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Episode 63: Medications During Lactation with Dr. Leslie Southard

, , February 1, 2022

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Jacqueline Kincer 0:03
Welcome back to the Breastfeeding Talk Podcast. I’m your host Jacqueline Kincer. And today I have a special guest that I’ve been trying to get on the show since the end of last year but of course holidays and all things family and illness and busy at work time we finally made it happen. So I got to sit down today with Dr. Leslie Southard. She is known as the lactation pharmacist, but she is a pharmacist. She’s a doula. She’s a certified lactation counselor. But more importantly, she’s a wife, a mom and a coffee enthusiast. She loves lattes, just like me. And so she is on the show today sharing with us her incredible expertise from a pharmacy perspective. And we’re talking about things that are compatible or not compatible during breastfeeding or with lactation. But then she also shares a very special medically complex journey with her own daughter with us. So please stay tuned to hear all about that. But Leslie is just wonderful. She’s an excellent resource, we’re going to have all her information linked up in the show notes for you. So without further ado, here’s my conversation with Dr. Southern. Welcome to the show. Leslie. I’m super excited to chat to you today. Because I just think you’re really a unique guest to have on the show. And you just I found you on Instagram. I don’t know if you commented on a post of mine, or somehow you popped up in the feed I don’t know. But I’m really glad that we connected. And I just think you’re gonna have so much awesome information to share with audience today. So thanks for being here.

Dr. Leslie Southard 2:20
Thank you for having me. I’m so excited. I I love talking about anything lactation and medication use and actually anything to do with kids. So I’m really, really happy to be here. Oh, yes,

Jacqueline Kincer 2:33
it’s always good if you enjoy talking about it, which is why we do what we do. And you know, I guess the good place to start always in these kind of situations is I love to have the listeners learn more about you. Like, how did you get into this work because I still have not met a child when I asked them what they want to be when they grow up. They don’t say lactation consultant, I haven’t found one yet to be asking all my kids friends at school. They’re like, Sorry, what is that? So probably not something you dreamed about. But you fell into it somehow. So how did that happen?

Dr. Leslie Southard 3:05
Yeah, it’s kind of a story. So cut me off. If I go too long. I had my daughter, I only have one kid I have I had my daughter five years ago, five and a half years ago in July of 2016. And I was a pharmacist at the time, and I kind of thought I’d be one of those career moms where I would have my baby, have my leave and then go back to what I was before. And that clearly has not happened in my life. But she kind of changed everything I had, you know, kind of a rough labor and delivery. I had a C section. And you know, I had the kind of mom guilt about, oh, I didn’t give birth the right way or you know, whatever we monologue we tell ourselves sometimes when things don’t go as planned. And so I was really determined to breastfeed and we had a rocky start, she had a tongue tie. And once that was clipped for her, you know, I think we could have gone either way. But for us once it was clipped. We just took off. It was like, we didn’t need help. You know, we had it figured out it probably helped that we saw the pediatrician a million times kind of beginning for the tongue tie and all that but you know, no problems. But then when I went back to work, the very first day I had shingles and I blame my husband because the night before he’s a stay at home dad and he makes pocket knives now but he was going to stay home with Carmen daughter. And he said something like, Oh, she’s gonna like me more now and I blame him. I’m like you started this. But he I ended up having shingles underneath my right breast and I was just like, What do I do with this? I don’t know how to breastfeed with shingles. I don’t know if my medication is safe that I was taking and then I thought that was real dumb because I’m a pharmacist. So I should know if the medication I’m taking is safe. So that was kind of clue number one that something was going to change. So get that under control the next shift I Have a needle stick injury from a flu shot because this child I was giving he flinched and you know, things happen so quick with those situations. And so then I had to go to the whole protocol. And I did not take the medication because the luckily somehow I ended up with this doctor whose wife breastfeed his four kids. So then he was like, Well, if you were my wife, I wouldn’t advise taking this, your risk is so low, I would continue breastfeeding, because I’m sitting there, like, just sobbing. Like, I want to breastfeed my 12 week old, you know, and, yeah, it was just amazing that he like, he understood. But so those two things, I was just like, Okay, I clearly have no idea about medication use and like teaching, because I couldn’t answer my own questions, let alone reassure myself, that what I was doing was okay, and continuing to breastfeed while taking medications was okay. And then I ended up getting involved in our local online, breastfeeding group. And I saw all those questions come in, and then no one had good answers. It was just across the board, you know, it’s the wild wild west out there. No one understand anything, it seems like and so then I decided that something had to change. And so that’s between my own experiences, my professional experiences, and then seeing others in my situation that really kind of set the tone for the rest of my career. And I’ve been doing this for, you know, four or five years now.

Jacqueline Kincer 6:26
Ah, that’s amazing. Yes. I love that. And I love that you, you know, really saw for yourself like I’m a pharmacist, how do I not know these answers? Because I think that’s so often what happens if you’re already in a profession where you may be working with breastfeeding or lactating parents, and then you experience a challenge of yourself, love that. You had a doctor whose wife had breastfed and helped to advocate for you, that’s so amazing. I love that you have this combination, too. And that this sparked, you know, your interest in the field of lactation outside of just, you know, pure pharmacy, because it is one of those things where I would love to tell people, you know, that, you know, well, they’ll you know, they’ll ask a question, right? And I’m like, Well, what did the pharmacist say? And they’re like, the pharmacist didn’t know. And I’m like, I yeah, I get that, you know, my sister in law is actually a pharmacist, and I’ve never asked her, but now I need to after chatting to you, like, do you know about medications and lactation? And how much do you know? So? It’s, it’s fascinating, right? I mean, was it something when you were going to school to become a pharmacist? Did it come up at all? I’m curious,

Dr. Leslie Southard 7:44
if did and you know, I’ve asked my intern since. So I graduated in 2014, which was, I don’t know, enough time ago that I forgotten how long how many years I’ve been a pharmacist, but so I checked with my interns that are in school now. And it has changed tremendously. But when I was going through, it was one lecture that was maybe one or two hours long. And it was combined with pediatrics. So in my school, if you wanted to do anything in pediatrics, there was a separate elective, and then they just covered the basics in, you know, the required coursework. And lactation was lumped into that. And for my particular class, that lecture ran bonds. So the actual portion that you had that talk about medication use and lactation, it was recorded. So I don’t know how many people actually listened to it. But I have been given away I wouldn’t say given but my interns showed me like their PowerPoint lecture. And they were like, Is this accurate? They’re like, if not, I’m going to tell the teacher that she needs to update this. And it is fairly accurate now, you know, as far as how they’re teaching it, and the time allotted, and what references they’re suggesting have proved tremendously. So I think it is on the radar. But, you know, with anything regarding women and children, I’ll try not to get on my soapbox, but with anything regarding us, it is kind of second to anything that might also include the male sec. So try not to get into controversial topics, but I think that’s part of the problem. So but it has gone on and on.

Jacqueline Kincer 9:25
And it’s interesting to me that it only was really something that in your program at the time was covered if you did the pediatric elective, because what about the mom? Right, like, right? Yeah, I mean, if you’re serving postpartum women, odds are that they’re at least making some sort of milk most do immediately postpartum, they choose to try to breastfeed so it’s just wow, what a huge oversight,

Dr. Leslie Southard 9:53
right? Yes, definitely. And I think you know, and then even in my, my particular pharmacy school, they didn’t even have a women’s health elective. So it was just the whole, you know, it needs to be addressed. You know, but you know, there are other pharmacy schools that are much better in terms of addressing that. And I have seen the changes. So I think, you know, it’s slowly getting better. It’s not where I want it to be. But it has definitely improved in the years since I’ve been in school.

Jacqueline Kincer 10:22
That’s so good to hear. It’s very promising for sure. I guess one of the things that I’m curious about is, what are the common questions or maybe misconceptions that come up for lactation, and you know, whether it’s medications or vaccines or anything, I mean, I think we can talk about the COVID vaccine as well, which is kind of a whole separate issue. But in general, like, you know, I think lately, I get a lot, right, people are sick with a cold or COVID, or whatever. And they’re like, What can I take? They think they’re like, unable to take anything during breastfeeding. So what are some of those things that you often see moms asking about?

Dr. Leslie Southard 11:05
Yes, definitely. Right now it is any vaccine, but particularly the COVID vaccine, I get a lot of questions about how it affects milk supply. If it does, I get a lot of questions about how the inactive ingredients transfer to milk, and that’s kind of that’s, that has me geeking out because you know, of all the things that have been researched, and in medication use and lactation, not a lot of medication companies or manufacturers will look at their inactive ingredients and how it transfers to mouth. You know, obviously, we want to know about those active ingredients. But it’s quite interesting. You know, sometimes, that could be an issue with some of those inactive ingredients. But they’ve actually done some studies with the COVID vaccine and to see what those inactive ingredients are doing, and how they transfer to milk. So I’ve had some people ask like, Well, what happens to you know, the polyethylene glycol part, the PID part of the vaccine does that transfer and they actually have some data on that. So it’s super, super cool in that aspect. So I get a lot of question,

Jacqueline Kincer 12:11
what does happen without actually now that you brought it up? Yeah,

Dr. Leslie Southard 12:14
I just look, I just had a console on this. And I don’t remember, I want to say it’s less than 1%. So some of the pig, and that pig part is responsible for help getting the mRNA where it’s supposed to go. So that part, you know, it actually it can transfer to mouth. But what they found is it’s less than a 1%, because it is a giant molecule. Can you know you don’t think about it, and when you’re thinking about the vaccine, but these polyethylene glycols, there’s a bunch of them out there, but they actually are quite a big molecule. So it’s hard for them to transfer into the milk making cells and stay in milk. And then there’s also some evidence with the mRNA. And I think that’s if it does turn, I can’t remember 100%. But if it does transfer me think a little bit does, they have seen once it gets into milk and that milk is to baby, it does not survive in the acidic environment of the gut. And so that’s been really reassuring to some parents is just knowing all these parts, and what happens once you take the vaccine, and then does anything go to milk and what happens once it gets to milk. So that for sure.

Jacqueline Kincer 13:23
And then I love that. I love that. And I think, you know, it’s very interesting to me where this idea of like, if you did ingest mRNA, like could it do something to you? And I’m like, I mean, if you eat like, you know, animal products, like you’re getting, you know what I mean? Like you’re getting DNA, you’re getting that in there, and it’s not changing yours. And so I think it’s really important to have that perspective. But I love what you said about the molecule size, because molecular weight is really a big determining factor as to whether or not something goes into the breast milk, right?

Dr. Leslie Southard 13:59
Yes, yes. Because when you think about the milk making cell you have, you have to have like the perfect fit to be able to get through. And there’s a ton of other factors, you know, lipid solubility, what if it’s soluble and fat because the outer part of the milk making cell is a lipid bilayer. And so you have to be fat soluble enough to get through that. But then water soluble enough to stay in milk, which is very hard for medications like they like from a chemical standpoint, they like one configuration, they like to stay in one shape. And if they alter that shape, you can always you can always move through things and stay in things. And then you also look at the molecular size because these lipid bilayer is they’re kind of gatekeepers, right. And so if you don’t fit through the gate, then you’re not really going to get through like some squeeze through, as we see with the polyethylene glycol or another example would be heparin molecules like those guys are pretty big and and Long. And if you don’t fit through the gate or you can’t get through the gate, then you’re not going to concentrate and melt very well.

Jacqueline Kincer 15:06
Huh? Yes. So, so important to consider that because, yeah, it’s not it’s not just completely porous. And it’s all just coming through and right. So I did you know, and there’s some places that I’ll commonly refer people to, when they have questions about this, if they want deeper information, like infant risk, or lacked med or some other sources. You know, you’re definitely more of an expert in this because you are a pharmacist and you, you know, specifically work with us. What are some of your favorite resources for moms looking for information? Or even, you know, maybe a doctor or somebody who’s like, I need to look this up really quick? And then I will just start with that question.

Dr. Leslie Southard 15:55
Yeah. So for professionals, that’s where I think we need the most help I think mom’s at are pretty resourceful. They’re able to find those references. And what you mentioned is great infant risk, and lacks med are very, very good at explaining why something might transfer what happens when it transfers and is this a risk. Professionals though, they don’t always have the greatest options, and it is expensive to purchase your own reference on your own. So a lot of professionals will use what their company provides forum. So you know, there’s different things out there for pharmacists, one of the most common if you’re lucky to get is Lexi comm. And that has a superb section on pregnancy and lactation, it often refers, it always gives a definition of relative infant risks, which is the amount a child might get from maternal dose of a medication. And so it always explains that it gives a definition, it tells you what research is out there, as far as what the relative infant dose might be, it explains any kind of risks or, you know, benefits to taking a medication during lactation, super great if you have it, and have access to it. And they do have like subscription services too. So if you don’t go through your company, then you can always purchase it on your own. And then another one that I don’t think gets enough attention that would be beneficial for both professionals and moms is E lefthand. And it’s an international website. So you get a wide variety of both medications and herbs, which is one of the reasons why I love it. And it does have its own rating system just like lax fed in February. So you have to use some clinical judgment there and kind of, you know, take it into consideration with the other options out there. But it does break it down in such a nice way that whether you have a clinical background or not, you can go on there, read it and understand what is being said.

Jacqueline Kincer 18:01
Yes, that is also a great resource as well. And one of the things too, that I think someone engaging with, like you and what you offer for your services is really helpful is you can, you know, try some things. But if you’re not used to reading that type of literature, sometimes it becomes confusing. And you might think there’s, you know, interpret something as an overstated risk. That’s really not or you want, like, you know, well what about my particular situation. And a really good example is I’ve had clients look up herbs like on ELAC, Tanzania, for instance. And I’m like, well, the leaf is different from the seed is different from the roots. And they all have different pharmacological properties. And so if you’re reading about the leaf of a plant, but you’re worried about the root in a tea, like you can’t apply both and so I do think sometimes there are limitations to that data and information where people, you know, can just kind of take one concept and extrapolate it to others. And so it’s really good to get specific if you truly have concerns.

Dr. Leslie Southard 19:03
Yes, and you know, I always for myself, I always refer to a clinic or a registered herbalist and they can be clinical herbalist too but registered herbalist have gone through all the my understands they’ve gone through all the training and they are registered with our council. And you know, I’ve I have a great working relationship with one of ours in town and she is just amazing. She breastfed her kids. And she has a medical background as well. And so it’s just been so interesting to work with her and know that she’s learning from me, I’m learning from her and then we’re both helping the person who’s interested. But there are some good references out there. There’s a botanical handbook. That is by one of the association’s and it is more. I love it because it’s more like a medical reference, but it’s for herbs. And so it talks about like you said, the different parts of the plant. How that works. They any clinical studies they have out there, they include those in references. They break down pregnancy and lactation. And it’s just, you know, there are options out there. But for herbs, especially, you know, like you said, you can go on to any of those like, like med you like, you can go on to those and get the basics, but it’s better to refer out to a registered herbalist who you trust just to answer the nitty gritty details of

Jacqueline Kincer 20:25
it. Yeah, absolutely. Yeah. No, I agree. I do think there is a lot of value. And just, you know, if you need to do that deeper dive, for instance, right. So it’s interesting, you mentioned Heparin, I don’t know exactly what medication was, but I had a friend who she had her fourth baby, she had breastfed the other babies. And she had. She had a blood clot issue after birth, and she had to be put on some medication for that, which ultimately meant that she could not give her baby breast milk anymore. And in her case, it was totally reasonable, because that just that medication wasn’t compatible with being able to offer breast milk to a baby. But I think that there were times where it’s overblown, right? And so like, I get this question a lot where, you know, moms or past clients will reach out and they’ll be like, Hey, I’m having like a cavity filling done. And the dentist said, I have to like pump into them for 24 hours, or 48 hours, or 12 hours, or some some random number that they pulled out of thin air, I’m guessing. And I get it, like you have this professional liability, and you don’t want anything to go wrong. But if you received a local numbing injection, is that problematic for breastfeeding? And if you know, just explain that for us, because I think that’s just such a common question.

Dr. Leslie Southard 21:44
Oh, my gosh, yes, it is, I don’t know. i There are definitely some professions where medication use during lactation is more scary than others, like I think, you know, because there are some professions, and it’s probably just lack of training and, and all of that and not due to that particular person’s heart, it’s, you know, just the organization as a whole, which is a whole nother rabbit hole I go down. But it’s, it’s almost like certain ones are more conservative than others, because they’re more scared, I think. But in terms of, you know, mouth work being done, you know, a lot of times, and you can always ask for specifics ahead of your appointment, as far as what medications are being used. But you know, in terms of local numbing agents, they usually use whatever they’re using to numb it. They typically also use like epinephrine or something like that, to constrict the blood vessels in that area. So the numbing agent stays where it’s supposed to, instead of going all around your mouth. And to me, it’s, you know, based on my profession, and my specialty, that should be common sense. Like, if you’re trying to localize it to an area, that means it’s not going to transfer well to the blood. And because of that, it’s not going to go to the milk making cells and have the opportunity to get into milk. But they do often throw out random numbers. And so I always warn people, I’m like, Okay, if you here 24 hours for pump and dump, like, I can’t even pull up a medic, I can’t even think of medication where you have to pump it down for 24 hours. I think it’s just like they like that number. So I’m like, if you ever hear pump and dump for 24 hours, immediately question it, because that number is usually pulled out of thin air. And it’s used so often that it it can’t be right for most medications, and it’s not so

Jacqueline Kincer 23:36
yes. Oh, yes. Thank you for speaking to that. And speaking of pumping and dumping, let’s talk about alcohol, please. I know it’s not a medication, but you’re a whiz at knowing about how things enter breast milk and how they leave it and whatnot. So yeah, what’s the deal?

Dr. Leslie Southard 23:55
So I think I approach alcohol a little bit different than a lot of people in terms of explaining. So I usually, you know, whoever’s asking me, I usually ask, Do you want any exposure to alcohol? Are you okay with minimal? Because I think that is really where the root of the question is, because the evidence out there is so crappy, like it’s old, it hasn’t been updated. You know, some of the conditions that it was done in was not great. So, you know, we’re working with kind of bad information anyway. So then I asked that question. And if they say, I don’t want any exposure. I mean, you can use the same information to support someone who says, You know what, I don’t care if it’s safe. I don’t care if I can do it in a safe manner. I don’t want any exposure. I’m like, Okay, well, here’s the evidence. Here’s how we can make that work for you. And then you have someone who’s like, you know what, I’m going to a bachelorette party. It’s a one time I’m going to drink while I’m lactating. were like okay, here’s the evidence. We could, you know, you can tailor it depending on how you feel about exposure, but from an evidence standpoint, what they know, is kind of a handful of things. So they know alcohol, I like to call it a partier for a reason, it likes to go everywhere in the body, because it has such a high volume of distribution, because it’s going all these places in the body, that means it’s not going to transfer to milk very well, just because it’s all over, you know, like, you can’t stay in one spot if you’re traveling the room, or in this case, the body. And so that’s, you know, tidbit number one. The second thing is, alcohol likes blood as much as it likes milk. So even if it does go into milk, it doesn’t like to stay there, because it also likes blood. And so because of that, it transfers in and out fairly well. And then you end up with this low amount in the milk. Or in terms of, if you’re thinking about it, like a medication, it’s a low dose of alcohol in the mouth. So that’s tidbit number two, the other thing is we know it peaks in the milk, about 30 to 60 minutes after you consume one drink. And so if you combine all that together, you know, someone says I’m going out for dinner, I want to have a glass of wine at dinner, and I want to be able to come home and nurse my baby. Well, one, if that person is comfortable, they could nurse without any concerns. But if they do have some concerns, you can always say, hey, avoid nursing 30 to 60 minutes after consuming a glass of alcohol, just because you’ll avoid that time where it might be the peak concentration. And there’s even, you know, calculators out there, there’s graphs that will take into account how much you’re drinking, how much you weigh, that kind of thing. So there’s all different tools out there so that you can make the right decision for your situation. And for you know, your family. But alcohol is such a controversial topic. Like if you say I don’t want to consume alcohol, well, lactating those people are gonna get attacked, if you say, I want to consume alcohol, I think they’re gonna get attacked. It’s such an interesting topic.

Jacqueline Kincer 27:01
I know. It is, you know, and I think like, I usually advise moms, you know, when they’re, when they’re asking this question, and they’re not concerned, you know, they’re not worried about zero exposure, right? They’re like, okay, and, and baby’s gonna get some I’m like, honestly, like, last year, baby, start drinking that beer or glass of wine. And then they’re done by the time that peak concentration hits. So like, if you’re worried about them nursing frequently, and you’re trying to time it. All right, like that’s a good way to go writer, or nurse and then like, drink right after? Yeah, if you can, right. But like, it’s funny, because I think the whole pump and dump thing, too, is like you said, there’s this transfer back and forth between the milk and the blood. So it’s not like once it enters the milk, it stays in the milk. Right? So it’s not like if you pump that milk out, the new milk that’s getting made, if there’s still alcohol in your blood, there’s going to be alcohol in the milk again,

Dr. Leslie Southard 27:53
you didn’t remove the alcohol from the milk, you cannot remove milk or alcohol from milk, only your body can do that. Exactly. Yes. That’s in that’s the same with any medication. It’s like by dumping, you know, there are there are certainly times where it’s an appropriate, appropriate recommendation. And actually, the first year

Jacqueline Kincer 28:12
we can’t like leave milk in the breast because that’s not good. Yeah. Yeah. And,

Dr. Leslie Southard 28:17
you know, some people get really up in arms about pumping and dumping anyway, because sometimes the people that want that are saying, like, oh, I want, you know, I need a pump and down for whatever time like, once you ask them, they’re like, oh, no, I want to like my doctor said it was fine, but I want to, and for me, like, my, my whole theme in my business is I support the parents. So if someone wants, if someone says, Hey, I get a lot of health care professionals, for example, they’re like, I know the evidence, I have the resources, but this is what I want to do. I’m like, Okay, well, let’s figure it out for you, because this will make you more confident in your decision. It’ll take all that, like guilt that we put on ourselves, like, Oh, am I making the right decision? Did I expose my child to something, you know, did I withheld breast milk for some reason, you know, all these like, what ifs, it takes all that away. And so for me, like, I just support the parents. So if they, if they know that evidence, and they still choose to pump and dump, then by all means, that is your choice, and I’m happy to support you. But some of these providers throw it out without any evidence. And they just, I mean, I, I’m never in those situations with the person but I always pitch her like, they say, Oh, you have to pump him up for 24 hours, and then they leave the room. And I’m like, Do you realize that what what you said in that one sentence can have an impact for a lifetime for someone it’s, it’s crazy, like,

Jacqueline Kincer 29:45
well on the assumption there too, is that I at least I’m guessing the assumption is that, oh, well, they just have other milk saved up at home. How do you know that? Maybe they don’t maybe now by giving that recommendation you might be making that up baby. Now drink formula that that mom never wanted to give in could potentially be problematic for that particular baby. So it’s, it’s not something we can just casually suggest or recommend. And I think that’s that’s the issue too, right? If you, like you said, if you don’t want any risk whatsoever, and you want to pump and dump and if you’ve got a freezer stash, and you don’t mind and it’s not going to be heartbreaking, or you’re bawling your eyes out as you pour that milk down the drain, then that’s the right decision for you. Right? So we support that. But if we’re talking about a mom who’s like, I can barely pump half an ounce, and you want me to throw all of this out? Like, that’s a different story. And we have to be really careful about that.

Dr. Leslie Southard 30:42
Oh, definitely. And it’s, you know, if you are going to have that conversation with someone, you need to be prepared for like a 30 minute consult, you need to be asking, like you said, what, what do they have at home? What resources do they have? Do they have a pump? Do they respond to a home? Do they know how to handle, you know, hand Express, like, they need to be able to answer all these questions and set their patient or client up for success, versus leaving that responsibility to them to figure out because, you know, there are certain times where pumping and dumping is appropriate. Like, for example, my first client ever, she was going through chemotherapy, and she, well, they were about to start chemotherapy. And so she wanted background. And, you know, I could have just said like, Okay, this is not compatible with lactation, you will have to stop. But you know, I made sure to offer, you know, like, if you’re going to stop, you need to work with a consultant that is able to help you we’ve, you know, not mean but you know, stop in a healthy manner. So you don’t get mastitis you from a mental standpoint and emotional standpoint, if you are ending sooner than you want, then maybe work with a therapist, and here are some therapists in our area that are really good with postpartum in situations like this. So you know, I could have easily just thrown out. Sorry, you’re not coming. It’s not compatible, but I made sure to go through all the steps because I, you have to care about the whole person, not just the baby, you know,

Jacqueline Kincer 32:16
that is so true. And I think that is where where a lot of the focus ends up getting put is on the baby. Right? But what about the mother’s well being? And like you said, there are so many factors to consider, you know, does this particular mother have a breast pump? Does she respond to it, all the other things. And so if you are going to make that recommendation, you’ve got to support her in pumping to maintain her milk production to prevent clogged ducts and mastitis all the things, you cannot just make that recommendation and then go by

Dr. Leslie Southard 32:45
figure it out. In my mind, that’s what happens. They’re just like, they just throw it out there. And then they’re they move on with their day. But for some people, the people that I see quite often they get stuck in that moment, especially when they have subsequent kids. And they’re like, I was told this medication was not compatible. And now you I saw on social media that you said it is and I see this evidence and it hurts. And I’m like, It’s been five years since this person had that information. I mean, they have to understand that the one that sends and how they approach this situation can have a lifelong impact. It can, it’s trauma for some people. And they you, no one wants to cause trauma. And so I feel like if providers recognized it for what it was and what it can cause, then maybe they would start changing the whole situation. Because, you know, I keep going back to it. But sometimes that’s the only option is to pump and dump or to end breastfeeding. And that if someone is in that situation, they’re not in a good situation. They’re having, you know, significant health concerns, because the medications that typically can’t be used during lactation are very much you know, they’re needed for a reason. So their first significant concerns, and you don’t want to leave them in that situation where they’ve already gotten health information and news that they weren’t probably expecting, and then say, Okay, now you figure it out. That’s, it should never be the person’s responsibility to figure it out for themselves, they should have the resources available. And if a provider doesn’t know how to support them, they need to be able to connect the dots and you say, Okay, I know so and so. Let me give you their contact information at the very least.

Jacqueline Kincer 34:29
Yes, preach, like Well said, because the other thing too, that, you know, I think that we have to think about is if we are really concerned about the baby’s well being. And you know, it isn’t one of those serious concerns, like you said, or maybe it is right. Has the baby ever had a bottle before because there are so many moms out there who struggle to get their babies to take a bottle so you’re assuming you know that all babies just have the skill? No, they don’t actually so There’s that too, right. But like you said, I think there’s so much more of like an emotional mental health component to this, when you are talking about a medication that’s truly not compatible with breastfeeding, that’s a huge consideration because you have something serious is going on. And a mother ending breastfeeding. Without that being her choice can be a really difficult thing, for sure can cause a lot of grief. So that’s worth talking about.

Dr. Leslie Southard 35:27
Yeah. And some parents will choose will forego training themselves to continue breastfeeding. I see that a lot. Not a lot. But you know, of the things I see. It happens a lot with antidepressants, for example. And we’re in a time where mental health is, you know, I don’t have to say it. But you know, it’s, it’s a big concern, because everyone’s mental health is so tested every single day in the pandemic. And for the first time in my pharmacy career when the pandemic originally, you know, first began, we saw back orders of common antidepressants, and I was like, I have never seen this in my career where, you know, the manufacturers just can’t keep up with the demand. And in this case, it was, you know, there’s probably some production issues, but there was definitely an increase in demand that made some of these medications go on backorder. And it was just incredible to me. But you know, in those situations, I do get a lot of parents that are like, I just don’t, I don’t want to risk it, I don’t, I will find other ways to treat my mental health than to take a medication. And I guess I don’t work well with it, but it’s just it’s something I know, it’s

Jacqueline Kincer 36:40
a right, it’s a it’s a decision making. There’s like a decision making tree essentially, right. Like, you know, the the sort of risk benefit trade off that everyone has to make. And sometimes you need some additional help with that. It’s not a decision you can make on your own because you do need, you know, all of the evidence, let’s say to have peace of mind, right? A lot of people have that kind of a thought process. And especially if you are already struggling with mental health and anxiety is part of that picture, you’re probably going to do better with more information. Not always, but, but a lot of times it can help soothe that anxiety. And so yeah, I do see that as well. And, you know, mental health, like you said, has become really at the forefront of the pandemic, which is a good thing, right, we’re paying more attention to it and whatnot. And maybe for some people, it is great that they can, you know, invest in a different way of taking care of their mental health, whether it’s, you know, more frequent therapy appointments or something and trying to stave off that need for medication, but we certainly don’t want anybody to sacrifice their own well being mental health or otherwise, just to preserve, you know, providing breast milk to their babies, you absolutely matter and we can’t just, you know, avoid taking care of ourselves and whatnot. And, you know, whether it’s, you know, some other type of medication or if it’s for, you know, mental health, like you said, I think it’s really important that we encourage moms to first take care of themselves. So please, please don’t put that off if that’s something that you really need to do. But what I guess with that, right, so, you know, a lot of moms are sometimes fearful of taking medications, let’s say for mental health, right, and SSRI and SNRI and Mao y or something like that, how problematic are those categories of drugs for lactation?

Dr. Leslie Southard 38:35
Oh, my gosh, they’re not there are there are so many options even within those categories that are considered compatible. And I think part of the struggle too, with treating anxiety and depression these days and especially with lactation is, you know, there’s always a preferred whether, you know, an agent that is preferred in lactation, or in your insurance plan prefers it or the doctor feels most comfortable. There’s always this preferred, and sometimes that’s difficult because people might have been on that. So for lactation, the preferred is sertraline, or Zoloft is the name brand. And so we have all this great data on sertraline, we know that it’s well tolerated. There’s been great outcomes in kids who received it via milk. They know that the serum concentration of sertraline and babies like you can’t even detect it until you’re at 200 milligrams of sertraline, which is quite a high dose. Most people start at five or excuse me, 50 milligrams. I see 100 milligrams commonly. So, you know, that’s always been reassuring to parents is that it’s not even detectable in the child’s blood. But what happens if you tried certainly in the past, you had side effects that you could not tolerate or it didn’t do its job. And that’s where I think providers can get hung up is they’re like, Well, we have all this data on sertraline, but we don’t have bid on some of these other alternatives that we have some but not as good. And sometimes providers will say, Well, I don’t feel comfortable prescribing anything other than this. And then you’re left like why No, that doesn’t work for me, I’m not going to take something that doesn’t work. And what providers should know is that there are a ton of options out there. And usually you can find one that works, that is going to treat what it needs to treat, but also be safe for baby. Because what we’ve found by and large is that these classes of medications are compatible with lactation.

Jacqueline Kincer 40:31
Hmm, yes. Thank you so much for saying that I’ve personally experienced just outside of lactation trying to get the right medication. When I’ve had some mental health challenges, and they’re absolutely summer, I’m like, That is not the drug for me. Okay, like, we need to look at something else. Like, I’m telling you, this is the wrong one. Why am I so angry all of a sudden? Or why I’m more depressed? That’s weird. So, you know, it does everyone’s different, right? Not everyone’s going to respond, like you said, but it doesn’t mean that, you know, there’s just no other options at that point. So I’m really, really glad that you said that. And I tried to tell people, yes, most things are compatible. What are some things I know you had mentioned chemotherapy, right? So that’s one of those ones, where you really just cannot be undergoing that and then expect to nurse your baby. So what are some of those things that are like absolute like, this is really not compatible with lactation and breastfeeding? And of course, there’s more nuance to it than that. But there are some things out there.

Dr. Leslie Southard 41:33
Yeah. You know, that’s a good question. Of course, that’s when my mind goes blank. But one that I’ve seen a lot of recently is a weight loss medication called phentermine. And it, it works well, especially if you’re using it in combination with diet and exercise. And, of course, you know, all this stress that people have been under with the pandemic, and what have you, I have seen an increase in in its prescribing and dispensing because I think people are trying some of the things that have worked in the past, and it’s just not, and, you know, they’re asking their doctor for help. And that line, because it can raise blood pressure, it’s is not considered compatible, and lactation. So it has that aspect of it. But then also, you know, when you think of lifestyle, they call lifestyle medications, because in insurance speak, it’s not considered necessary, because there’s other alternatives of methods of losing weight. And so that has been kind of adapted into this particular part of medication use and lactation, it’s just that, you know, if you don’t have to use it, and it’s not something that you need to survive, then it’s not recommended because of the blood pressure raising aspect. You know, right now they’re saying medications like Xarelto, which help with clots, you know, they’re often prescribed after clots because they work so well. They don’t have enough data on it to say it’s compatible and lactation. And when ever you think about clotting and things like that, people tend to be more prescribers tend to be more conservative and their recommendations, as far as using and lactation. Those have been the big ones I’ve seen, because I’ve seen a lot of postpartum complications with blood clots and cardiomyopathy, and things like that recently, and I don’t know if that’s just my area and the people that are coming to me with questions or if it’s in general, but those are at least two examples.

Jacqueline Kincer 43:31
Hmm, yes, very good ones. Thank you for sharing that as well. Yeah. And then, like you said, I think sort of optional things, right, I get this question too, like about not necessarily weight loss medications, but some of these products out in the market marketed as fat burners and, or workout supplements and BCAAs. And whatever. And I kind of go, you know, I don’t know if this is really a breastfeeding question. Like, I think what you’re really like, if it’s not good for your baby, maybe we should examine whether or not it’s good for you. Like, is the intention behind using this to achieve a certain physical appearance school? Are we are we trying to like improve your overall well being and health? Because those are actually two different things. They can be separated, sometimes they’re connected? And then also, then how would you rank that in terms of importance to, you know, providing breast milk to your child? So, you know, is breastfeeding something you’re going to do for the rest of your life? No. is maintaining your physical strength and overall health something you’re going to do for the rest of your life? Hopefully, yes. So but do you have to do it right now? Like, it’s so it’s one of those things that you know, we do have to talk through it though, right. We have to talk through it. I think that there’s a lot of times where people will sort of treat me a bit like a hotline, right? And they’re like this, you know, I’m like, well, first of all, I know nothing about your health history. So I don’t know. Second of all, I can’t actually prescribe. So I can’t tell you. So it’s like this tricky little layer also, where, you know, moms just want like the quick answer. And I’m like, you know, they can tell you something like, if you’re experiencing a cold or allergies, absolutely, you can use a nasal saline spray, yes, you can definitely use that it’s not gonna affect lactation, side effect your breast milk, it will help with your symptoms, I can tell you that over counter thing, you can go by that. But there’s like limitations, you know, we can’t just right, start just throwing out this is good, this is bad. It’s not that simple. Everyone is different, our physiology is different.

Dr. Leslie Southard 45:42
Right. And most of it lives in the Grey’s out, because even if you have clear cut data, which, you know, back to the whole women and kids thing, like we don’t have a ton of good data on just medication used in women and children, let alone when it transfers through milk. I lost my train of thought

Jacqueline Kincer 46:02
that’s, oh, yeah,

Dr. Leslie Southard 46:04
there it is. There it is, is this not Mom Brain or what, where it kind of like you have to go in a circle to get back to where you were talking. But it all lives in a gray zone, there’s, there’s so little that is actually good and bad. And usually the bad is just those, you know, extreme medications like chemotherapy, intense radiation. When radiation, there we go. And, you know, it’s, there’s so little that is actually clear cut, that you have to be willing to live in the gray zone, especially when addressing medication use and lactation. And that’s probably part of the root of all of this is that, because we don’t have good data, and we’re in this gray zone providers and professionals are just there. They don’t feel comfortable. And especially when you don’t have the training, and I can understand why people are saying like, Oh, I don’t know, or like no, that’s not compatible, and things like that. And I think one of the ways that we can do address it, besides everything else we talked about is just having that network of people. So if you like I don’t know anything about tongue ties beyond my personal experience, but I can tell you, the providers in my area that are good with it. So being able to have that network, and if you don’t know, an exact person, you can always say, Oh, let me talk to one of my ibclc friends, I know they’ll know this, or like they’ll know at least where to start looking. Just having that network can address a lot of these issues, and especially if you’re not comfortable answering questions when when it’s all in the gray zone?

Jacqueline Kincer 47:38
Ah, yes, absolutely. And I think that there is a subset of healthcare providers that just lack that sort of investment in their patients, or who may have a bit of an ego overriding things. And so it’s like, dude, no one expects you to know at all, like, it’s okay to be like, You know what, that’s really not my area. And even if you don’t know, somebody, you should be like, you should probably find a lactation expert to ask that question to I don’t know where to start. But Google it. Like, even if you don’t know where to start, it’s okay to admit that you don’t know it all. Because I had someone asked me something. I don’t even know what it was the other day. We hadn’t what was it? She I don’t even know, it was a client though. And I was like, I’ll be honest, that’s really not my area. And I don’t know who to send you to. But this is the type of person you’re going to want to look for to help you with that. And it just it is what it is right. And I’m like, I’ll reach out to my colleagues and see if there’s anybody that knows anyone that I can connect you to in your area, because that’s what we do. So it’s really great when other people do that as well. I did want to talk about, you know, I mean so much with medication and pharmacy and lactation and all of that too. But you have had a significant personal experience with your five year old who you’ve mentioned, you know, a couple of times and whatnot. And I think that your story is really powerful. And I love that you’re open to talking about it. And now everyone’s like, my interest is piqued. I’m going to stop folding the laundry, what are they going to talk about? But I’d love for you to share about how things went and what happened with your daughter during your breastfeeding experience with

Dr. Leslie Southard 49:19
her. Yeah, so I would like to preface that my daughter is happy and healthy right now because sometimes I start going out and you’re looking at me with wide eyes like what what is she now though? So when shortly after she was three she was diagnosed with Wilms tumor which is a solid tumor, kidney cancer. You typically find it in kids around the age of three to five so she was right in there. And it was just it was so bizarre because she had no outward signs. She was super healthy. We had just taken her to her well check for three year pointment and her pediatrician. I love her. She’s like one One of the best in the area, especially, you know, I chose her because she’s a lactation consultant as well. And, but she’s very like a kind of abrupt, she’s wonderful because she’s just very to the point and she is the same way with her physical mannerisms. So I remember watching her feel around in Carmen’s abdomen to make sure everything was okay. And so, long story short, I was nursing Carmen right after about a month after this. And she leaned back in my lap, and I tickled her, and I felt this bump, and I was like, what is that, like? I just knew it was bad. But it was just, I was just like, please go away. And so she sat up and and disappeared. And then she leaned back, and we felt it again. And so we took her in. And, you know, we can have later we had this diagnosis, but I just remember sitting there and like, her pediatrician fell around, and they’re like, how did was not felt? Even even when talking about it. She was relaying, you know, what they were seeing on scans and things like that. She’s like, I just, I did not feel anything I know. And I was like, No, I remember you were like, in there begin. So. But she ended up having this tumor. And, you know, Carmen went through surgery had it removed along with her kidneys, she had 25 weeks of chemo. And now she is almost two years into remission, or no evidence of disease, as it’s called now. And I really, you know, like leading up to her third birthday, I told her, she always woke up at night and to nurse like, that was her thing, like, she nursed before bed. And then at night, and I told her, I said, Girl, if you sleep through the night and give me a break, I will nurse you for however long you want. And timing wise, I don’t like you know, I’m like, what is that three year old really understand of that. But timing wise, she stopped waking up at night. I was like, This is amazing. And so then, you know, it’s like, well, I guess it’s good that we’re still breastfeeding. And I will say, you know, I have an incredibly large community of providers and professionals in my area, Omaha, Nebraska, that are supportive of lactation, we just happen to get the surgeon that is like a breastfeeding advocate. And so after her surgery, she did really well took minimal pain meds, which is probably her stubborn nature. She didn’t like medications by mouth, but he attributed some of it to the, you know, natural pain killers in our, in our milk. And he was like, well, now I’m telling people that they need to nurse to at least three years because you can detect cancer, because he’s like, You found it as soon as she could, because you are nursing her. And he’s like, I’m telling him all this good stuff, my resonance about it. And it was just that part was incredible. But then we get to the oncology section. And she starts chemo and I noticed that, you know, she didn’t get constipation like she could have from some of her medications. She did have nausea, she, it was more like the taste of the medications. Like she could taste those infusions. And

Dr. Leslie Southard 53:00
yeah, so like, some of it we couldn’t avoid. But she, you know, a day after her chemo, she was back to normal in terms of not having nausea. So I, I really think breast melted a wonder. And for her at least, it was like her whole entire world change. She went from being this happy, healthy, no problem kid, to having all this stuff done to her. And then that was something normal, especially when she was getting her port access. She hated it. And so being able to nurse afterwards, she you know, it was something that could calm her down, it would maintain some kind of normalcy that she remembered before that. And then you know, so we get through chemo. And I was like, well, when do I stop? Because now like, we’re into you for a loss. And then right as her treatments were ending COVID was starting. And so I’m like, Well, I guess we’re going for another round, because, you know, you want to try and protect your kid as much as you can. Because at that time, no one knew what we were supposed to do. So it was just a journey. It was it was incredible. You know, I didn’t meet any providers that were against nursing. I’m sure I got some weird looks in the infusion center if she was nursing there, but I didn’t care. I was I was debating, you know, I thought like, do I need to increase my supply because of her chemo? A lot of kids that were on her regimen, they ended up you know, not being able to have an appetite and some of them would end up with feeding too. And I was like, okay, what can I do? If that goes that route? Is there anything I can do to help? And you know, I never ended up doing that. But I had the support of my community. They’re like, Okay, I’ll help you. Increase your milk supply. I’ll help you get the pump that you need. Because of course, I tossed my years before that. So it was just an incredible journey. And wow, it was amazing. That’s yeah, that is amazing. Honestly, before we sat down in here record here, I

Jacqueline Kincer 55:00
was telling Leslie for the listeners out there that I had a really good friend through La Leche League that her son went through a different type of cancer and treatment. And she continued to nurse him through that time. And then when she was unable to nurse directly at the breast because of distance, like they were flying across the country to get treatments and whatnot, she would pump her breast milk, and still find a way to give that to him. But she did not have as the same support in the medical community as you did, I do actually remember her telling me that she basically had to bring evidence to the oncology team to, you know, the infusion team or whatever, right? And just say, like, look, this is still helpful for him to receive breast milk there, there are Hamlet cells, there are stem cells, there are all of these things, if he’s not getting food, he did have a feeding tube, things like that, like he needs breast milk, and it is still beneficial to give it to him, it is not some weird selfish thing. It’s not a behavioral thing, which you know, it can obviously, like you said, it can be so comforting, right to that child who’s incredibly scared. And so she kept pumping, really the entire time to give him breast milk, which is amazing. But she had to do a lot of advocacy. And she was, she was in the right position to do it, because she was a lactation consultant. So she was like, Oh, you want data? I’ll go get your data. So and then she was also very strong about it to say, sorry, did you have data that this is bad for my child? Let’s see that data. And they were like, No, we actually don’t have that. So it’s, you know, I like that you shared that. Because yeah, I breastfeeding. The milk is so powerful. But so is the act of nursing your child’s and I love that you were able to offer both to your daughters through that challenging time. Yeah, and it was, you know, it

Dr. Leslie Southard 56:52
was very beneficial, beneficial to me as well, because I was for a while there, I was super, super angry. Because, you know, when you think about it, you know, you hear all these, like, how breast feeding and breast milk protect against cancer. And I mean, obviously, we know that it’s not, you know, it’s not going to treat everything. It’s not going to, like prevent everything. But it’s not Are you sure? Good for eye infections? Yeah. But I’m just like, I even wrote a blog post about how he’s so angry at breasts. No, because here, I was thinking I did everything right. And I still missed my good. Well, you know, and of course, I’m in therapy, I have gone through a lot of therapy. So I know that’s not true. But you think that and you just get so angry, you’re like, I did everything that I was supposed to do. And this still happened and but then at the same time, we know the nurse her and have that connection, and remember that we have this relationship still that happened before cancer, and it was going to happen during cancer and continue afterwards. It was it was healing in itself for me too. And, you know, I think when you get to that age with your kid, being older nursing people are like, Oh, it’s just for the mom or whatever random thing. They throw it. They’re like, Oh, you’re just doing it for yourself. You know, it’s ironic because I was thinking I was like, Well, I am kind of doing it for myself, because it is healing for me to be able to do what I’ve been doing.

Jacqueline Kincer 58:24
Right. But it’s not like it’s against the will of your child. Right, exactly. But I always think that like, holding them down and nursing them. Like that’s not how it works people. Yeah,

Dr. Leslie Southard 58:34
I’m like, well, they’re right. But they’re not the reasons why they’re right or not. Right. You know, I’m like, I’m not forcing her. But yeah, kind of for me. So it was, it was like a whole interesting part of our relationship. And, you know, I really, I struggled with deciding when to stop, because, you know, I mean, I think every parent struggles with that, because you either like, you either want to weed and then people are like, No, you should gentle wean, or you don’t want to stop, but they’re older or what have you. And I just had all that extra guilt. I was like, Well, you know, I got her through chemotherapy, and I got her through the start of the pandemic, when do I stop? But we we ended up taking a gentle weaning approach, because for me, it ended up going to getting to the point where I just I knew nursing was coming and I didn’t want to do it anymore. I was like a whole mental. You know, I had an aversion at that time. And we worked it out together, which is like, one of the benefits of nursing that long is you can sort of kind of reason with a four year old or a five year old can be like, Okay, this is you know, this is what we’re going to do and they’ll be like, well, in current case, she’s like, I’ll compromise let’s do this. Instead. I’m like, Okay, we’ll go with your route, but we’re still gonna end up getting to mine. Most as a whole and nursing. Older kids is so much fun because they say the craziest things like she used to tell me Well, they’re not crazy, but they’re not things that you’re expecting. And she would tell me like, oh, I read, like, What does it taste like? And she’s like, the milk tastes like love. And I was like, Oh my gosh, oh, go away, you know, because you just hear all these sweet things sometimes are, like, it’s super, it’s sweet today or like that tastes spicy, you know, they come up with all this stuff but it’s, it’s, I don’t know you could talk about that for hours is how fun it is to nurse an older kid if both of you are still wanting to nurse.

Jacqueline Kincer 1:00:26
So true. So true. It’s it’s very fascinating. It’s also fascinating, you know, because I have two children, right? And so to hear the oldest two, you know, he knows still he was for. And then you know, him observing me nursing his younger sister and how he would talk about it. And he would know, too, right? Like, sometimes, you know, you kind of with two kids and you’re busy, you get a little distracted, and he would be the one to alert me that she needed to nurse. Like he would pick up on it sooner. I mean, cuz she wasn’t full on crying, you know, but she’s starting to stir whatever and, and, you know, maybe maybe he’s playing with or she’s doing tummy time or something, right? And he’d be like, beeping the nurse and you’re like, oh, okay, all right, like, wow, you’re very intuitive. It’s funny, too, because my kids now asked me about, you know, what I do for work, right? So sometimes I’ll get a message from a mom and, and I just, I’m completely focused on it once it comes out, and I can’t hear or see anything that goes on around me. And so, you know, they’re like, Mom, Mom, did you hear me? I’m like, I’m sorry, sweetie, this mom messaged me, and she needs help with nursing her baby, you know, and they get very interested in actually, I’ll ask me questions. And that’s really cool. Because, you know, they just, they know about it. They know what it is because they remember doing it. And I don’t have to explain it to them. And it’s funny, though, because they they do forget things as well. Right? I’ll be like, do you remember when I used to like, hold you and nurse you’re asleep? And they’re like, kinda like, yeah, so the memory just feed which, you know, always have those memories, but they may not. But it’s neat to have that where your child can actually have a memory articulate that experience to you. I think that’s just really beautiful.

Dr. Leslie Southard 1:02:09
It is this. I you know, I think my for me, personally, I enjoyed nursing, a newborn. Just she was she was easy, easy baby. And then, like, one to two years, it was difficult because she had all the teeth coming in. And it was, you know, I never felt the teeth. And sometimes her saliva would bother me. But it, it was really like the constant week, you know, that bothered? One like I could never like say no to her. And so like that time was a little bit rough, and then going through chemo and stuff. That was an interesting experience. But the end was very sweet to her. She would just say, you know, like, I don’t know if she’d even say like, oh, that one ran out, or like, I need to switch to the other side. Because there’s no milk in that boob or whatever. And so that was really sweet. But it was an interesting journey. And I felt really, I you know, I had a friend asked me, she’s like, Are you sad that you quit? I said, Absolutely not. I’m glad I’m done. I was like, I got to do all the things I wanted to do. She was happy. She got to end things, you know,

Jacqueline Kincer 1:03:13
not exactly the way she wanted, because she’s probably still be nursing or she could but you know, we kind of ended on her terms. So it was Yeah. I love that. I love that. See, this is what I think people like, like Leslie and I want for families is like we want it you want we want you to go out on a good note. Like we don’t want you to stop breastfeeding and have extreme sadness, guilt, self blame, or, you know, anger or those kinds of things. Right, which kind of ties us back into the whole conversation about medications and, you know, compatibility with lactation, right, the last thing we want for anyone out there is to receive advice that is counter to that well being of that breastfeeding relationship with their child. So how can we balance those two things? Right. So had someone told you early on in your breastfeeding journey? Well, you’ve got to stop because she’s a year old, and she can walk and talk now. And that’s just weird. Like, and you listen to that, you wouldn’t have the next four years of this, you know, beautiful, not always pleasant, not always enjoyable experience. But you feel so much pride, I hear you express about this now. And you were able to find a way to meet your needs and your daughter’s needs. And that’s what it’s all about. Right? We always just want you know, that mother, baby Mother Child dyad. We want to find a way to try to compromise and be meet both of their needs. And that’s what it’s all about. If we’re talking about medications, we’re talking about length of nursing time. We’re talking about tongue ties, anything I think so I actually think that your personal story ties in so much with what you do because you’re just looking to help families preserve their goals. Right, like you said, it’s not about trying to make anyone continue breastfeeding, or, you know, anything like that. It’s really just what is it that you want? And how can we support you in getting there?

Dr. Leslie Southard 1:05:11
Yeah, and I think, you know, for a long time, I don’t know, maybe it’s still this way. But you know, when I first started, it was it for me, it was all or nothing like I was either providing all milk or I wasn’t providing any. And over the years, I’ve just really seen like, it’s not, it doesn’t have to be that way. And that doesn’t, if you don’t provide all breast milk, that doesn’t decrease from what you’re doing, you know, what you’re doing is still valid, and it’s still important. And if it’s meeting your goals, that’s great. And, you know, there’s

Jacqueline Kincer 1:05:41
so many ways to make breastfeeding and providing milk work for a family. It’s just, I’ve learned that over the years, it’s when you put the parent and their goals and and the child’s goals, forefront, then you’re able to meet those needs so much more. Huh, yes, that is so true. And I think that the work that you’re doing is really important in in furthering that, right, because you’re able to, to do that with everyone that you work with. And by the way, I’d love for you just to chat about like, what exactly do you do? How do you serve families? Because we’ve been kind of chatting about that in a roundabout way. But just more directly, you know, you are the lactation pharmacists. So how does that work? And you know, how can people work with someone like you when they have these questions, and they need this type of support?

Dr. Leslie Southard 1:06:34
Yeah, so I work I have my own business, but then I also just practice in every aspect of my life. So I do have my own business called the lactation pharmacists, I do consultations, mainly. So what I did last week was on the COVID vaccine, where someone was like, these are my health circumstances, I, you know, been kind of thinking about getting the vaccine, I have a newborn, what would you you know, what evidence do you have? And how would you manage this and, you know, we are able to work through that. So like it was more of a back and forth, I do have written consults, so that if someone is going to their provider, they have that, that consult with them, that provides references, it breaks things down, as far as like, how the medication gets into milk, what evidence we have of what happens when the baby receives that medication through the milk, all that stuff. And then I do quick questions. So if you just have a really quick question like, oh, I have a cold I was considering Sudafed, is that a good option? Most of the time, we have other options, we prefer over stupid, since it can affect milk supply. So I have that option as well. And I also I do some doula work. So I have worked with clients in that aspect when it comes to lactation with home visits. And I typically see my clientele is the type that has a complex medical history with medication needs. And so I tend to get that clientele with my Doula clients as well. So that’s one of the reasons I think I’m a good fit for those clients. And then in everyday practice, I also work in a community pharmacy and home health care pharmacy for children’s, the local hospital here in Omaha for kids. And so I kind of practice in those areas, too. So I’m always getting questions from coworkers or text messages from, you know, people I know from other pharmacies and things like that. So I’m able to help in that aspect as well. Oh, well, you’re

Jacqueline Kincer 1:08:35
just you know, you’re just doing it all. And I love that also she else in the super cute T shirts on her site. There’s like and the pump and dump and then you have one about like childhood cancer awareness. I believe it’s very beautiful design. So all all link up everything that Leslie does in the show notes. So if you guys are interested in working with her, I know you’re definitely someone that I’m going to be sending people to when there are those you know, deeper questions, or it’s something that I’m like, You know what, I just think you deserve a really good answer. I love that. Like you said you’re putting it in writing with references and whatnot so that that can be then taken to you know, because it’s it’s so hard right? And it’s a lot to ask of a mom to to go you know, have this conversation and then they’re trying to say it remember it say it in the same way you said it to another health care provider who’s kind of looking at them like I don’t know if I believe you like hats. That’s a tough spot. We don’t want to put moms in that position. Right so yeah, I always tell people like I’m I can fax my notes. Yeah, pediatrician so the OB whatever I don’t want to put this on your plate you don’t need more on your plate. I’m here to try and help you get less stuff on your plate. So you I love that you do that. It’s not just a conversation you’re having with someone you know and then they’re just, you know, supposed to remember it all you’re actually putting that in writing for them. So thank you for doing that. Yeah, of course, yeah, oh my gosh, I just you guys, she’s the best, I don’t know how to express this like. So I think, you know, for me, I, I learned a lot from you, you know, I know, you know the anatomy of the lactating breast and how milk is produced, and you know how things kind of go into the milk, but I definitely got a deeper understanding of it from you just doing your explanation, and you explained it in a way that’s, I feel like so accessible and so easy to grasp. And I think one of the things that we can all appreciate about you is that you’re able to break this down in an accessible way, right? So you can go to the lacked med database, and you can go What the What is molecular weights? What does this mean? What? And like for the average layperson, that’s really, really difficult to interpret that stuff. But you’re the translator, you’re the one who’s like, not going to just throw a bunch of science and Latin based terms at someone, you’re actually going to tell them something in a way that they can understand it and make a decision with it. Wonderful.

Dr. Leslie Southard 1:11:05
Thank you. It’s my favorite part. Because, you know, I’ve found throughout the years that if you’re able to explain something like that, in terms that people understand that they feel more confident in their decisions. And that’s really, that’s what I hope for with anyone that I work with is whatever decision they make they feel competent, because they understand the material that is present for it.

Jacqueline Kincer 1:11:25
Hmm, yes. Oh, my gosh, that’s just so key. And I’m so so happy to hear that everything has gone as well as it could with your daughter, and that she has the status she does now with her health and everything. And that breastfeeding ended on such a good note for you both. It’s really, really beautiful.

Dr. Leslie Southard 1:11:44
Thank you so much. Yeah, you’re

Jacqueline Kincer 1:11:45
welcome. Well, thank you so much for being here and having this conversation. You’re an invaluable resource to so many families and professionals out there. I have one last question for you, which is, do you do consultations with professionals as well? Or do you? Do you ever speak at conferences? or do any professional trainings? I know, you mentioned some changes you’ve seen and you’re connected with some interns in pharmacy school. So for anyone who’s interested on the professional side of things, is there anything you do with

Dr. Leslie Southard 1:12:13
that? Yes, so I have taught virtually, at breastfeeding centers or organizations, I’ve I done that periodically through the years. And I’ve always enjoyed that. Because, you know, it’s, I want to hit everyone I can and if we can help, you know, the person actually producing the milk up to the person that’s, you know, advising the person producing the milk and everyone in between, that’s where I want to hit. So I have definitely done local presentations to bombs. I’ve done speaking engagements virtually to professionals. So I kind of eight ranges, but I definitely do that.

Jacqueline Kincer 1:12:52
Awesome. Oh, I love that too. Because I know I have a lot of lactation consultant or lactation professionals, birth professionals, all kinds of professionals that also listen to the podcast. So if you guys are interested in you want to connect with Leslie, let me know or try to connect with her directly through her website, and we’ll make it happen. So thank you for being here. Thank you for sharing your amazing wisdom with us and your personal journey as well. Leslie,

Dr. Leslie Southard 1:13:18
thank you for having me.

Jacqueline Kincer 1:13:21
Did you know Most moms stopped breastfeeding in the first month postpartum. I believe succeeding at breastfeeding means having the right mindset. In fact, studies show that the number one factor that determines breastfeeding success is commitment. Which is why I’ve created my incredible audio download of breastfeeding affirmations where I give you actionable mantras so you can breastfeed your baby with confidence and peace of mind. And best of all, it’s free. To get access to this audio and PDF. Simply visit holistic And you can get started right now.

Dr. Leslie Southard  is the  owner of The Lactation Pharmacist and is here to share her incredible expertise with us about what types of medications & supplements can transfer into breastmilk & how it happens. We are debunking ALL the myths today, so pay close attention! She also shares her harrowing journey of nursing her daughter through chemotherapy.