Ep 250: Breastfeeding Advice From Board Certified Breastfeeding Medicine Specialist Dr. Andrea Wadley

Dr. Nicole (00:00): Have you ever heard of a doctor who is board certified into both pediatrics and breastfeeding medicine? Well, that is exactly what we have in today's episode with Dr. Andrea Wadley.

(00:16): Welcome to the All about pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

(00:58): Hello there. Welcome to another episode of the podcast. This is episode number 250. Whether this is your first time listening or you have listened before, I am so, so glad you're spending some time with me today. In today's episode, we have Dr. Andrea Wildly. She's a pediatrician and breastfeeding medicine specialist. She opened 127 Pediatrics in 2018 as a way to provide a different and more personalized option for pediatric and lactation care for families in the Dallas-Fort Worth area of Texas. She was recently one of only 100 physicians to become board certified in breastfeeding medicine. She only provides home visits and direct primary care, and she is a course creator and is launching a comprehensive breastfeeding course this year. We have a great conversation, including how she has this different model of care compared to traditional pediatrician offices. It's going to give you some food for thought for sure, and then we get into breastfeeding some things that people can do during pregnancy to set themselves up for success with breastfeeding.

(02:13): I loved her answer to this question because she mentioned that there are actually some conditions that can increase the chances of you having low milk supply and we can address that while you're still pregnant. This is not something that OBGYNs talk a lot about or taught about. We also chat about what to expect with breastfeeding in those first 24 hours once your milk comes in, what breastfeeding looks like in those first few weeks. And then we go through some common issues and myths about breastfeeding, including about how mastitis is treated. She has a completely different approach, one that makes a lot of sense. So I know you're going to learn a lot from this episode. There's some really great information here. And another place to find great information is my free birth plan class. Make a birth plan the right way. Making a birth plan is so important to help you have the birth that you want and those templates, those forms that you print out online, those don't cut it.

(03:13): That is not enough. Just filling out that piece of paper. It really needs to be a structured and informed discussion with your doctor to make sure your doctor and your hospital are on the same page as you with the things that you want for your birth. And that does not happen by just filling out a piece of paper. I teach you the right way to make a birth plan, and the right way is a way that helps you feel empowered, that helps you feel prepared, that helps you feel ready, that helps you feel confident when you go into your birth and know what to expect and know how to deal with both if your doctor in hospital are on your side, which is great, but also if they are not. So check out my free birth plan class. Make a birth plan the right way. Grab it at drnicolerankins.com/birthplan. Okay, let's get into the conversation with Dr. Waley. Thank you, Dr. Waley for agreeing to come onto the podcast. I'm excited to talk about your unique practice as well as breastfeeding. But why don't we start off by having you tell us a bit about yourself, your work and your family, if you'd like.

Dr. Wadley (04:23): Yeah. Wonderful. Thanks for having me. I'm excited to be on. I am a pediatrician as well as a breastfeeding medicine specialist. I started a direct primary care pediatric practice a little over five years ago, so I kind of call myself concierge medicine, but DPC and concierge are sort of interchangeable, but we'll get into that later. I'm the mom to an almost 11-year-old, so preteen girl. Yay. My husband and I have been married 16 years. He's also an entrepreneur, owns an insurance agency locally as well as started a side business for SEO optimization for people, which we need more businesses, more things to do, but, so that's a little bit about us. I'm a stepmom. My stepdaughter's in her twenties. She lived with us briefly and now we kind of keep in touch with her. I am a dog mom. I work from home, so my dogs are always around, thankfully, not right now, but usually. But that's a little bit about me. I've been a pediatrician, a doctor for 16 years. I worked initially as a newborn hospitalist, so in the hospital working with just newborns in the first few days of life. Did that for eight years, then opened this practice about five years ago just to be different just because that's just how I am.

Dr. Nicole (06:00): I like it, I like it.

Dr. Wadley (06:01): So that's a little bit about me.

Dr. Nicole (06:03): So I always like to, I want to make sure that the people who I've share information about are trained, and I like people to know what background that people have gone through so they know how people are coming to the conclusions and the things that they say. So can you tell us a bit about what training you went through to be a pediatrician and then what it took to be also certified in breastfeeding medicine? What does that mean?

Dr. Wadley (06:31): Yeah, so pediatrics is we start down the path of high school, then four years of college, four years of med school, and then we do postgraduate training for three years. Pediatric residency. I did all of that time in San Antonio, Texas, both my medical school, my residency, and then I moved back to the Dallas-Fort Worth area. And like I said earlier, I became a newborn hospital doctor, and a lot of what we did in the first two days of life was help mothers with breastfeeding. So learned a lot on the job, hands on. And then I had my daughter and all of that large amount of knowledge I thought I had was blown up when I went and try and did it myself. So during my time in the hospital, I learned from the amazing hospital IB CLCs. And then as I was leaving, that job became an I-B-C-L-C myself, which requires a thousand hours of contact with breastfeeding moms as well as many hours of book work, kind of continuing education.

(07:47): So at that time, that was all that offered as far as kind of a higher level of breastfeeding training goes. And it's a great education and I learned a ton from all of the amazing ladies in the hospital. But within the last few years, there's been this growing movement among certain physicians to practice breastfeeding medicine. So it kind of takes what we know hands on from the I-B-C-L-C perspective, but also from our medical training perspective. So we can diagnose, we can treat, I treat moms in the practice as well as kids, even though I'm a pediatrician. And then within the last year, really last fall, 130 physicians sat for the breastfeeding medicine board exam for the very first time. So we were grandfathered in as far as our experience and CME credits, all the things we still needed to do. But we had an easier exam maybe, I don't know to kind of set the curve, but a hundred of us passed. So there's a hundred physicians in US and Canada that are board certified in breastfeeding medicine. So it's a new and rare board certification, but

Dr. Nicole (09:13): Very

Dr. Wadley (09:13): Rare. But I think it's a win for moms because it's validating this time of life as a specialty. It requires S care.

Dr. Nicole (09:24): Absolutely, absolutely. So I love the fact that not only can you help moms with breastfeeding, but you can also diagnose and treat any problems that come up. So like mastitis or that's what comes to mind, but you can do the whole package.

Dr. Wadley (09:41): Yeah, it's great. So within my practice, I take care of my breastfeeding moms, and then outside of my practice, I offer one time breastfeeding medicine visits in the community. So lots of

Dr. Nicole (09:56): Fun. Nice, nice, nice, nice. So I want to start off by talking a little bit first about your practice model. I want people to hear this a little different for sure. And then we'll get into some advice about breastfeeding. So you have a different type of practice, as you said, direct primary care or concierge medicine is what it's called. What does that mean? Tell us about that.

Dr. Wadley (10:20): Yeah, so Direct primary care is a movement among, it started mostly with family physicians who can run the spectrum from birth to death and take care of patients for the majority of their life. So 10 plus years ago, the small group of physicians started doing this direct relationship with patients. So back to the old days where you used to pay your doctor with chickens or eggs from the farm. And then it moved into the eighties and early nineties where we would pay for specific visits just directly out of our pocket and away from, as you know, it's gone to the insurance model and all the things that go along with that. Well, this group of physicians trying to take back the relationship piece of it. So it was popular among family physicians. When I was starting to look into it, I was leaving the hospital wanting to take care of kids for the longer duration instead of just the first two days of life, which I loved.

(11:28): But my dream as a pediatrician was to kind of watch kids grow up. And when I looked around town, I live in a big metro area, everything seems like it's owned by the hospital system, which is great, but offering people a different choice was something that I felt strongly about. And starting an insurance-based practice in this land of giants felt really daunting to me as far as getting good contracts and all of those things. So for selfish reasons, that is the selfish piece of it, but also for a patient reason, I wanted to offer something different. So a more personalized sort of experience with pediatric care, breastfeeding medicine, I chose to do home visits only in order to serve this new mom population better. So I'm sure, I know you have kids, right? You remember those first few days? Yes.

(12:29): There was no reason that you wanted to leave the house, your body hurt. Your baby was a mess, you hadn't slept a day. So I wanted to provide that option for moms in the community. So the way direct primary care works is my patient families pay me the same monthly fee on the first of every month. So it depends on their children's ages and the number of children they have, but they pay the same amount, whether I interact with them 40 times that month or I don't see them at all, it's kind of a yearly fee almost split up over time. So that entitles families to all of their children's, well visit care, sick visit care, I can do a lot of video visits, telemedicine, texting, they have my personal cell phone number. If they're deciding whether to take their kid to the ER in the middle of the night, they can call me if needed. Right before I hopped on, I had a mom say, I think my kid has conjunctivitis. Can I have some medicine? Sent that in over text. She's a very reliable person and has many children, so she knows what conjunctivitis. Just stuff like that. More of a personalized approach to medicine.

Dr. Nicole (13:46): Yeah, I love it. I love it. Now, I know it's not covered by insurance, but can patients submit to their insurance to get any sort of reimbursement at all for out of pocket or out of network care? So

Dr. Wadley (14:00): It gets a little sticky. So I don't love providing superbills to families because it is really a physician fee. I can't assign it to a specific visit very well, but for my one time visits for breastfeeding, absolutely I will do a super bill for them. They can turn it in for out of network benefits. I also have a company that I work with that will allow me to charge insurance for the vaccines for Children. So that has been a helpful piece in the practice in attracting young families because a lot of my families when I first started were insured and people are actually moving away from health insurance, and they're finding me because don't take insurance because they're realizing what a money spend it is without much benefit. So over time, I have more and more families that are uninsured and we are able to help them get vaccines for less expensive out in the community, and I just take care of their children's care otherwise.

Dr. Nicole (15:14): Gotcha. Yeah, I mean when you do the math and you're paying a monthly whatever or whatever it is, your benefits that it'd being deducted, then sometimes the math may work out, especially for a family, if you have a couple of kids and you get catastrophic insurance coverage for the hospital or anything like that, which is going to be a lot cheaper, and then you pay that monthly fee, the math can certainly work out.

Dr. Wadley (15:41): And my husband and I tag team people. He is an insurance agent, so he can write some catastrophic policies or help you with the ACA, those kinds of things. So it's been kind of nice. So several families in the practice have used him for that kind of wraparound coverage. And then my own family, we have a direct primary care family physician. We have marketplace insurance, but we also pay our direct care physician. And my husband has told me for years he can never go back to the regular system after having been spoiled by just being able to have all of his chronic conditions managed by one person,

Dr. Nicole (16:23): Which

Dr. Wadley (16:23): Has been really nice,

Dr. Nicole (16:24): Very nice. It probably leads to better health. You have someone who knows you and you can keep in better contact and all those kinds of things. Okay, so let's talk about breastfeeding. And what I thought we'd do is talk about you. Obviously you have a lot of experience within that newborn period, and let's just talk about newborn in those first few weeks because I think that's the period of time that's just the most crucial and potentially most difficult in terms of breastfeeding. So helping people know what to expect during that period. I thought we would start with even before the newborn period during pregnancy, what are two or three things that you recommend that people should do during pregnancy in order to set themselves up for success with breastfeeding?

Dr. Wadley (17:06): Yeah, so I love this question. I remember sitting with moms who show up in the hospital, give birth, go through all that, and then they're like, teach me how to breastfeed. Yeah.

(17:18): So my thing is always know your body and know a little bit about breastfeeding because really it's very time sensitive. If you have no knowledge of it, you show up, you want us to help you, you have to have some sort of background knowledge. So the first thing is to know your body, know your medical conditions, know things that might set you up for low milk supply or no milk supply or your family history, your medications, those kinds of things. If you're at risk for low milk supply or maybe you failed, failed at breastfeeding in the past or felt like you didn't achieve your goals, the meeting with someone like me or a lactation consultant or a knowledgeable OB or pediatrician who can help you sort those things out and make sure that you're on the right path. And then make sure you're doing some things ahead of time to increase your chances of breastfeeding success.

(18:25): And then learning from a good source. So there's millions of classes and internet sites and things that you can do and take and learn about breastfeeding, but really piecemealing it all together. Sometimes that feels overwhelming for people. I have kind of an inexpensive online class that introduces you to kind of the science of breastfeeding. So from beginning to end a grand overview. And then I'm working on more of a personalized kind of breastfeeding coaching program, but really anyone you learn from is fine. Just make sure they're reputable and make sure you're doing the work to learn about breastfeeding.

Dr. Nicole (19:12): Absolutely, absolutely. So I guess, what are some things that could potentially make you at risk for low milk supply?

Dr. Wadley (19:20): So really there's a lot of stuff. So one of the biggest medical problems in our society is obesity. And that sets you up for low milk supply for sure. Any sort of hormonal issues, unexplained infertility, PCOS, those kinds of issues, thyroid, metabolic issues, diabetes or any just maybe insulin resistance before you're even truly diabetic. All of those hormones work and for milk supply. And then something that we thought was kind of rare but maybe is not as rare as we thought is insufficient glandular tissue. So moms who just don't have enough breast tissue to produce a full milk supply. So sometimes you can tell that by a physical exam, sometimes that you can tell that by history. Often I don't diagnose it until I'm seeing if a mom who's failing at breastfeeding, their baby's not gaining weight or whatever. So just those sort of things. It's good to know ahead of time if that is any of your risk factor.

Dr. Nicole (20:34): Yeah, that's interesting because I will say on the OB side, that's not something that we will tell people or identify or say like, oh, if you have PCOS, maybe you want to be sure you have a lactation consultant because you may have some challenges not breathing, breastfeeding, I don't know where breathing can, hopefully not. You may have some, yes, you'll have some challenges. Breastfeeding, we don't share that. Some of those hormone changes, it makes perfect sense because so much about breastfeeding is related to hormones. So I think that's a great point that just take a second, think about your medical history. Like you said, know your body to help best set yourself up for success and have the resources available so that you can be successful. So what about in those first 24 hours right after the baby's born? What should folks expect with breastfeeding then? So

Dr. Wadley (21:25): The first 24 hours is a very important time. The whole having a birth plan. I know you talk a lot about birth plans, and that needs to extend on into the first 24, 48 hours if you're delivering in a hospital because really that uninterrupted skin to skin time makes a huge difference for not only breastfeeding, but your body, your bonding, the way you feel about the baby, all of those things. And then just knowing that you're not going to produce bottles full of formula type milk right in the beginning, your body produces a substance called colostrum. It's the very small amounts at a time, maybe a teaspoon, maybe two teaspoons if you're lucky, every few hours. It's a small amount, but your baby's stomach is also small. So in the hospital I would see, oh, well, I'm not making any milk. Let's get formula. And then the baby was spitting up and not going back to the breast.

(22:32): So just knowing that it's a small volume and it's normal. And then the second piece about the first 24 hours is your baby is sleepy. If you think about all the labor that you've gone through, the stress on your body, it's similar stress for the baby. So they're alert and active in the first couple of hours, which is what makes it so important. And then they go into this super sleepy time where it's really hard to wake them up, but that doesn't mean you get to wrap them up, put them in the bassinet and shove them in the corner and go take a nap. Unfortunately, breastfeeding doesn't work that way. So you have to be waking the baby every few hours, putting the baby on your chest, skin to skin with you, activating all those hormones, telling your body that you want to breastfeed, all that good stuff. And then if your baby's not feeding because they're tired, or for whatever other reason that someone is teaching you how to hand express spoonfeed, alternatively feed the baby and get all of those things going. So unfortunately, it's not a time where you can just chill out and wait to see what happens, really an important critical time, those first 24 hours.

Dr. Nicole (23:49): Gotcha, gotcha. And then their stomachs are like the size of a marble, maybe a little bit around that size, is that

Dr. Wadley (23:56): Correct? That's correct. They have little teeny tiny tummies, and so they need to eat pretty frequently in those first two days,

Dr. Nicole (24:04): Yes. Gotcha. But just not huge amounts, so don't be surprised if you don't have a ton of milk coming in. So when then even do you consider maybe we need to give the baby some formula?

Dr. Wadley (24:16): Yeah, so babies, you just those 24, 48 hours where you can't get 'em to wake up, you can't get 'em to do anything. They won't take any from the spoon, all those things or babies becoming really jaundiced or losing weight or not having the amount of output that you would expect. Those are times that we would consider supplementing the baby in general. As a newborn hospitalist, I try not to do that in the first 24 hours unless the baby just had big issues. Other times as if the baby has low blood sugar, sometimes we would have to supplement 'em with formula. The protocol started to change where we could give them glucose gel instead. But formula is not evil, it's not bad, and it is a tool that we can use to help you to get to your breastfeeding goals for sure.

Dr. Nicole (25:14): Gotcha, gotcha. Well, I like how you put that, that it's to help get to the breastfeeding goals, not to replace breastfeeding.

Dr. Wadley (25:22): Right, exactly. And then just making sure that they're giving physiological amounts of formula. So you're not going to hand a 24 hour old baby a two ounce bottle and feed it to them. You need to know what the amounts that would be typical so that you're allowing the baby to be fed and nourished, but also allowing them to be able to be hungry enough to go back to the

Dr. Nicole (25:48): Breast. Gotcha. Gotcha. That's really important. So then when should people expect that their milk fully comes in, and then kind of what happens with breastfeeding after that?

Dr. Wadley (25:57): So generally you produce colostrum starting in your pregnancy, so about the 16th week of pregnancy all the way through the first three to four days postpartum. And then there's this lacto genes. Type two is the technical word that we use, or copious milk production or better known as your milk coming in. And that generally occurs for most women between day three and five postpartum. There's lots of reasons why it could be delayed or not come in as expected, but that is for the majority of breastfeeding moms.

Dr. Nicole (26:37): Okay. Okay. And then how frequently are you breastfeeding? How do you know the baby's getting enough?

Dr. Wadley (26:45): Yeah, so in the beginning it's all you're doing is breastfeeding. Okay,

Dr. Nicole (26:51): No sugarcoating, let's just put it out

Dr. Wadley (26:52): There. Yeah, that's all you're doing. It's a full-time job. So we say eight to 12 times a day. A lot of moms like to say, well, he just fed. Well, that's not how it works. So 24 hours, they're really sleepy, 48 hours, they wake up in their ravenous little monsters that you're like, maybe this is the wrong baby. I dunno. But then you feed them sometimes every 30 minutes, sometimes every hour. This cluster feeding usually lasts until about the time your milk comes in, and then you feed eight to 12 times a day. So if you think about a 24 hour period, that's what, two to three hours. But sometimes they'll feed every hour for a little while, and sometimes they'll feed every three hours. It just, it's an average. But yeah, for sure, it's a full-time job in the first few weeks of breastfeeding.

Dr. Nicole (27:44): What other things can people expect in those first few weeks?

Dr. Wadley (27:48): So newborns lose weight. That is something that sometimes shocks people, whether you're formula feeding, breastfeeding, whatever, it's normal. So babies have this fluid weight that they accumulate while they're living in water for nine months, and then when they're born, they diurese, which is the medical word for lose all that water weight. So we expect them to lose some weight. Specifically for breastfeeding babies, their weight should stabilize in the first week, so they're not really gaining, but they're not also losing anymore. Formula. Fed babies will regain a little faster because they don't have to overcome all of these barriers of breastfeeding. And then by two weeks of age, we really expect them to be at least at their birth weight, if not more, and then start to gain then babies between that two week mark and three months gain weight rapidly. Their velocity is rapid as they're gaining, and then it starts to kind of slow as they get bigger. And then around four months, they kind of find their own growth curve and then follow that usually into toddlerhood and stuff.

Dr. Nicole (29:02): Okay. So what are the two or three most common issues that you see people having, especially starting out in the beginning with breastfeeding, and what are things that they can do to help with those issues?

Dr. Wadley (29:15): So not knowing what a good latch looks like feels like is one. So having lots of pain saying, oh, just going to grin and bear it because I want to do this so badly. So any pain with latch that's sustained means it's not happening correctly. And not only is it hurting you, but it's also inhibiting the baby's ability to get milk from the breast. Making sure if that is happening that you're asking, reaching out for help really quickly because it just takes one or two bad latches to make you not want to breastfeed ever again. And then just knowing how to manage some common early problems and how to expect them. So engorgement, when your milk comes in around day five, only expressing enough to feel comfortable not pumping and giving yourself artificial twins. And so you're dealing with tons of milk later, those kinds of things, what mastitis looks like and feels like. So fever, flu-like symptoms, body aches, breast redness, how to manage it correctly, which even a lot of doctors don't know how to manage it correctly. I think those are the big things.

Dr. Nicole (30:38): Yeah. So what are your thoughts on hand expression? I hear a lot more about IV CLCs talking about hand expression and how potentially helpful or useful that is. What are your thoughts about that?

Dr. Wadley (30:50): So hand expression before the baby's born or after or both?

Dr. Nicole (30:54): Both. I guess.

Dr. Wadley (30:54): Both. Okay. Yeah. So it's become a little more popular. I think that people hand express before the baby is born and just know that that's very possible, that you can hand express small amounts of colostrum before your baby's born. And often we will recommend this if you've had a history of low milk supply in the past, or you have diabetes or you have some sort of reason like you think your OB is telling you your baby's going to be large, some sort of reason the baby might have low blood sugar. It's nice to have your own milk to be able to supplement with, if breastfeeding is the, I have to breastfeed, I have to have my baby have only breast milk. So that is fine. And usually you have to discuss with your OB and make sure you're not at risk for preterm labor. And the timing of all that usually is kind of later in your pregnancy, and it's such a small amount, you're going to get the smallest amount that you're going to use these little tiny syringes.

(31:53): And that's something that you can meet with a lactation consultant about if that's something you're interested in. And then hand expression in the first couple of days of life really is much better than the pump. Because if you think about those small volumes when you're sending them into that bottle and there's those little drops, and usually the colostrum is very sticky, so it's really hard to get it well from the pump. So hand expression is a great thing to be able to express some of that milk if you're spoonfeeding the baby, or if your baby goes to NICU for some reason and you want to be able to give them the milk. So really in the first few days until your milk comes in, the breast pump doesn't do a lot as far as extracting the milk. And then later on, it's nice to just have that skill of hand expression. Maybe you're at work and you don't have 10, 20, 30 minutes to sit down and pump, but you can hand express in five minutes and get some milk. Or maybe you're in the airport or on a plane or something and you forgot your pump or your plug or something. So it's a nice skill to be able to relieve milk and continue expressing later in your breastfeeding journey as well.

Dr. Nicole (33:11): Gotcha. Gotcha. Now, I do want to ask a minute about low milk supply. What are some things that you think can help in general with low milk supply?

Dr. Wadley (33:21): Yeah. Well, so it really depends on the reasons, and we talked about the reasons health wise, why moms wouldn't have low milk supply. There's also some reasons for low milk supply postpartum. So hemorrhage, retained placenta, you had hypertension, you were on magnesium. Those kinds of things can not only delay your milk coming in, but can give you some low milk supply in those first few weeks of your baby's life. So really obviously identifying the cause, solving the cause if it's possible. And then after the first 10 days of breastfeeding, it becomes a supply and demand. So increasing your milk supply really just means increasing the amount of times you empty your breast effectively. So if the pump is more effective than the baby, than use the pump, eventually you want your baby to be the more effective pump. So if the baby's more effective, you just increase the amount of times that you're feeding.

(34:23): That gets to a point, right? There's only so much you can increase it based on your anatomy and physiology. There's other things that we can do as breastfeeding medicine doctors. So moms with low milk supply, I can check some labs. If their prolactin level is low, we can prescribe some medication temporarily to help that prolactin increase in, help them to have a bigger milk supply, certain herbs and foods and stuff that aren't 100%, but there's certain ones that we know that will increase milk supply and that we can recommend to you. And really just the basic things, sleeping as much as you can, which is really hard with a new baby, making sure you're taking in enough fluids because your body will scavenge all that fluid and put it in the breast milk and leave you with nothing. And then nutrition. So just making sure you're eating healthy foods, all of that. You want your body to be as optimized as possible for breast milk production.

Dr. Nicole (35:31): So what are a couple of myths about breastfeeding that you love to dispel that you hear every time? And can we please stop saying that about breastfeeding? Is there anything that comes to mind?

Dr. Wadley (35:43): Yeah, so there's several things, and I confess before I studied for the breastfeeding medicine boards, I recommended some of these things. So start with that. So the expressing milk, letting it dry on your nipples. So that's one of my pet peeves. So we never use dryness in wound healing in any other aspect of medicine. So it's always moist wound healing. So you don't want to let things dry. You want to keep them moist but not wet. So difference between moist. And so those hydrogel pads are really nice breast ointment, you can use milk to do it, but really just not letting it dry because that can lead to more pain and problems. And then the other thing is mastitis and the way we manage mastitis. So the breastfeeding industry, all of the people that make money off of breastfeeding mamas want you to believe that massaging vibration, all of those things are what you need to do if you have plugged ducts or if you're starting to have mastitis.

(36:52): Really, the physiology of the breast is very different than what we're thinking. So those are things that we think about with abscesses and such. But the breast is not like that. Instead of it being like this one tube where you can squeeze out a plugged duck and like, yay, it's all gone. It's really just this interweb of ducks in the breast. And so when there's a point of inflammation in one of those ducks, it stops that milk flow, but it's not just a nice discrete place where you can squeeze it out. So really you have to treat the inflammation. So things like Motrin ice, gentle lymphatic massage, those kinds of things will treat the inflammation instead of aggressively massaging, which can lead to abscesses and mastitis. I know I learned all this year too. And then early mastitis, you don't necessarily have to start with antibiotics, you can start with the inflammation sort of treating things. But of course, if a mom has fever, flu-like symptoms, that's something that you would treat with antibiotics and then make sure you're seeing her in the office. I'm guilty of it too, but treating a lot of stuff over the phone and something that you would want to see someone for in person, I think. Got

Dr. Nicole (38:18): It. Got it. Got it. Okay. So then as we wrap up, what would you say is the most frustrating part of your work?

Dr. Wadley (38:25): I think the whole, do you take my insurance? Oh, well, you don't sort of thing as far as my practice goes is frustrating. And then we talked about all of the people that are really not super qualified to be giving certain advice or all over the interwebs telling you all the things, which is with any professional profession, I think. But that is definitely frustrating part of what we do. I think spending all this time dispelling myths instead of teaching people ways to do things. Right,

Dr. Nicole (39:05): Right. Exactly. Exactly. And then on the flip side, what's the most rewarding part of your work?

Dr. Wadley (39:10): Gosh, I just love breastfeeding mamas. And whether they breastfeed for a long time or a short time or whatever time, it makes them so happy, which makes me so happy. And to be able to solve what seems like a really hard problem to them is simple if you know how to solve it, and just being able to do that and see them excited about the potential to breastfeed their baby when maybe they didn't before. So my favorite story is, I have a package where you can meet with me before your baby is born and then I come see you afterwards. And this one mom, her first baby, she had to pump and she just didn't want to exclusively pump with this baby. And so we met with her. I talked her through all the things, and then I was able to stay in constant communication with her as her pediatrician was telling her, well, you have to give formula because he is jaundice and you have to do this. And just being able to give her the confidence to give her own breast milk, how to get her baby to the breast because he had been in the NICU and she was pumping for him and really just wanted to breastfeed, and we got him to the breast and it just made me happy. It made her so happy. So it made me happy.

Dr. Nicole (40:30): Yeah, I love that.

Dr. Wadley (40:31): Just moments like that. It makes it all worth

Dr. Nicole (40:33): It. Yeah, for sure, for sure. So then what is your favorite piece of advice that you would give to an expectant mom?

Dr. Wadley (40:41): Gosh, I think just there's so many voices and opinions and resources nowadays. Your mother-in-Law has an opinion about your pregnancy and what your baby, just tuning out some of those things and focusing on preparing yourself, finding one or two really good resources that seem like they know what they're talking about and following their advice and letting everybody else have their own opinion and not letting it ruin your pregnancy and your breastfeeding experience. Yeah,

Dr. Nicole (41:23): Absolutely. Absolutely. Excellent advice. So where can people find you, your website, you have lots of great blog posts about breastfeeding and things like that, so where can people find you? Yeah,

Dr. Wadley (41:34): So I'm at 1 2 7 pediatrics.com. So all numbers. I've moved my breastfeeding blog over there. I also have a pediatric blog, so any sort of thing that you can think of that you want to know about pediatrics, let me know, write about it for you. And then my Instagram is all spelled out, onetwentysevenpediatrics, and I talk about breastfeeding there and pediatric stuff. And then I have a specific YouTube channel just for breastfeeding. So breastfeeding at onetwentysevenpediatrics is the YouTube channel, and we talk about all these things that you and I chatted about just in more detail.

Dr. Nicole (42:12): Awesome. I love it. And we will put all of those links in the show notes. Well, thank you so much for agreeing to come onto the podcast. This was super duper helpful. I know the listeners are going to find it useful.

Dr. Wadley (42:21): Yes, thank you so much for having me. I appreciate it.

Dr. Nicole (42:33): Wasn't it a great episode? I found that information to be incredibly helpful, and after an episode when I have a guest, I do something called Dr. Nicole's notes, which are my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Dr. Wadley, number one, the way that she approaches care and this whole direct primary care model or this concierge model of care, I have to admit, it has me thinking about the way that I approach my own care. You know what I mean? When you add up the copays, when you add up the deductibles, then maybe the math can work out that you can have a more personalized relationship with your physician and actually some direct primary care practices do accept insurance or help you work with insurance. I haven't seen it so much in OBGYN yet, but it just seems like a nicer way to have a closer connection with your doctor.

(43:30): That's just some food for thought for how you approach your own care. Okay. Number two is your doctor is just really not going to tell you much about breastfeeding other than encourage you to do it and give you a script for a breast bump. We just do not get any or very little training on breastfeeding. So please don't expect that your OB is going to be a great resource in terms of breastfeeding. Now, there are some OBGYNs who do also become certified lactation consultants, and they can be quite helpful, but it is the exception and not the norm. We just don't have a lot of education and training about breastfeeding at all, and you may not even see us for six weeks afterwards. So definitely know that your OB isn't going to be the greatest source of information. I'll be honest, the conversation that we had in this episode about some things that are present during your pregnancy and in your health that can impact your breast milk supply, just not a part of our typical conversation.

(44:39): So I'm not trying to be all doom and gloom. I just want to let you know that don't expect your OB to be the best source of information about breastfeeding. Okay. The last thing I want to say is that learning information about breastfeeding doesn't have to be overwhelming or information in general, doesn't have to be overwhelming. Find one or two sources of information that are reliable that you feel like you connect with, that you feel like you can understand. You don't have to follow everybody on the internet. You don't have to follow every single account. Of course, I'm so grateful that you are here and I love being able to provide information for you, and I hope you stick with me, but maybe my voice doesn't always necessarily resonate with you on something. So definitely find some sources, one or two sources, stick with it.

(45:28): Don't go crazy with the information and make sure they're reliable. Reliable means that they clearly state who they are, what their training is, what their background is, what they bring to the knowledge and experience, and things that they bring to the conversation about whatever topic it is that they're discussing. They're willing to admit that when they make mistakes or when they're wrong about something, they're willing to change and adapt. They stay up on the latest information about things. They base their discussions, not just on personal experience, although that's important, but also on evidence and on research and on science, when that is applicable. And not that there's anything wrong necessarily with just basing information on personal experience, but you want to be clear that that's where the person is coming from. You don't want anybody saying things like, this is fact that this is the case when they don't really have anything to back that up.

(46:26): So transparency, all of those things are common, and I'm a little bit here, but that's because I see so many people stepping into the online space who are providing information that isn't that way, and that is misleading in a sense, and that it states things as fact and as absolute when that actually is not the case. So just be careful about the sources of information and then just stick to a few that resonate well with you. All right, so there you have it. Please share this podcast with a friend and have we really, really, really, really love it. If you would leave me a review of the podcast and Apple Podcast, it just really helps the show to grow, and it helps me to know what you think about the show. It helps other women to discover this show. So not just for me, but for all the other pregnant mamas out there who you think could use this information.

(47:20): Leaving that review in Apple Podcast is so, so important, and I would definitely, definitely appreciate it. And I do shout outs from those reviews as well. So please do that for me if you don't mind. I would so appreciate it. And then don't forget to check out my free birth plan class. Make a birth plan the right way so you can actually have the birth that you want. Check out the class at drnicolerankins.com/birth plan. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.