Jada Shapiro, founder of Boober offering complete care for pregnant and new parents. This includes vetted providers, live classes and free resources from the comfort of you home. Here, we discuss important information about breastfeeding.
Georgie: Tell us about you and Boober.
Jada: Boober is a platform where expectant parents and new families can find all of their pregnancy to postpartum care providers like birth, doulas, postpartum doulas, lactation consultants, and now mental health therapists who specialize in pregnancy to postpartum.
We fast-tracked mental health when COVID hit. Imagine you're pregnant or you just had a baby and COVID just hit and we don't have any information about it or enough information. Things were going crazy. You know, for five days in New York, you couldn't bring your partner to the hospital when you're having a baby, and all of a sudden, people had to go in alone. They just had no idea. All of a sudden people can't have any family members visiting right after with their babies. I know that the stress for me was incredibly high and I was not pregnant at the time. I think it made a difference for people who called us late at night just seeking help. I'm happy we were able to add that.
Boober really started a few years ago. It grew out of my first company, which I started in 2002 called Birth Day Presence, the leading childbirth education and doula training center in New York City. We've been teaching childbirth classes breastfeeding, newborn care, infant CPR and safety and then running about eight doula training sessions a year plus certified lactation counselor training sessions.
I was running that for many years and many of my childbirth education students would call the company freaking out, “I called the five or seven lactation consultants on this list. I'm really having problems breastfeeding. I can't find anybody who's available today. Help!” I would help her try to figure out what to do but realized we are living in a demand age: you can get your hair done, you need your dog walked in one hour, you press a button. Why can't we get anybody to help people who are struggling with lactation today?
It makes a huge difference when you get help. The earlier you get help, the faster you get help, the more likely you are to succeed at meeting your lactation goals, whatever they are.
I knew all of the lactation experts in this city through my work, and I started passing out a card basically in our folders for classes that have my cell phone number on it. When texts started rolling in faster than I could keep up with, Boober was formally born. Since then, we matched close to 4,000 people with same day lactation support in the city, which has been a real, real game changer for people who are struggling.
It's not only about helping people with lactation, but it's also about having human contact and having somebody who really gets the postpartum experience and can listen and hear what's going on. In the US, we tend to just drop people after they have a baby. That's not a lot of support. Women aren't expected to go back and see their care provider for six weeks, which is like, essentially a lifetime. I would say, after you have a baby, having a professional there who can support answering questions about breastfeeding, pumping, lactation, bottle feeding. Additionally, it is helpful to have a real human who can be there who's compassionate, who can listen, and answer those questions.
During COVID, we quickly switched into being a virtual care provider, which has been amazing for when people who can't do in-person care to be able to engage in this way even though I'm on your little rectangle and popping in. I just did a session this morning with somebody virtually. It makes such a difference to have a human pop in when a human can't pop in. It's been pretty, pretty great to be able to support that way.
Boober started with lactation and then I really wanted to bring over all of the birth and postpartum doula matching I’d done for 15 years. We eventually moved all of the doula matching onto the Boober platform. We then added mental health therapy and down the line, we'll have more like pelvic health, sleep and everything you could imagine related. Right now, we're really concentrating on these four topics.
Georgie: What you are doing is needed. I had a baby almost five years ago. I was fortunate. I had a baby late, and I learned from all my friends about the challenges with nursing, and I was prepared knowing that it would be hard. I remember two incidents in the hospital.
One, they kept trying to kick me out. I literally could have left the hospital as soon as he was delivered because I was fine. But I said, “No, I'm not leaving until I know how to nurse because I can't get him to nurse.”
Then, one night, in the middle of the night, a nurse wanted me to nurse in an odd position. I told her, “This position is for advanced people!” I told her she had to teach me the basics. Because I knew it would be hard, I was ready, and I knew how to stand up for myself.
When I went to the pediatrician, and my son was struggling to nurse, they said, “You know, just give him formula.” First of all, I want to be clear, I don't think any of us are saying breastfeeding is the only way formula is bad, but it was my choice to nurse. Luckily, I was in a very supportive community in North Carolina who taught me that I can go to these lactation consultants because I didn't know who they were and that they existed and they saved me.
Tell us all the things that we should know. So that we're as successful as possible. Let's tell the real stories. Perfect little pictures on advertisements with the women smiling and their beautifully sized breasts with the baby there and happy. However, this is not everyday reality, and not in all cases, and maybe not even in most.
Jada: I absolutely second that. Boober meets parents where they are, wherever they are, right. So if you are reaching out to Boober for lactation help, because you actually don't want to breastfeed, which happens sometimes.
I had a conversation with him with a mom who was like, I just I don't I don't I don't want to do this. I was listening to, “Because I just don't want to do this. Actually, I want to wean.” Her baby was five days old, and I said, “Okay, you can do that. Why don't we talk about helping you to slowly wean so that you don't have, you know, engorgement and then mastitis or breast infection.” By the end of the conversation, she was crying, and she was just like, “You're the first person who told me I didn't have to breastfeed. And thank you.”
That is not why most people call us, you know. Most people call us because they do want to breastfeed and they're struggling with it, but it was amazing to be able to support her through that and for her to feel like, oh, okay, you heard me because nobody else did. And that's really important. We are not here to shame anybody who chooses not to breastfeed. And on the flip side, I do want to say that the people who do want to breastfeed really struggle in this culture also because there's not enough support for breastfeeding.
Breastfeeding is just feeding your baby. The UN came out a couple years ago said brelfies are one of the most important things, which is the breastfeeding selfie. That the brelfie is actually helping people around the world be able to feel confident and comfortable with nursing.
If we don't do this extra help and support on breastfeeding, it can be a lot harder because our hospitals, at least in the US, most of them, not all of them have practices and policies that make breastfeeding harder.
There are so many reasons why somebody would choose not to. And that is totally fine. But for the people who are choosing to or even let's say that we never even talked about it, a lot of people don't understand why, or how, or how it works or what are the fundamentals or what are some of the benefits.
The most important thing about prenatal education is about setting you up for success by knowing what the points of failure are. For example, what things make it harder to nurse for instance, asking if you can keep your baby's skin to skin contact. In some cases, that's one factor that could make it easier for you. Knowing also that sometimes your baby can't be in skin to skin contact and that that doesn't mean all is lost.
I'm all about education and meeting people where they are recognizing that not all people are going to make a full supply. That's true. And do they have to do all or nothing? Like do we have to make people feel crappy for using formula? No. Why would we do that? They're feeding their baby, right? Do we have to make people feel crappy for breastfeeding all the time? No. And so it's just so it's so fraught right now. People are so quick to shame online. A part of parenting, of course, is getting in touch with your own self but it's tricky.
Georgie: I’ve also heard pediatricians don't have a lot of training in breastfeeding. It's helpful for women to understand that dynamic so that if they feel like they're not being heard, it's the system. So maybe you can help put that together.
Jada: We just have to be really upfront about this. I work with tons of pediatricians and we get tons of referrals from pediatricians as well. But so many of the pediatricians I know are the first to tell you they studied lactation for 30 minutes to an hour.
There's a couple pediatricians in the city in New York and around the country who are IBCLEs, which means they took the extra time and years to become a lactation expert. In my opinion, for sure, of course, pediatrics would include a rigorous education in lactation. If we were designing the world now, the pediatricians would study lactation and you'd have very little need for lactation consultants because you go to the pediatrician so frequently, right? Your OB GYN and your midwife would also be skilled in lactation because they're the first people after the baby comes out who'd be helping. The hospitals would hire more than one lactation consultant. (In New York, we have one lactation consultant for 50 people. Are they supposed to see everybody?) I think that people's intentions are good, but our system is severely compromised.
We're also coming out of our culture from the 1940s, 50s, early 60s, where we were very much against breastfeeding in this country. We anesthetized everybody, when they went into birth. We even gave them injections of medications to drive their milk. We told them not to pick up their babies when they're crying. So of all the people giving birth right now, maybe half of them were breastfed and half weren't. They don't even have their parents necessarily to help them. It's not the same as in other cultures where it's just the norm, and the baby just latches on and you've watched it growing up.
One of the big things people don't realize is how frequently babies eat in the beginning, and it makes us doubt that we have enough milk. At first, you don't even have full flowing milk. You have this amazing thing called colostrum, which is that liquid sticky, yellow gold, thick fluid,and it doesn't look like full flowing milk. If nobody ever told you that, and nobody said your baby only needs one to two tablespoons in the first 24 hours. The size of their tummies is like that of a little marble and they can only hold so much. They're going to be feeding every 60 to 90 minutes for much of the time.
If nobody has ever told you that, every time you're when that baby shows hunger signs, again, you're like,”No, but I just nursed half an hour, half hour ago.” So you start to think, “I must not be making enough milk.” Then if some staff member or somebody in your family who didn't nurse says to you, “I can't believe you're feeding that baby again….”
We plant these seeds of self doubt. And if we give a bottle really early to a baby, that's fine. And I'm not saying there are situations where you do need to give a bottle, but that baby is not stimulating your breast anymore. But you're not then removing milk which tells my brain to make more milk so I can very quickly in one day, not signal my body to make as much milk so the next day I'm gonna make a little less milk because if in the hospital, they told me to give a bottle, but nobody told me to pump my breast or nobody instructed me how to get in there and extract my milk, then I'm going to find my milk supply starting to dip very quickly. Instead of like, in the early days we’re in the milk building phase. If people just knew that they knew that they have enough and it's super rich with antibodies, and it's helping line the baby's gut and helping them build their immunities from the beginning. If we don't help people understand that, that's, that's one of the things that really disrupts the process.
The other really big thing is that whole putting the baby on the chest and helping if we just put the baby on the chest and leave it there. Babies crawl to the boob. All mammals do that. We're mammals, kitties, puppies, and they all crawl up. And we do lay back and place the baby there, that baby will do that too. The American Academy of Pediatrics has done many studies on this. They show that the one of the easiest ways to help increase initial latch rates of breastfeeding is to actually place the baby and skin to skin contact, and do nothing. Of course, check that the baby's fine, but as long as the baby's fine, that baby will eventually crawl from below the nipple. They kind of latch on in the best way possible. It doesn't work 100% of the time, of course.
I really want to help people know that if they want to nurse right, getting educated and getting support early on, makes a huge difference. The American Academy of Pediatrics does recommend exclusive breastfeeding for six months, but that's a really hard goal to attain.
In this country, people assume that pain is required or is a normal part of breastfeeding. And it's not. Pain is a sign that we need to fix the latch. Pain is a sign that something's not going quite right. And if we can work on solving that pain, whether it's through deeper latch, getting a better positioning, then that better positioning creates more milk supply. It’s all linked. But when you assume that the pain is supposed to be there, then you don't reach out for help, and you just power through it. But when it's really painful, you're not going to nurse anywhere near as much, and so you're going to very quickly make less milk and have to supplement because the baby is not able to stimulate sufficiently. Also, you say, “I can't stand it because it hurts and if I have to do it eight to 15 times a day, how could I possibly do something that hurts eight to 15 times a day like that be intense stress and, and make me have an aversion to doing that which would be normal and to be expected.”
Georgie: Is it as simple as supply and demand?
Jada: For a lot of people it is as simple as nursing more. People just aren't educated about it, and they don't imagine that you could possibly have to put your baby to the breast that many times a day. For some people, it is 15 times a day, every 60 to 90 minutes.
We always like to say, “More milk out is more milk made.” But then you're pumping all the time. Nursing all the time. You think, “I'm doing all this and it's not working.” There are some other factors a really good lactation consultant will drill down into. They're going to ask about the birth. Some things that could happen are:
Retained placenta. If your placenta didn't fully come out of your body, you will not have the hormone drop in hormone shift that has to happen to start making the right amount of milk. This is not common, but it could happen.
Insufficient glandular tissue (IGT). They don't have the full tissue that is going to make a full breast milk supply. They may have signs during pregnancy - the breast tissue didn't change at all, their boobs didn't grow at all, and your nipples didn't enlarge a little or darkened at all, that is sometimes a sign to us that you may have a milk supply issue. You can also tell there's a certain shaping to certain breasts that tend to be more toward IGT. An OB GYN should have this flagged in their mind. Let's prepare somebody for that rather than not talking about it at all right.
Fertility medications. It seems, anecdotally, that those who take them sometimes seem to struggle more. There may be a hormonal something that's going on that may affect nursing. We should look into that more.
Significant blood loss during the labor. This can affect our milk spikes.
Scheduled cesarean. It can take more time for somebody who had this procedure and didn't labor at all. The body doesn't necessarily make the full cocktail of hormones that we would make during labor. Thus, we would often expect a bit of a delay in the milk coming in. Coupled with that, very commonly after a cesarean birth we separate babies from their parents, and if that happens, and nobody instructs that person who's not with their baby to really start stimulating their breasts on their own, then that person is gonna be way behind the eight ball.
Babies in NICU. If I were designing a NICU today, it would allow parents to stay the whole time. In the New York City area, most parents get kicked out when they're baby’s born. There is just no space, and so we don't have a place where the parents can stay. It's very hard to create your milk supply and keep bringing it back and forth to the baby and people aren't helping. Nobody's at home with them saying, “Okay, it's been 90 minutes. You got to pump again, or extract again.” If you were in the environment and you could put your baby on you because many NICU babies can actually go into kangaroo care and could be on the chest, and we could be working with a lactation consultant who'd be in the NICU specifically helping, right?
There's a lot of things where it's not just as simple as supply and demand. But then there's eating one of the things you know, nutritionally, nutritionally that I hear a lot. That does seem to work for many people and you'll hear it from many other cultures, but especially bone broths, used in aromatic and Chinese medicine, especially if it includes all the collagen. We don't make a whole lot of pig feet soup here, but it is something that people will swear by for increasing milk supply. Yet we feed people in the hospital cold, sugary stuff. We’re not doing the warm, soft nourishing foods that would help build the blood and milk supply.
Also, make sure that the latch is right because you can nurse all day long, but with a poor latch, that is not the case. If you learn with a poor latch and you're not an over producer, then you're less likely to make that whole supply. That can sometimes be what's going on and finally there is the tongue tie situation. So many parents are struggling with nursing and so many pediatricians feel that tongue ties are so over diagnosed, that they're like, “Forget it, it doesn't exist.” Then parents who come into Boober, for instance, are really struggling with milk supply. Their baby has all sorts of things like gas and acid reflux. Acid reflux is common and can very commonly be actually just related to the tongue tie or a nonfunctional tongue. There are some pediatricians who really get it and then there's many who don’t believe it exists. For the parents who have a baby who's not nursing well, and they're experiencing all of those things that I just said and then have their pediatrician say that's not a thing is really hard because they're stuck. A lactation consultant says one thing and the pediatrician another.
I think it's such a controversy partially because one of the fixes for a tongue tie is to clip that skin flap right underneath the tongue. Of course, people are rightfully concerned about clipping a newborn’s tongue. That is valid, and it's not always the fix for everybody.
You can also use craniosacral therapy or chiropractic care. With some babies, especially if there was a traumatic labor, and in some cases, babies are very curled up or their head is tipped to one side, called torticollis. Many may think this is blue and crazy, but it's a holistic treatment. It allows babies to unfurl and their bodies get straighter and their jaw relaxes. It doesn't always work, but it's certainly one possible thing to try.
There are pediatric dentists who specialize in tongue tie as well and then in clipping or using lasers. It's a really big topic, but so many parents feel that this was missed and they didn't understand. They struggle for so long and then they start to see the other things that come up with tongue tie later such as the baby struggling with speech or eating solids. Then down the road, the baby also has problems sleeping because their tongue doesn't sit on the roof of their mouth.
There's all these things that can really be linked. It's so tricky because if we could just listen to parents. If somebody tells you they're in pain, then they're in pain. It doesn't matter that their latch looks fabulous. We also want to help people know that if something is going on, then they do need to feed their baby and while working on trying to build supply or whatever they're doing, that they you know, a lot of, I think for a lot of people
There's a real personal struggle or sense of defeat if they can't fully feed their baby at the breast, so for the lactation consultant to be able to give permission to say, “If you need to use formula, donor breast milk or pump that is okay.” Let's get the baby fed so that we can work on the steps
For some people, babies just latch right on, and it's really easy. On Instagram we're seeing a lot more now of the hard stuff. We're starting to see that more. I think that people are getting more confident or comfortable sharing that this was really hard.
Georgie: As I'm listening to you and I'm just thinking about the podcast interviews I've been doing. Alyson McGregor, started sex and gender practice at Brown University because she saw some of the disparities in women's health and she said, “Gone are the days of doctor knows best. Doctors are consultants.” What's really becoming clear is there are sub experts like lactation consultants and even endometriosis surgeons (rather than an OB GYN who may or may not have trained).
The other theme that I'm hearing is that you really need to build a team - and the right team. Back in the old days and even in the days of living in caves, you had these communities where if I'm not mistaken, women would help nurse other people's kids if the mother couldn't and there's all this help. In our modern day society, so much of that has disappeared and that's why we need these resources. It's nice that they're available and, and I hope women listening to you understand that nothing's wrong. There's the support system, use it, get the help, and we don't have to figure it out ourselves. Get a lactation consultant, if you're struggling. There's no shame, and I can tell you like I had such a good team when I delivered and it was great.
Jada: I think that is the number one thing absolutely and get your team built. We do prenatal preparing for postpartum classes. Know your circles of support, whether they are good friends and family who can help you. However, friends and family can help you but they come with baggage and they have opinions. Then there are the people that you hire whether that's a postpartum doula or your lactation consultant. Those professionals are very specialized. There's a lot that goes into it, and it takes a couple years to be a full level, International Board of Certified Lactation Consultants(IBCLC). Then there are lactation counselors like myself who have many years of experience and why can help with the basics and then refer up and out when things are complicated.
One of our hashtags on our Instagram, #ifithurtsgethelp. Don’t think, “I guess it's supposed to hurt. I can't do this today.” Instead, get help.
Today, I did a session with somebody and it was amazing. The thing that helped was my asking her to try pressing in between the shoulder blades of her baby right with the heel of her palm. I asked her to bring the baby in a little bit closer, and I wanted to see if the head tips back a little. It worked!
There are these very subtle shifts. But she's not surrounded by her aunts, mother-in-law. In the old days, you grew up watching nursing as how everybody fed the baby. You would feed your neighbor’s baby. They would exchange babies and help, but now it's so behind closed doors.
Georgie: One woman in our Facebook group had said that her baby only nurses on one side and she's producing obviously more milk on that side because that's where the baby's nursing. It was suggested she go to a chiropractor. Now, clearly you haven't seen this woman, you don't know exactly what's going on and this is literally all that we know.
Jada: if the baby's really only nursing on one side, she will benefit from a chiropractor. It’s likely because it might really hurt the baby’s neck to go to the other side, for instance, or be held in a different way. It often has to do with the baby, for eight or nine months might have been laying in this one position and that really influenced their body. Thus, it's too painful to get a good latch in one direction. So what happens is lactating parents start on the one side, and there was so much easier on the other. They kept putting a baby back there, too, because the struggle is too much on the one side and then they start to overproduce on the one side. As we said, more milk out, more milk made. I do think seeing having an appointment with either a craniosacral therapist or a chiropractor would help, but they have to specialize in infants. That's a great first step, at least. It's possible her breasts didn't have enough tissue in that past or something's happening where the flow is so much slower.
Georgie: What is your greatest hope for those in the world of postpartum?
Jada: I would love to see in-home visiting care. In many other countries like ours, they have midwives or nurses who come every other day by your house and are paid for by the healthcare system. They do all sorts of things from lactation to checking your bleeding to like checking your emotional health. I would love to see our system really shift to a model that understands that if you give birth, the care is not over.