very poor. Let me tell you, very poor. I said, okay, we can start pumping your milk. We can start getting into it. She didn't have money. So what I used to tell my patients, and I still do, is that if you're not using a pump, bring it to me. I'll give it to the needy and people who need it.

 

Rinie (10:53)

Yeah, yeah.

Dr Zinal (11:04)

I gave her one of my pumps, which one patient had lent to me. She started pumping, and her babies would not get ready for three months. Right. She started pumping. Okay. I need milk for three babies, three babies, three babies because, psychologically, it is a lot. She started giving milk. She started producing so much of milk that

 

Till her babies were ready. She made friends with all the mothers who were outside whose babies were in the NICU and were not making that much milk, and the majority of all the babies in the NICU were having that mother's milk.

 

Sanchita (11:32)

What?

 

Dr Zinal (11:34)

Yeah, she had so much milk made so much during the day. She was sitting outside and pumping. So this is an excellent example of the more you pump, the more you can make, and when her babies were ready for milk, she had 15 litres of milk stored in the freezer for all her three babies 15 litres.

 

Rinie (11:50)

That is...

 

Dr Zinal (11:51)

And you know what? I should also share with you that recently, this mother came to meet me. She and her triplets came after her 10th birthday, and all three babies are healthy. Believe me, it is so satisfying to see that.

 

USING SUPPLEMENT AND SPICES TO SUPPORT MILK PRODUCTION

Sanchita (11:53)

for that.

Yeah, like even for me because I actually couldn't do skin-to-skin till about five days later because they were on a catheter. But I just started pumping. And the one thing I tell all my friends is to figure out how to use the pump before you deliver because I was stressing out at like 1 am. But then I finally figured it out, and I was pumping every two or three hours, and I got more than enough milk for both my kids, and it was quite interesting to see how my body was still able to

 

Figure it out, even though I couldn't hold them yet for the first five days.

 

Dr Zinal (12:35)

you very correctly said that right. You need to know the pumps because buying a pump is like buying a phone or a mobile phone. You go to the market, and you need clarification because there are hundreds of brands. Same way pumps. Okay, the motors are different. The capacity of every pump and the flange sizes are different.

 

Sanchita (12:37)

Yeah.

 

Rinie (12:47)

Mm

 

Dr Zinal (12:51)

So, what flange size is going to fit into what nipple also decides on how much milk you are going to be pumping. So, I have had mothers who have damaged their nipples very severely because of not using the correct flange size. And if your flange size is not correct, you are not going to be able to pump out that much milk from your breast. And then psychologically, you will think that I don't have milk.

 

Sanchita (12:52)

Yes.

 

Rinie (13:05)

Mm

 

Dr Zinal (13:13)

I believe that even if you are going to be pumping for any reason, like I have mothers who are celebrity moms who have to go for shoots on the ninth or tenth day of the delivery because there is an ongoing shoot, and they cannot go. So then I only tell them one thing: try to give the baby whatever skin-to-skin you can and give the baby that touch you can so that your body continues to get the milk-making hormones.

 

Because if you are going to be exclusively pumping and if you are going to be separated from your baby, your supply is going to drop.

 

So even if your baby is in NICU you need to go and see the baby. You need to go and touch the baby. You need to go and cuddle up the baby.

 

Rinie (13:46)

Hmm.

 

Sanchita (13:48)

Yeah.

 

Dr Zinal (13:48)

Yeah.

 

Sanchita (13:49)

And, for a lot of parents, it's this whole low milk supply, because when you're breastfeeding, you get very confused. Is it enough? So how do we know as parents whether they're having a low milk supply? Should we pump and check the amount? the quantity?

 

Dr Zinal (14:05)

I gave a very beautiful international talk on low milk supply last year, I think. In this, I tell all parents that 95 % of the time, whenever a parent tells me that I have a low milk supply, it is a perceived low milk supply. What I mean by that is that the mother feels that I don't have milk.

 

Rinie (14:11)

Mm

 

Dr Zinal (14:28)

because maybe the breasts are not getting fuller as people tell her or when she's pumping, she's not seeing anything or at times, they feel that after I fed my baby, my baby is crying, and they perceive that every time a baby is crying the baby is crying because the baby is still hungry but which is not true

 

Rinie (14:42)

Mm -hmm.

 

Dr Ziinal (14:43)

I was talking about stress. Stress is the only thing that kills the milk-making hormones. And a majority of the time, the reason a mother does not make milk is stress. Only five percent of the time is the low milk supply real. It could be because the mother has breast hypoglycemia, maybe she has a small breast, or she's had breast surgery.

 

Rinie (14:43)

Mm -hmm.

 

Dr Zinal (15:03)

Now, for a mother to understand, is my milk supply fine or is my milk supply low? There are certain check check marks. I have created a rule of eight. That means after day eight,

If the baby is passing minimum 8 times urine in 24 hours, if the baby is taking 8 feeds in 24 hours, however those 8 feeds are spaced, if your baby is started to regain the birth weight, if the potty color of the baby has turned yellow,

 

Sanchita (15:16)

and

 

Dr Zinal (15:28)

And the baby has a nice calm look on its face. That means you're doing a great job. So this is about the first few days. In the first few days, you're always confused about whether you're doing well or not. The body has its way of calibrating. Now, when we talk of milk supply, there is little physiology that goes in. Okay, so there is lactogenesis stage one, stage two, and stage three.

 

So stage two starts first, first stages in pregnancy, stage two starts when the baby comes in, when the body just starts to make milk, which is colostrum. So colostrum is very minimal in quantity, not visible to the naked eyes, and it's like few drops of yellow liquid. So at that point of time, if you as a mother know it, that okay, colostrum is not going to be a lot in quantity, colostrum is not going to be like flowing, flowing, and it's okay if I cannot see milk, but this is there in my breast.

 

So, having this knowledge that colostrum is there for the first 48 to 72 hours, which gets converted into mature milk, which is your lactogenesis three after 48 to 72 hours. So after 48 to 72 hours, suddenly the breast becomes full, and you know, lot of times the mother gets engorged at that. They also get that mastitis and that fullness feeling, and the breast becomes very hard. So that is a time when your body's hormones are kicking off to make a lot of milk. Then

 

You need to keep feeding the baby to remove that. If you don't do that, then there is something called a negative inhibiting factor, FIL, which comes in with the message, "Okay, do not milk, stop. Do make milk, stop." And if you are not frequently feeding on the second, third, or fourth day, this is what happens, and the body reduces making milk, which a lot of times, you know, just goes unnoticed.

 

If you have been frequently feeding at that time, then the body calibrates on its own within seven to fourteen days. So this is like a calibration, like an auto mode that says, okay, this is the milk we need, this is what we will make. So if that calibration doesn't go right, then again, the milk-making process reduces.

 

Sanchita (17:29)

I think as moms, we need to trust the process. Before we move to the next topic, I have to ask you about this because I feel like I got a lot of milk because I ate certain things right so I got this thing satav variks I use that in my oats I had a lot of jeera I had a lot of ghee

 

My mother made me something with some powders in it. So I was just eating all of these things. Now, I want to know from you and your expert opinion: Do all these supplements and extra stuff in the food actually help with milk supply?

 

Dr Zinal (18:01)

So, the first thing is that the milk-making process is here. If I decide today that I want to run a marathon, I can do it. Whenever there is a will, there is a way.

 

So if a mother decides that she wants to make enough milk for her baby, she can. As you know, in Mumbai, there are a lot of people who come on the signals. I mean, I don't know how many of you have ever come to Mumbai and seen a bai who will come asking for money, like begging for money. She'll have a small baby, which she's tied over in a sari over here. And the baby is continuously latching. Right?

 

Sanchita (18:21)

yes

 

Dr Zinal (18:31)

That mother does not have Shatavari or a doctor; she must be just eating basic Dal, Chawal, Roti, Sabzi type of food. But she makes milk. How? Because she knows that this is the only milk she has to feed the baby. When we as parents understand this, that milk making process is a hormone-driven process, which your body is already knows how to make milk. And if you know that I have no option, I will make it.

 

Sanchita (18:34)

Yeah.

 

Dr Zinal (18:54)

The problem is we get carried away. Can I pump? Can I take tablets? Can I eat this? And then we confuse ourselves more.

 

I always tell to mothers that I am conservative. In going back to the basics that breastfeeding does not require any gadgets breastfeeding only requires you your baby and maybe a dupatta to cover you. You don't need anything more than that. Now if at all your body is not well hydrated or maybe my body does not have nutrition, then my milk supply will fall.

 

so what you did, Sanchita was excellent because when you are eating these spices now in Indian culture Indian food, these spices hold a real good value

 

Whichever mummies make laddus, they make it raab they make sheera. All these have some properties to regulate your hormones. And that is why your body stress reduces your bone pain, your back pain decreases, your body starts making more milk and you start feeling more energetic. So I believe in using Indian spices a lot because I am very proud to say this is something within our culture.

 

Which is excellent for making milk.

 

Rinie (20:04)

I mean, in Singapore, the doctors don't have that much awareness about all the Indian spices. But the only supplement that I was given were these Fenugreek tablets, basically methi tablets, And apparently that is supposed to boost the milk production.

 

How do you feel about fenugreek tablets?

 

Dr Zinal (20:20)

So fenugreek is excellent, Galactagogue it is proven to be. So, in India, we get methi seeds, so we ask mothers to either have them as a laddu or soak them and have them.

 

So it's like if you don't have methi, you take the capsule. If you have raw methi, if it's available to you, then have the methi.

 

Sanchita (20:31)

Yeah.

 

Yeah.

 

Dr Zinal (20:36)

So all these Shatavari, whether it's a Moringa, whether you see a Methi or all these are our Ayurvedic treasures, which are there going on for years, like in Gujarat when I went. So I am also associated with UNICEF, where I do a lot of grassroot level training.

 

So I go to Anganwadi walkers at village levels and train people to breastfeed. So I have done this like in Odisha, Shettyasgarh, Maharashtra, Gujarat, and many states. so in Gujarat, they use Moringa because they don't have money to buy anything; they have Moringa trees. Moringa is drumsticks, right?

 

Sanchita (21:13)

Yeah.

 

Dr Zinal (21:14)

there, I saw that every mother who is breastfeeding the mother -in the relative will go pluck Moringa Patta. We'll make a chutney out of it or she will add it like she will garnish her food like how we garnish it with coriander and that mother starts making amazing milk. So, all these things do work at times. I feel that it also psychologically works on the mother okay because I'm having this I am going to make more milk. So that could be a possibility.

 

But I think if there is no harm in having it, if it is not harming your body, if it is only replenishing your body and giving you nourishment, it works. Please take whatever works for you.

 

Rinie (21:50)

Thank you so much for clarifying that. There's so much marketing out there where there is like the milk tea and then there are all these lactation cookies available in the market now. So you get confused and you fall into the marketing trap, but I like that you're saying that you don't need to spend a ton of money in, you know, investing in all of these things. It's just going back to the basics, looking back in your spice cupboard, and pretty much anything that you need to supplement and help your milk supply is probably already there.

 

Dr Zinal (21:58)

Yes

 

Sanchita (21:59)

Yeah.

 

Rinie (22:18)

Thank you, Dr. Zinal That gives us a lot of clarification regarding how to initiate breastfeeding, how to get a good milk supply out of it, and whether or not we need supplements. So now there is a mom who has given birth, and the breastfeeding relationship is more or less established.

 

But the most common question that moms face is, how often should I feed my baby? When you go online and Google it, it's going to be like, okay, every three hours. Or somebody's telling you, no, no, no, you just have to feed on demand or anytime baby cries, you should be feeding. So, can you advise us on how often we should feed babies during the day? Should it be on demand, or should it be roughly after fixed intervals?

 

Dr Zinal (22:58)

So I'll ask you a question. Do you make chapattis?

 

Rinie (23:02)

Yeah.

 

Dr Zinal (23:02)

So, do you make round chapatis from the first day?

 

Rinie (23:04)

Definitely a map of Africa right here till date.

 

Dr Zinal (23:05)

None of us do.

 

Sanchita (23:05)

No, yeah.

 

Dr Zinal (23:09)

So imagine if I tell you that the baby will become an expert on the first day and start making round chapatis from the first day; that's not going to happen. In the same way, when the baby is breastfeeding, the baby also needs some hand-holding. So that hand holding is that we need to do proactive feeding. So, I tell most of the parents that we need proactive feeding for seven days. That means you need to

 

make the baby come to the breast again and again so that the baby gets a practice and the baby kind of learns how to do it. That means you can you can wake up the baby put the baby to breast every three hours.

 

So you can do like 20 minutes this side, 20 minutes this side because you're stimulating both your breasts enough so that both your breasts learn how to make milk.

 

after the regulation has happened once the baby has learned to latch. That means once you know how to make round rotis, you can make rotis. can do it. Why? Because we know how to do it. Then, once the baby has learned once your breastfeeding has got nicely established, which happens anywhere between seven to 14 days

 

Sanchita (24:02)

and

 

Dr Zinal (24:13)

Then you can start going on to on-demand breastfeeding. That means only following when the baby demands. So, if the baby is sleeping, you let the baby sleep because the baby will also go into cluster sleep.

 

So, at times what happens is that the baby might take a feed, keep the baby down, the baby will do potty, the baby will be hungry again. So, are you going to tell the baby that you are hungry for three hours? No, you are going to give the baby. So that time also at times a lot of mothers tell me, doctor I just breastfed, he is again asking what do I do? I am a give. So then there is no rule. The rule is the baby. Let the baby form its own rules.

 

Rinie (24:33)

Got it. Got it. but Dr. Zinal the on -demand model is something that is very popular and the, research also shows that it's good for the baby. But what do you do in scenarios where, you know, it's not just after one feed the baby is asking for milk immediately, but this is happening throughout the day. So, you know, we, I work with moms and they have told me that, like my baby just never leaves the breast. I'm feeding for 40 minutes at a time every two hours.

So, is that something that we need to fix?

 

Dr Zinal (25:12)

See, a lot of times when babies want to latch for longer time or they want to be closer to the mother. So I feel we need to differentiate that first is it hunger or is it that the baby needs to be along with the mother to co-regulate. So what I mean by co-regulation is like we all have an autonomic nervous system, right? So babies, when they are new to this world,

They cannot self-regulate. This is a huge complaint I get from almost every mother. As soon as I leave, the baby starts crying. The moment I lift the baby up, the baby is calmer. Now, this is because the baby needs that physical touch.

 

Sanchita (25:39)

Yeah.

 

Dr Zinal (25:50)

So, if the baby wants to stay latched onto the breast, is the baby wanting to stay because the baby wants to co-regulate or because the baby is still hungry? We need to differentiate that first. Now, if it is hunger,

 

Sanchita (26:00)

Thank

 

Dr Zinal (26:01)

That means we need to check the other parameters such is the baby gaining weight is the baby passing in urine is the baby passing enough potty. So here, there could be a possibility that if a baby is taking long feeds, the supply of the mother is dwindling, or the baby is not transferring enough milk.

That means we lactation professionals come into the picture to check the latch. Is the latch fine? Is the baby transferring milk?

So, this is how we need to analyse what is going wrong. What is the thing which is missing in the picture?

 

THE IMPORTANCE OF MILK TRANSFERENCE AND THE IMPACT OF A POOR LATCH

Rinie (26:34)

Dr. Zinal, one of the things that I picked up from what you mentioned is milk transference.

 

Transferring the milk is very important to get a good supply to ensure the baby is happy and getting enough in the day. What problems can occur in the latch that can lead to a poor milk transference?

 

Dr Zinal (26:52)

So, see it's like for a complete latch to happen, okay, like this is for example, it's the baby's mouth and this is the breast. The nipple needs to reach the junction of the hard and the soft palate, and the baby seals on the breast. Now, if the seal is not complete, when the baby sucks, the negative suction which needs to form at the back of the mouth,

 

for the baby to transfer milk does not happen. So the milk transfer is actually suction driven. That means if I do this, if there is suction only then the milk because of the pressure gradient will move from the breast into the mother baby's mouth. Now if the seal is incomplete, then actually, the baby is only sucking at the breast, but the baby is not transferring the milk. At that point in time, we do have mothers who come to us with probably

 

a lot of nipple pain, the mother is having blocked ducts the mother is having again mastitis or the baby is not gaining weight, the baby is having reflux, the baby is having a lot of gas and the baby is cranky, baby who's wanting more and more milk even after feeding. Like I have this mother who came and took me to the doctor, I fed him for one hour and he's still hungry, he still wants formula. So the mother doesn't know that actually, my baby is not transferring milk.

 

if you think that your baby is not drinking, please take help of a lactation professional so you know that the baby is transferring milk. But For you as a parent to analyze the latch, I will just explain you one simple thing. One. When the baby is drinking, observe the baby's swallow. We focus on the suck. We don't focus on the swallow. So when you see the swallow, like if I'm drinking water, if my mouth is full,

 

IDENTIFYING AND ADDRESSING PROBLEMS WITH LATCH 

Dr Zinal

Only then I will swallow. So if my mouth is not full, I can't swallow. If I'm chewing a gum, okay, you will see my jaw movement.

 

but I'm not drinking. So that is the difference. So if the baby is only doing the baby's not drinking, but if the baby is doing.

 

COMMON ISSUES CAUSED BY A POOR LATCH 

Dr Zinal

swallowing that means the baby is actually so you can actually hear the swallows if you notice it well. Now, why doesn't the baby transfer? Sometimes it is that baby has a restriction which could be either a tongue tie or a lip tie or a buckle tie or probably the baby's chin is quite retarded. It could be like a you know, which is a quite recessed jaw because of which the tongue is more behind.

 

It could be that the baby has a very high arched palate. At times it could be inverted nipples, recessed nipples. It could be probably very, very flat nipples, or it could be the baby is having some muscular issues. So there could be multiple reasons why the baby is not transferring milk, and that is why you need to get it analyzed and assessed. Now, if it is a tie, which is a very common thing what I see

 

IMPACT OF TONGUE TIES ON BABIES

So whenever there is a tie, the baby is not able to cup the tongue. And because the baby does not cup the tongue, the tongue ideally needs to go and rest at the palate.

Then now if the tongue does not go and rest on the palate because there is a tie that tongue will sit on the floor of the mouth. And these babies will keep their mouth open majority of the time. That is why they are more gassy. These babies are not cupping the tongue. So they are not drinking milk. These babies will have a lot of reflux because there is a lot of facial tightness.

 

Rinie (29:42)

Okay.

 

Dr Zinal (29:56)

The baby keeps spitting up milk. The baby has a lot of Torticollis and the baby keeps arching and the baby has preference to one side and these babies are very uncomfortable and they don't settle down. They are looking very

 

all the time uncomfortable. And because they have spit up, unfortunately, I'm seeing a lot of time pediatricians put up these babies on 100 medications to stop the reflux, which is not advisable. They ask them to put some give some cereals which are thickened, which is not advisable. They ask them to keep to propped up and elevated, which is again not advisable. So it is not good for the baby to be very, very propped up.

 

it is also not good for the baby to you know you you're trying and experimenting by giving so many antacids and reflux and gas medications. So ideally, identifying why the reflux is happening is very important identifying why the gas is happening is very important. So a lot of things could be related to the ties

 

Rinie (30:52)

let's say you do spot this issue that, okay, the baby is latching but not transferring milk. Who would you go to? Like, would you go to a pediatrician about it? Or would you go to a lactation consultant to get a diagnosis of an oral tie?

 

TREATMENT OPTIONS FOR ORAL TIES 

Dr Zinal (31:07)

if you ask me, I would say lactation professional first because pediatricians, a majority of the times are very busy in their practice. They don't assess the latch and probably in a medical school. Unfortunately, we are not taught all about it.

 

I would personally feel that if at all it is an issue of baby not transferring or you feel that the latch is not adequate, then going to a lactation professional helps more because they would give you that much of time which you need.

 

which a pediatrician will not.

 

Rinie (31:32)

True, true. And I think it's very rare to go to a pediatrician and get a latch assessment. Like you never go breastfeed at a pediatrician's office for the pediatrician to analyze it. Because if you...

 

Dr Zinal (31:41)

A lot of times it is a male pediatrician, she is feeling awkward, you know there are a lot of things going on there.

 

Rinie (31:45)

So

 

Sanchita (31:45)

Yeah.

 

Rinie (31:47)

Absolutely, because then  if the baby is not getting enough weight, maybe if you go to a pediatrician's office, they're probably the first solution you will get to start supplementing with formula. But if you go to a lactation consultant, they're going to dig so much deeper into your breastfeeding relationship. OK, what's going on over there? Let's assess and fix that. OK, so let's say we do go to an IBCLC or a lactation professional in our area who specializing in oral ties. And they do say that, OK, yeah, your child has an oral type.

 

Sanchita (31:56)

Yeah.

 

Rinie (32:15)

Can you tell us like what are the various treatment options available for an oral tie and how do you kind of choose which treatment option you should go for for your child?

 

Dr Zinal (32:26)

So it actually depends from baby to baby, So you treat a symptom and not an anatomy

 

Like I had recently a baby who had a severe tongue tie, which I could see very evidently, but the baby was latching well, the baby was drinking well, the baby was gaining weight well. The mother had no complaints. So a lot of times there is a tight tie, but the tongue learns how to perform its function.

 

So if the tongue is performing its function, I will not do anything about it. I will just let the mother baby dyad be happy amongst themselves. I will tell them that if there is any problem, come back.

 

So I will treat a symptom. I will not treat an anatomy. If there are severe symptoms, which is affecting the baby and the mother, then only I'm going to intervene or otherwise. Second, if I feel that maybe there are one or two symptoms, then the only thing which I would advise is doing some tongue exercises. So it's like you kind of training the tongue to cut, training the tongue to elevate. Okay, then just some exercises help.

 

If I feel that the problems are a lot, then something called CST helps, is called craniosacral therapy. Craniosacral therapy is not really, really that recognized in India because there are very few CST therapists, but it's kind of aligning the body to the centre and aligning the autonomic nervous system of the body and aligning the babies between the cranium and the sacrum. So that can help. And if it is

 

Anatomically a very tight tie which is causing a lot of function and symptoms in the mother-baby  then a probable release by the appropriate doctor is required who has the right knowledge who could be a pediatric dentist or a pediatric surgeon or a person who has been trained to do this. There are two options one is doing a scissor release and second is doing a laser. So either you could choose depending on which provider is available in your city

 

Sanchita (34:14)

I really appreciate what you do because, honestly, just listening to you, I feel at ease that for moms, if there is an issue, there is always, it's okay to seek help. Sometimes, as parents, we'll figure it out. So I appreciate the number of parents you've helped and the moms because it makes our lives better.

 

It is so much easier and more comfortable to know that we have that support and that there is a way to fix things.

 

Hahaha

 

Rinie (34:42)

Yeah, my god, I think I've learned so much about this. Like I feel like these are fields where you're like you may have breastfed your baby, but only when you talk to a lactation consultant you're just like, my god, there's so much I did not know that can happen, and I think this episode will be so great not just for mums who are breastfeeding their babies right now but also for expecting mums.

 

Who are planning to breastfeed. So thank you so much, Dr. Zinal, for sharing everything with us.

 

Sanchita (35:10)

Yeah, okay.

 

MYTH OR FACTS RAPID FIRE 

Rinie (35:11)

Okay, all right, so everybody, the next segment is a myth or fact rapid fire.

It'll be like that coffee with Karan style, rapid-fire, but just with the myth or fact style.

 

Dr Zinal (35:18)

yes!

 

Rinie (35:21)

So, let's hear from Dr. Zinal whether the following statements are myths or facts. First, drinking milk helps to improve your milk supply.

 

Dr Zinal (35:31)

Myth

 

Rinie (35:31)

Okay, breastfeeding can reduce the risk of breast and ovarian cancer.

 

Breastfeeding helps you to lose weight.

 

Breast milk can have different colours.

 

If you breastfeed with your hair wet, then the baby will catch a cold. You can't overfeed a baby.

 

Dr Zinal (35:52)

Myth.

 

Rinie (36:01)

Women with small breasts will have a low milk supply.

 

Dr Zinal (36:04)

Myth.

 

Rinie (36:05)

If we  start going into the explanations of every single one of them, we will have one more episode ready right here. This episode will need a sequel to it.

 

Sanchita (36:08)

Yeah, Yeah.

 

Sanchita (36:14)

thank you, Dr. Zinal for taking the time and really, really providing us with so much knowledge that I think also I wish I had some of it before, but I'm glad that everyone listening here is going to have such a great experience with this podcast. Thank you for joining us.

 

Dr Zinal (36:34)

The pleasure is mutual. Enjoyed talking to you two.