#61 | When Breastfeeding Sucks: Interview with Zainab Yate

November 11, 2020

Breastfeeding aversion is a little known and little discussed phenomenon that more than a few mothers experience. Zainab, author of “When Breastfeeding Sucks” and advocate for women who experience breastfeeding as less than wonderful at best and seriously shitty at worst, is here to explain what it is, what it means, and how to work with it...or not because sometimes breast is not best. If you've ever had the overwhelming urge to stop breastfeeding, this episode is for you.  

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View Episode Transcript

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

I didn't hate breastfeeding in the beginning, but certainly there was a trigger down the line. And I personally think that given enough research, we might be able to find those connections to birth trauma, and connections to the initial start of the journey.

Breastfeeding a version is a little known and little discussed phenomenon that more than a few women experience. Zainab, author of when breastfeeding sucks. An advocate for women who experienced breastfeeding as less than wonderful at best and seriously shitty at worst, is here to explain what it is, what it means and how to work with it or not. Because sometimes breast is not best.

So firstly, I love your podcast, I find it so informative. And I've shared it already. Because I think that the way you tackle these views really empower people who listen to make informed decisions about their birth or their breastfeeding experiences. And that, you know, in a world where there is so much saturation of information, it's just key to being able to navigate it. So I was so excited to be coming to talk to you. And for a while I've been doing research and breastfeeding. But before that, and my day job, so to speak is a biomedical ethicist. So I sit on a research ethics committee panel, I co chair that with another gentleman. And we basically look at clinical trials and protocols and things look at the ethical implications of what they're asking to do. And we give ethical approval or not for the trials to go ahead. So my love, my first love was ethics. And I did find a lot of ethical questions come up in my personal experience of birthing and breastfeeding. So I found that when I struggled with breastfeeding, I needed to take it that step further to answer these questions that kept coming up in my head that I couldn't find any answers to. And that's, that's really why I started the work. So I fell pregnant from choice, and we discussed it a lot. And I was, you know, happy to be becoming a mother. And I really went into what the birth would be like. So I really informed myself about choices. And what I assumed would happen. And actually, until lately, I didn't have really any considerations of breastfeeding. If I'm completely honest, I didn't really think that breastfeeding could be difficult. I come from a very cultural upbringing is Iranian. And I'm also brought up a Muslim and we have this kind of idea that you breastfeed for two years. Is this saying that every everyone knows, you know, boys and girls, men and women, so I just had that in my head this this goal of two years. And that was really what I thought about breastfeeding. But um, I had my boy, it was not as I planned. It was a rather traumatic, it was an emergency, although I can test that C section. And obviously, the instant connection wasn't there. So I, I now attribute that fully to the lack of the rush of oxytocin. It makes complete sense with what happened with me and my son. And then the difficulties with breastfeeding happened, they happened over a period of time, and I didn't seek help as soon as I should have done and they actually, I think got worse, because of the lack of professional help or any help. By the time I had that help. I don't, I just started to have a sort of negative association to breastfeeding. And it didn't really get any better. Because, you know, if I'm really honest, I had all of the risk factors in the sense for experiencing aversion, which is when breastfeeding can trigger particular negative emotions and intrusive thoughts, that without realizing it, and also without being able to plan for it. And also just because I didn't know the answers to why I had it until after I'd done kind of half a decade of research. So that that's where I started.

See now You made a reference to having a lack of oxytocin. And I think that would get a lot of women's attention. And they would stop and think, oh, gosh, how do you know what if that happens to me? Why would there be a lack of oxytocin? Can you explain what you meant by that? Oh, so there's some research to indicate when you have interventions, birth interventions, or, particularly when you have a C section, you kind of will miss out on the the rush, quite a gigantic rush of oxytocin, that can go through your body upon the end of the birthing phase before lacto Genesis, you know, oxytocin's phenomenally interesting hormone that has many sides and many facets, but what we understand from it as a layperson normally is that it's the love hormone, and it allows you because of that, to tolerate pain and tolerate difficulties, and it gives you a kind of rosy peachy view of the world. And I, I didn't get that in any way, shape, or form. In fact, if I'm, you know, brutally honest, I got I got, I got a thought in my head when they handed me my son. And my thought was, what the fuck is this, because I felt violated. And I felt like disassociate, as there's dissociation with the, the actual situation, because of what happened to my body, and then what I was going through emotionally, so I think there's a very, there's something to be said, for getting off on the right foot. So if you start a relationship, any relationship, you know, an employee relationship, a loving relationship between the partner, on the right foot, you have a certain trajectory. If you start it off on a, a difficult for that doesn't mean you're going to go off on another trajectory. But getting to point A, which has like, say ideal is going to be is going to be that much harder. And there are many women that do experience the challenges at the beginning, because of the birth interventions, the birth trauma, the obstetric violence, the different unexpected pneus, that comes with the birthing process, that that can make the start of their journey, that much more difficult. And as you go into your motherhood, you sometimes you begin to learn that those those challenges weren't necessary. And you there's a lot of anger and frustration that comes with that knowledge. And then if you're not the first person that we have interviewed on this podcast, who's described a very similar experience, and before we have you go into talking and defining what breastfeeding aversion is, I'm curious, in late pregnancy or throughout pregnancy, did you have any anxiety or depression or signs of

No, no, not? Not in the slightest. Okay, so it really was a sudden shift for you at the time of birth?

Well, it's so interesting, because I don't. Okay, so here's my theory. And because there are lots of things that are theory based my whole book is theory based, I propose a theory on why aversion happens. And what it is I tried to find its characteristics based on Mother's self reported symptoms, and I try and explain why it happens. So I'm hoping that it would, someone would just take it and run with it, or a few people will and do their different bits of research. So what I've noticed, in addition to all the stuff I wrote is that is that for some women, obviously, aversion can come come from a newborn stage, but it's not that common. But there is there is an interesting part of the phenomena or phenomenon and of itself, where I find that it's a delayed response. So for example, I noticed the mothers with Nick, cue babies, do you call them Nick utu? Yes, yeah. So with Nikki babies, they'll kind of get to the point where they're kind of pumping and getting through the highest intensity part to get the milk to the baby. And the baby is bigger than the baby latches, and, you know, the baby's latching and oh, maybe I'd have to pump in and around three, four month mark, where that seems to get a bit more stable. I noticed the virgin kicks in then. So it was also the same for me. It didn't happen in the beginning. So I definitely did have that. Oh, my God, it's so painful. Oh my god, I'm dreading the next few. But I have no negative emotions, no feelings of aversion or dread, necessarily about breastfeeding. I didn't hate breastfeeding in the beginning. But certainly there was a trigger down the line. And I personally think that given enough research, we might be able to find those connections to birth trauma. aversion is essentially what seems to be breastfeeding. triggering negative emotions. So these emotions can be anger, agitation, irritation, particular intrusive thoughts like feeling like a prisoner wanting to run away, there's often an overwhelming urge to D latch. And by overwhelming I mean like the the kind of, you know, when you vomit or something, you get this sensation where you can't stop it. It's a guttural urge to do actual baby and push them off for or just get away from the breastfeeding. Although it varies in severity, the self reported symptoms that I described there so often repeated, it's just alarming from everywhere in the world, they use the same words mothers to to say how they're they're feeling and a virgin is this, this phenomena that occurs, I don't think it's necessarily new, I think it's always been around. And I think that's there may be some indications as to why mothers would, you know, win early or to try to feed their babies. Back in history, we know that mothers try with anything to feed their babies from animal milk, or they make concoctions themselves of foodstuffs, and we know the devastating consequences of that. We also know before the formula, aggressive formula marketing that takes place. There, there was always a steady percentage, a very low percentage of women in almost all populations who would use formula when it was first arrived. So some of the reasons could be that they experienced a version.

I have two questions. One, how do you distinguish breastfeeding a version from the postpartum depression and anxiety first? And the second would be how do you distinguish it? And do you distinguish it from dysphoric, milk ejection reflex?

Those are both really pertinent questions. And part of the reason I wrote the book is because many mothers like including myself would go to a specialist or GP, they call them here, general practitioner or doctor and talk to them because they, they're feeling and thinking these things, or they're concerned. And my husband did also think that maybe I had postnatal depression. But upon assessment and screening, there was nothing I didn't score highly enough. And what really, what really, I noticed is that it seems to be pretty localized to the activity of breastfeeding, and it's triggered when breastfeeding, and it's about breastfeeding. And often, aside from the difficulties with weaning and the emotions with other things that often subsides or just disappears when there's cessation of breastfeeding. But we know that's quite emotional. So we have to give it a bit of time before assessing that. Another reason I, I know is because, unfortunately, many of these mothers have been misdiagnosed. And given SSRIs, which are essentially, you know, maybe you call them Prozac over there. We call them antidepressants, and there's varying types of them, and they're just not working. You know, they work to treat the symptoms of depression in these mothers, but with a version a version still persists. So for me, that was a clear indication that there's something else going on. And then the more I looked into it, I began to realize there's other causal, mechanistic things that are slightly different. So we know from depression we have, I mean, it's multifactorial, and it's also, in a sense, bio psychosocial. But we have new research indicating that actually, inflammation is the source of depression and things like that. So when we think of that, I, I can't, I can't always fit that into a version. Because with the version, we're talking about mothers with persistent ties or traumatic births or Reynaud syndrome, which is persistently painful, and we have much more clinical indications to look at. However, I think there is a fine line. And certainly having breastfeeding aversion could be a risk factor for developing postpartum depression or anxiety. So I'm really hoping someone researches that because there's an added emotional burden that really takes its toll on you. So I can completely imagine that would happen. Yes.

And, and is it the same thing then as the dysphoric milk ejection reflex? Are we talking about the same thing? Or do you somehow distinguish it?

Trisha, will you please explain that?

Yes, so dysphoric milk ejection reflex is a phenomenon of breastfeeding that occurs in a small percentage of women who describe these feelings that you're describing these sudden emotional shifts and changes or the need to take the baby off with the milk letdown. It doesn't happen actually with at the just with contact, and it doesn't happen throughout the whole fetus. happens specifically with the milk ejection reflex or the left arm. And it's thought to be caused by a sudden and sharp drop in dopamine levels. And again, it's a rare condition, it doesn't happen to a lot of women, but when it does, it's significant.

So what I've seen is that, and this is my insight into it, I suppose, is that a version will happen for the whole feed. So whether that's 10 minute feed, or two hour bedtime marathon feed, you will have a version the whole part you can't seem to link it to the the letdown that happens in the first few minutes or so. I've also noticed that there are, well, there are different, very different emotions to dysphoria. So having particular emotions of anger and irritation and agitation, the skin crawling sensations, things like that. They aren't really the same as having hopelessness and despair. And this kind of bottomless pit of your tummy this emptiness that you can't describe. And certainly those two things that the duration and the the difference in the feelings seem to indicate that it's something different. Also, I've noticed that many women in they do experience both. And having di m er, the short version of it as for market action reflex seems to I think it puts you more risk of experiencing aversion. So you can have them they're not mutually exclusive. You can experience them both at the same time. But but having a version doesn't make you at any risk of experience experiencing destroyed milk ejection reflex. So I've noticed that works one way but not the other way. So whether that's specifically a hormone or reason or, again, multifactorial, we don't we don't know yet. And it's also really interesting new work by Kathy Kendall tackett and Moberg about their theory on dysphoric mood protection reflex they actually link it to oxytocin as well. So, you know, we had we had research about 10 years ago about prolactin being a possible culprit, essentially. And then we had the dopamine and certainly in the the kind of aversion and dysphoric milk ejection reflex communities working with the dopamine seems to help them others struggle with dysphoria and breastfeeding. So there is weight to that. But I also I read with great interest, Moberg and Hackett's work because oxytocin and addressing oxytocin in that dyad seemed to be really, really important for dysphoric milk ejection reflex as well. So yeah, I don't think they're the same. And I think dysphoric mood protection reflex is now considered a medical condition. Yeah, so we're not we're not we're not there yet with a version. Yeah, I

think that's why it was it was good to have that discussion and make that and distinguish those because you don't want people writing off what you're talking about, just as dm er.

So Zainab, I know, from reading your study and some of your publications that breastfeeding aversion affects a wide demographic group, and it isn't specific to race or ethnicity. Is that part, correct?

Yes, I haven't found anything to indicate those demographics vary. So I guess my question is, and that doesn't surprise me. But I think my question is, if a woman starts to recognize that she may have breastfeeding a version is the only solution to stop breastfeeding?

Oh, no. Not in any way, you know, actually, for the lucky ones. So I'd like to say, finding the community that we have online or finding the literature sometimes is enough, because it lifts the weight off them to, to allow them to feel the way they're feeling without actually doing anything about it. Because some for some women, it can be enough between the make or break of the breastfeeding journey. It can be enough. However, I would say that that's probably women that don't experience it severely on a very frequent occurrence, if that makes sense. But the one Yeah, so the ones that experience it on the severity scale, right near the end, would have more complex reasons as to why it's happening. And so those would need to be addressed before you would see it less than or disappear. in finding out it gives you permission to look at the solution. Does that make sense? You need to get past the step of recognizing it or not being in denial or having an acknowledgement before you can, for example, app track before you take it seriously to plot your menses and see your ovulation and Your postpartum mentors have returned, then you take that next step of action. And mothers realize, Oh, hang on, so I get it, but it's not it's not all the time or I get it, and it's these three days a month, and then you're prepared. And you, you know, oh my god, I can't better cope and you still know the back of your mind when it's gonna end. So for those that get breastfeeding aversion, particularly linked to their menses, or hormones around that time, or the sensitivity in the area, or a nipple area, due to that, we'll know that there's a there's the light at the end of the tunnel.

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Do women who experienced breastfeeding aversion particularly women who might experience it at a higher level, when their hormones are more sensitive? Do they feel any different if they pump?

So as with anything in life, it's not as there's always a bit of gray. Right? So for that there's a kind of two two pronged answer just depending on where you where you sit. So for example, if you're a virgin has to do with something particularly external pressure for, for example, or the, the lack of control due to being triggered from being a survivor of sexual abuse. And that's really to do with the breast contact in a way that you can't control, you can't stop them moving, you can't stop them waking up at night to clamber onto you in the dark. And so for these women, actually, I have supported some to start to pump, because it gives them that freedom that control the prevention of the symptoms getting worse the options for them to to be able to work on them themselves and what's happening. However, pumps aren't necessarily kind to your anatomy, and definitely not. Yeah, so if you have a sensitive, you know, area pumping can actually trigger a virgin. So yeah, she is some women the the, any contact with her, you know, aside from mothering, if a towel brushes over their nipples, they see instant rage. And it's just, it's just we don't know enough about it. Because we're not men, essentially, we need the research to show that, hey, this is what happens to your nipples postpartum. And for some women, it's irreversible. And for some women, it causes nipples to be highly sensitive. And for some women, you know, this, this and this at the moment, we don't really know that we know our generic data, which is breastfeeding shouldn't be painful, oh, your nipples and breasts go back to the way they were, you know, the fatty tissue reduces and all this stuff, but it is actually the case that we don't have very much, Katie Hein said that we know more about tomatoes than we do about lactation and breastfeeding. So they're, and they're very true. And that's so true.

Yeah, there are more published research articles and books on tomatoes and there are on breastfeeding and lactation is unbelievable.

Have you seen that women who experienced breastfeeding version experience in subsequent with their subsequent babies?

Yeah, not always. I remember I speak about her in the book cuz she really stands out. As a person I supported you know, she'd had six children, I think it was on her sixth or her seventh. And she'd never experienced a version and she'd been breastfeeding for like 20 years. And, you know, she just it just came all of a sudden when the baby was a few months old. So it can come out of nowhere. And that sense, mothers obviously do worry when they experience it with the first child or with any subsequent children when they get pregnant again, they do worry that it will come again. And I just have to be honest to tell them and you date isn't doesn't always. For example, once the change in the pregnancy stage happens, the aversion can disappear. So and that makes a lot of sense as well because you've got the repeated let downs of oxytocin when you're breastfeeding the newborn. You know, you're not going to have a version kick in your The nipple sensitivities that you that you experienced when soreness and breast and nipple sensitivity when you're pregnant abates, when you give birth, you know, you use, you hit a different state. So it's a biological state. And because of it, the aversion literally disappears overnight.

Is there also a component of this that does involve tactics? Try this do that.

So I tried, I tried to make this part of the book, the most accessible part. So the initial part of the book isn't necessarily for the mums, who managed on one hour sleep last night, and can't just can't be bothered to read anything semi academic. So if you're listening to this, and you're struggling, you know, go straight to chapter eight. Yes, the first few chapters, they explain the phenomena, they describe the phenomena, they state Well, the literature for them, and phenomena, and they go into detail about why it happens. And all of those things will help you in to understand your own aversion and what to do about it. But if you're not in a place where you can do that, go to chapter eight, where I outline alleviating aversion. And this, I created a mnemonic acronym called BROMPHALYCC, and I just outline the steps that I essentially go through with with mothers, or I allow mothers to take by just being present, and asking the right open ended questions in order to understand and alleviate their aversion. So for example, BROMPHALYCC would be be breastfeeding aversion triggers, this is the first step, what are your triggers? When do they happen? Do you notice a pattern? And then the next one is reactionary behaviors, understanding how you deal with your aversion and when you d latch, what happens when you do that, too? How do you react visibly to your aversion that plays a role in the cycle of aversion. So often, just being made aware of this can actually help you shift the vicious cycle of aversion, because nothing's when they become scared, or when something's upsetting to them, for example, seeing you upset or you crying, or you lashing out or screaming like f sake, what will happen is that there will be a D latch occurring, especially if the nurse things old enough. And then because they're feeling scared, or there's a disconnect, they'll ask to nurse again. And often mothers now they're very well informed about gentle parenting, the importance of neuroscience and deep connection that they want to be responsive. So they'll end up breastfeeding again, because they want to console their crying nursing, they want to calm them, then what happens is it triggers the aversion again, so you get that vicious cycle. So the first thing is triggers. And the next thing is what what what are the tiny steps happening just after aversion? Can we identify if in these reactionary behaviors, you're actually making the situation worse without knowing it. And then there are a number of other steps which are that you know, they're non invasive, essentially, their lifestyle changes their shifts in mindset, there are practices that you can start to develop at home, and the supplements and hydration is under one of them. Because essentially, some women notice, you know, once I mentioned, once you acknowledge the version, you you can realize, Oh, it's the thing, and I'm not crazy, and there's thousands of other women. And let me read what they do. And mothers are struggle with a version really badly, particularly at night can find that just hydration is the key. And they've not bothered to make the effort because they're too tired, they haven't made the link because the fluids leaving the body and they're not replacing it as much as they should. Getting a particular bottle that doesn't spill everywhere. Because you can't move in your bedroom in case your nursing wakes up so you can't reach your glass. That kind of thing. making those shifts and hydrating can really lessen or alleviate the burden. And then in the community. There's a lady and I'm in Australia doing amazing work on supplements and magnesium in specifically and why it seems to less than or completely get rid of aversion for many women and hasn't for years. They've literally just taking magnesium supplements and some also spray it topically because it's absorbed better.

Magnesium just seems to be the cure for everything. It's amazing.

All right, so after breastfeeding after reactionary behaviors, what would you what comes next?

So we have ovulation and menstruation. So that's the O and the M? Because some women can pinpoint their aversion to the day they ovulate.

Okay, so we've done BROM -

yeah, so P would be taking all the previous steps and implementing a plan for prevention. Because I've noticed when you don't prevent or address it actually can get worse. This is where you start to look at the prevention in terms of shifting a lifestyle, and your mindset, which can be a lot more work for some women. But once you understand it, it becomes easier for you to take those steps. Things like their hydration and nutrition as part of your pertaining what you eat. Because we know there's research to indicate when you are sleep deprived and have repeated sleep interruptions, you wake up, you will make poor food choices. And many women with aversion will essentially, like unconsciously use distraction in order to cope. And that's what's called cognitive distraction because your brain can only focus on one cognitive activity at one time. So if you're doing something with your phone, like playing a game, replying to someone on social media, things like that, your negative emotions and feelings can can appear to subside because your brand doesn't have the ability to stop focusing on that, and like kind of exponentially making that worse. So women will spend time on their phone. And that's a problem, you have to do things to change that. And sleep hygiene is is a big shift. I mean, this is no screens two hours before bedtime. This is making sure you have habitual routines linked to your sleep space. It's about being consistent, it's about it's a really big shift. But it can change things with a virgin because of pressures around breastfeeding, just breastfeeding itself.

Ages hydration and nutrition. Okay, and then once after that we've got from a active distraction and redirection. So be as breastfeeding triggers are as reactionary behaviors. O is ovulation Emma's menstruation, P is prevention. H is hydration and nutrition. A is active distraction and redirection. And then l comes for lifestyle. So that's lifestyle changes. So that can include what I talked about the sleep hygiene, making changes, but also, so I know, it's it seems like a fad. But it's really not because it's been practiced for centuries, but incorporating mindfulness and and minimalism. You know, if you can't make it to the toddler groups, and no one's going to be harmed by it, don't, don't force yourself to do these things that everybody is doing. If they don't work for you let it go. You can practice minimalism in your life by letting things go that they're not for you. You don't have to copy the trends if they don't work for you. And it's about giving your self permission to let go of these things. Because what I show in my book is the external pressures necessarily affect your breastfeeding experience, because negative emotions don't come out of nowhere. And so we're, we're, we're lifestyle. And then we're interventions, interventions are essentially practicing something, making an intervention, like mindfulness, you're going to be practicing mindfulness. And this is about breathing. This is about recognizing your thought patterns, your rumination they call it and addressing those and it's it's a specific intervention on looking at your thought patterns and your responses and whether there's something you can do there. And then the last two are C and C. And the first one is counseling and other clinical therapies. And I put them into one because that's essentially where we've got through the stages where you can do things yourself. But if not, you need to seek specialist infant feeding support, you need to speak to a doctor or hire clinical specialist for assessment and screening. You need to have access to other kinds of help for medical conditions or complications with your breastfeeding. And that's why intuitively many mothers they don't they don't just want to start but surely they want to. They want to know, like, there is a really lovely piece I read about Angus real name is grief. And you see that a lot in mothers because they've lost their life. You know, they lost who they were. And they're mourning that they're in grief, but they don't know it because they're supposed to love motherhood and love breastfeeding and love everything. And you can find a sense of a sense of hope and a sense of relief once you identify that maybe your negative emotions around breastfeeding are to do with these other factors. And then the last thing is cessation of breastfeeding. So that's the winning I didn't want to quit winning because winning has multiple uses for the word and I can more often than not mean the story. Have solids. And that's not what I'm referring to, I'm referring to the start of a long, hopefully longest process to stop breastfeeding. And I try and give like a lot of, you know, information and support about why that is a really good option for some mothers, if it's certainly if they've tried the other steps, whether intuitively or following them through in my book. So that's where at Brown Falak ends with two C's. So, so for the book, the book is called when breastfeeding sucks, and it's what you need to know about nursing aversion and agitation. And it's available with Pinto and Martin on their website, a London based publisher who experts in parenting and infant feeding and breastfeeding. And it's available on Amazon too. But for international viewers and listeners, the best place to go would probably be the Book Depository because it has free international delivery. But you know, you may not be in a place to read the book, or you may not have the time and energy. So I have a free podcast where I will be going through different sections of the book in a bit more of a logical way in very short accessible podcasts about how and what to do, essentially, because you know, mothering is a very vulnerable time and I want everything to be made available immediately. So you can sort it out before your next feed because it's such an emergency situation sometimes. We have a free online support course, where you can just sign up you'll have tips and videos sent straight to your inbox. We've got a free peer to peer support group on Facebook, where we have a wonderful community of mothers who peer support, including lactation consultants, breastfeeding counselors, psychiatrists, psychologists as part of the group who struggle with a virgin themselves. And we have a public platform as well. So we're on Instagram and Facebook with the handle of breastfeeding aversion. And you can remain anonymous and just read the posts and so many mothers share their stories and what helps so you just just reach out because secrecy never makes anything better.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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