Your Lucky Day: A Free Sneak Peek Inside My Book

This Chapter is For You

One of the coolest things about self-publishing is that you get to do things however you want.

Today I want you to have a look inside the book. It’s coming out on April 2, and I hope you are as excited as I am!

It’s a deep dive into what is really going on today for new parents in the first hours and days of their babies’ lives, why so many newborns are getting formula before they’re even 48 hours old, and why changing all of this can make the entire experience of breastfeeding and lactation better.

You, me, and this book: we’re going to make change happen.

Before you scroll down to preview the chapter, if you’re new here, welcome!

This is my Substack, where I write every week or so about things relating to lactation care.

If you subscribe (which you can do for free), my new Substack posts will just show up in your email inbox whenever I write them.

You won’t have to go digging around or scroll through social media to find them.

They all live right here on Substack.

In fact, you can browse my past articles here very easily; just scroll up to the top on click on my name or on the little graphic that says “Evolve Lactation.”

What’s really awesome is when you share my posts, which you can always do right from inside them.

Then even more people can read them and become engaged in the conversation.

Thanks for dropping by, and stay tuned for details on how to order my upcoming book!

Excerpt from Evolving the Modern Breastfeeding Experience: Holistic Lactation Care in the First 100 Hours (publication April 2, 2024)

The Heart of The First 100 Hours

I created this concept in 2014 while supporting a new mother in the hospital.

Her preterm twins were 36 hours old, and she relayed to me that she had been given an ultimatum by the twins’ doctor in the NICU.

If she didn't bring a certain number of ounces of expressed milk for the babies within the next few hours, the babies were going to be given formula.

Despite telling the doctor and nurses that she had been following the pumping protocols faithfully and letting them know that she, too, was worried about how she was not getting more than a few drops of milk, no help was given or offered to her.

They didn't call lactation staff to assist her.

Instead, she was admonished for not bringing milk.

Fortunately, she asked her postpartum nurse how to get help with lactation.

After providing the clinical lactation care she needed and subsequently following up with the NICU staff to keep them updated, I went home that day with this mother on my mind.

I really, really wanted to understand why the nurses caring for these less-than-48-hour-old babies, who were born too early for oral feeding and who were both receiving all the nutrition they needed intravenously, were doubting this mother's report that she was pumping according to the routine taught to her.

I also wanted to understand why a medical doctor, an expert in preterm and sick babies, did not know enough about human lactation to have reasonable expectations of how much milk might be expressed in this timeframe.

I was frustrated to hear that the NICU's medical staff did not appear to understand that the mother of two of their patients was also experiencing a serious medical condition which could be interfering with lactation despite her telling them she had just come from the Emergency Department.

How could this happen?

It dawned on me the next morning that we were really missing the mark with how we were educating the hospital staff.

They did not know how or when milk is made in relation to birth, so they had unrealistic expectations that were seriously impacting their patients.

There was a lack of trust in breastfeeding and human lactation on top of a lack of clinical knowledge.

These medical professionals were operating with a vague notion that milk would suddenly “appear” a few days after a baby was born. 

I knew that those giving birth in our hospital were not receiving accurate information about lactation in an organized, logical, simple way.

That was the day I outlined The First 100 Hours strategy and how it could make a difference.

The heart of this strategy is reframing the concept of "getting milk on the 3rd day."

Not only is it scientifically inaccurate, it is inherently confusing.

What is the 3rd day? If your baby is born on Wednesday, is Friday the 3rd day, or is it Saturday?

What if they were born at 10pm on Wednesday?

That means they won't be 48 hours old until 10pm on Friday.

If you think Friday is the 3rd day and you're wondering why there isn't copious milk production on Friday morning - when the baby is just 36 hours old - aren't you going to assume there's a problem?

To simplify the First 100 Hours, begin by drawing a timeline from the time of the baby's birth.

Include 4 sets of 24 hour periods, and make a heart after the 4th set.

That's your first 96 hours, plus 4 to get us to 100 and make it simple.

What should be happening in terms of lactation at that time?

What should we expect regarding how a baby is feeding at that time?

What should we expect in milk volumes expressed if the baby is not being breastfed?

What changes are expected in the breasts?

This is such a commonly misunderstood timeframe that we see parents and healthcare workers alike struggling to set appropriate expectations.

We see so many research studies published which define and discuss "perceived low milk production" as a significant factor impacting the duration of any breastfeeding and the duration of exclusive breastfeeding.

It is normal for new mothers to wonder if their babies are getting enough milk at the breast. 

However, when  their doubts or concerns about milk production and milk intake are multiplied by doubt and misunderstanding from medical providers, the situation becomes more complicated.

When a mother expresses concern over how much milk they are making and/or how much milk their baby is getting, they need accurate and actionable information and encouragement rather than uninformed and unfounded doubt on the part of healthcare workers.

Each misunderstanding of what is supposed to be happening compounds the problem and results in babies being fed formula they don't need, mothers being told to use breast pumps they don't need to use, and completely unnecessary stress and anxiety for new parents about breastfeeding "problems" that aren't there.

Early issues (like jaundice and hypoglycemia) which are multifactorial are too often mislabeled as breastfeeding problems that should be solved with formula.

New parents who are separated from their babies for medical reasons can be following everything they are taught about expressing milk by hand or with a breast pump in the First 100 Hours, and if they report that they are feeling discouraged about how much milk they are getting out, they may be offered a "sympathetic" way out (like "just get some extra sleep and don't worry about it too much") and a pat on the back that provides no real education or support that would help them sustain their milk expression routine.

It is normal for new parents to have doubts about breastfeeding as they are learning a new skill. What is not normal or appropriate is for health workers who should know the most fundamental science of human lactation to make the situation worse for them by building upon their worries and concerns with misguided information and advice.

The First 100 Hours approach is a reset button that provides the foundation of what to expect  versus what truly constitutes a breastfeeding problem that requires intervention during the earliest hours of lactation.