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Episode 72: Breastfeeding Advice from a Pediatrician with Dr. Rebekah Diamond

, , June 29, 2022

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Jacqueline Kincer  0:03

Welcome to the show Dr. Rebecca Diamond, I am so excited to chat with you today about all things babies, parenting, breastfeeding, you name it. You’re just such a wonderful guest, I feel really honored that you would even come to join me on this podcast because I feel like a little bit of a fan girl. I love your content, and just your message and everything. I wish that I had found you when my children were smaller. But alas, here we are. So thank you for coming to the show.


Jeanne Marie Paynel  1:07

My gosh, thank you so much for having me. That is the kindest introduction, I feel exactly the same way about your very scientific realistic breastfeeding content. So this is a dream meeting.


Jacqueline Kincer  1:19

Thanks. Yeah. And I feel like we’re probably like kind of being a little unconventional by having this meeting. Because I think there in both of our professions, me as a lactation consultant, you as a pediatrician there, there can be this not great perception of one another and whatnot. And so I just love that we can have a conversation that’s going to really benefit the people who listen to it today.


Jeanne Marie Paynel  1:42

Yeah, this is such an important meeting, like you’re saying, between two very different types of baby experts and to different professions that often have different approaches or different philosophies, or just, you know, almost even different, like pediatric politics behind them. And so the more we can talk to each other, and, you know, that’s my whole thing, bridging pediatric and parenting worlds and, and getting everyone to come and see that we all have the same goal. And we all kind of want to do the same thing. So this is fantastic.


Jacqueline Kincer  2:13

Yeah. Oh, I love what you said. And, you know, you’re just obviously so passionate about what you do and your field in general. And I’d love to hear more about how you became a pediatrician and why you got into this work?


Jeanne Marie Paynel  2:27

Oh, yeah. Well, I haven’t I haven’t answered that question in a while. I feel like that since my application days. So I’ll, I’ll try to remember what has driven me to get here. But, you know, I went to school, I studied all the things the way people do, I didn’t really know exactly what I was interested in. I like to learn languages, I liked to do different creative things and talk to people, I didn’t even like science that much. Because I thought I wasn’t good at it. And then it kind of turned out I was good at it. It’s just I didn’t have a lot of confidence in it. And I just didn’t have the best guidance towards that. So it took until the end of college for me to realize that if I went into medicine, I could actually really use intellectual things to help people and not just sit around and write interesting, but not necessarily that helpful papers or study sort of intellectual things, and I went to med school, med school, it was pretty obvious to me pretty quickly that I love kids that kind of well, I already knew that.


Itt was pretty, pretty clear right away that that was the best part of medicine. I’m fully biased. But treating cancer is just the best. And so I did you know, I did the whole thing. After that, I went to residency. And after residency, I became a hospital pediatrician or Pediatric Hospitalist, which means that I actually only see children when they’re in the hospital and admitted at what you know, it’s not necessarily your darkest, hardest time. But for many parents and many children, it is it’s one of the harder experiences you’re going through. And as I did that, and as I had my own daughter, I started to see the ways in which when you do traditional science-based medicine as good as your intentions and as good as the evidence behind it, you can sometimes miss the family and miss the whole person. And miss that parenting dynamic.


If you had compared to if you had gone in from a little bit more of a personal perspective or a little bit more of a parenting perspective. And I also saw, I know, you know, you mentioned wanting to have parents wanting to have had parenting guidance when you had your own kid. I felt the exact same way. I was a pediatrician when I had my daughter and I had no idea what to do or where to look. You know, I was getting guidance from the pediatric organizations that I worked for that I knew was right, but they didn’t feel right for me or they felt stressful or restrictive. But then I would go online and I would see advice that felt maybe easier or Kinder but I also knew wasn’t quite right or was and even safe sometimes. So, the rest of my career since then, you know, my clinical work in the hospital, and then also the book and the Instagram, and everything I do, is very much in line with this conversation we’re having, which is trying to bridge all these parenting worlds together and use each other’s expertise, you know, to help parents not pit ourselves against each other, which, sadly, we do feel much like, like we were talking about, you know, we do


Jacqueline Kincer  5:25

is the Wild Wild West, and I just, I’ve been in it, you know, and I don’t know if you know this, because I think our connection is, you know, more recent, but I got swept away by the so-called Wellness community for quite a bit of time after becoming a mom and really got misled, was really believing some information that I now know is not necessarily safer, healthier, you know, accurate. So I get it, I get how parents fall into that trap, right, I get how someone can look like a trusted source when they’re really not. And, you know, through the process of becoming an IBCLC. And, you know, learning.


It’s not that I wasn’t educated, or, or smart, or any of that, right? Like I and I kind of, there’s this marketing that convinces you that you know, just do your own research. And you can, you can know, the same things as all of these scientists and experts. And it’s like, well, you can, but I mean, it’s not like, you could just do that by reading blog posts, though, they sort of convince you that you can write and I get that, you know, and now I’m on the other side of it, where I’m like, Oh, stop reading all this stuff on the internet. And you’re doing the same to write it, but we are on the internet also saying things. And so it’s kind of a funny place to be in, isn’t it? Yeah, no, absolutely.


Jeanne Marie Paynel  6:43

I mean, what you’re saying about the whole wellness world, and my profession and medicine, it’s pretty easy to shut it down altogether, and just say, don’t look at it. And, you know, for the most part, a lot of the stuff is predatory people are selling products. And it’s important to be skeptical. But some of it is really well-intentioned, it just doesn’t have that science behind it. But what I find so appealing about it, and this is why really can understand when parents get sucked in by it I’ve been there myself, is that they’re telling you that you’re the expert on your kid. And that part is true. You aren’t the expert in your kid, you know your kid best, you know if some advice if it’s presented to you appropriately with the appropriate risks and benefits, you’ll know if it’s worth following or not, it’s not a one size fits all.


It’s not that at the pediatrician’s office, you can get this checklist of things to do and you can follow a recipe, and then your kid will be fine. And so it’s those kinds of competing things where I understand, you know, I understand that when I was a new mom, I was anxious, depressed, overwhelmed. If I didn’t have the science background and medical background I had if someone had said, Oh, actually, that’s not really that stressful, you know what to do, just do whatever you want, I would have said like, Oh, that’s much better. Let’s do that one. But instead, like, you know, like everything in life answers somewhere in the middle, which is, you do know, most things for your kid, you are the expert, you will cone your instinct really quickly.


You just will need some guidance to inform your decisions. And it’s going to be a range of things that you can do that are safe, and you’re gonna get to choose based on your values. But it’s not going to be completely ditching science or completely ditching modern medicine because there’s a reason we still do. It’s why babies live longer. It’s why moms don’t die in childbirth, like a lot of modern medicine is good, a lot is stressful and probably unnecessary. But we can’t, you know, throw the baby with the bathwater.


Jacqueline Kincer  8:46

Yes, I figured it’s so true. Right. And I think that there’s become this narrative around, you know, it just overall allopathic medical care and pediatric care, in particular, you know, this, this sort of anti-science narrative that pits us against you, and that is so unhelpful in every way, right? Because, like you’re saying, I mean, you’re when you work with patients, you’re not trying to control them or parent for them. You’re just trying to give them this information that, you know, is based on science and what have you. And I mean, your intent is to help people like why would you? Why would you want to harm babies? It just makes no sense. Right? So there’s kind of wild narratives out there.


Jeanne Marie Paynel  9:36

Yeah, it would be a weird field to go into if I wasn’t interested in helping kids and families, you know, to your point about calling out or calling in or whatever. You have it, you know, whatever you might say for our own fields, you know, our pediatric education is lacking to breastfeeding is probably the best example. I have some really amazing mentors who are both IBCLCs and pediatricians. And that’s where really the exception that level of detailed pediatric and lactation training, but they all the time remind me when I started to get really frustrated with my gears, you know, where I’m like, how could they tell someone to do this? That’s not realistic. That doesn’t make any sense. You know, they remind me Hey, did you know any of this before you did all your own lactation research and take your courses? Had your own baby tried to breastfeed? Did you learn a single part of this in pediatric residency? And I say, Nope, not a drop.


Jacqueline Kincer  10:31

Right. It’s not part of your curriculum.


Jeanne Marie Paynel  10:34

I mean, yeah. So absolutely, it’s it must be it should become that it should be, you know, almost a majority of the curriculum in pediatrics, that’s a baby’s nutrition for ideally, the first year of life is through, you know, some amount of breast milk or breastfeeding. And I try to get pediatricians to understand how important it is to start embracing and advocating that we learn these things. And I also try to get people to realize it’s not that your pediatricians aren’t educated in this, it’s just they don’t necessarily have the amount of expertise that we wish we all wish we had, and that they should.


And so there is a bit of a back and forth, and a lot of collaboration that needs to happen, for example, between people like me, and people like you, where we can acknowledge the gaps in our own training and expertise. And, and instead of, oh, well, they’re terrible. And I know this, or I’m, you know, she’s terrible. And I know this other thing better saying, Oh, I see what you’re saying. That’s an interesting perspective. Here’s why I would be reluctant to recommend that based on my experiences. How do we find the best solution for this family? I mean, easier said than done. But that’s the dream situation. We’re working together. Yep.


Jacqueline Kincer  11:51

Absolutely. That is the dream situation. And I will say, from my perspective, you might know a bit about it, but maybe the listener doesn’t. So becoming an IBCLC, there’s a fair amount of education on some things that we’re trained to look for where we No, like, that’s immediate, we’ve got to get you back to the pediatrician. And while I certainly cannot recognize her name, you know, maybe a neurological issue a baby might have, I can sure tell something’s off, and that’s affecting breastfeeding. And I go, Hey, you need to have a conversation with the pediatrician. And I know how to create a report that I faxed to your office that says, something odd is going on, here’s what I observed in relation to feeding, sending this patient back to you, right?


And then if we need to have a conversation about it, we do. Sometimes, you know, we don’t, right, it’s I don’t need to be involved anymore, what have you. So that kind of collaboration is so important that it is taught to lactation consultants. And so, you know, we’re, we’re always trying to, at least I hope, but I know for me, like, I’m not trying to step on your toes, I’m trying to respect what you’re doing. And I always try to remind parents to like, hey, they’re doing a lot of things every time you go see them, right, you’re checking out the whole baby, and their health. And then you’re also keeping in mind what’s going on with these parents and how they’re coping with, you know, having this child’s come into their life. And especially if this is brand new, especially if there are challenges, there are all these things that you’re trying to fit in and examine and assess for and whatever.


Maybe you get some time to look at feeding as well. And you’re certainly asking questions about that. But if there’s something more in-depth and involved there, you just don’t, you’re not able to help with that at that moment, or that appointment, or, you know, whatever it is, right. And so I always remind sometimes parents get angry, you know, why didn’t the pediatrician tell me to do XY and Z? And I’m like, well, because the kind of is not really their job at that point. Like they did what they could, and that’s why you’re here with me, you know, so I always try to remind them like, it’s not an us versus them thing. Like, it’s really that we’re both working together in your best interest.


And so I’m sure they come back to you and say, Why didn’t my lactation consultant tell me that? It’s not my job? So we cannot do it at all? That’s just too much task? Yeah, no, absolutely. I think that’s perfectly said, Gosh, you know, you’ve had some great training and everything right, and your profession and whatnot. And you’ve gone above and beyond, like you said, a lot of your colleagues and learning more about breastfeeding and lactation and all of that and, and trying to work to further those goals. You know, I’m curious what you see, in terms of what do you think are some of the biggest barriers for breastfeeding success for people or even people just wanting to you know, try to lactating give that milk to their babies?


Jeanne Marie Paynel  14:38

Yeah. Oh, my gosh, what a great question. What a complicated, great. No, I mean, as I’ve mentioned, I’m, you know, I’m working on this book that’s trying to be a parenting book to read all these gaps in it between the kind of prescriptive scientific advice versus the less scientific but a little bit more formal. So advice. And so as I’m writing my breastfeeding chapter, which I finally finished and edited, and I’m very pleased that, that it’s really what it is, is a call to collaborate, as we said, and also a call to, to work towards helping parents really know what to expect. And I feel I would say expectations and resources are probably the two most like difficult barriers that we have in our society.


One is I kind of assumed I would know how to breastfeed. I was a pediatrician, I was around kids growing up. I very like, arrogantly was telling everyone, why would I take a breastfeeding class like, I’ll just I want to breastfeed. I know I want to breastfeed. And it wasn’t until my child came, and I encountered all the issues that I did encounter, where I was like, oh, it’s like, very complicated. There’s like, actually a lot of parts and a lot of things, it would have been nice to have just a little bit better understanding of some of the bigger themes of what might go wrong, and how you might troubleshoot and also just line up what those supports might look like around you, the lactation consultants, does your pediatrician’s office have one? Are you going to use a tele lactation or a different service? Do you have your pump set up? How are you going to be using it?


Are you know all of these things that just didn’t occur to me to think about, and part of me is because I think this kind of useless debate about fat is best versus breast is best, has like sucked all the air out of the room, and everyone thinks breastfeeding is about are you going to do it? Yes, sir. Now, which, my goodness, if it were that simple, then we probably wouldn’t be having all these difficult conversations. But everyone is so busy, kind of needlessly arguing about fat as best and breast is best rather than saying, you know, hey, we think breastfeeding is a good goal for most new parents, like, maybe not always, but most of the time it is, how are we going to prepare and support that whether or not there ends up being some formula or not, is, you know, that’s a different conversation. And that’s going to be an individual conversation.


But to me, it’s part of the whole torture parents mentality that we have sort of make them worry about things that, you know, they can’t control and make them make all these decisions based on all this, this needless noise in the background, and that time would probably be much better spent if we could say, so you know, so you’re thinking about breastfeeding, or you’re interested in breastfeeding? Here’s how we should start getting ready for that. Rather than do you want to do it? Yes or no? Which is almost a needless conversation.


Jacqueline Kincer  17:41

Absolutely. That gets us nowhere, right? You can because we know, we know the majority of people want to, I mean, we can look at the CDC numbers and say that, you know, well, this many are initiating it, that’s how many want to probably right. But the rates fall so dramatically, because we haven’t prepared anybody to not only really get it off to a great start, but sustain it. And so, you know, are there breastfeeding management things that play? Sure. But are there a lot of other things like, you know, returning to work early, and, you know, lack of access, and all of those other things, apps, you know, those are all playing a role, right? So it’s really hard.


I’m glad you said that the whole Fed is best. The best conversation really detracts from anything that could potentially be beneficial to parents, it’s a momentary feel good if you’re on one side of those camps, and unfortunately, online content creation, you know, people have latched on to this mentality that if you’re polarizing, that is great for your engagement and getting your audience and whatever, that’s awesome for you. What does that actually do for your audience, though, other than make people angry and feel like crap and feel like they’re not good enough or, or feel like they need to passionately defend some choice that they’ve made? And, you know, we’re not really helping anybody? So I appreciate that.


Jeanne Marie Paynel  18:57

You called that out for sure. And no, absolutely. And one thing to clarify about the Fed is best breast is best. I mean, it’s, we can’t even get into it here. It’s such a complicated history. And there’s so much back and forth. And, and so much kind of, I don’t know, like, oversimplification, I think on both sides of that coin, but when I say that, we don’t need to argue about whether it’s worthwhile to start breastfeeding. I’m not saying we shouldn’t provide good information and counsel and talk to, you know, pregnant people and ask them what their goals are, what their thoughts are, there’s so much complex, you know, thinking that goes into it.


There’s a history of racism and trauma, and there’s just so much to think about, and that’s all-important, but, but assuming that we’re able to have those conversations, and really focus on Okay, there is some motivation to breastfeed. How can we support that? That doesn’t take anything away from the fact that some new parents may choose formula altogether or many will choose to introduce formula or if breastfeeding doesn’t work, that’s fine. So You know, the D stigmatizing formula and the removing pressures about lactation. It’s not contrary in any way to supporting breastfeeding, you can do both.


And when I say supporting breastfeeding, which is what you do, I’ve seen in your work, it’s giving those resources, it’s not taking away formula, it’s not taking away, you know, alternate plans or not saying, Hey, you’re going back to work in six weeks, we might have to make some difficult choices here because that’s our society. It’s just adding more things that help to breastfeed if and when you want it. And I think it really actually aligns with the heart of fat is best, which is stop trying to expect, you know, new moms new parents to breastfeed, and giving them zero support to do that.


That’s when bad things happen with families and babies. So the lack of resources that we give parents both before the baby’s born, especially after the baby’s born, it’s the lack of resources that creates this, this kind of emergency around breastfeeding, as we’ve seen now, with even formulas, you know, crisis, which I can’t even begin to get into, but as you said, return to work, a lack of lactation support, a lack of parental leave the lack of community support in-home, education and physician visits, like our society is telling women to breastfeed and then telling them, I will not help you with it. And that’s just not physiologic. That’s just not how breastfeeding works.


Jacqueline Kincer  21:31

So well said, I mean, you mean, so many excellent points. And, and I think on the flip side of that because our society has told women for so long, that we’re not here to help you, help support you with breastfeeding, they don’t even know where to go to get support. Like, I cannot tell you, the number of colleagues that I know, I’ve actually done some I used to run a practice before I became a lactation consultant. So I’ve done some kind of, you know, private practice, business coaching and whatnot and mentoring.


There are so many lactation consultants in private practice out there that have calendars that are far from full of appointments, there are so many, and there are so many that are willing to under charge to the point that I don’t even know why they’re in business, just because they want to help, right? There are so many people out there that offer sliding scale, whatever, and they are not fully booked. And it breaks my heart when I hear parents say, I don’t have support with breastfeeding. And I’m going and this person that supports breastfeeding doesn’t have any clients. Right? So and it’s not an easy problem to fix, right. And I’m not saying it’s the parent’s fault for not seeking this personnel, if you don’t know they exist, and you don’t know how to find them.


I mean, that is not something you would probably know as a new parent right off the bat unless you were given some direction to do that. And so there’s just this like complete crumble and breakdown of everything. And it’s sad because I’ve seen so many really good people leave the profession altogether because it’s not sustainable financially for them. They cannot make a living doing three appointments a month, and having their partner spouse not provide all the financial support so they can go and do this work they care so much about and so, you know, it’s really hard right?


To fix this, I mean, it’s a massive problem. It’s not just in the US, it’s all over. And you know, these poor parents are kind of left in the middle of it and their babies. And it’s like, well, yeah, no wonder everyone’s not everyone, but almost it feels like a lot of the time, but most breastfeeding parents are also using formula. And there’s a really good reason for that. No, it’s not because the baby medically needed formula, it’s because what the heck, like, if they’re having to wait two weeks to get in here, or you know, they don’t know this person exists, or they don’t have the money, or they can’t get even time off work to even go do on a plane. I mean, there’s all these reasons why you know, or they’re up in the middle of the night, they don’t know why the baby keeps screaming, they just know that formula keeps that baby happy.


So there are so many aspects to this that we could talk about. And it’s like, yeah, we’ve got a D to stigmatize all of these things. Right. I think, you know, there was like, and I think there still is, to some degree, but it’s, it’s overplayed a bit. You know, there has been a stigma against breastfeeding in the past. And so, you know, I think there’s still some hurt and a lot of, you know, sort of general generational issues we’re trying to overcome there. But there certainly is a stigma against formula as well that we have to acknowledge and it’s pretty, it’s pretty bad right now, it


Jeanne Marie Paynel  24:25

seems like especially if it’s the formula shortage, you would kind of hope like that would be not as bad but it brought some ugliness to the surface, even for America even for the ugliness that we throw at American parents. When I was initially asked to speak on on the formulas, shortage issue when even asked to write an op-ed, which I did, I remember I turned to Hell no, it was my husband or someone I was like, why would they ask me to write an op-ed, how is this controversial? The formula shortage is bad. Like, I don’t, I truly couldn’t wrap my mind around it. And I went back into working with them.


And I was like, Okay, I’m happy to do this. But just to be clear, like, could be a sentence formula shortage is really bad for babies and parents, let’s fix it. And then as I dug deeper, I was like, Oh, wow, people are using this as an opportunity to shame parents. I should have seen that coming. But my brain almost couldn’t make that connection. Like, how would you use this as an opportunity to punish parents who are already dependent on formula? in no small part because of the ways that we have failed their breastfeeding experience? And now you’re gonna go and tell them they should have just breastfed I mean, if that isn’t the most, gaslighting, manipulative, terrible thing to tell a loving parent, I don’t know what is.


Somehow, we have found new and amazing ways to really tell new parents, especially new mothers, no matter what you’re doing, it’s somehow not right. And it’s not because we failed you, but somehow you failed, or kid. And that is just so not true. And I would say if anyone is giving that messaging from either a pediatric perspective, lactation perspective, but anyone, anyone who’s telling you that the failures of society are yours, to bear is, you know, not only is that monstrous, it’s just not true. It’s just not true.


Jacqueline Kincer  26:19

Absolutely, absolutely. I don’t know if you’ve encountered this too. But like, it happens all the time on social media, where I will point out, you know, every now and again, on a post, like the reasons why breastfeeding fails, and I talked about that lack of support, parental leave, whatever. And, you know, inevitably, just sometimes people don’t read what you wrote very carefully, you know, and so they’re like, Well, I couldn’t breastfeed because X, Y, and Z. And, you know, how dare you shame moms. And I’m like, Girl, I literally didn’t say anything about individuals on their I talked about the societal workplaces, like racism, trauma, like, where did you find yourself in? And yes, unfortunately, you are caught in the middle of that. But I was actually saying, it’s totally not your fault, right?


Jeanne Marie Paynel  27:05

We’re so conditioned to see something and be like, Oh, someone is blaming me, for all of my, it was apparent that it like doesn’t even register that someone might be saying, No, it’s not your fault. Like, this is not your fault. We’re seeing this with so many things in pediatrics and parenting and public health right now. It’s so hard to say this is our reality, it’s not your fault. And not to say okay, so it is what it is, let’s just give all babies formula, let’s just let our kids get COVID. Let’s just not do anything.


I think that’s usually that’s often what happens is sort of this like, well, it is what it is, who cares? Or not, who cares, but I can’t, you know, it’s going to be what it’s going to be. And then, on the other hand, there’s this sense of deep personal responsibility. That’s not right, either, which is, okay, I hear what you’re saying. But I’m still going to kill myself trying to make breast milk, I’m still going to take on the COVID precautions as if it is public health or personal, I’m still going to do all these things. The reality, which is again, this is like me, not always practicing what I preach, it’s really hard. But the reality is, you can say, hey, this isn’t my fault. Society has failed me in these ways. But you can also say, I’m going to try my best to do the things I want to do despite that, and, you know, look for the people like you like me, who are trying to change those things in society, and also give me the tools to navigate it before it changes. That’s the really hard thing to live sort of in the middle between despair, and, you know, and pressure and all of that.


Jacqueline Kincer  28:37

Human condition.


Jeanne Marie Paynel  28:40

You’re always gonna be a little bit uncomfortable. You just have to not be too uncomfortable. Most Yeah, right. It’s like, Yeah, except things but doesn’t accept everything. Give yourself a break. But also try. I mean, these are the gray areas that are really hard. And yeah, that’s probably been the hardest part of being a parent. And then God bless me to try and actually help other parents on top of it and say, Yeah, you’re right, like, breastfeeding may not be sustainable for you. As much as it should be based on what you’re saying. However, here are the resources I think will give you your optimal experience. But if at you know, three months, you’re going back to work and you just have to do a bottle of formula overnight, because that gets you to sleep, you’ve still you know, you’re still at breastfeed or and I still want you to work with your lactation consultant. I still think it’s not all or none. You know, you can do what works for you at that time.


Jacqueline Kincer  29:38

Yes. Oh my gosh, can you just be every baby’s pediatrician?


Jeanne Marie Paynel  29:44

Oh, my gosh, I want well, I’m trying to be I you know, I’m really, no, I, I want to also be everyone’s lactation consultant. I want to learn I want to be, I want to be everyone’s everything. And I think, you know, a lot of that for me is just trying to undo some of the damaging stuff I see with parents and a lot I lived with, you know, this is intense pressure to do these things that at the end of the day, kind of didn’t matter, it didn’t end up mattering, that I pushed myself until seven months to pump around the clock through depression and anxiety. Because in my mind that was giving my daughter, you know, a concrete thing when I left her out, you know, I went, I was a resident, I was doing 24-hour call.


And I remember pumping overnight, and being like, well, at least I’ll give her milk Well, on the way on the shift, which I think is a relatively common thing that happens with working parents, or at least my peers. And I look back on it even a few months later, and I was like, Well, that was dumb. Like, she would have been fine. Or just you may be even happier if I had come home and gotten an extra hour of sleep, and given her three ounces less that day because I was so tired. Just things like that. You know, that’s one example. But yeah, it’s just we’ve got to be nicer to ourselves, and we can still help our kids and push ourselves to do good things for our kids. But the idea that somehow agonizing and torturing herself, we’ll make that happen. It’s really, I don’t know, I think people who are trying to sell things came up with that. That’s my guess.


Jacqueline Kincer  31:19

Yeah, there’s actually a really good podcast out there that I’ve been listening to that you might be interested in. I don’t know if our listeners will care, but it’s called Duped: The Dark Side of Online Business talks about that kind of marketing push and how it gets people to kind of engage and buy those types of products that they’re selling, right. And so I always try to be very cognizant of that, it’s sometimes hard to try to share your message without sounding like you’re, you know, doing that it’s a fine line. So we’re always working hard at it.


You brought up something about, you know, parents really kind of overdoing it, right, like, really pushing themselves to the point where it starts to become not optimal for them to breastfeed, and a lot of self-blame and that kind of stuff. And let’s switch gears just a tad. Because I think it ties into one of the things I really wanted to chat to you about, which was tongue tie. There’s a lot of times, you know, when I’m seeing a niche subset of people, right, like, you get to see it all, we get to see the people that have breastfeeding problems specifically. So, you know, in our world, it’s like, whoa, why are so many babies are tired? Well, we don’t see the ones that are breastfeeding just fine. Because why would why on earth would they come to us? You know, most people are not like, hey, just want a breastfeeding checkup.


Jeanne Marie Paynel  32:33

Like, although we should, that’s a different story.


Jacqueline Kincer  32:36

we should have those, we should. We should you know, every now and again, I do get that rare person that just cool head on their shoulders about it and like, okay, and you’re like that was the shortest appointment ever. Thank you get to go have lunch now. But it’s, I see where it gets to the point where they and it’s kind of this conversation that we’ve been having all along about, like going on the internet and finding things too. So there’ll be like, I’ve tried it all. I’ve watched YouTube videos, I bought these cookies, I took this person’s course I saw to lactation, you know, and it’s like a mess of things. And they’re like, What am I doing wrong?


And then someone like me works with them. And I’m like, You’re doing everything right. But your baby has a congenital defect called a tongue tie that is preventing breastfeeding from going well, holy cow, you went and bought, you know, all these breast pumps and bottles, and, you know, all of these things, right? And all this time and emotional energy that’s been invested. Now, this isn’t all the time, right? I’m just giving one example. But this blame, you know, or when moms don’t make enough milk it’s like, well, what am I doing wrong? What’s wrong with my body? And I’m like, nothing, you’re just working a lot. And you don’t have time to pump. Like, your body’s responding exactly as I would expect it to. And that’s okay, you know, and so, there’s this self-blame where I feel like they take it upon themselves, if breastfeeding doesn’t go, well, like that personal responsibility, but sometimes gets taken way too far.


But back to what I was saying about tongue-tie, you know, we can only optimize things to a point because otherwise, I mean, you know, it’s like, it’s not as bad as that. But if a baby has a cleft palate, I mean, well, gosh, we can only do so much. Right. So what do you see with tongue-tie and whatnot? You know, I think you have a really good head on your shoulders about it a conservative approach, which I think is refreshing. In some ways. I feel like there’s the lactation side of things where people can be really overzealous about ties and just be very convinced that there’s always a tie and let’s chat about that. What do you see what’s tied is what are your thoughts on them?


Jeanne Marie Paynel  34:44

I agree with everything you’ve just said. Those are all amazing points. The tongue tie thing you know, reminds me of everything else with parenting, and breastfeeding comes so so weirdly polarized and in ways you might not expect. Sometimes I take a step back and I’m like, Oh, that’s so interesting. It’s almost the wellness community, the noninterventional nonallopathic community, yes, really into this procedure. And whenever something is incongruent, like that is, or anything that’s polarized. I mean, it’s a complicated way to look at things. But I do think you have to take a step back and ask yourself, like, how did we get here? Like, why is this happening?


I know more about my community side of things, the pediatric side, which is a little bit of something that’s going to parallel the breast is best Fed is best. It’s a pendulum where we used to do them all the time. And we did way too many of them and we were the ones who were, you know, snipping everyone in the newborn nursery and, and thinking that tongue ties cause speech delay, and they actually don’t really it’s, it’s, you know, we’re thinking that most, you know, even a mild tongue tie is going to be at the root of these breastfeeding issues. And they usually aren’t, you know, in those cases, especially when there are other things going on, that we haven’t optimized. And so we tried to course correct.


We tried to get some more evidence and, you know, do actual real science and get studies and try to get a better sense. And that’s part of a trend in pediatrics overall, to stop guessing quite as much as we do. And some of our guesses are good, you have to guess if we don’t have evidence, and you can use science, but we try to get more evidence. And so I think what we’re seeing right now are the pendulum kind of pretty far against the friendly luck dummies and the other repairs. Because the evidence showed us that we were definitely overdoing it on our end, we definitely would jump pretty quickly to correcting things that we saw without actually taking the time to understand if they were a problem or what the other problems might be.


When you do that when you change how you train pediatricians, but you don’t really give them tools to become experts in breastfeeding, then it’s hard for us to not go the other direction of saying, well, tongue ties really aren’t the problem, because we don’t get to see all the work of okay, this is what it might look like to do a true assessment of feeding up the breast because we don’t necessarily get the best training on that, or this is what it might look like to work really hard on some positioning and worked really hard on other kinds of maternal factors or, or what have you, we don’t really have that experience the way we should. So we ended up saying don’t do it, kind of as our default. And I think it sort of just worse the cycle becomes more and more we’re saying we perceive that they’re being overcorrected, others perceive they’re being under corrected.


The truth is probably as it always says, It’s like my third time saying this could be a drinking game, but it’s somewhere in the middle. You know, it really is somewhere in the middle. So I’m not, you know, I’m not an all or none. I think there are instances in which tongue ties are clinically significant. And the repair benefit is more than the risk, I think there are instances in which they’re not and the risk outweighs the benefit. And that’s kind of like the unsatisfying, nuanced answer as much as medicine is it’s not a yes or no, it’s a risk or benefit. You know, a procedure has risks, even if the risks are small, for something to have benefit, it has to have risks for something of risks, you know, theoretically, there’s some benefit to it, when it’s so clear that the risks outweigh the benefits, we just say it’s not safe. And that’s like not getting vaccines or not having clean drinking water or something like that. But if there are some cases where the benefits outweigh the risk, like, even the emotional importance of using formula strategically, and maternal mental health, or you know, things like that, then, you know, we just need to talk about it more,


Jacqueline Kincer  38:47

yes, risk and benefit. And, you know, it’s I don’t know, you probably don’t get this as I do, but you know, sometimes I get these messages from people, right, and they send me a photo of their baby’s tongue, and they’re like, is he tied the knot? And I’m like, first of all, that would be medical advice. And I can’t do that just right, Instagram. Second of all, a photo doesn’t tell me anything about what’s going on with your baby’s oral function, nursing or bottle-feeding, or any of that. And then third of all, even if I was like, holy cow, that kid’s tongue is tied to the tip of his tongue and like, it’s very obviously a tongue tie.


Why on earth would I send you to go get a procedure to get it snipped or lasered or whatever method, you’re gonna get it done, and not make sure that you’ve already got all of the breastfeeding management stuff in place or feeding management stuff in place to optimize feeding outside of that problem because it’s never one thing I can confidently say after six years of practice, it is never one thing. It is never all the way it was just the tongue tie and you didn’t need the lactation consultant. You didn’t need the pediatrician. You didn’t need the whatever, OT or something and that Oh, just like cases where sometimes we just need to involve even more people, because a lot of times, parents get fatigued with trying to latch the baby one way, or they were taught one position in the hospital. And three months later, they’re still using the same one. But their baby has, you know, gained all this weight and as a totally different baby. It’s like, we’re still using football, like, whenever, when no one ever showed you anything else, like, that’s just wild to me.


And they’re like, it didn’t occur to me to ask, you know, right, right. And so you’re like, Well, if we’re not optimizing all of those things, and seeing if that gets us the level of improvement we’re hoping for, which is really kind of subjective, right? Because it’s like, you know, how much does this parent want to breastfeed? Right? And then what’s what improvement look like for them? Is it no pain in their nipple? Is it the baby’s getting enough to eat? Like, what is their goals? And then once you reach those goals, if we did those without having to clip a tongue tie, then great, why on earth would we go and recommend that you get that clipped, but when parents go in mom’s groups, they go online, and they find these directories of dentists and doctors and EMTs.

And whoever, you know, has got a fancy device out there, or maybe just a pair of scissors, and they go and get this done. And then they go. Now there’s like this backlash, which I appreciate because they’re like, well, that, you know, I got my baby’s tongue, tongue tie release didn’t fix anything. Yeah, I wouldn’t have expected it to, because what was going on, to begin with? And what did you do to fix it besides surgery, these things are expensive, and it’s painful for the baby. And it can be traumatic for the parents and the baby and all of that.


And if you’re just, you know, I think the over treatment comes in with the rush to treatment, because I would say if something has been properly evaluating, and assess that that risk-benefit has been done, well, then we’re not over-treating because we’ve decided this is going to result in X percentage of improvement that is worth it to you. And then ultimately, it is the parent’s decision to sometimes you go through all of these things. And, you know, maybe that family comes back and says, You know what, like, that just seems like a lot or we don’t want to put our baby through that. Yes, we acknowledge there is a tie. But you know what, we’re more comfortable? Just bottle feeding. Okay, great. Let’s support you in that.


So I love what you’re saying. Because I think there is this like passion on the part of parents where it’s taken them so long to get that diagnosis of a tie. And they fought so hard for it that they feel kind of slighted by the medical community until that one person finally listened and did it and you know, it was needed for that family rights and others like very vocal advocates for it. But then you get these parents that latch on to that. And then they go, oh, yeah, that must be why it hurts. That’s why it’s not going well must be a tie. And then you’ve got moms and moms groups going, have you had your baby check for ties, you know, or here’s how to check. Here’s how to self-check your baby. And I’m like, Whoa, hold on, because there’s just so much more involved. And I appreciate that you have that perspective, because it is not so black and white, like you said.


Jeanne Marie Paynel  42:50

I appreciate you’re echoing it. And even saying, like, as we talked about the formula is not the enemy. Friend, your left knee is not the enemy like nothing is the enemy and nothing is a quick fix. And anytime you’re getting a quick fix recommended that’s just to meet should always kind of signal some sort of alarm, that if someone is telling you this is going to be easy or quickly fixed. I mean, that feels good. I would like to hear that more often in my life. If I could just get this, then I wouldn’t have to worry about that. Or if I just got this then I could have breastfed that is that is a nice thought. And I wish so much that that was the case.


But as you know, breastfeeding, again, not to overstate it, but you can’t really overstate it is so complicated and multifactorial mechanically, emotionally, and physiologically it is, it is not an easy process. And so it is highly unlikely if not impossible, that there’s going to be one single way that you can optimize it. And usually, if someone is saying there is they are probably in some way making money or gaining notoriety that then gets the money. And we see that in the mainstream medical community, we see that in the wellness community. And that always to me, in any part of parenting, and very commonly in breastfeeding. That to me is always like an automatic take a pause, ask yourself, Is there a problem? What is the problem? Who can actually help me evaluate the problem?


Not just this is the solution to x? Because that’s how advertising works. Like you were saying you have to convince someone that there’s a problem. And sometimes there isn’t in parenting or breastfeeding. Sometimes there isn’t like a true problem. There are just some ways that you can optimize it. And then you have to convince someone that they’re one single thing they’re one single intervention will fully fix that problem. And it’s just never like that. Because parenting is freaking hard.


Jacqueline Kincer  44:47

Yeah, it’s so true. It’s so true. It’s funny when people and I get it like they’re, you know, you have to pay out of pocket for so many health care things these days. I mean, even you know in my family my husband has a great employer and in great health care through that great being subjective, because we have a super high deductible and all these things, right? So it’s like not really. And so parents are trying to be more cost-conscious.


And so they’ll sometimes contact me and say, Well, if I come to you, for, you know, you do this assessment of feeding and you know, assess for function and all of these things, and whatever, well, are you going to be able to fix my baby’s tongue tie issues? Or should I just save money and go right to this doctor that will treat it? And I’m like, Well, neither. And if you’re not committed to the process of exploring what’s really going on, and working with multiple people, we might not be the best fit to work together. But if you want to maximize your improvement of breastfeeding, I know we can do that piece for you. And then my favorite question is, do you have a money-back guarantee? And I’m like, what? I would never guarantee anything in health care. Are you kidding me, not to be offensive, but I’m just like, oh, no, I could never, you could never, I’m like, you know, and I try to illustrate that picture to people like, I don’t breastfeed your baby for you. So when you’re done with this appointment, what you do is in your hands, and I don’t have a say in that, and I cannot control you, I cannot watch you, nor do I want to, I do not want to hover over you and micromanage you.


I want to give you the information to empower you to do this really well on your own. And ultimately, my job will have done is when you don’t need me anymore. You should not be I mean, yes, you may need more than one visit, right? But it’s like, you definitely shouldn’t be coming back to me for months and months and months and months. Because that would just be a money grab on my part. And we don’t play that game here. So I try to remind people of that, like, you know, but also going to a pediatrician, not the same as a lactation consultant, but like, you don’t go once check out the baby and go, Yeah, everything’s an Okay, bye. Like, no, that baby is growing, they need to be monitored. And all of these things like, you know, it’s health care, right? It’s not a, I don’t know, yeah, we’ve kind of gone arrived with some of this sort of polarizing and marketing stuff that parents are so subjected to these days. So how are you gonna market your book? Oh, just kidding.


But I love the title of your book and your Instagram account of the same name parent, like a pediatrician, because it’s so approachable, you are so approachable. The fact that you were like, Yo, come on your podcast. And I was like, awesome. Because I feel like sometimes, you know, there’s this perception that people like you might not be approachable. And here you’re writing a whole book about it. So tell us more about like, what’s in your book and more about what you’re really I mean, you’ve shared so much about what you’re already advocating for. But you know, what, what you’re really advocating for out there in the world and what you hope your book will accomplish? Oh, well, thank


Jeanne Marie Paynel  47:44

you for all of that. I mean, the book really, is just what I wish I had had. And I mean that So truly, and when I say parent, like a pediatrician, I mean, it’s a little bit tongue in cheek, it’s a little bit, it’s mostly genuine. But you know, when I had my child I was I had a really difficult postpartum experience with a share very openly. And, and part of it was this, this terrible divide that we’re talking about between those sort of accessible realistic parenting advice, that just struck me as unscientific or not completely scientific, and is what I was sort of just like grasping for anything to help me feel like I was doing okay, and would know what to do.


And then the quote, unquote, scientific advice, that just the way that pediatricians are presenting it is more out of a medical, you know, a medical perspective and less of a parenting perspective. And it is, honestly a lot of rules and a lot of checkboxes. And it took me a while to understand that. You know, while there is a lot of good science behind those parents are being turned off, I was turned off by the fact that it didn’t seem to really understand my unique situation. And it didn’t seem to understand, so it was easy for me, because for example, here’s an example of vaccines. It was easy for me, I had done decades of deep diving into them. And I understood not decades old, but many years of researching why I was passionate about them. And I had no worries about vaccines.


Great. But breastfeeding, that was something I really didn’t know a lot about. And all I knew was that breast is best or some version of that. And then I wanted to breastfeed, but I really didn’t understand the nuances of what it might look like for me how I could set myself up to try what it might look like if it didn’t succeed and the way I thought how I could redirect with the resources where I was the seeing again, nonsense fed as best versus breast is best. I was seeing ads for supplements, ads for pumps, and these and expensive things that just confused me. I couldn’t understand how to get the thing I wanted, or even really know what my breastfeeding goals were how to even begin to think about that, because I was just being flooded with all this very unhelpful messaging, a lot of well-intentioned but it’s just in synthesize things for me in a way that explained what I ultimately, you know, go through in great detail in the book, which is, you can absolutely want to breastfeed, it’s great, you probably try to breastfeed in most cases, here’s what that might actually look like for you, in the first year of your baby’s life, here are all the people who are going to come in and help are the things that might be red flags.


And at the end of the day, whatever you end up with, if you’ve not tortured yourself, and if you’ve gotten the support you can, that’s what your baby needs. There were so many topics I was, you know, Safe Sleep was another controversial one that I took a deep dive into, you know, Kevin, visitors over people would ask me things like when can my baby travel? And I would say, I don’t know. I have no idea. Or I would ask myself, when can I fly and see my family? I was like, I have no idea. I’m a pediatrician, I have no idea what the answer is to this, I just knew that I had to do a lot of research. And I had to ultimately, what I really am trying to do is share the perspective of knowing that you can be safe and realistic at the same time, that you can both be the expert and your baby and follow your instincts while also getting good advice, you know, from good scientific sources that there is this, like you said, parent, like a pediatrician, you can ultimately do what the seasoned pediatrician parents do, which is know how to find the information you need and know how to use it in your situation or have a philosophy rather than a, you know, a step by step recipe for how to grow your baby. Yes,


Jacqueline Kincer  51:33

I love that. Well, you have this post that you made that I still see, you know, getting reshared that’s gone viral. And I cannot remember the exact phrasing. I’m never good at that. But it’s something about you sharing something about your daughter. And like an example of you know, this is happening, and I’m a pediatrician, what we’re supposed to get, I can’t remember what it said.


Jeanne Marie Paynel  51:56

It’s me, it’s the fact that and this is very true. One day, I was trying to get my daughter to eat dinner, but all she wanted to do was pick strawberries and catch up. And that became her meal. And honestly, I was kind of pleased with it, it’s through. And it’s pretty good for her. But it was also just like, at the time, I was also taking calls from work. And I was also posting, you know, and answering questions for people who are like, Is this okay for my baby? And I was like, I mean, yes, I have a lot of expertise. But don’t think I’m perfect. My daughter is just sitting here eating this very weird, like, not ideal. At the time for me. I mean, it’s totally fine. But it’s not like I’m sitting here, my toddler is doing this perfect baby-led weaning and sitting there and has table manners and is breastfeeding on demand. Like, none of that’s happening. So I’m just doing my best I am having doubts. I’m trying to get through them. And you know, I’m, I’m making mistakes, of course, because I’m a human person and not a robot.


And, and I just wanted people to kind of see in this, what I’m trying to see is that I’m not saying it doesn’t matter and do whatever you want. I’m saying it’s the patterns of what you’re doing. It’s the love you’re putting into it. It’s the kindness you’re giving yourself. And it’s, you know, following a few basic things, like I said, making sure that you’re getting reputable medical advice, you know, not not going too wild into the, into the fringes of the internet. Other than that, it’s harder to mess it up. And we think it is if you’re coming at it from a place of modeling, taking care of yourself, and making using some critical thinking. And that’s basically it.


Jacqueline Kincer  53:38

Ah, oh my gosh, it’s so approachable. It’s so doable. You know, and I was just, it’s funny, you say all this because I happen to just be reviewing some studies about, you know, specifically looking for one, you know, unfortunately, the pandemic kind of, you know, blew a hole and our ability to see really recent studies and things.


And then it’s, it’s catching up now. Right, but like I was looking at when you know, what are the reasons when we’re studying this? Why do moms stop breastfeeding? And, you know, or even why did why do they not start breastfeeding? And some of the answers were so sad because it would be something like, you know, parents saying, you know, I have some friends that are saying breastfeeding is the best thing ever. And they love it and you know, it’s going great. And I have other friends who tell me how hard it is, how miserable it is. And then you know and having to drop your baby off at daycare and then pump it work and all of this in like I didn’t even want I don’t want that I don’t want to experience the misery and, and all that and it’s like, it’s not one or the other though. And, you know, it’s I even tell people like, especially like I get a lot of patients where we get them to a point of improvement. Right.


And it’s really, you know, breastfeeding is going really well. And then any time there’s like this niggling little like a minor thing that isn’t going 100% Great. And they’ll call me and I’m like, No, like not every latch is going to be perfect. You are gonna have days where you’re like, oh my god, it’s we have to like to calm down that hyper vigilance, I think as parents like what you’re saying is, yeah, you know what, one meal of strawberries and catch up as long as it’s not every day, right. So it’s like one bad latch one clock-docked one, whatever, if we’re putting in the context of breastfeeding, that does not have to ruin everything, it doesn’t mean that you’re not doing this right or any of that.


And I love that that’s your message, right. And I think you also open it up to an opportunity for parents to say, this is like recoverable. So maybe, like what I like about your message, especially when you talk about things like on your profile, and you probably touch on these things in your forthcoming book. But you know, whether it’s like sleep right, or lately, obviously, unfortunately, you’ve had to address gun safety, you know, all these other topics, it’s like, just because maybe you weren’t on board with something in the past doesn’t mean that you can’t be on board with it now.


And you leave that door open. I feel like for parents, it’s like an invitation, this warm welcome invitation from you, that just feels like hey, I’m here for you. And I’m not perfect either. And I really like that I think that is the key to having healthier babies, healthier families, increasing breastfeeding rates, and just making the world a safer place for everyone. And I think that your work is incredible. I’m so I’m, I’m no big, you know, the newspaper for op-ed or anything. But I do hope that giving you a voice on the show today is something that will create some echoes for you and for people to access you and your book in the future because you’re doing incredible work and you inspire me and I hope that parents are inspired to check out your book but also follow you on Instagram and just get some really like realistic evidence-based you know, the doable conversation going in their feeds as opposed to a lot of the stuff that seems to anger and upset people these days.


Jeanne Marie Paynel  57:01

Oh my gosh, I’m absolutely beaming that is so beyond kind and really means so much coming from you. I’m so happy to have found this connection and be with someone who just like you said, we just, you know, trying to make parenting trying to make breastfeeding trying to make life this take on this terrible spinning globe. That is Earth right now. Just trying to make it a little kinder, a little easier, a little more understanding. Because if it were about proving that you’re right or proving you know that you are the fix or making the profit or giving that money-back guarantee, like you said, like, that brings me no joy, I can tell it brings you to know, joy, all that brings, you know, me and the people I work with and your joy is just trying to actually help parents, if anyone can learn from my mistakes, even the mistakes of just giving myself way too crazy expectations and viewing myself as a failure when those hiccups came and I did the best I can. If I can spare you from that I will have absolutely done my job. And it will fuel me for the days and weeks to come.


Jacqueline Kincer  58:09

That’s so beautiful. Well, it’s been an absolute pleasure. Dr. Diamond, thank you so much for your time today. And thank you for doing the work you do.


Jeanne Marie Paynel  58:18

Thank you again.




In today’s episode, Jacqueline chats with Pediatrician, Dr. Rebekah Diamond about all things breastfeeding, motherhood, and babies. 

This episode is a meeting of two very different types of baby experts. Jacqueline and Dr. Rebekah Diamond are in two different professions that often have different approaches, philosophies, and even different pediatric politics. This is a conversation that bridges the gap between IBCLC and Pediatrician.

In today’s show, we discuss:

  • Some of the biggest breastfeeding struggles mom’s are experiencing
  • Myths and common misconceptions about tongue ties
  • Why pediatricians and IBCLC’s should be working together and not against each other

A Glance at This Episode:

  • [2:14] How Dr. Rebekah Diamond became a pediatrician and why she got into this work
  • [14:23] Some of the biggest barriers for breastfeeding success from a pediatric point of view
  • [32:55] What Dr. Rebekah Diamond sees with tongue ties, and her thoughts on them
  • [47:09]What’s in Dr. Rebekah Diamond’s upcoming book, what she’s advocating for and what she hopes her book will accomplish

Related Links: