Certified Lactation Consultant Andrea Syms-Brown on Why to Do Natural Breastfeeding, Breastfeeding vs Pumping, and More

Despite the fact that breastfeeding is a natural process, many women struggle in their efforts to achieve natural breastfeeding. That’s where a certified lactation consultant can be a lifesaver (sometimes literally). Adrienne spoke with Andrea Syms-Brown, an international board-certified lactation consultant, founder of Baby in the Family, and the women who “saved” Adrienne on her own breastfeeding journey. Read on to learn about why natural breastfeeding can be so difficult for women, how to think about breastfeeding vs pumping, the importance of proper positioning, and much more.

*This is a short clip from our interview with Andrea Syms-Brown. Click here to watch the whole thing*

You can also listen to Adrienne’s interview with Andrea Syms-Brown on The WellBe Podcast.

Why Certified Lactation Consultants Are So Important

Society talks a lot about breastfeeding being a choice, and it is. But when we put the emphasis on it being optional, we set women up to quit as soon as they experience a difficulty. This is understandable — as anyone who has struggled with breastfeeding knows, it can be incredibly hard and discouraging — but it also ignores the fact that breastfeeding is very important for the health of both baby and mother. For this reason, it’s vital that women have the support they need to push past challenges rather than giving up at the first hiccup. And the only person who can provide that support is a certified lactation consultant.

To understand the importance of a certified lactation consultant, it’s helpful to first understand just how many health benefits come from natural breastfeeding:

• Breastfeeding is linked to a lower risk of endometriosis in mothers 
• Even partial breastfeeding for the first few months lowers risk of SIDS (sudden infant death syndrome)
• One study found that nursing mothers reduce their risk of breast cancer by 4.3% for every 12 months that they breastfeed, and another found that breastfeeding reduces risk of ovarian cancer by 24%
• Breast milk colonizes the baby’s microbiome, setting them up to have a healthy immune system and avoid allergies
• Exclusively breastfeeding for seven to 12 months reduces the risk of early menopause by 28%
• A recent study from the American Heart Association found that breastfeeding decreases a woman’s overall risk of heart disease (which is the leading cause of death in the U.S.)

On the flip side, you have the risks inherent in formula itself. A 2017 study showed that 80% of infant formulas tested were positive for arsenic — commonly known as a rat poison — which is associated with developmental defects, cardiovascular disease, neurotoxicity, diabetes, and even cancer. Plus there’s the risk you face when you and your baby are reliant on a large corporation, which the Abbott formula shortage has shown us can lead to tragedy and extreme stress. 

Yet despite all of this, in 2018 the United States was the only nation to oppose a WHO breastfeeding resolution. Why? Because of the lobbying power of the U.S. formula industry. 

Of course, certain families and mothers don’t have a choice: babies are born prematurely, or adopted; work schedules make breastfeeding impossible; medical issues may be obstacles. In these cases, it’s perfectly fine to seek out a healthy formula that will nourish your baby. 

But for women who can breastfeed and are simply facing challenges, it’s often advisable to seek a certified lactation consultant. These experts are trained in lactation support, and can help women overcome any hurdles and access not only the countless benefits, but also the joyful ease of truly natural breastfeeding. 

Natural Breastfeeding Should be Natural — But It Often Isn’t

If breastfeeding is an innate, natural process necessary for survival, why do so many mothers today struggle with it? According to Syms-Brown, the fault lies largely with doctors, nurses, and other medical professionals. 

“What I’ve learned in my 30-plus years that I’ve been doing this is that we in the medical community are at fault. We make it hard for you,” says Syms-Brown. She explains that if a woman who wants to breastfeed holds her baby in a comfortable feeding position (more on that later), the baby knows what to do. The lactating parent’s job is simply to facilitate that process. But the medical community, she has, has taken this agency away from women, overcomplicating the natural process of breastfeeding and making women doubt their bodies and their babies. 

The second reason that breastfeeding can be difficult is because it requires you to show up, literally. “If you plan to breastfeed your child, then it means that you need to be with your child,” says Syms-Brown. “For many families, that can be somewhat distressing and difficult, because giving birth is an event — it’s over at some point. Lactating and breastfeeding goes on and on and on. It’s a process.” The ongoing nature of the process, combined with fatigue and concerns that you’re not doing it “right” can take its toll on families, she explains. 

To overcome these challenges, she says, the most important thing is to empower women with the information they need to confidently and correctly feed their child. “The number one thing to remember is that your baby is born motivated to be fed, and to feed him or herself. There are literally synapses in the brain, neural pathways that say, ‘This is what you’re going to do when you’re born,’ which is why they practice sucking in utero. They’re born with this innate ability, and we take it away from them by doing some things that are not helpful,” she says. “Once you get this concept that the baby knows what he’s doing or she’s doing, and you understand what your baby is communicating to you, then everything becomes much simpler. And that’s where I feel my colleagues have done mothers who choose to breastfeed a disservice.” 

For mothers who cannot breastfeed immediately after birth for whatever reason — if the child has to spend time in the NICU, or if they’re not latching, for instance — Syms-Brown explains that the mother still has the power to begin the natural breastfeeding process. “You can literally squeeze or hand-express the colostrum, which is a honey-textured syrup, basically early milk, that comes out of your breast specifically for baby,” she explains. This hand-expressed colostrum can then be offered to the baby in a bottle, on a fingertip, or otherwise. When women don’t express their colostrum it remains in the breast, which tells the brain that the baby didn’t make it (i.e. didn’t live), and ceases milk production. 

“The real trick is to get the colostrum out, and delivered to baby, including if the baby is not latching him or herself,” she says. “That’s fine. We can figure that out afterwards, but getting the milk out, that’s the key.’

What’s the Deal with Breastfeeding vs Pumping?

On the surface, it may seem like there aren’t a lot of differences when it comes to breastfeeding vs pumping. After all, both processes deliver breast milk to the baby, and both tell the mother’s body that milk is needed. But as Syms-Brown explains, they’re actually vastly different in terms of how your body and milk supply is affected — something that Adrienne experienced firsthand.

Early in Adrienne’s breastfeeding journey, she ended up pumping on one breast and feeding on the other for various reasons. Soon, she had an oversupply on her left side (where she’d been feeding) and an undersupply on her right side (where she’d been pumping); then, when she began pumping a bottle so that she could sleep through the night, her overall supply plummeted. 

As she learned after working with Syms-Brown, both of these things happened because your body is listening to whatever you’re doing, and responding accordingly. “My body thought, okay, the baby doesn’t need to eat at night. So I wasn’t making quite as much milk as I normally would, because I wasn’t actually doing what he was eating, right?” Adrienne says, reflecting Syms-Brown’s teachings back to here. “I was pumping into a bottle, then he was eating in the night, but my body, of course, doesn’t know that he’s eating because he’s not nursing.”

It makes sense that overnight weaning would disrupt supply — but why would pumping on one side and feeding on the other throw things out of whack? Aren’t they the same? As Syms-Brown explains, not at all. 

“A breast pump was made in a factory, and a baby was made in a uterus,” she says. “So your body knows exactly the age, weight, and health status of your baby, and it produces a specific blend of food for this child. When we separate the child from that lactating person, and that person chooses to use a breast pump, there’s no more feedback.” She explains that in natural breastfeeding, when babies latch onto the breast, their saliva gets into the milk ducts, where they are carried up into the milk producing tissue and tell the mother’s body exactly what the baby needs. With a breast pump, there’s no input, only negative pressure that sucks out the milk. 

What’s more, Syms-Brown says, breast pumps can only effectively remove one third of the milk that’s available, whereas babies can effectively remove two thirds. That’s a big difference, and your body takes note of it; the rules of supply and demand apply to breast milk supply as well, so the reduced demand of the pump can lead to an inadequate amount of milk to feed the baby.

“But all is not lost,” Syms-Brown says. “I have many clients who choose to pump exclusively, and mothers who go back to work but want to continue providing breast milk to their babies. So there are some tricks that we can employ to help this factory-made breast pump act similarly to a baby, or at least remove as much milk as it can from your breast.”

For women who choose to pump for whatever reason, Syms-Brown has three tricks that can help them avoid supply issues:

• Nurse and pump early in the day. “If you’re going into your office or work situation anytime before noon, ideally you should nurse your baby before you leave your home, if you can. And then the minute you get to your job, pump immediately,” she says. This is because your levels of prolactin — the hormone that tells your body to make milk — are the highest overnight and early in the morning. By nursing and pumping in the first few hours of the day, you’ll send a strong signal to your body that milk is still needed. 
• Eat a protein-rich snack. Syms-Brown explains that protein increases your levels of oxytocin, the hormone that pushes the milk out of your breast. She recommends protein bars, cheese, or any other healthy snack with high levels of protein.
• Smell your baby. Your baby’s smell — or anything else that tells your body the baby is near — will also increase oxytocin. While your baby is usually not there when you’re pumping, you can bring their smell along via some used clothing. Syms-Brown recommends putting one of your baby’s used shirts in your pumping kit, so you always have it there. You can also look at videos of your baby while you’re pumping to help release the oxytocin you feel when you’re physically with your baby. 

While breastfeeding still comes out on top in the breastfeeding vs pumping discussion, using these strategies can help to even the playing field. “If you employ all of those tricks, and do a little bit of breast massage before and during pumping, we can help the breast pump to remove more milk,” she says. “The supply goes down because of a lack of removing milk, so things get better.” 

Proper Positioning for Natural Breastfeeding

As a certified lactation consultant, Syms-Brown works with women who are having issues with natural breastfeeding. While of course there are many potential root causes of breastfeeding struggles, she says that more often than not, the baby’s position is a factor. 

“I would say that between 85 to 90% of the time, the baby is uncomfortable,” she says. After assessing what position is being used, Syms-Brown then works with women to figure out what position would work best for the baby. “Let’s come up with a position that this baby would appreciate for drinking,” she says. “That’s where most of the problems tend to lie.” 

Before they even give birth, many women are told that they need a breastfeeding pillow — it’s a staple item on baby registries, and ubiquitous in targeted ads to pregnant people. But, Syms-Brown explains, these pillows actually put the baby in a suboptimal position for natural breastfeeding. “If a baby is lying on his or her side on a pillow, and trying to eat with his head sideways, that can be a bit of a challenge, because a human being can’t do that easily,” she says. 

What’s more, she explains, women are often told to push the baby’s head forward (toward the nipple) to encourage feeding, and this makes the baby’s position even worse. “The way that our anatomy works is if you push a human head forward, the only thing that’s going to happen is the chin is going to go down,” she says. “Take a sip of something with your chin on your chest. How’s that feel? If you’re gonna drink tequila, you’ve gotta lift your chin. Having a baby in a position that allows him or her to lift their chin, 95% of the time that takes care of the pain.” 

Breastfeeding pillows also often place the baby too high up relative to the breast, which was one of the issues that Adrienne faced. Syms-Brown explained that when the baby isn’t low enough, not only is gravity not on their side, but they’re also unable to tug at the nipple as well as they would if they were lower (think of the position calves are in when nursing from a cow’s udder). By simply positioning a baby lower, they’re able to more easily access milk, allowing them to feed more quickly and become more full, and subsequently increase milk supply by more effectively emptying the breast of milk.

Watch our entire interview with Andrea Syms-Brown to hear Adrienne’s whole breastfeeding journey, the primary causes behind sore nipples, what Syms-Brown thinks about the official recommendation to stop breastfeeding at age one, how breastfeeding helped when Adrienne’s baby got Covid-19, what the deal is with tongue-ties, how capitalism affects breastfeeding advice to women, the minimum amount of breast milk necessary for a baby to reap benefits, and much more.

You can also listen to Adrienne’s interview with Andrea Syms-Brown on The WellBe Podcast.

If you’ve ever breastfed, what was your experience like? Share your challenges, triumphs, and questions in the comments section below.

Citations:

1. Farland L V, Eliassen A H, Tamimi R M, Spiegelman D, Michels K B, Missmer S A et al. History of breast feeding and risk of incident endometriosis: prospective cohort study BMJ 2017; 358 :j3778.
2. Van den Elsen Lieke W. J., et al. Shaping the Gut Microbiota by Breastfeeding: The Gateway to Allergy Prevention?Front. Pediatr., 27 February 2019. 
3. Langton CR, Whitcomb BW, Purdue-Smithe AC, et al. Association of Parity and Breastfeeding With Risk of Early Natural Menopause. JAMA Netw Open. 2020;3(1):e1919615. 
4. Babic A, Sasamoto N, Rosner BA, et al. Association Between Breastfeeding and Ovarian Cancer Risk. JAMA Oncol. 2020 Jun 1;6(6):e200421. 

The information contained in this article comes from our interview with Andrea Syms-Brown, IBCLC, RLC, founder of Baby in the Family. Andrea worked as an independent Newborn Care Specialist/Educator for several years before becoming an International Board-Certified Lactation Consultant, specializing in the Hands Off Technique (HOT). She served as both President (2012-2014) and Education Director (2008-2012) of the New York Lactation Consultant Association. She is also certified in Infant Massage Instruction. You can learn more about Andrea Syms-Brown at the Baby In the Family website.