Transcript: Ask the Midwife – Postpartum Questions Answered

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called Ask the Midwife – Postpartum Questions Answered and you can click on the link to view the full episode page, listen to the episode and view the show notes.

In this episode I had the pleasure of speaking with Kristin Mallon, who is a board certified nurse midwife, breast health expert, published author and a mother of four.

Kristin has attended over 1,000 births so has a huge wealth of knowledge when it comes to all things childbirth. I used the opportunity to ask Kristin some of the burning questions that I’m often asked by mums who are just embarking on their parenting journey and there’s some great tips and insights in this episode on topics including the first hour after birth and latching.

Helen Thompson: Welcome Kristin to First Time Mum’s Chat. I’m delighted to have you here. I’ve always wanted to talk to a midwife so let’s start with asking what you do and what you’re passionate about.

Kristin Mallon: Thanks, Helen, thanks so much for having me here. So I’m a midwife in private practice in America, and I’ve been a midwife for 16 years and had a very busy practice. So even though it’s only been 16 years, some people would say 16 is a long time. It’s been many, many, many women throughout the years and that’s what I’m really passionate about. I really love working with women before they give birth, because I believe that when the baby is born, the mother is born too. And so I love to kind of give women that great first start.

Helen Thompson: That’s a nice way of putting it. The mother is born too. I really like that. That’s nice because you don’t normally hear that very often that the mother is born too, because she’s born to a new life.

Kristin Mallon: You know, she’s a mother in some ways before the baby is born but I feel that it really comes to full fruition when she holds the baby in her arms for the first time.

Helen Thompson: That must be such a lovely experience for you as a midwife, but also for the mother as well, picking up the baby and just passing it. Do you cut the cord before the mum cuddles?

Kristin Mallon: So there’s a lot of talk now about when to cut the cord and there’s a lot of discussion and so that’s in a lot of prenatal conversations ahead of time about when to do delayed cord clamping, to not do delayed cord clamping, to do cord blood collection, to do what’s called the Lotus birth, which is when you wait for the placenta to be born before you cut the cord. So lots of different options and women and families have all different options.

And I don’t cut a lot of chords, believe it or not. A lot of times a woman’s partner will cut the cord or a woman herself will cut the cord.

Helen Thompson: Okay. That’s nice because I think it gives you that connection.

Kristin Mallon: It’s kind of a ritual in some ways. There’s a little ceremony to it I think. It’s a moment in time and I think that we have a lot of rituals for a reason and they serve a great purpose. And that’s one of life’s kind of cool, unique, once in a lifetime, twice in a lifetime, five times in a lifetime, how ever many kids you have, rituals.

Helen Thompson: Yeah, because I know you’re a mother of four so you would have experienced that from the mother’s side, as well as being a midwife.

Kristin Mallon: Yeah, my husband cut the cord all four of my own births. We kind of had the conversation ahead of time and he was the one that did it all four times.

Helen Thompson: What are some of the things a mother should see after she’s given birth? We’ve just talked about cutting the cord, but are there any other things the mother should see after birth?

Kristin Mallon: Yeah in the immediate postpartum time, the first hour is that time when, for most women, they really describe that moment as a very surreal out of body experience. And I find a lot of women, they struggle with that. They feel lost, they feel out of body, they don’t know how to verbalize it and some women have all different types of emotions around that.

Sometimes there’s immense joy, there’s immense guilt, there’s immense apprehension. And I really just think that women should know that in that first hour, there was a lot of movement. It’s called the golden hour, when the baby should really be skin to skin. And I’m not as big a proponent of that as some think. There’s a very wonderful doula who created this concept called the birth pause. And I thought it was so beautiful where she talks about how, when the baby is born. If a woman is kind of left to her own devices and not put into her head that she should have any kind of, the baby has to go immediately to the chest and we have to do this and you have to do that and you should, should, should, should that women have this pause, whether it’s a beat or a minute or five minutes where they just take it all in. And I think that’s what’s happening in those moments and in that pause. It’s the transition from either not having any children outside of the womb to having your first child outside of the womb, or to be going from if the unit is with one child, to two, or to many. Any time a new life is added to, or a new baby is added to a family, there’s a shift and a transition, and she did this beautiful explanation of the birth pause. And her name is Mary Esther Malloy and I can give you the information to put in your show notes about that, where women can read about it. And then the first hour, I think we have to kind of let go of what should happen in that first hour.

Some women don’t want to hold the baby, some women do want to hold the baby, some women want their partner to hold the baby, some women need a minute to kind of collect themselves and they need a moment alone, or they want to be in darkness, some women want to be surrounded by lots of people and I think that all of those things are accepted and okay.

And even when you look at a newborn and, doing infant massage, working with a lot of infants you would know this too. A newborn, isn’t always rooting right away. Isn’t always ready to nurse immediately within that first hour. Some are and some aren’t. And so sometimes women can frustrate themselves if they have this feeling of should nurse, should have to breastfeed in this first quote, unquote golden hour.

So I always tell women, the skin to skin isn’t really important for the first hour. It’s really important for the first 48 hours until the milk is coming in. And you have two days to do that important skin to skin, to tell your brain, okay, make milk now. Okay. Brain start releasing the hormones that are going to start making milk and I find so often that women in prenatal care are so obsessed with this golden hour and they get obsessed with the colostrum and they get obsessed with, the baby was born at 9:42, so until 10:42, the baby has to stay on my chest and you can’t do any tests and you can’t weigh the baby.

And some babies, about 10% of babies, do need a little assistance after birth. They need a little observation, a little assistance. They need a little kind of rub on the back or pat on the head and women kind of get disappointed if they fall into this 10% and their baby ends up needing a little bit more observation.

And when I go see that same woman, the next day, or several hours later, if she gives birth at 10:00 PM, I’ll go the next morning and see her just maybe 12 hours later and the baby’s laying in the bassinet and I’m like, oh, you’ve, you’ve missed the point of this skin to skin conversation that we’ve been having as birth workers for so long. It’s not about the first hour. It’s really about the first 48 hours.

Helen Thompson: And you mentioned the rooting reflex. I know what that is because of my background, but for mothers that don’t know, what is the rooting reflex?

Kristin Mallon: So the rooting reflex is when the baby is kind of smacking its lips, licking its lips, opening and closing its mouth, making big mouth movements. And what I’ve noticed is that women who tend to have relatively quicker labors or relatively faster labors. Their babies sometimes do tend to show the signs of readiness and willingness to breastfeed sometimes a little bit quicker than a baby who has gone through a longer labor itself or who has gone through a longer second stage of labor.

So the second stage of labor is, you get to 10 centimeters and now you’re starting to push and you’re pushing for maybe two hours, three hours, four hours. In the states, we let women push for four hours before we say it’s arrest of descent now. Our new standards have changed. It used to be two and then you evaluated and then three and you were saying, okay, we can do a C-section on three hours of pushing, but it’s changed to four hours.

So sometimes we have women that are pushing a long time and those women are exhausted and they need that birth pause more than ever. And the babies need it too. And the babies don’t always come out ready to breastfeed immediately. And women sometimes get that birth disappointment that I’m always trying to avoid through education and through talks like this and through working with women through prenatal care.

It’s okay if the baby doesn’t get to the breast. We actually tell women, they have four hours to get the baby to the breast after the baby’s born. And sometimes it does take that long. It can take two or three hours before the woman and the baby have really recovered. I mean, the woman, I think emotionally, it’s hard to know what’s really going on with the neonates, but I think they’re both recovering, especially from these longer labors or these labors that have these longer second stages where the pushing part can be quite drawn out.

Helen Thompson: It can be drawn as you say, for the baby as well, because we always think of the mother being exhausted, but I’m thinking of the baby going through the birth canal. That’s quite a dramatic experience for a baby as well. And when the mother’s pushing, it can put a lot of strain on the baby, I would imagine as well.

Kristin Mallon: Absolutely, so in the first hour, the woman is having her own kind of transition. There’s a lot of realizations that are happening, a lot of aha moments. There’s a lot of instincts that are kicking in and it’s okay to take the time to let that all wash over you. There’s not these time limits on, everything has to happen within this first quote, unquote golden hour. I really say, give yourself four hours to bond and skin to skin and latch and do all these things.

Women will often go through in the first hour or two, the, the shakes. And I’m sure you might’ve heard about that. There’s usually a tremendous amount of shaking and that happens with, or without epidurals. A lot of times women will blame that on their epidural, but it happens without epidurals also.

If you look at an animal and this comes from Bradley. Bradley was an obstetrician who created the Bradley method of childbirth. And he modeled his method of childbirth based on watching animals give birth. He did have some really good points, which was that whenever an animal goes through a significant event, there is shaking. You’ll see often animals do this, if they have near misses, they’ll have any type of something where their adrenaline gets up very, very high. They will have a shake to kind of process physically what happened to them emotionally.

And there is the fluid shift and there are the hormone shifts, which are also contributing to the shaking but the shaking is a big thing that happens to women for usually about an hour or even 90 minutes after they give birth, the uncontrolled shaking.

Helen Thompson: I can understand that. You mentioned earlier about latching. That was one of the things I was going to ask you about. What are some of the common issues that happen both for baby and mom, when they first started latching.

Kristin Mallon: Well, I think what’s really helpful about latching in general is the concept of latching should start before a woman gives birth, hopefully, ideally, and we don’t really live in a world anymore where we grew up watching women breastfeed, where it was something that we saw all the time. You know, women are told to cover up all the time and you didn’t see your mother breastfeed, your aunts, your cousins, your sisters.

It wasn’t a common thing. So we didn’t have that visual learning of the proper position and holding and what it should look like. So we’ve lost a lot of that just as a society and a culture. And so I really encourage women to take a breastfeeding class before they give birth.

But it’s very helpful to understand what latch should look like, the proper latch techniques, different positions, different holds. So you have some ideas of how to troubleshoot if it should come up. The other thing that I think is incredibly important and some preliminary research is coming out about this now, is the supplementation of DHA and EPA, which are omega-3 essential fatty acids.

So this is very big in the states. It’s not so big in other parts of the world, but research is coming out that lip tie and tongue tie has been associated with a decreased levels of omega-3 essential fatty acids and specifically EPA, which is an omega-3 essential fatty acids. So I think the supplementation of EPA is incredibly important. And then the last thing is that some women actually have flat nipples or inverted nipples.

And this is a question that I have on my own personal checklist in the office to ask women in the third trimester. If they’ve had an exam by one of my colleagues, it might not have been noted. And so I’ll say, do you have flat or inverted nipples? And obviously women know immediately what I’m talking about.

And that is something that there’s all these tools that can be helpful, that you can have antenatally like the latch assist and the nipple shields and nipple shells to help with latching, if you have flat nipples or inverted nipples, because the worst thing is, you don’t want to be on the finish line and then all of a sudden you realize you don’t have all the proper tools that would make it a lot easier. And then for latching, what we know to be the most effective thing to get women to latch is to have an experienced guide, help you and watch you latch. So, wherever you give birth, in the home, in the birthing center, in a hospital, having experienced personnel who have lactation experience, who can help you latch the first time, the second time, the third time, is proven to be extremely beneficial for long-term breastfeeding success rate.

Helen Thompson: Yeah, I can imagine that because if you have a bad latch, it may affect the milk supply, but I don’t know if that’s true.

Kristin Mallon: So probably not necessarily affect the milk supply because the milk supply is coming from a production scheme I always say, so it’s really a supply chain thing. So you’re stimulating the breast with anything really with the baby’s mouth, with the baby suck with a breast pump or with your hand. And that’s telling your brain to make more milk. And there’s a little bit of a delay, there’s a lag. So, as long as you’re stimulating the nipple, you’re going to make milk. If you don’t have a good latch, it could lead to pain, it could lead to blister formation, and then that could ultimately make it so that a woman can’t take the pain anymore and then doesn’t ultimately breastfeed because it’s too painful.

Helen Thompson: When my sister gave birth with my niece, she breastfed both my niece and my nephew, but when she gave birth to my niece, she said that she used cabbage leaves on her breasts because her breasts were so painful. I’m assuming that could have been because she’d had a bad latch and she wasn’t connecting as much. And that’s why. I don’t know if that was a good thing or a bad thing, but that’s what she did.

Kristin Mallon: Yeah. So cabbage leaves are kind of a old wives myth, whether they, whether they work or not, if they work for you, that’s great about for engorgement or when the breast can get overfull and now there’s a lot of different kind of ointments and creams and there’s something Soothies which can help for any type of nipple or blister formation on the breast and that’s what the shells and the shields help with also. The shields will actually protect the nipple if the baby doesn’t have a good latch, but if you’ve done all the steps, if you took the EPA in pregnancy and you went to a breastfeeding class and you evaluated whether or not you have flat nipples and then you give birth. And then within those first few times that you’re breastfeeding, you have an expert that’s helping you get a good latch going, and you’re still having issues, then it’s good to consider the possibility the baby has a lip or tongue tie, which is much, much more common these days.

Helen Thompson: Yeah, I’ve heard about that. I’ve spoken to a few doulas who have told me about that and what they’ve done to help that. So, can you actually give your baby too much milk? Can they suck so much that they get too much milk.

Kristin Mallon: Yeah. Not very many women, but some women do have oversupply and it’s a very complicated problem that is very multifactorial and ultimately have a lot of different issues. If the baby’s getting too much milk, a lot of times they’ll be throwing up after every feed. Throwing up after every feed can signify other things, too. It could be that the baby exactly like the baby has reflux or that the baby there’s something else going on. Gastrointestinally or the baby has a milk allergy or some sort of lactate allergy or the baby’s allergic to something that you’re consuming, but most of the time, if a baby’s overfed, the baby will actually throw up after every feed. Most women who have oversupply know, because in the beginning, in the first six to eight weeks, when a woman pumps she’ll get anywhere between two to six ounces out and women who have an oversupply are getting 8 ounces, 12 ounces, 16 ounces out when they pump and that can also create a different issue believe it or not with weight loss in babies, because they’re getting too much of the milk. That’s the sugary watery milk, and they don’t end up getting the fatty milk, the hind milk that comes from the second part of the let down of the breast, so that they end up getting too over full on the sugary watery milk, and they don’t end up getting the fatty milk that’s behind.

And there’s all different ways to kind of correct over supply in breast milk. Working with a lactation consultant is really helpful, I think, in those situations. And the pediatrician can, a lot of times be very helpful. In the states we use this website called Kelly Mom. So that website is one of my favorite websites to refer women to, because it helps to filter out all the noise on the internet.

There’s a lot of noise when it comes to really good information and it’s monitored by lactation consultants. And so they monitor all the content and they filter out all of the bad information, which I think is great.

Helen Thompson: Yeah, I’ve heard that some moms say that they’d been told that they have to drain one breast before they go on to the next breast. I would say that’s a myth, but I’m not experienced in that.

Kristin Mallon: So I tell women a lot that when they give birth, this is like another really good thing for the immediate hours after a woman gives birth, every single person, every nurse that they go through in their rotation throughout whatever center they give birth in, their sister, their mother, their friends, anyone who has had a baby is going to give them advice and no one is going to be a better expert on their body and their baby than them. So I try to tell women as much as you can take all the information that you’re getting in and try to sift through and see what, try to grow your intuition and see what sits right and feels right with you. If someone’s telling you, you have to feed that baby every three hours, you have to wake that baby up in the middle of the night, but that doesn’t intuitively feel right to you, then it’s probably not right for you and your baby because no one knows your baby better than you.

Helen Thompson: And nobody knows your body better than you.

Kristin Mallon: Exactly. So some women might need that. They might need to drain one breast and then go to the next breast and that’s how breastfeeding works well and best for them. In some women, it doesn’t work well for them. They have to use both breasts for every single feeding and they use both breasts and that’s just how that type of feeding goes for them. And then it’s really helpful to not get caught up in advice that someone else told you specifically.

And I tell women this as much as I possibly can. A lot of times they’re listening to me in the prenatal period. When a woman gives birth, especially if she has sisters and her mother, those voices are going to be the loudest to her, and they’re not always the most correct for her. So, a lot of times women think I’m going to give birth the way my mother gave birth, or I’m going to give birth the way my sister gave birth.

And I want to say that it usually doesn’t go that way. It works both ways. It works in a woman’s favor sometime. And she’s like, oh, my mom had this horrible labor and it was four days long and she surprises herself and her labor is only 12 hours long and it works the other way.

Well, my mom’s labor was four hours long with all five of her kids. And I was her oldest and she pushed for 15 minutes with me and then when that woman’s labor doesn’t go that way, she doesn’t really understand why and she thinks something’s wrong when in fact nothing’s wrong.

Helen Thompson: I feel we’ve covered a fair bit, but is there anything else that you feel would be beneficial to moms.

Kristin Mallon: We talked a little bit Helen, you and I briefly about this before but the postpartum period is really a year and I really think women should give themselves the freedom to experience that whole time and that whole year that it takes to recover from giving birth. Especially with their first, because that’s the greatest transition when you go from having no children to having one child and all these great points that you brought up about the first hour and we don’t have to have all these should. You know, Tony Robbins that guru says, you should all over yourself when you have all these shoulds and everything is real, however, you experience it and the way that go through it is okay for you and really a beautiful thing.

And that’s the fun. And I try to tell women that a lot. They’re like, I don’t know when I’m going to go into labor and I’m like, that’s kind of the fun of it. And I don’t, I’ve never, I don’t know what to do. I’ve never been a mom and that’s kind of the fun of it. Figuring it out and not having these expectations of not just the birth, because birth disappointment is a whole other podcast topic that we could go on. I think that what you bring up is the postpartum, the few hours and days in the postpartum time, the baby should have this hour latch and that I should do this and I should be doing all these things.

And just throw that out the window and there’s a lot of wiggle room. You know, babies are born with this brown fat that they metabolize and they’re meant to lose a little bit of weight after they’re born and that’s normal and women should cut themselves a break. We’re so hard on ourselves and we should really just go a little easier on ourselves and the postpartum period is no exception.

Helen Thompson: I agree and I think it’s important that they take care of their physical health. There’s so much going on after you’ve given birth and as you say, you’ve got to allow yourself time to relax. And I don’t agree with shoulds either. I think you should do this, you should do that, you should go with your gut feeling and not listen to your mother’s gut feeling. Listening to your intuition and thinking, do I really feel comfortable with this? Can I do it this way and talking to your midwife or your lactation consultant about different ways, saying, no, I don’t feel comfortable that way, can I do it a different way?

Kristin Mallon: Yeah, absolutely. And I think you bring up this really great point, which is about honing your intuition. And I say that intuition is like a muscle. The more we use it, the better we get at it. And you can hone your intuition, even during your pregnancy.

If something doesn’t feel right. It probably isn’t right. If you feel like you should do something or you want to do something, then that might be a good thing for you. And then you start to have these really good experiences with trusting your intuition, and then that can carry over into your transition to motherhood.

Yeah. And it’s something that we can get better at as we get older too. .

Helen Thompson: So after all these wonderful tips, if a mum wanted to get in touch with you, how would they go about doing that?

Kristin Mallon: So we have a podcast called True Birth Podcast and it’s at TrueBirthPodcast.com and we talk more about pregnancy and labor. It’s really about a lot of those topics. And the website to our practice is MaternalResources.org.

Helen Thompson: Thank you. I really enjoyed talking about all this. I’ve actually learned a lot more about latching. So thank you for coming on the podcast and sharing all this wonderful information and just to add about your podcast. I did listen to it and I found it very informative. I liked the approach. Male, I think he’s a doctor involved as well, because it makes it more fun. I think you two have a very good rapport.

I recommend it to moms. It’s very good.

Kristin Mallon: Yeah. Thank you. And thanks so much for having me on. It’s been so fun.