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Breastfeeding, which is sometimes known as chestfeeding, is a natural way growing babies and infants get nutrients after birth. Dr. Heidi Szugye, medical director of the Cleveland Clinic’s Breastfeeding Medicine Clinic and Center, discusses the physical and emotional benefits to breastfeeding, what parents can expect from the process and tips on breastfeeding success.

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Breastfeeding: What You Need To Know with Dr. Heidi Szugye

Podcast Transcript

Speaker 1: There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts. The world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health questions, so you get the answers you need. This is the Health Essentials podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Annie Zaleski: Hello, and thank you for joining us for this episode of the Health Essentials podcast. I'm your host, Annie Zaleski. Today we're talking about breastfeeding with Dr. Heidi Szugye, Medical Director of Breastfeeding Medicine Clinic & Center. Breastfeeding which is sometimes known as chest feeding is a natural way babies and infants get nutrients after they're born, and offers many physical and emotional benefits to not just them, but also parents. Dr. Szugye is here to discuss the importance of breastfeeding, what parents can expect from the process and tips on breastfeeding success. Dr. Szugye, thank you so much for being here today.

Dr. Heidi Szugye: Thank you for having me.

Annie Zaleski: I'd like to start off our conversation by having you tell us a little bit about your work here at Cleveland Clinic, what kind of research and clinical work do you do?

Dr. Heidi Szugye: Sure. I'm a board certified pediatrician and pediatric hospitalist. I'm also an international board certified lactation consultant. On the clinical side of things, I am a breastfeeding medicine specialist. I work in the outpatient center, helping both moms and babies who are going through any challenges related to breastfeeding. And then on the administrative side of things, I'm involved with various research and quality improvement initiatives relating to breastfeeding. I'm also passionate about training, education, and so I'm involved in the medical school as well.

Annie Zaleski: But you are the perfect person to talk to today then because we are taking a look at breastfeeding, which is sometimes known as chest feeding. What is this?

Dr. Heidi Szugye: Breastfeeding in general is the act of providing breast milk to an infant or child via the breast or your chest, whatever terminology is preferable. I want to make sure that we're inclusive also of parents who decide to breast milk feed as well. It's possible also to express the breast milk from your breast, your chest, and provide it via various methods early on. Sometimes that can be a little spoon, a cup, when there's not a lot of milk. And then later we can use things like a bottle to give them milk to babies. And certainly when moms go back to work, this is often how they provide milk for their babies. And breastfeeding is really by definition what a mammal is. And so all mammals go through this process and it's what the word mammal is derived from that mammary tissue and what makes us all mammals.

Annie Zaleski: I didn't know that, that makes so much sense when you explained it that way. Why is this whole process important then? What makes the milk that comes from the breast such a good source of nutrients and just so vital, especially in the early days of a baby's life?

Dr. Heidi Szugye: Sure. Breast milk has a number of benefits for both the infant and mom, and some people even refer to that early milk or the colostrum as baby's first immunization, because it really primes the gut and the baby's immune system to fight off infections later in life. And so breastfeeding has been shown to decrease the incidence of respiratory viral illnesses, as well as GI illnesses, diarrhea. It's been linked to a decreased risk of obesity and type 1 and type 2 diabetes later in life for infants, as well as leukemia. And then more importantly it's linked to a decreased risk of SIDS and infant mortality. And then for our premature babies and those that are very low birth weight, or less than 1500 grams, they're at decreased risk for some of the diseases and conditions that are specific to that population.

Dr. Heidi Szugye: There's something called necrotizing enterocolitis, there's retinopathy of prematurity. So some of those disease processes that we see that are specific to the really little ones in the premature babies, they're at decreased risk when they receive moms breast milk. And then we also see a decreased risk in autoimmune conditions and allergic conditions. So decreased risk of celiac disease, as well as asthma and allergies and eczema later on in life for baby. For mom, there's a number of benefits as well. We see a decreased risk of breast cancer, ovarian cancer. Recently there was some studies published that show there's a decreased risk of actually endometrial and thyroid cancer as well.

Dr. Heidi Szugye: And then we also see decreased prevalence of hypertension, cardiovascular disease, type 2 diabetes. So a lot of the conditions that cause a lot of morbidity and mortality in the general population, especially the US population. And then when breastfeeding is going well, we see a decrease risk of postpartum depression, anxiety, and other mood disorders as well. It can actually be protective of mental health as well as physical wellbeing. And just a lot of moms report increased in improved bonding with their infant. And so there's a lot of physical and emotional benefits for mom.

Annie Zaleski: That's incredible that both parties have just so many benefits. I think people, you think of breast milk and you think this is giving baby nutrients, and this is very positive, but I just can't get over how many long lasting benefits there are for everybody.

Dr. Heidi Szugye: It's pretty fascinating. And the more and more research and studies we do, the list keeps growing. And I would say a lot of moms are, when I go over those benefits, a lot of moms are surprised at the number of benefits for both mom and baby. What's interesting too is they're showing that there's actually a cumulative risk reduction for moms as well. The more you add, if you add up all your years' breastfeeding, there's an increased risk reduction of those disease processes, so the longer the better. There's also been studies done recently too showing that the longer with each individual pregnancy. They looked at risk reduction if you breastfeed your baby for two months versus four months versus six months versus greater than a year, that benefit actually increases over time.

Dr. Heidi Szugye: And so this was a big reason why the AAP recently came out with recommendations to support moms who decide to breastfeed for up to two years, before that it had been one year. And so now we're having more and more research show that actually the longer you breastfeed, the more benefits you experience.

Annie Zaleski: Over time then I guess, because does the milk change, are there different kinds of milk that maybe then when someone is a newborn or when a baby is maybe reaching the age of one or even older than that?

Dr. Heidi Szugye: The milk when it's produced, it's sort of provides what the baby needs at that time. And so when babies are first born moms produce what's called colostrum and this is what's really, really high in antibodies and immunoglobulin and helps again prime that immune system and create immunity for the baby, so that if they do come in contact with any viruses or bacteria, they tend to less commonly contract them. Or if they do contract them, studies show that they get less sick. They have shorter hospital stays or they're less likely to end up in the hospital. And then the milk is very much tailored to their nutritional needs at each time point in their life.

Dr. Heidi Szugye: The milk transitions over to more mature milk, which has a little bit different nutrient contents throughout the first month but really provides all the benefits and nutritional needs of baby up until six months when we recommend introducing solids. What's nice about breast milk is it provides some live immunity as well. We know that if mom is exposed to a virus or a bacteria, mom will actually provide antibodies then to her baby that are passed through the milk, and then baby is less susceptible to those things that they're exposed to in real time, which is nice. They've done studies even through COVID to show that these antibodies are passed through the milk when mom's exposed to COVID and things like that.

Annie Zaleski: Is breast milk then completely different from other kinds of milk then? Or what similarities might they have?

Dr. Heidi Szugye: Breast milk and formula, there are some similarities when you think about fat content, protein content, carbohydrate content. We can do the best we can to mimic that ratio of nutrients, but there's things that we just can't make and put in formula that are in breast milk. There's actually over a hundred of these different factors and proteins and immunoglobulins that all fight viruses and bacterial infections and are shown to be really good for the immune system in preventing autoimmunity, autoimmune conditions, as well as allergic conditions. And these factors we're not able to man make and put into formula. All those things that you're seeing are beneficial to breast milk are because of the hundreds of different factors that are found in breast milk that are not in formula.

Annie Zaleski: When does the breastfeeding process after someone gives birth and do baby just instinctively know how to breastfeed or do you have to teach them, how does that work?

Dr. Heidi Szugye: The breasts start making milk as early as 16 to 22 weeks, but the high progesterone that's present in the body during pregnancy prevents that milk from coming out. But really the breasts are getting ready to produce milk, they've shown as early as signs of conception. And if babies are born early in the NICU, this is why even if the baby is born at 22 weeks, moms are still able to produce milk and pump milk for the baby even if they're not ready to breast feed at the breast. For babies that are full term and even babies in the NICU, we can get them to the breast. But there are some motor reflexes and instinctual behavior that happens with more mature infants that sometimes need to be in place before the baby is strong enough and able to suck, swallow, have a coordinated feed at the breast.

Dr. Heidi Szugye: But a full term baby who is well, we recommend skin to skin right away. So as soon as that baby is born, if it's safe for mom and safe for baby, the recommendation is to put that baby skin to skin right on mom's chest as soon as baby is born. That skin to skin time helps the baby regulate their blood sugar, their temperature, it helps with bonding. And then naturally it's very fascinating, but the babies do what's called kind of a breastfeeding crawl and you put them skin to skin on the center of mom's chest, then you'll notice that they instinctively start to try to find that the breast. And so they can actually smell the milk. The nipple during pregnancy gets larger and darker. And we think that that potentially helps the baby find the nipple better. And then they eventually will start to do things like lick the breast and suckle a little bit.

Dr. Heidi Szugye: And then eventually the goal is to get them doing some nutritive sucking, where they actually consume some colostrum. They don't need a lot. They've done studies that look at moms who have pumped their colostrum and not fed their babies the first day or two of life, because babies are in the NICU. And really moms only produce sometimes upwards of an ounce in 24 hours. It's those first day or two, the milk slowly ramps up, but it's really often ml like five mls per feed that babies are taking in that first day. They don't take a lot, but they don't need a lot. Their stomachs are actually very small. So the size of a cherry when they're born. By day three the stomach slowly increases. It's the size of a walnut. But they don't need a ton of milk to sustain them. I think that's something that surprises a lot of moms.

Dr. Heidi Szugye: And so we watch their weights closely. We make sure their babies are pooping and peeing. But there's not a ton of, it's not like their milk comes in day one and it's this copious amount of milk, that tends to happen more around day three. Babies do often need a little bit of assistance, and so I say that learning to latch and breastfeed is like learning to walk or crawl or ride a bike. Kids often don't learn those skills overnight, holding a pencil and writing, fine motor skills. It takes a little bit of practice and guidance. And so often having the mom guide the baby, having nursing and lactation consultants help, will often set that baby up for more success.

Annie Zaleski: I think that that's also interesting, the human body is such a fascinating thing anyway, but I think it is that parents worry. They worry, is my baby getting enough to eat? Am I doing things? Am I breastfeeding enough? Am I pumping enough? I think especially new parents are very worried. They want to make sure they're doing the right thing.

Dr. Heidi Szugye: We did a study here at Cleveland Clinic looking at what are the biggest provider and patient misconceptions surrounding breastfeeding. We surveyed a number of providers at Cleveland Clinic. I think we had about 150 respondents. We surveyed OB providers, pediatric providers, lactation consultants. And the study showed that the number one actually patient and provider misconception is that breastfeeding is easy and natural, which we know based on studies a lot of parents will go through difficulties and challenges with breastfeeding. Many you can overcome with support, but yeah, it's not uncommon for it to present challenges, especially at the beginning.

Dr. Heidi Szugye: And then the second most common patient misconception is that they're not providing enough milk for baby and that they have what we call a perceived low milk supply, when actually the baby is gaining weight just fine and getting enough milk. I do think it's a common misconception, and no fault at the mom. Your natural instincts is to make sure that you're providing for baby. But I think it's hard too when you're not seeing the amount of milk that you're giving your baby. And so you have to rely on other methods to know that baby is getting enough. And so this is where that support and education is important to know how my diapers, should my baby be having, pees and poops. All babies actually lose weight in the beginning and that's normal. As long as they don't go beyond 10 to 12%, that's what we expect.

Dr. Heidi Szugye: And then once mom's milk comes in, babies start to gain about an ounce a day. Most of them don't reach their birth weight until two weeks and that's completely normal. A lot of parents are also surprised to learn that as well, that babies don't just gain weight from the get go and what's normal and what's abnormal. And again, I think it's hard because you're not visualizing that milk being given to baby if you're not expressing the milk and directly breastfeeding. And so we have to rely on some of these other metrics to know if baby is getting enough milk.

Annie Zaleski: I think that's really helpful because, I think people wonder how long should you breastfeed or how long should you pump? Is there a standard for that? And how often should you be doing this? Does it vary from person to person for those things too? What have you found?

Dr. Heidi Szugye: I say every mom is different, every baby is different and it can vary from pregnancy to pregnancy. One breastfeeding experience with the same mom can be different from baby to baby because every baby is different. So you have to look at each dyad individually. I do tend to say in general though, assuming we have a full term baby who doesn't have other medical conditions going on, we try to provide a big emphasis on following hunger cues and satiety cues. And so a lot of babies when they are hungry, will show signs of rooting, sucking on their hands, they become more alert. They become restless and start moving. Those are those early signs of hunger. When we start seeing babies crying, that's actually a late sign of hunger. And sometimes it's actually harder to latch that baby and put the baby to breast.

Dr. Heidi Szugye: We try to educate parents on what are some of those signs that my baby is full. And so some of those signs are, baby will get very relaxed. The hands I say, it's all in the hands. So when babies are hungry they tend to have a very clenched fists. And then when they're full, their hands will kind of splay out, look very relaxed. Their head will go back. Their eyes will close. A lot of people refer to this as the milk coma. And so looking for those subtle signs and starting to learn your baby, will help you determine how long to feed for, and then certainly following up with your pediatrician to make sure baby is gaining weight. But for the majority of babies, you can go based on these hunger and satiety signs to know how long to feed your baby.

Dr. Heidi Szugye: And then as far as pumping goes, again, every mom is a little bit different, but we talk about when you're pumping, you want to first get that initial let down, which happens through the release of oxytocin, which is a hormone in the brain that lets the milk come out, and then pumping until the milk stops flowing. Some moms are able to then get a second let down. And so we recommend switching pump settings to try and get another let down and then try to get that milk flowing again. Again, I try to focus less on the time amount and more on being in tune to what your body's doing and what the baby is doing.

Annie Zaleski: I think that's such a good rule of thumb. And I think that's so helpful, because I think people might get a little bit upset. Okay, I'm supposed to be doing this for 30 minutes. I'm only doing it for 15, what's wrong? I think taking a step back and realizing what's right for you, I think can also be so reassuring.

Dr. Heidi Szugye: Sometimes at first I think parents need those numbers, and so we will give parents numbers sometimes if they feel like they need that. But then at the same time I think it's important to teach those signs as well. And so that people don't get fixated on those numbers forever. And the numbers change too. Babies get more efficient with feeding. And so as they get better at feeding those numbers, they're a moving target. And so we'll sometimes provide numbers if they want them or a general average, but again, every baby and mom is different. And then as time goes on, things change as well.

Annie Zaleski: You mentioned earlier that the recommendations are for exclusive breastfeeding or pumping for the first six months, and then you start introducing solid foods after that. Where do these guidelines come from?

Dr. Heidi Szugye: Sure. The American Academy of Pediatrics has a policy statement on the use of breast milk and human milk. This statement was, they update at about every 10 years. So the last policy statement happened in 2012. And then we recently had a policy statement published in, it was actually July of this year. So had off the press. They revised their recommendation at that time to support moms up to two years as far as breastfeeding. And then the recommendation has always been exclusive breastfeeding or breast milk feeding through six months. But the reason for the change from, they originally had recommended one year to two years, is really because we now have more evidence that shows there's benefits to breastfeeding beyond one year for both mom and baby.

Dr. Heidi Szugye: In addition, these guidelines align with what the World Health Organization in UNICEF have been recommending. So two years was always their recommendation. And then third, there's been some research that shows that moms who breastfeed for more than a year were actually experiencing alienation and shame. A lot of them weren't sharing it with their healthcare providers and felt unsupported and almost embarrassed by the fact that they were breastfeeding for longer than a year. And so the American Academy of Pediatrics wanted to come out and say, no, you know what, we're here to support you, there's benefits. Don't be ashamed of that. I think just let society in general know that we need to be supportive of these moms as well.

Dr. Heidi Szugye: So some of these moms may choose to, for example, continue pumping in the workplace, and we need to make sure that we're supporting them, not just in that immediate postpartum period, but for the duration of their breastfeeding journey.

Annie Zaleski: When do you know when it's time to wean your baby from breastfeeding? How can you tell? Is the baby going to let you know, or is the parent going to sense it? How do you tell?

Dr. Heidi Szugye: Weaning is a bit of a difficult topic. And again, every baby and every mom is different. In general they've looked at studies looking at mammals in general, and it's actually pretty rare for an infant or a child to self wean before the age of two to four, is what the studies show. Most often it is the mom deciding if it's happening before that time period. If is the infant, it tends to be again like the two to four year range and the child will just start to show some disinterest. But more often than not, we know that it's usually moms that are deciding to wean. Sometimes when moms go back to work, babies will develop a bit of a bottle preference. And so that makes breastfeeding a little bit harder and challenging, so that can certainly play into it.

Dr. Heidi Szugye: But again, I think the decision to wean is different for every family and the reasons behind weaning. I think it's important to as healthcare providers to support. And if the reason for weaning is a challenge that they're experiencing, which we know 60% of moms are not breastfeeding for as long as they intended to. And so it's usually because of some sort of breastfeeding challenge that they're experiencing, that they wean, which is kind of unfortunate. And so we want to make sure that we understand the reason for weaning. If it's something we can help them work through, then we want to provide them with that support.

Dr. Heidi Szugye: And then certainly sometimes moms decide for various reasons, personal reasons, that it's time and they're ready to wean their baby. I also tell moms it doesn't need to be all or nothing, and so I think there's this misconception out there and we know there's this misconception out here that was one of our top five misconceptions reported by patients and providers through our research that we did, that it needs to be all or nothing. And so when you decide that maybe you don't want to breastfeed as much, it doesn't mean that you need to completely stop and wean overnight. A lot of moms will choose to, especially if they go back to work and they find after a year pumping, it's a lot, it's hard work, and it's often not the fun part of breastfeeding.

Dr. Heidi Szugye: But if they choose to stop pumping, they still like to breastfeed their baby at night. And so you don't have to breastfeed eight times a day to breastfeed. You can breastfeed once at night before bedtime and a lot of moms like that bonding experience with baby. I think it's our job as healthcare providers to make sure we're supporting through challenges and also providing just all the options and alternatives that are out there as well.

Annie Zaleski: That's really great to stress that, because I think you're right. I think a lot of people might think it's all or nothing. And that can be very stressful. And the idea of there's a lot of options, there are a lot of different ways to do it, do it with the way that works for you. I think that's also really powerful and empowering too.

Dr. Heidi Szugye: I like that. I like that message. I like the way you stated that, to do it the way that works for you. Every baby, every mom's different and their situation is different, their social situation, their support system that's in place, their childcare situation. That decision is going to look different for everyone. And so I think we just need to be there to support them through that decision making process. And if there's a challenge presented that can be worked through to help them work through that.

Annie Zaleski: When someone makes a decision to stop breastfeeding then or pumping, are there things that people should not do or things that they should be careful to shy away from when they're doing this?

Dr. Heidi Szugye: Sure. If you do decide that you want to wean and you have the luxury of time to do so, certainly sometimes unfortunately there's medical reasons that moms need to wean. But if you have the luxury of time, I say it's always better to do it slowly. If you wean quickly, you put yourself at risk for mastitis. There's also been studies that show that it can also affect mood. So if you wean quickly and stop cold turkey, there's an increased risk for anxiety, depression, because a lot of those hormones that are involved with making the milk also play into our mood stability as well. I always say the slower you can do it the better. Again, it's different for every moms. Some moms can wean more quickly than others. So you want to go based on your comfort.

Dr. Heidi Szugye:,If you're having a lot of engorgement or discomfort when you're weaning, you want to pump or hand express to make yourself feel comfortable, you don't want to fully empty your breast because when your breasts are completely empty, you actually tell your body to make more milk. And so you want to be comfortable, but not fully empty your breast through the weaning process. Some of it depends on supply as well. So a mom that has an oversupply is going to take a lot longer to wean than maybe a mom who has an undersupply, that person might be able to wean more quickly as well.

Annie Zaleski: I think that goes right well into our next question then. And we've talked about this a little bit throughout this conversation. What are some things that new parents might be just really surprised to encounter with breastfeeding or pumping or anything like that that maybe they weren't expecting or things that they might have questions about that you hear?

Dr. Heidi Szugye: So again, talking about the study that we did at Cleveland Clinic, the top misconceptions that parents had were that it's going to be easy. So that was number one. Providers and patients had this misconception that it's going to be easy, it's going to feel natural, my body should just know what to do. I shouldn't need any support, the baby shouldn't need any help. We know based on research data that that's not usually the case. However, the good news is that when moms do get that support and that support is there, it has been shown to increase success and breastfeeding rates. The second most common misconception, again, was that perceived low milk supply.

Dr. Heidi Szugye: So again, I would advocate if a mom does have concern for that to seek out the support of a lactation consultant or their pediatrician, because often there's not a low milk supply there, and it's just the perception of a low milk supply, and I would hate for that to be the reason someone stops breastfeeding. And that leads me into the third misconception, was that it needs to be all or nothing. And so unfortunately a lot of moms are unable to provide a full milk supply to their babies, for various reasons. Sometimes it's health reasons, sometimes it's other barriers, but it again doesn't need to be all or nothing. Any breast milk that moms can give their babies is beneficial. And any breastfeeding mom is doing is beneficial to her health.

Dr. Heidi Szugye: And so I try to emphasize that too, for moms that are not able to reach a full supply, that you're still providing benefits to baby and yourself. The fourth misconception was that that milk comes in right away and baby latches right away, and there's not this slow ramping up of the milk supply and that there's not this learning curve for baby, and we talked about that earlier in the podcast. The milk takes time to come in. First it's a yellow, sticky colostrum, very low volumes at the beginning, and that's normal. That colostrum amount slowly increases over the first three days. And it's usually around day three that that milk transitions from colostrum to what we call transitional milk. So it'll look a little more white yellowish and it'll be a little less thick.

Dr. Heidi Szugye: And then by about a week, sometimes later it transitions over into that full mature, what we consider milk to look like, and it looks more white. There are moms, there are certain risk factors for having a delay in that milk transition from colostrum to mature milk. And a lot of these conditions are pretty common. So actually moms with their first baby, moms that have C-sections, moms that have gestational diabetes, postpartum hemorrhage, those moms are at increased risk of what's called delayed lactogenesis too. And so that's when the milk takes longer to come in as we say, and sometimes those moms and babies need a little bit more support and babies need their weight followed a little more closely.

Dr. Heidi Szugye: And then the last misconception, which makes me sad is, it was reported that a lot of moms will feel like a failure if they're not able to fully breast feed their child. And so again, I try to emphasize to parents that your worth as a parent or a mother is not linked to the number of drops that you make for your baby. And every drop counts, every drop is beneficial, but it's hard. The studies show that when breastfeeding is going well, it can actually decrease the risk of postpartum depression and anxiety. But when breastfeeding presents challenges, especially moms that are doing what we call triple feeding, where they're having to breastfeed their baby and then pump, and then even then the baby's still needing bottle fed with some formula, that can be really, really stressful. It can be tiring, it can be exhausting.

Dr. Heidi Szugye: So on top of all the hormones that are shifting and the sleep deprivation, all those feeding challenges, those moms actually can be at increased risk of postpartum depression and anxiety. And so we have to balance all those factors and keep a pulse on mom's mental health through all of it and support them through their journey even if that does look different than what they had first intended their journey to look like. There can actually be a little bit of a grieving process that moms experience if the journey doesn't look like how they envisioned it and we need to make sure we're supporting moms through that process.

Annie Zaleski: I'm really glad you mentioned all that, because I think that's so important to mention, and to let people know that this is normal and you're not harming your baby, or if something is not going right. Because you want to be a good parent and you want to make sure that you are doing the right thing for your baby. And that can be, I can absolutely understand just how fraught and just anxiety inducing could be when it's not going right or you don't think it's going right.

Dr. Heidi Szugye: There's a lot of pressure I think on moms, especially right now. I can feel it, it's palpable in the clinic, amidst the formula shortage that we're experiencing. And so I'm glad you bring that up. There's a lot of pressure. There's a lot of anxiety to make sure that breastfeeding is going well. And interestingly when we did our study, actually the number six misconception was that it's difficult. And so on the flip side of this I think we do need to prepare parents that there may be challenges and their support for those parents, but we don't want to create so much fear and anxiety around it, that again, it's affecting mental health or that people just don't do it because they fear it's going to be too hard. There's balance there that we have to strike in our messaging and education around breastfeeding.

Dr. Heidi Szugye: I think a lot of the media attention around the AAP policies was that we are putting a lot of pressure on moms. And this two year recommendation was seen by some as adding more and putting more on the shoulders of moms amidst a formula shortage and this pressure to perform and provide milk for their baby. I think it's the job of society in general to make sure that we're supporting moms. I don't think it should all be, all that pressure and responsibility shouldn't just be on the moms. And the policy does highlight that as well, that we need to make sure within our community, within our workplaces, that we're supporting these moms and that we're creating policies and laws to support moms through their breastfeeding challenges as well.

Annie Zaleski: What help might be available if someone is feeling frustrated or down or thinks they need a little bit extra help, what kind of resources are available?

Dr. Heidi Szugye: At Cleveland Clinic, we have a variety of different resources and it depends on what you're looking for as a patient. We have one-on-one virtual and in-person appointments available with our breastfeeding physicians. We also have one-on-one virtual and in-person appointments available with our lactation consultants. And that's both on the east side and the west side. In addition to that, we have both virtual and in-person breastfeeding support groups. And so those are a little bit more informal, but still have the ability to work with a lactation consultant and get a weight on baby. But it's a nice way for moms to network with each other and bond with other moms going through the same thing.

Dr. Heidi Szugye: We also have our melanin rich support group, which is a support group specifically for black mothers, which we know that that population has actually decreased rates of breastfeeding, and so is a particularly vulnerable population for breastfeeding cessation. And then in addition, we have our website, so www.clevelandclinicchildrens.org/breastfeeding, includes a number of educational resources, handouts. On that website too there's a number of prenatal classes that parents can take related to breastfeeding education. So if they want to be prepared early on. We're also happy to see patients in clinic, if they want a prenatal visit, if they are at particularly increased risk for challenges. And then our lactation consultants are also available in the nursery setting.

Dr. Heidi Szugye: And so they see every baby that is breastfeeding in the nursery every day and they're available daytime hours and evening hours as well. We actually have a pretty high initiation rate of breastfeeding. So happy to report. It's like 85% I think of babies born at Cleveland Clinic are initiating breastfeeding. Fun fact, we deliver over 12,000 babies a year at Cleveland Clinic. And if you do the math about every hour, a baby is initiating breastfeeding at Cleveland Clinic. We're seeing a lot of babies. And just again, trying to make sure that we're supporting them when they leave the hospital and have that support in place and are able to access it as needed.

Annie Zaleski: That's so great that that's so comprehensive. And it's just, again, going back to it tries to reach parents where they are and what they need, that it's very tailored to their personal experience.

Dr. Heidi Szugye: There's a national hotline that parents can, I should mention, can access as well for after hours if they need breastfeeding support. And then we also have our lactation consultants locally at the Cleveland Clinic that will provide answers via our hotline as well. So if moms are unable to do a full visit or transportation is an issue, we have those resources as well.

Annie Zaleski: Well, this has been a wonderful conversation. Is there anything else you want to add or any points we haven't covered that you'd like to make?

Dr. Heidi Szugye: Yes. I'd just like to mention that we have a new website that just launched www.clevelandclinicchildrens.org/breastfeeding. The website includes information on how to make an appointment with myself, any of the other providers in the breastfeeding medicine clinic, as well as the lactation consultants. If you click on the make an appointment tab, it'll direct you to the phone numbers to call for appointments. The information also has helpful educational resources. It also has information on our support groups and we keep the information on this website up to date as things change and our clinic and center grows and evolves, and we hopefully will be providing more and more resources to patients in the future.

Annie Zaleski: Well, thank you so much for being here today. This has been a really great conversation and I think it's going to help a lot of people.

Dr. Heidi Szugye: Thank you so much for having me

Annie Zaleski: For the most up to date information on breastfeeding or Cleveland Clinic's breastfeeding medicine center and clinic and lactation services, visit clevelandclinicchildrens.org/breastfeeding, and click on the make an appointment tab.

Speaker 1: Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter, and Instagram for the latest health tips, news and information.

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