Cheyenne: From Richmond, Virginia this is How Many Weeks — I’m Cheyenne Varner
Francie: And I’m Francie Webb!
This season is sponsored by Manhattan Birth.
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Francie: My name is Francie Webb, my pronouns are she/her. I am the mother of three kids, and a professional certified birth and postpartum doula, an International Board Certified Lactation Consultant-in-training, and the founder of Go Milk Yourself[1]. At Go Milk Yourself, we teach lactating people, and the professionals who support them, to hand express milk, with confidence. I teach people to do things they think are impossible, and I’m committed to a world in which every person really gets how powerful they are.
Cheyenne: My name is Cheyenne Varner, my pronouns are she/her, and I am a professional certified birth and postpartum doula and I’m the founder of The Educated Birth[2]. At TEB we create intersectional reproductive health educational content, from online articles to social media posts to digital and print teaching tools. We also publish Everyday Birth Magazine[3], a print and digital magazine with the same mission, to make information and education about pregnancy, postpartum, and more, inclusive.
Did you know that How Many Weeks has a phone line?
Francie: A good chance they did not know since we’re still pretty new at this.
Cheyenne: Yes, you can call in to share your comments, questions and stories with us, and maybe even to come on the air with us sometime… our number is 804-601-6065
Francie: So today we’re going to introduce you to the working of a certain assembly line.
Cheyenne: And we’re not talking about a Henry Ford kind of assembly line.
Francie: No, we’re talking about an internal assembly line — one that's inside your body — it's inside the bodies of anyone who has mammary glands[4].
Cheyenne: And some very special hormones that turn certain functions on. And this whole story, this whole exploration, starts with something that happened to you a couple weeks ago, Francie.
Francie: Something that happened to my boobs — actually something that happened in my boobs.
So one day last week, I woke up with what felt like a rock on my chest. And by that I mean, I had a breast with some very full mammary glands. My first thought was, “Yikes! I need to do something about this!” and my second was, “How could this happen?” See usually, when someone has really full breasts –
Cheyenne: That’s called engorgement[5] — when the milk becomes congested in the chest. It often feels swollen and tight.
Francie: Yeah, so And usually when someone has really full breasts that’s because their milk is just coming in (and that isn’t true for me — I have a 11-month-old, so it not like my body is just starting to make milk), or it’s because they haven’t gotten any milk out in a really long time / or there’s been a change in the way milk is removed[6]. The body’s like, “Wait, I thought we were getting milk out!” and then “Ummmm why did we stop?”
And then I remembered - the night before, I’d been making videos demonstrating a number of techniques for hand expression[7]. In the course of making 3 videos, I’d gotten a small amount of milk out - I’m guessing about a teaspoon, maybe even less.
Cheyenne: Not alot of milk
Francie: No, just a little bit
And then I slept, and my baby slept - she sleeps through the night now, which is no small thing. So I slept and she slept I get! (I feel you, listeners who are up with babies throughout the night) - and I woke up engorged. Like, uncomfortably full, to the point when I was concerned I’d get clogged ducts or mastitis[8] - all from removing less than a shot glass of milk.
Cheyenne: That’s really interesting because my understanding is that milk production is all supply and demand so if you express a little it fills back up a little. But it sounds like what you’re saying is that you expressed a little and a lot filled up.
Francie: So a better way of explaining this would be to say that I started the assembly line of milk making. Which — I hadn’t even thought of it this way until Amey Fields came into the picture.
Cheyenne: Amey it’s so great to talk with you —
Amey: I’m excited to talk with you!
Francie: This is Amey — Amey is a nurse and an IBCLC[9] who runs Arizona Breastfed Babies[10].
Cheyenne: I caught up with her on the phone on a very very hot day,
Amey: It definitely gets really hot, it’s been like 115 it’s supposed to be 117 here pretty soon.
Cheyenne: Oh my goodness…
Cheyenne: ...to just get some IBCLC perspective about what Francie experienced and this whole making milk process.
Amey: So we know, and these are definitely not my concepts or my ideas by any means, but we know are not we know that our breasts are a factory, not a warehouse so when we move milk, we make more milk… (5:55) So when Francie said oh you know I modeled hand expression just a little bit it wasn’t a lot and then all of a sudden the next day I wake up and have all this extra milk — and we know that there’s studies that show that — I remember learning this in the very beginning, ten years ago – that especially in the US we tend to not touch our breasts — they noticed in some of the studies that were done — that women that were breastfeeding their babies were latching their babies on and that was it and maybe even covering them up for modesty — and the baby was nursing. And they noticed that in other countries that women were very hands on and doing a lot of breast massage and expression — so it’s a great skill. It’s one of my favorite skills to teach a new mom… I basically told Francie, like, you woke up the factory workers, you were like, “Hey! There’s a need for more milk!” And if you envision that...
Cheyenne: So now that we have a bit of a better idea of what happened with Francie, let’s back up and cover some of the basics.
Cheyenne: When we talk about this assembly line — what we’re doing is we’re taking a journey inside. Like the Magic School Bus, so everybody get ready to buckle up and travel inside!
Francie: Do they have buckles on the Magic School Bus?
Cheyenne: I think they do.
Inside the body let’s zoom in on the area we refer to as the breast or chest — there’s all this tissue inside — it’s called adipose tissue[11] or more commonly fatty tissue — and this kind of tissue is all over the body, but here it’s what determines the size of our chests. All this adipose tissue — it really has nothing to do with milk making — it’s just atmosphere — it’s like are we making milk in a nice little cafe on the corner or at Costco? Is that - it works right? Doesn’t matter, same milk making whatever size.
Francie: So yeah, it’s what’s in between all that adipose tissue that’s important — and that’s glandular tissue, mammary glands. There are typically 10-20 mammary glands inside each breast[12].
Cheyenne: You can feel them! If you press down around the nipple, you may be able to feel the little lumps of these glands. I’ve actually felt mine before, they feel to me like very small pebbles, like very small like little beans that you’d fill up a planter with, or little those little pebbles you find on a pebbly beach, or little bits of sea glass.
Francie: And inside each gland are alveoli[13], small, grape-like sacs that fill up as milk is made. To me the whole thing looks like a bunch of broccoli - which by the way, has been my favorite vegetable since I was a kid. I love broccoli.
Cheyenne: It’s a good one.
Francie: And basically, it looks like we have broccoli inside our bodies.
Right, so that can help kind of you visualize some of this equipment — and that’s where milk will be made — but how will it come out? Traveling through these little tubes from the mammary gland to the nipple — we have ducts[14]. Milk will be produced in the mammary gland, fill the alveoli, travel through the ducts, and come out of the holes in the nipples.
Francie: For the folks who like to know the textbook names, aka, all of us nerds out there — those holes are called milk duct orifices[15]. How many are there?
Cheyenne: There was actually a study done on this in 2014. Researchers studied the nipples of 95 women and found 2-16 orifices per nipple[16]. And no notable difference between the number on the right and the left sides. And on average, they concluded, people had 3.9 orifices per nipple.
Francie: Okay Cheyenne, this is so wild because I definitely thought that there was just ONE hole that milk could come out. Like I thought that when I was a kid, I don't think I thought much about breastfeeding as a kid, but I remember the first time I realized there was more than one and it’s when I saw multiple sprays coming out of the pump and then when I would hand express I would see multiple sprays or streams and that was really shocking to me that it was even more than one - like we have multiple holes milk can come out of.
Cheyenne: Yeah it is kind of wild, isn’t it? And it’s also funny that it’s 3.9. That’s such a weird - like to say “You have on average 3.9 orifices in your” - it’s like when people talk about the house, the car, the fence, and like the 2.5 kids being the American thing, you know? It’s like 3.9 nipple orifices.”
Francie: Can I choose which half of the kid to have on any given day? Can I have the not-whiny part?
Cheyenne: It’s weird. But I get it. It’s numbers. It’s data.
Francie: Yeah. It IS weird that it’s 3.9. Do you think you have 3.9, Cheyenne?
Cheyenne: I guess we’ll find out one day!
Francie: I guess we’ll find out!
Cheyenne: They did also add that in their study people who’d had a baby before had more orifices than the first-time parents.
Francie: So that’s the equipment. That’s where milk will be made and where it will travel through and out of, but what’s going on that starts the action? What will cause these tools to be dusted off and activated? A couple of stars, VIPS if you will, will have to show up in the building — in the body.
Cheyenne: These stars are hormone — Progesterone and prolactin[17]. Hormones are messengers in the body — chemical messengers that travel in our bloodstream. Different hormones are produced in response to different things that happen in our bodies and then they travel, travel, travel through the bloodstream until they get to their destination where they plop — and they say — hey! I’ve got this message about what you’re supposed to do now.
Francie: Yeah they tell other parts of our bodies to do things. They’re such bossy little things.
Cheyenne: So when someone becomes pregnant, there’s a certain hormone that the body starts producing a lot of — Progesterone[18].
Progesterone is produced in the ovaries, in the adrenal glands (which are on your kidneys) and as the little fetus grows and the placenta that’s nourishing that little fetus grows — the placenta makes progesterone, too[19].
Cheyenne: So progesterone is this messenger and it travel, travel, travels through the body and it says:
Francie: “Loosen up! Stretch out! Make way for this growing human!”
Cheyenne: It’s responsible for loosening ligaments and the uterus stretching[20] and it’s a big deal at the start of pregnancy, too, helping the pregnancy to stick and stay. Later in the second trimester of pregnancy, when the placenta is in on this production too, the progesterone travel, travel, travels through the body and it gets up to the chest where these mammary glands are hanging out, straight chillin’, in the adipose, and it says:
Francie: “Hmmm…”
Cheyenne: And it waves its magic wand and it says,
Francie: “Bippity, boppity, make boob juice.”
Cheyenne: Well, kind of! It tells these glands to start making colostrum[21], which is the first stage of human milk. This happens as early as 16 weeks of pregnancy. So if you notice clear, or yellow fluid leaking from your nipples during pregnancy, that’s why. Milk making starts way before labor — all because progesterone says so.
Francie: So textbook here — that whole stage is called Lactogenesis I[22].
Before we continue let’s just address that lactation starting as a result of pregnancy is just one way that lactation can start. It’s one of these — a square is a rectangle but a rectangle is not a square kind of things.
Cheyenne: Right, lactation is kick-started by pregnancy but pregnancy is not required to kick-start lactation. Lactation can also be induced by parents who don’t go through a pregnancy[23]. These can be adoptive parents, parents through surrogacy, a partner to a pregnant person who cannot or doesn’t want to lactate, trans parents, the list goes on.
Francie: So if someone has the equipment, but the pregnancy hasn’t kicked up these hormones what does that mean for the milk that’s made? Is it real milk? Is it different?
Cheyenne: Here’s an answer to that from La Leche League[24], “The composition of milk produced by inducing lactation is comparable to that produced following birth. The milk does not contain dangerous levels of artificial hormones—in fact, it very rarely contains any artificial hormones at all. In most cases, the only artificial hormones that are taken are estrogen and/or progesterone before there is milk production.”
Francie: You know, talking about artificial hormones to start lactation really makes me think of when we use artificial hormones to induce labor. It’s really very similar isn’t it? But societally I think those things are looked at very differently. We’re much more normalized around and accepting of induction of labor than induction of lactation.
Cheyenne: I think you’re right about that correlation. So bottom line here, when it comes to lactation, most people have the equipment, it’s just about getting the stars on stage to get the show started.
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Cheyenne: So okay — back to where we were — when milk making starts during pregnancy and everything stays pretty chill until birth. Progesterone continues to travel, travel, travel, just doing its thing, bossing all these parts of the body around:
Francie: “Stretch, loosen, make milk, stretch, loosen, make milk.”
Cheyenne: And then one day a baby is born.
Francie: [Attempts baby cry sounds, LOL]
Cheyenne: And it’s not just the baby coming out that is a big deal to this milk making assembly line — it’s also something else...
Francie: The placenta!
Cheyenne: Yes, the placenta, which remember, had been making these progesterone hormone messengers, it gets the boot. It comes out of the body and progesterone levels plummet. All those little messengers — they’re gone.
Francie: But there’s another messenger — it was playing second fiddle, it was singing back-up, it was just behind the curtain —
Cheyenne: Prolactin[25] — it was high during pregnancy too. It’s a messenger made in the pituitary gland, which is in the brain. And during pregnancy it too travel, travel, traveled throughout the body telling things what to do. It helped with chest growth and that early milk production. But while progesterone was around prolactin just couldn’t do everything it wanted to do.
Francie: These two butted heads and nudged shoulders, prolactin wanted to do its whole job and because progesterone actually inhibits prolactin it was in the way[26], so prolactin was like, “Ugh, hold me back!” And progesterone was like, “Yeah, I actually am.”
Cheyenne: — but when progesterone falls off the charts, prolactin doesn’t have anything in it’s way anymore — it steps up and it sings out,
Francie: “Move that milk!”
Cheyenne: Prolactin tells the alveoli to secrete milk[27]. It also triggers a change in the composition of the milk. The first form of milk that the assembly line has been working on since 16 weeks of pregnancy — colostrum — that’s a very concentrated, thick, nutrient-dense first form of milk that the body has made just for the first few days of this newborn’s life, to protect them, fight off any illness or infections — it’s really good stuff.
Francie: Around 4-5 days postpartum, the assembly line starts producing what we call transitional milk[28]. This form of milk is thinner, whiter, and — it kind of kicks the assembly line into high gear — it’s like someone in the main office popped their head out and yelled, “Go faster, make more!” — it’s produced in much larger quantities than colostrum is, which is why people often feel engorged for the first time during this shift.
Cheyenne: Lactogenesis II[29].
Francie: So you remember how progesterone was high during pregnancy because it was being produced by all these different parts of the body?
Cheyenne: Yeah.
Francie: And prolactin was too but now, in postpartum, it’s different[30]. Prolactin in the body ebbs and flows depending on how much milk is moved. When milk is removed — aka — when it comes out the body goes, “Okay, we need more prolactin now!”, more prolactin is made, the prolactin tells the mammary glands to make more milk and secrete more milk, and then when the milk leaves the body again, more prolactin is made, prolactin tells the mammary glands to make more milk and secrete more milk and then when the milk leaves the body, more prolactin is made, prolactin tells the mammary glands to make milk…
Cheyenne: And it keeps going like that. This cycle is especially important in the first few weeks of pregnancy but continues on throughout the rest of the body feeding relationship.
Francie: If you look at the fancy textbooks they’ll say, “the milk supply is maintained via autocrine control.” [31] Which I think, if I’m understanding what we’ve researched well, this means that the cell kind of talks to itself. Like when we talk about hormones travel, travel, traveling to send their messages — autocrine hormones don’t have to travel far. It gives messages to itself or to its neighbor[32].
Amey: So I call the endocrine driven portion of it, like the honeymoon period. It’s like the period where our body kind of does more of the work for this brand new baby -- it’s our hormones that are driving the supply … because then we get closer to the autocrine driven it becomes more supply and demand…
Cheyenne: So the bottom line here is that the body shifting from making milk because of the chain reaction going on on the inside to the body continuing to make milk because of what’s going on on the outside — something is taking milk out, and how much and how often —
Amey: It becomes more supply and demand and then it’s more of the baby’s responsibility to move the milk and create the supply… so yes, then the hormones that are released are more localized. So yeah, that’s kind of what I learned as well.
Cheyenne: This is also a time when milk becomes mature[33], the composition shifts again to include over 200 different components that we still don’t know what they all are! But it’s full of nutrients to support growth and development and protection from illness and it changes with every feeding to best fit the needs of the growing baby.
Francie: Sounds magical.
Cheyenne: It is, like it blows my mind that we still don’t know everything that is in this milk.
Francie: And it’s in our bodies. Like right now it's in my body.
Cheyenne: It's in your body right now.
Francie: That's pretty cool.
Cheyenne: Okay so there’s one more hormone in this assembly line that we should mention — oxytocin[35].
Francie: You’ve definitely heard of oxytocin if you’ve taken a childbirth education class and all the things that it does to support labor and birth. Now, in postpartum, oxytocin sends out messages just before and during each feed. It’s responsible for the ejection of the milk through the nipple. It says,
“Let it out!”
Cheyenne: When people feel a tingly sensation in their breast or chest (and sometimes they do and sometimes they don’t) — that’s oxytocin.
Francie: When milk starts flowing when you think of your baby or smell or see them — oxytocin does it.
Cheyenne: When milk switches from one breast to the other because the baby’s been switched to the other side — oxytocin does that.
Francie: When milk sprays out of our 2-16 milk or our 3.9 orifices — oxytocin does it.
Cheyenne: When the uterus cramps during feeding or pumping — yeah, that’s oxytocin too [36].
Francie: That - my friends, our friends - is the assembly line of milk making.
Cheyenne: And milk giving! Milk that might go directly into a baby’s mouth, or be pumped into a bottle, or leaked into a Haakaa, or donated to a milk bank
Francie: Or hand expressed— So amazing! I know we talk all the time about bodies being amazing in reproductive health work, it’s like our eternal tagline.
Cheyenne: But it’s true!
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Cheyenne: But before we totally wrap up here, there’s one more really important thing that I just have stuck in my head from my conversation with Amey...
Cheyenne: Because we’re outlining this whole process and it feels like this very step by step thing that just happens and takes off in the body and just regulates itself — like that’s how it’s outlined from this like textbook perspective but we know that lactation is not just this kind of totally intuitive easy like it just happens and you just go, there are bumps along the road and we prepare people for this will be a journey so get support on it —
Amey: When we compare our bodies to other people it can really mess with our confidence and maybe make us feel like there’s something wrong with us. And what we need to know is that there is support for whatever is happening in our bodies and we cannot compare our bodies to everybody else and so while some people can make a full milk supply with only four milk removals in a day and other people need eight, we know that the average number is about eight milk removals a day to have a full milk supply, and some people need 12, you know what I mean? And so I think knowing that it’s okay if your body doesn’t fall into the textbook definition of what would be normal or expected and that somebody that works as a breastfeeding or chestfeeding supporter, we have tips and tricks that can help whether it’s supplementing at the chest or the breast, you know it doesn’t have to be all or nothing …
I always think, like oh my gosh, I don’t want someone to hear this and think oh I’m not making enough milk because I’m not trying hard enough. So I definitely always say for most people this is true, like if you add in an extra milk removal it’ll increase your supply or — you know there are studies that prove this, if you do a minute of hand expression after you’re done breastfeeding or pumping that it will increase your milk supply. If you do breast compression and breast massage while the baby is nursing, the baby will get more milk. So...I think celebrating anything we can do to feed our children is powerful, really.
Cheyenne: Yeah I think it’s so important that we do talk more about the variation and normalize that people will experience things on different parts of these spectrums and connect people with people who are having similar experiences to just help affirm that there’s nothing wrong with you, you know.
Amey: There’s nothing, yeah there’s definitely nothing wrong. There’s variations of normal so you just have to kind of find where it is that you are on this beautiful spectrum or continuum and then find the support that you need at that place.
Francie: There couldn’t be a better way to wrap up than that. This is incredible work that our bodies are capable of doing AND it’s not the same for all of us AND there is support for all of us.
Cheyenne: Absolutely. How we make milk is an amazing process. We hope for all of our listeners who have made milk or are making milk right now or will make milk one day — that you know how incredible you are and that there’s always support for you along the way.
Francie: There are upwards of 40 citations in this episode - if you want to dig into the details - really get your nerd on - head over to the show notes for a beautiful transcript with links.
Credits:
How Many Weeks was created by Francie Webb from Go Milk Yourself + Cheyenne Varner of The Educated Birth and is edited and produced by Leo Mayorga, Patrick Mamou and Cheyenne Varner. Fact checking by our intern, Nicholas Peña. Visit www.howmanyweeks.studio for more episodes, call into the How Many Weeks phone line, 804-601-6065 to leave comments, questions, and stories, and email hello@howmanyweeks.studio for media and sponsorship inquiries.
Cheyenne: And a huge thanks to Amey Fields for being our very first guest.
Amey: Hi, my name is Amey Fields and my pronouns are she/her. I own AZ Breastfeed Babies in Phoenix, Arizona and do breastfeeding support virtually. You can find my at www.azbreastfedbabies.com or on instagram @Az.breastfedbabies
Francie: Thank you for listening!
Cheyenne: I’m Cheyenne!
Francie: And I’m Francie!
Francie/Cheyenne: And this is How Many Weeks.