Medela Australia Asks the Experts: Questions to Dr. Donna Geddes

Some of the most exciting and practice-changing research in the world of breastfeeding and lactation comes from this group. We are super lucky to have them here in Australia.

Donna and her team were the first researchers who used ultrasound methods to show that the anatomy of the breast was completely different to what all health professionals had all been taught in their textbooks since the 1840’s!

Here, Donna talks with us about the research she did looking at how babies suck.

What did you and your team see when you looked at babies sucking at the breast with ultrasound?

When we used ultrasound to get images of the baby’s tongue during breastfeeding we were able to see that the baby does not “milk” the nipple or breast in the way people do when they hand milk a cow.

Instead we found that the baby draws the tongue down and evenly expands the nipple allowing milk ducts to open up.

As the tongue draws down a vacuum or suction is created to help remove the milk. So the vacuum and smooth tongue action appear to be the main way the baby removes milk from the breast.

Is this the same type of ultrasound used in pregnancy?

Yes the machine is the same however we use a small long-handled probe that does not interfere with feeding.

Did the babies mind all that cold jelly?

Well we have the jelly at room temperature so we haven’t shocked a baby yet with cold gel.

When they are feeding they tend not to be too disturbed at all about the probe and jelly.

What should every new parent know about how their baby sucks?

Parents should know that their baby will suck to remove milk, which is termed nutritive sucking and sometimes they will suck and not remove milk, which is called non-nutritive sucking. Both are normal.

They should also know that breastfeeding should not be painful and, if it does hurt, mothers may need to seek the help of a qualified professional such as a lactation consultant.

Our studies have shown that some of these babies suck so strongly it is painful.

Are there any good tips for new mums to know that their baby is feeding well or signs of when to seek more support?

Usually, we measure how much milk the baby removes from the breast by weighing the baby before and after a feed. Babies often take different volumes at every feed and the volumes one baby takes may be smaller than those of another baby.

Also some babies feed frequently and others not so often. So it’s best to feed when the baby is hungry rather than expect the baby to feed every 3 hours rigidly for example.

Signs that the baby is not feeding well include if they are consistently not satisfied after feeding or are fussy at the breast. This might be because the baby is having difficulty feeding or it might be because the mother is having a problem making milk.

It can be hard to tell which is the issue as it is necessary to remove milk to make milk so if less milk is being removed less milk will be made. That is why it is important to seek help early.

Another sign the baby is not getting enough milk is when their weight gain stalls or does not follow the normal growth curve.

Did your research show any differences in how preterm babies suck or start to feed?

Yes our research shows that preterm babies suck more softly when they breastfeed compared to term babies. This is probably due to their limited energy, which is diverted towards growth and maintaining their temperature as well as being generally underdeveloped such that they have less muscular strength or low tone.

Breastfeed babies have to stretch the nipple and then move their tongue up and down to create the vacuum or suction to remove milk. This requires extra effort therefore it may take practice for the baby to learn to suck at the right strength and position the nipple correctly to remove milk.

Importantly, our research shows that every baby is different and has different patterns therefore each baby will progress with their feeding at their own pace.

How has your research changed the clinical practice of the health professionals, which support mothers and babies breastfeeding?

Our research has placed more emphasis now on how strongly the baby sucks. For instance, if the baby is unable to attach to the breast and/or remove much milk, it may be because they cannot create enough vacuum.

In this case, the clinician may recommend that the mum pumps her milk to preserve her milk supply whilst working on resolving the issue with the baby.

If breastfeeding is very painful, after ruling out infection or vasospasm clinicians may suspect that strong vacuums are the problem. Then they can devise a strategy to either rest the breast occasionally throughout the day by feeding expressed milk or consider the use of a nipple shield for a period of time to reduce the vacuum and the pain.

Can you tell us a little bit about the Hartmann Human Lactation and Research Team – What significance it has for lactation research around the world?

The team is one of the largest in the world studying human lactation and one of the few studying it from a holistic view where we consider the mother and the baby as well as the milk the baby is consuming.

We are working to understand how the mother produces milk and how babies remove the milk from the breast. This knowledge will provide a solid basis from which to develop treatments and good advice for breastfeeding women that are experiencing difficulties.

We are also working to understand how breastfeeding confers its myriad of benefits such as optimal growth, protection from infection and also how it lowers the risk of chronic disease later in life such as obesity, metabolic syndrome, diabetes and heart disease. If we understand these processes we have a chance to improve them if things go wrong.

Our research is classed as basic research. Therefore, most of it can be applied to mothers and babies all over the world.

From a scientific perspective, we have partnerships with other eminent scientists that allow us to discover even more about the amazing process of lactation and breastfeeding.

What studies are you working on right now or do you have planned?

We have many studies in progress right now. One is aimed at looking at how human milk helps lower the risk of disease later in life.

Human milk contains what we call appetite hormones that are known to tell us when we are full or hungry. Leptin is one of these and tells us when we are full.

We are looking at the leptin in the milk and are determining whether it is related to the babies body composition (muscle mass and fat mass). This is important because we know that the mothers BMI influence the amount of these hormones in her breast milk and this can potentially affect infant growth, which can contribute to risk of obesity later in life.

In some babies, a short frenulum (the membrane under the tongue) is tight and is called a tongue tie. This can sometimes cause problems during breastfeeding where the babies either can’t latch to the breast or latch on and cause pain.

We are looking at whether the strength of sucking changes in tongue-tied babies after surgery (frenotomy) and if this is a factor in improving breastfeeding. This information will help in making decisions about whether surgery will really help these tongue-tied babies.

Further, we are investigating the source of nipple pain which is one of the main reasons women wean their babies earlier than intended. We have many techniques that allow us to do this such as metabolomics, which accurately measures very small molecules in the milk and we are also able to test for infection.

Interestingly, some of these babies have a very strong suck so we are working out how we can best help the mothers of these babies breastfeed.

We also have studies that measure the milk production of the mother and the milk intake of the baby (often the baby does not remove all of the milk the produces in her breast.) This helps us decide if a mother has low milk production and then we investigate the reasons why this might be.

For instance, from these studies we can tell whether the mother has trouble producing enough milk or whether the baby is struggling to remove the milk from the breast.

What topics would you like us to cover in a future “ask the experts” article? Let’s start a conversation here or on the Medela Australia Facebook page!