Ep 259: Understanding the Link Between Feeding & Sleep with Hillary Sadler of Baby Settler

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So many parents feel like they have to choose between sleep and breastfeeding and today’s guest, Hillary Sadler, says that's not the case - and she knows what she’s talking about! A registered nurse, International Board Certified Lactation Consultant, and mom of four, Hilary is a true expert in the art of balancing feeding and sleep.

Getting enough sleep is going to be vital for your mental health. I’ve said it a hundred times and I’ll say it again: To have a healthy baby, you’ve gotta have a healthy parent. Do future-you a favor and understand the link between feeding and sleep before baby comes home.

In this Episode, You’ll Learn About:

  • How “quality, effective, efficient” feeds can impact sleep
  • What the biological link is between feeding and sleep
  • Why you should think about your sleep goals
  • How to maximize your newborn’s wake time
  • What makes an efficient feeding pattern
  • What the five S’s are
  • Why you should approach day feeding and night feeding differently

Links Mentioned in the Episode

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Dr. Nicole (00:00): Interested in getting a headstart on how to get sleep while breastfeeding? Then this episode is for you.

(00:12): Welcome to the All about Pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now, let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 259. Whether this is your first time listening or you have been here before, I am so glad you're spending some time with me today.

(01:08): So many moms feel like they have to choose between sleep and breastfeeding. And Hillary Sandler says that is not the case. Hillary is the founder of Baby Settler and she is on a mission to empower new mamas and mamas to be with on demand evidence-based information to help them rock the precious newborn stage. As a registered nurse, international board certified lactation consultant and mother of four, Hillary has been providing her growing online community of more than 66,000 moms with foundational tips to understand the biological link between feeding and sleep to help lay the foundation to maximize the fourth trimester. Hillary believes it's best to understand this relationship before your baby comes home. That way you can really maximize those precious newborn days. So we have a fantastic conversation about how to help your baby have more efficient and effective feeds, and how that in turn leads to more sleep.

(02:12): We talk about how you can gain control of your baby's wake time to help prevent fussiness. We also chat about effective strategies to get your baby to naturally sleep through the night. This episode is packed with information and I know you are going to find it useful. Now, another thing that's packed with information is the birth preparation course. The birth preparation course is my online childbirth education class that will get you calm, confident, and empowered to have a beautiful birth with a focus on getting ready for birth in the hospital. You can check out all the details of the birth preparation course at drnicolerankins.com / enroll. Well over a thousand mamas have gone through the birth preparation course, and I would love to help you get calm, confident, and empowered for your birth too. Check it out and use the code Dr. To get 10% off today. All right, let's get into the conversation with Hillary. All right, thank you so much, Hillary, for agreeing to come onto the podcast. I'm very excited to hear your story about what you do and how you came to do it.

Hilary Sadler (03:21): Well, thanks for having me. I'm excited to be here. I have a hard time with being brief, so I'm going to try to keep it short.

Dr. Nicole (03:31): I love it. I tend

Hilary Sadler (03:33): To linger. It's hard.

Dr. Nicole (03:34): We have to know where we stand, so it was like how we approach things. So why don't you start off by telling us a bit about yourself and your work and your family if you'd like. Yeah,

Hilary Sadler (03:45): Absolutely. So I'm a mom of four. I come from a family of healthcare providers, which I think is always good to know just because growing up in a family, my dad, he's a family practice doctor now, but he was an ER doctor. And then my mom is a family nurse practitioner, but she actually works, she's family nurse practitioner, but she works in an OB g yn office. So she does women's health. She doesn't deliver babies, but she helps support the OBS in their role. And then my background was I actually went to nursing school after my first child was born. So my age, I have a 12-year-old, an 8-year-old, a 5-year-old, and a 21 month old. So three boys and a girl.

Dr. Nicole (04:28): Okay, I have to ask, is the girl the fourth one? Did you keep going? She's number three. Number three, okay.

Hilary Sadler (04:32): Alright. She's number three and number four was a surprise. We did not find out what we were having was number four, but I knew it was a boy. That's a whole nother story I think sometimes when you're in the healthcare world and they didn't tell me it was a boy, but you could pick up on language and some things happened that I was like, it's a boy. I had to go see maternal fetal medicine for something. And the way he answered a question for me, I was like, it's a boy. It's a boy.

Dr. Nicole (04:58): Gotcha.

Hilary Sadler (05:01): But yeah, so I went to nursing school with the intention of becoming a labor and delivery nurse just because I had such an amazing experience after my first baby and just I was like, I want to be involved in some way in this season of life for the rest of my life, but I know my husband is not going to let me have 10 children, which I don't think I could do that anyway. But I have passion for moms, new moms and babies. So went to nursing school after my first was born and then got a job directly in labor and delivery, which was amazing. And I worked as a labor and delivery nurse for about five or six years and then ended up moving into a lactation consultant role in the hospital, inpatient, lactation, loved that side of things, but initially did that just because of the hours and it was really getting hard to work 12 hour shifts and needed a little bit more flexibility with my personal life. And then long story short, I am from the area that I grew up in this area, and so all of my friends started coming to the hospitals, having babies, and I would see them and I'd get the text messages and I just realized that there was a gap and they needed some more support after they left the hospital. So I became that person, and I think I am because I'm medically grounded and definitely evidence-based. But also over the last couple of years I would say I'm a little bit crunchy, but not

(06:34): More just like root cause and more than surface level and just really trying to share that side of things as well. I have that my parents keep me in check as far as when I have a wild idea. They're like, well, what They help keep me accountable to, what does the evidence actually say about that? And they're right. We should look at that for

Dr. Nicole (06:55): Sure. Absolutely. Absolutely. Yeah. And that led you to start baby settler. So tell us of what baby settler is.

Hilary Sadler (07:03): Yeah, so Baby Settler is kind of like your non judgy nurse friend who is always available. So there's a lot of information on social media, which is good, but there's some cons to it. And especially I was telling my friend the other day, I was like, I cannot imagine being a first time mom right now if I had to go back even 12 years ago as a first time mom. The amount of information, conflicting information, overwhelming information, whether it is an influencer or a brand or somebody locally, everyone wants to help pregnant women and new moms. And it's really hard to figure out what is accurate, truthful evidence-based information, and it's just overwhelming. So that is what Baby Settler seeks to do is we hope to show up and be that non-judging nurse friend. So my background, I am an I-B-C-L-C lactation consultant, and I'm also a registered nurse and I have my master's degree in nursing.

(08:12): And I say that because I spend a lot of time really questioning the status quo and looking at like, okay, well this says this because the truth is is that you probably can find some kind of PubMed article to support whatever position you want to support because there's so many out there. And I think it's just really hard for people in this season of life and really for anyone to unpack what is the truth and what's not the truth. But really even deeper than that is just making sure that moms have the information so that they can make truly informed decisions, truly informed decisions.

Dr. Nicole (08:52): Yes, I love that. I love that. And thank you for sharing your credentials. You're an rn, registered nurse, master's in nursing and I-B-C-L-C, which is international. Oh my God.

Hilary Sadler (09:02): It's a big one. International board certified lactation consultant. It's a lot. Thank you.

Dr. Nicole (09:06): Thank

Hilary Sadler (09:07): You.

Dr. Nicole (09:07): So this is something that has become very important to me in the age of social media of people being transparent about where they come from and the training that they have so people can know the background behind the person who's sharing the information. Of course there's something to personal experience as well, but it's not the same. And people should know, are you telling me this because this is just something that you think is important, or are you telling me this because you have background training? These are the things, I'm not saying one is necessarily better than the other. You have to make that decision in terms of what you trust for resources. But I appreciate people coming from a background of research science and also questioning the status quo. So I love all of that.

Hilary Sadler (09:55): Yeah, good. And I think that's a good call out is that, and if you are, and there are times when I give my personal experience because I do, like you said, it is sometimes patients or even people that on social media, they want to hear, well, what was your experience or what did you, but I think disclaiming that, hey, this is not, this is my personal experience is so important because yeah, this kind of gray, I feel like a lot of people try to live in that gray area and make you try to guess, well, is this evidence-based? Or is this just what you do or what you think is right?

Dr. Nicole (10:33): So we're going to focus our conversation on something that I think is really important, and I don't think I've ever heard this, talked about this before, so I'm excited to talk about it. And that's the link between infant feeding and then moms or parents I guess sleep, is that correct?

Hilary Sadler (10:50): Absolutely, yes. So that significant connection, but I don't think that it is widely understood, but the good thing is is that it's very simple. So hopefully your listeners will walk away with some yes,

Dr. Nicole (11:02): Some actionable is a better understanding. So you say that moms may feel like they have to choose between sleep and breastfeeding. I feel like that's 1000% the case, but you're like, no, it's not. So tell me what you mean by that.

Hilary Sadler (11:18): Yeah, so I think to start it's understanding with a newborn, and really I'd say in the first six months of life, feeding affects sleep and sleep affects feeding. The best example I could give of this is let's think about a baby that's zero to six weeks old, early newborn baby if they are not able to get quality full efficient feeds. So let me back up even a little bit more. So a newborn baby is their wake window, and by wake window, I don't mean their eyes are awake because their eyes are not usually open. Their eyes might be closed because the light is too bright. So I just mean awake enough to take a vigorous feed and they're actively feeding and not in that non-nutritive, pacify sucking, but typically awake window for a newborn is not going to be more than about 30 minutes. They might stay awake closer to 60 minutes, but about 30 to 60 minutes before their brain has to shut off and they have to go to sleep, even if that's like a 15 minute power nap, they're going to sleep every 30 to 60 minutes.

(12:27): If they don't, then that's when we see them, they can become frantic and overstimulated. It's like their little brains just can't handle being awake for more than that amount of time. So with that, if you have a baby that is so in that short amount of time, so let's say 30 to 45 minutes, most of their time is spent feeding in these first six weeks. So if we have a baby that has any complications with feeding, and it could be as simple as mom has a really fast letdown and there's absolutely nothing really going on with the baby, the baby doesn't have a tongue tie, there's no tension, but mom is just in that initiation phase of breast milk. Her milk is transitioning and coming in and it is just s spraying out, and that baby is just having a hard time. Yesterday it was thick colostrum.

(13:16): Today it is just like a water hose. That baby might be really uncomfortable after feeds because there is so much milk. And so let's do, and this is just one example, but let's do a laid back position or let's remove an ounce or two of breast milk before we latch. Let's try to figure out a better position for feeding so that we can get a better quality feed. Because quality feeds lead to quality sleep. So if you have a baby that's not getting a quality feed, another example would be, let's say a bottle feeding baby who there are some bottles out there that are marketed to breastfeeding moms as the best bottle for a breastfeeding baby. But we know based on, so just I know if you're not on video, you won't see this, but if this was the corner of a baby's mouth, if they have this shallow latch, they're chomping for feeding and they're probably swallowing a lot of air because the latch is not supporting them to get a really wide deep latch to stretch mom's nipple or the bottle nipple to their soft palate.

(14:22): And so they're chomping, and so they're potentially getting a lot of air and then that in return shows up as a baby that's uncomfortable. Maybe they have reflux, they can have reflux from breastfeeding or bottle feeding. But those are just little things that don't mean there's anything wrong. It just might mean position change or using a bottle that really allows them to have this really wide deep latch on the bottle so that they aren't swallowing as much air. There's a lot of nuance to it, which I think can be confusing, but the short of it is quality, efficient, effective feeds sets your baby up to naturally sleep better after feeds. And if your baby is sleeping well between feeds and we're feeding them at start of the wake window, they're going to wake up and take a good quality, efficient, effective

Dr. Nicole (15:10): Feed. Got it. Got it. Okay. So I thought this was more like how the parents sleep and then how the baby feeds. But actually it is still related because if the baby is sleeping well, then by extension parents are going to get more sleep too. So if you're getting your baby to a point where, or you're doing things that help your baby feed, like you said, more efficiently and effectively, then that is going to help them sleep better, which of course in turn is going to help parents sleep better for sure.

Hilary Sadler (15:41): Yeah, and I think the quality of a feed, but like you said, efficiency and effectively, so if you think about our ultimate goal, well, at least my ultimate goal being a type A working mom was that by three or four months, my baby is sleeping through the night so that I'm sleeping through the night

Dr. Nicole (15:59): So that I can

Hilary Sadler (16:00): Function. And that's not everyone's goal, but if that is your goal, wouldn't it be nice if we can make it to that point without having to sleep train? Everyone believes, everyone tells us sleep training is just like, not everyone, but a lot of people will say sleep training is just this developmental milestone that you and your baby have to go to and you just have to decide when you want to do it. But with the thousands of babies that I've personally worked with and my team in Charleston and just people that have read my book and used my course, they have found that if we really approach feeding, looking at this holistic picture of how feeding and sleep are connected and we're setting babies up to naturally take in their needed volume during their 12 hour day, then they naturally will drop those nighttime feedings. Love it,

Dr. Nicole (16:44): Love

Hilary Sadler (16:44): It, love it, love it. I think what's hard is I'll hear from parents who have a baby that's like six to nine months old and they're still feeding multiple times overnight, and they're at that age where whether their breasts or bottle feeding, they are interested in life, they are distracted, whatever, so they're not feeding during the day, and so they keep feeding all night long, and it's just the cycle of, well, the truth is is that we have to get them to feed during the day so that they can drop those nighttime feeds. They're never going to drop those nighttime feeds. They're never going to feed during the day if they're still feeding overnight, they're getting it.

Dr. Nicole (17:19): And I recently talked to someone who her baby was like, I want to say maybe 13 or 14 months old and still waking up during the night a couple of times and she was dying. It was like, I can't do this. And part of it I think was maybe related to feeding. I'm saying this to say, y'all listening, this is an important thing to try to get under control because eventually you can't survive with your baby getting up four times during the night or whatever. Most of us are going back to work and things like that. So this is just I think, a really important connection to make and the sooner you understand this, the better it will be longterm.

Hilary Sadler (18:06): Yes, absolutely. That is the truth for

Dr. Nicole (18:09): Sure. So what are strategies then to make sure that feeds are efficient and effective? And I guess what do you mean by efficient and effective?

Hilary Sadler (18:17): So there is a newborn is not going to, I guess this is a good way to put it. So a newborn, if they're breastfeeding or bottle feeding, we say for breastfeeding, newborn time spent feeding is somewhere between 30 to 40 minutes In that first month of life before your milk comes in, it might seem like they're feeding all the time, right? Because that colostrum is super thick. But once milk has come in, if your baby is feeding more than 30 minutes at every feed, I would highly recommend working with a lactation consultant in real life who can watch a feed, evaluate a feed, do a weighted feed, and let's just see, sometimes it's as simple as a mom has been told I need to do 15, 20 minutes on one side, 15 to 20 minutes on the other side. And the truth is, is that we all have different ONTAP capacity for our milk.

(19:10): So everybody's breast milk storage capacity is different, and it's not necessarily large breasts versus small breast, but one mom's ontap milk. So that's like you empty your breasts, you have prolactin is higher from 2:00 AM through, it's kind of like up here at 2:00 AM then it's on a downhill slope and then it starts to go back up. So 3, 4, 5 pm it's down here. So your rate of refill is lower. So a baby is going, let's say you feed at 2:00 PM and then you're feeding again at 4:00 PM or 5:00 PM you're depending on how much breast milk storage capacity your breast has, your milk may not have filled all the way back up for that on tap versus 6:00 AM versus 9:00 AM you're going to have a lot more milk at that time. So going back to efficiency of feed, you may have some babies that completely empty a breast in 10 minutes and then they've transitioned over to that non-nutritive sucking versus a baby that truly does take 20 minutes to empty a breast. You just want to make sure that when they are no longer swallowing that you're moving to the next side or even moving back to the first side. You want to make sure that the time spent at the breast and the bottle that they are actively sucking and swallowing.

(20:29): And I think that's the piece that's really hard. There are postpartum nurses that I have worked with in the hospital as an inpatient lactation consultant that really had a hard time noticing the difference, which it is hard in the early days because if mom's milk is not in, it's not quite as apparent. But I think it's important for moms to know what is the difference between a swallow versus just a suck. Got it. So if you have a baby that has to do five sucks for every swallow, whether that is at the breast or the bottle, that's an inefficient feeding pattern. Got it. So they're going to get fatigued with feedings and in return, a baby that is say eight or nine pounds, their full volume for a feed might only be two or three ounces versus a baby who's now 12 pounds. A full volume feed is going to be somewhere between four to six ounces.

(21:23): If it takes them 30 minutes to transfer two or three ounces from the breast or bottle and they aren't able to increase the efficiency of feeds, they're going to be feeding around the clock every two to four hours because they can't feed. They'll get fatigued. You'll see like little quivers in their cheeks or they'll just fall asleep. They can't feed for more than 30 to 45 minutes efficiently. So that's a red flag where it's like, okay, let's figure out is it the bottle? Do we need to do some suck training? There's all different reasons why it could be like that, but that would be an inefficient feed that would lead to not being able to get longer nighttime sleep because they're not able to transfer efficiently. Got it. Okay. But there are things that can be done to help. Yes. So feeding at the start of the wake window is one of those, and a brief, the why behind that is if your baby is awake for say, 15 or 20 minutes, and even if they're not sucking on a pacifier, but they wake up and they're awake and their wake window is only 30 to 60 minutes, as soon as they start sucking at the breast or a bottle, they're likely to fall asleep.

(22:32): They've spent a good part of their wake window, so they might do some swallows, but we know sucking is away that they soothe in the fourth trimester. So they start sucking and then they fall asleep. So that's a quick easy, if you feed at the start of the wake window, you're going to have the most efficient feed because they're going to have the energy, for lack of better word, to have a full feed. Yeah, that makes sense. And then feeding on cue. So that goes with feeding at the start of the wake window. But this is a good example I saw in the hospital. So in the hospital, a lot of times you have, as nurses, we tell our patients, you need to feed every three hours. Your baby needs to eat at least eight times in 24 hours. So if you do the math, that is every three hours, but most newborn babies are going to cluster a feed or two, and then they're going to sleep for a longer stretch.

(23:19): So there are things in the first two weeks of life, they lose weight and they can be jaundice, and sometimes they have low blood sugar. There's things that we need to be mindful of in those first two weeks. But generally speaking, as long as we're getting in at least eight feeds in 24 hours, we know that based on the size of their stomach, they need that to get in the volume that they need. But if we kind of let them drive, be in the driver's seat a little bit as far as feeding at that, every one and a half to four hour frequency, most babies will feed two feeds close together, and then they might go a three to four hour stretch, and then they'll feed two feeds close together. Feeding in that way really does promote that, letting them sleep through until they're ready to wake up and feed.

(24:04): If you wake up a baby that's in a deep sleep, that's the mom that is sitting there for 30 minutes. She set her alarm to do a feed. She's 36 hours postpartum. She just had a marathon cluster feeding session. She sets her alarm to feed the nurses in there saying, you got to feed, it's been three hours, but the baby won't wake up because he just did a bunch of cluster feeds. So if we just give that baby a little bit more time, and there does need to be parental guidance with that, but generally speaking, following that rhythm really does help. Okay.

Dr. Nicole (24:37): Okay. Gotcha. Love it. Love that. So then what about decreasing baby's fussiness while they're awake? What impact does that

Hilary Sadler (24:44): Have? Yeah, I think what I see mostly with babies that are really fussy in the first six to 12 weeks of life has to do with being awake too long, either not getting good feeds and they're hungry, not getting quality feeds, or they are awake too long. So if you really focus on that wake window, that 30 to 60 minute rule, if you know your baby is, it's been 60 minutes since they woke up and they're sitting there, quiet alert, just staring off, you want to use those five Ss. Do you want me to

Dr. Nicole (25:18): Run through the five s? Yes, please.

Hilary Sadler (25:19): Yeah. Okay. So the five Ss are, is it Dr. Harvey? There's somebody who coined that phrase, the five S's, but generally the five S's are the ways that are really highly effective for soothing a fussy baby in the fourth trimester or the zero to 12 weeks. So the first S is sucking, sucking on a pacifier. That's why breastfeeding will tend to quiet help them because it's the sucking, sucking, swinging, obviously supporting their head and neck, but doing a swinging motion sideline, turning them on their side, swaddling. And I always, oh, and shushing, which is that white noise. So I actually have an Instagram reel pin to my Instagram account at baby settler that shows me doing these five S's. And it's a very popular reel because so many people are like, oh my gosh, I tried this and it worked, and it's not anything special that I came up with. It does work for babies who are zero to 12 weeks old. That's just a highly effective way to soothe them. Got it. Got it. So if you feel like you're kind of past, they had a good feed and they become more difficult to settle when they've been awake too long. So that's when you pull out those five S's.

Dr. Nicole (26:32): Gotcha, gotcha, gotcha. So really, I mean, it's been such a long time since I had a newborn, so you shouldn't expect that your baby's awake for more than how long

Hilary Sadler (26:41): Newborn. So if we say newborn technically would be, what, zero to 28 days? I mean, really, probably like 30 to 45 minutes is probably max. Maybe some babies could do an hour at some point, but it really is not super long and their eyes are probably not even open that long. They're really, it could be as short as a 20 to 25 minute wake window. They just sleep so much.

Dr. Nicole (27:03): Yes, they do. They do. For sure. And then I guess, what is the importance of when they're fussy then They're not getting sleep, you're saying?

Hilary Sadler (27:13): Yeah. So if you have a baby that's super fussy and they're not getting that pocket of sleep between each feed, then when you start a feed, whether it's breast or bottle sucking is a soothing. So you start a feed and they start sucking, and then they're taking a snack feed or they're falling asleep five minutes into the feed, so then they don't take a full feed. So then they feed for maybe 15 or 20 minutes, but probably not a lot of that was actually swallowing that was more of that sucking. So then they don't sleep well because they didn't get a good quality full feed. And then you're just in the cycle. So one way to break out of that cycle is to use the five S's and just get them to sleep. However, whether it's a contact nap, whatever you have to do to get them to sleep, want to, your goal is to get a good pocket of sleep, not long pocket, because we know newborns do not sleep that long, but a good pocket of sleep between each feed during the day so that we're setting them up to not get to the witching hour, which I'm sure everyone's heard about and they've been awake way too much during the day, and now witching hour is way more difficult because they are overstimulated and they haven't had good feeds and they haven't had good sleep, and then that sets you up for a night.

(28:33): That can be really overwhelming.

Dr. Nicole (28:35): Gotcha. Gotcha. So then what are some strategies to help additional strategies to help them naturally sleep during the night?

Hilary Sadler (28:43): Yeah, that's a great question. So I think that the truth is that parents have to understand the why behind all of the recommendations that they hear, and just taking a holistic approach that starts with feeding. So they really have to become the expert of their own baby related to the cues and what they're giving them. And they will learn this, but is my baby hungry or is my baby uncomfortable or is my baby tired following that feed? Wake sleep feed cycle helps you feel more confident in, okay, I know this is a hunger cue, or I know this is a tired cue, but really learning those cues and then being able to pivot and use your own knowledge to be able to troubleshoot the challenges related to feeding that really could be impacting sleep and navigate a path forward to better sleep. So some tangible recommendations here would be try to only wake a sleeping baby for a feeding as suggested according to their agent stage.

(29:38): So we kind of talked through that in the first two weeks of life. We really don't want them to go more than four hours without a feeding when they're not back to their birth weight. We know babies that are below birth weight and babies, especially if they have a high percentage loss of birth weight, so 10% or more, they kind of go into hibernate mode and we really can't trust them. They might just sleep. You have some babies that cry and they just are difficult. And then you have some babies that they just sleep, they're not getting enough and they just sleep. So there are times when you do need to wake up a sleeping baby, but generally speaking, we want to follow that feed, wake, sleep cycle and let them sleep through to their queue if we can with definitely some hard stops as far as we're not letting them go much longer than four hours in those first two weeks.

(30:27): The second thing is differentiating between daytime feedings and nighttime feedings. So for that, I always say daytime feedings, talk to your baby, have a light on, do a diaper change after feeding. I know with my babies, I would always just hold them on my face and just kind of talk to them and just like, you know what I mean? It doesn't have to be anything crazy, but you're interacting with them. Whereas nighttime, it is like all business, it's boring. We are feeding and we are going back to sleep. Of course, you're still going to kiss on your baby, but we're not keep a straight face.

Dr. Nicole (31:01): This ain't playtime. No, this is

Hilary Sadler (31:04): Feed and we're going back to sleep. Exactly. And then I think I already mentioned feeding, feeding on cue, which kind of goes back to learning their hunger cues. One thing that I get really not frustrated about, but I feel like there's some confusion on social media that literally every cue a newborn gives is a hunger cue, and that's just not true. And so you really have to learn. That's a whole nother podcast, but you just have to learn your baby's cue and be able to differentiate. And I think that's one of the hardest things in the first. It is a, it's learn on the job. You can learn about stuff, but you can't really learn until your baby is here. Then understanding that concept that daytime sleep promotes nighttime sleep. Got it. Keeping your baby up all day, getting to the end of the day and having them overtired and overstimulated is actually not going to set them up for nighttime sleep.

Dr. Nicole (32:01): Now, here in all this, it can sound and feel a bit overwhelming. So how often, what do you see typically, how long does it take people to get into a rhythm where they're like, okay, I am understanding what's going on with my baby. Things are kind of, I get this, I'm picking things up. So what can people expect in that regard?

Hilary Sadler (32:21): Yeah, I would say the first two weeks as far as implementing these strategies, usually you see results in three to five days. You really do. But I hear you and I do agree that it is a big learning curve, but you do have to really understand that connection, and you have to be, if you can learn this prenatally, that would be ideal because when you are postpartum, you're sleep deprived. There's just so many things. I think you might have to read something five times before you really truly understand what it means because you're so sleep deprived. So does that answer your question? Yeah,

Dr. Nicole (33:06): It does. I want people to have a realistic sense of, it may take a little bit to figure things out, but it's not going to be like three months before

Hilary Sadler (33:16): You

Dr. Nicole (33:16): Have this down, typically.

Hilary Sadler (33:18): No, not at all. Yeah,

Dr. Nicole (33:19): Don't think you're going to be on the struggle bus forever. I think there's some element of we do need to be honest that when you have a newborn, you're both figuring each other out, and it's going to take some time. But if you prepare yourself with some information before that on the job training, it helps on the job training be a lot easier.

Hilary Sadler (33:41): That's so true. And just knowing exactly, if you've already heard it, you already know a little bit about it, then you'll know you're like, okay, I remember this. This is what this means. And that's such a good point.

Dr. Nicole (33:53): Or a place to go back to look for help if you need it. For sure. Yeah. Yeah. So another thing you're passionate about is feeding and mental health. So what are your thoughts about that?

Hilary Sadler (34:04): Yeah, so I guess, do I have time to tell you a little bit about my fourth baby? Yeah, please. Feeding journey. Okay. So my fourth baby, he's 21 months old now. So in my mind, I had breastfeeding challenges with all of my kids, which is probably why I ended up doing what I'm doing because we end up on that path based on our past experiences. But Clay, my fourth child, he is the, to date, he's the absolute worst feeder I have ever worked with in my life. He's not anymore, but his first three months of life were hard. Of course, I went into it, baby settler was founded in May of 2020, so it's almost four years old. So I was doing this. We have a private practice in Charleston, brick and mortar patients. I've helped thousands of moms breastfeed their babies, navigate challenges, all this kind of stuff. Of course, I thought to myself, this is going to be,

Dr. Nicole (35:00): And you're like, I got this easy.

Hilary Sadler (35:02): I'm going to have a great milk supply. This is like, this is going to be the best one. I remember telling my husband, this is going to be my best breastfeeding journey, yet this is going to be so great. So fast forward, he had an unmedicated delivery in a hospital. He had a shoulder to socia. He was eight pounds, nine ounces. He was op. So face up, it was fine as longest labor. My other babies all were super fast. He was like a 16 hour labor. It was just

Dr. Nicole (35:36): Fourth

Hilary Sadler (35:36): Baby, right? It's not supposed to happen like that. And he came out and as soon as they put him on my chest, I was like, oh my gosh. His tongue is tied to the floor of his mouth. He has a terrible tongue tie. He can't even stick his tongue out past his lower gum line. Great. This is going to be great. Okay. So there were many things that happened in the first couple weeks, but major things were he couldn't even hardly feed from a bottle. So it wasn't even just about breastfeeding. He just couldn't even hardly feed from a bottle. He was having something called the Renzo spasms in that first week of life. And so he was having, I was very stressed because I was worried I was a new mom, seeing my baby have, it was just stress and a baby that was not feeding effectively at all. My body does not respond well to pumping. I tried eight different pumps. I know how to hand express. I did all the things and I was pulling milk out of my breast, my body, I was not having letdowns. The oxytocin was not flowing.

(36:45): It was crazy. So I remember, I think I was five or six weeks postpartum, and I remember talking to a friend and she was just like, well, Hilary, what would you tell your patients? And I was like, oh my gosh, you're so right. Because I was lying in my mind, I was thinking, I'm a failure. How can I, this is what I do. How can I not make this work? I've made this work for all these other moms. What is wrong with me? Why can't I do this? Why is this happening and why is my body failing me? And I was in a really hard spot, and thankfully I had friends who reminded me they're on the outside, and some of them were lactation consultants, and they just said, well, what you need to step out of it and what would you tell another mom?

(37:35): And so from there, I gave myself a lot of grace, and I actually quit putting him to the breast for several weeks and exclusively pumped and just took all pressure off of myself. We introduced some formula, and long story short, I ended up doing combo feeding with him until he was like 10 months old. So we do some direct breastfeeding, we would do some formula bottles, some breast milk bottles, but I just let go of the pressure, and I have gotten a lot of negative feedback on Instagram from the I-B-C-L-C community related to formula feeding and sharing that part of my story. And it's been a little bit frustrating, but I just have to remind myself that even though some people will make you think that you're failing in some way, if you aren't able to feed in a way that whoever tells you you should feed that, that's just not true. It's a lie. And you just have to be able to hopefully have people around you that support you in that

Dr. Nicole (38:41): Way. Oh my God, some people need to shut up and mind their business. I know.

Hilary Sadler (38:45): Yeah, it's hard. Well,

Dr. Nicole (38:46): It's not affecting, you're being honest about the journey, and this is just some of the challenges. It's not like you, it's unfortunate that that happens.

Hilary Sadler (38:57): It is. And my whole point of sharing my story was that, and I got a ton of feedback from moms who felt validated and they were like, oh, this makes me feel so much better to know that you're actually a lactation consultant who does this, and you're struggling. Because I think the other thing that I see is I will see moms who are spending their entire maternity leave trying to figure out feeding, whether they're triple feeding or trying to increase supply, or they're not getting any sleep at all because they're up breastfeeding all night long and their baby's just not very effective at transferring out the breast. So they're feeding 12 times in 24 hours or all the different variations of what feeding. They spend their whole maternity leave doing that, and then they kind of become obsessed with it, and then they're getting ready to go back to work, or they're reaching their breaking point because they've been doing this for three or four months, and then they might look back and say, gosh, I know with my first child, I had a really rough whole first year postpartum because it just wasn't enjoyable because I felt like it was just, that was all I was doing was focusing on feeding and not getting sleep.

(40:11): I wasn't getting sleep.

Dr. Nicole (40:13): Okay. That's really important. Thank you so much for sharing that story and just we have to give ourselves grace sometimes. For sure. So then as we wrap up, what would you say is the most frustrating part of your work?

Hilary Sadler (40:27): I would say, I hate to repeat what I've already said, but I think that honestly, it's that the majority of healthcare professionals who help moms with babies and feeding, they don't really understand that feeding sleep piece of the puzzle. And so it's not easy for new moms to figure this out. And I think that I try to put out the message that prioritizing your sleep as a new mom is not selfish. But I think that there are, and I would argue that you have to get sleep for, we have a biological need for sleep as a mom and then also our babies. But I think that there's this message out there that you can't prioritize sleep if you're breastfeeding, and it's just not true. There are strategies that you can put in to be able to exclusively breastfeed and have a baby that sleeps through the night, but it does take knowledge and really, I would say, a strategy to get there, because if you're just looking up, because really everyone is saying that you either, if you're breastfeeding, it's normal that your baby is waking up multiple times at night, but it might be normal, but it doesn't have to be

Dr. Nicole (41:37): That way. Gotcha, gotcha. And then on the flip side, what's the most rewarding part of your work?

Hilary Sadler (41:42): Oh, gosh. I think knowing that I make a difference in a family's life, because babyhood can really, I've seen that it can really pull relationships apart due to so many different things. I'm sure you have seen this, but a lot of times it starts with feeding and sleep. I've been married for 15 years and have four kids, and there have absolutely been challenges along the way. I mean, this season of life, I feel like it can both literally and figuratively suck you dry sometimes, but it doesn't have to. Your baby can thrive, you can sleep, your relationships can evolve. You just really need that truth at your fingertips. And I hope that that is what baby seller is, and that it's there to really help moms through early momming. And I've seen that it has, and that brings me, yeah, that fills my cup up for sure.

Dr. Nicole (42:34): Yeah. Yeah. So then what is your favorite piece of advice that you would give to an expectant mom or expectant families?

Hilary Sadler (42:41): You probably know what I'm going to say.

Dr. Nicole (42:44): So take the

Hilary Sadler (42:44): Time to learn about the connection between feeding and sleep so that you really know, navigate it so you know how to navigate challenges, and you're able to pivot as needed. And by pivot, I mean if there are any feeding complications, you're able to say, okay, this is how I'm going to approach this, or I know this is impacting sleep or sleep is impacting feeding because sleep is so important for your baby, and I would argue it's important for the whole family

Dr. Nicole (43:13): Unit 1000%. Definitely. Definitely. So where can people find you and what are all of the resources that you have available?

Hilary Sadler (43:19): So we are, I'm on Instagram at baby settler and we have a new app that's launching at the end of the summer, so summer 2024, and it's going to be all things early momming in one searchable place. So it's for kind of, not really pregnancy, but more like birth prep, like just tips for birth, but mostly it's postpartum, breastfeeding, baby sleep, all those things that you get postpartum and you plug in Google, you're just going to plug them in our app and there will be a video or download or I'll be in there weekly doing live sessions. Or if you're the mom that really likes a book to reference, you can order my book Babies Made Simple on Amazon, and I highly recommend reading that book prenatally. Got it. It's like probably a three hour read if you sat down and read it from start to finish, but it just plants some seeds that then you can decide, okay, I'm going to go look into this further, is my goal with that book.

Dr. Nicole (44:15): Awesome. Awesome. I love it. Well, thank you so much for agreeing to come onto the podcast. This was really helpful information and I know folks are going to find it useful.

Hilary Sadler (44:23): Well, thank you for having me. I really appreciate it.

Dr. Nicole (44:31): Wasn't that a great episode? I really appreciate Hillary's passion for her work and sharing her information with us today. Now, after every episode when I have a guest, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Hillary. Number one, prepare for postpartum while you are still pregnant. This is so, so important. We put a lot of emphasis on getting ready for childbirth and not as much emphasis as we should on getting ready for postpartum. Of course, you can't prepare for every single thing that happens, but sometimes there's no discussion at all other than get a breast pump. And if you can arm yourself with information and set yourself up for success to get off to a great start after the baby is born, you're going to feel so much better.

(45:20): So definitely start preparing for postpartum in that third trimester, I say around 28 weeks or so is a great time to start thinking about things. I talk about this inside the birth preparation course and things that'll help you get off to a great start postpartum. Again, you can check out the birth preparation course at drnicolerankins.com/enroll and use the code Dr. Nicole to get 10% off. Next step is that feeding and sleeping are going to affect all aspects of your life after you have a baby. How your baby feeds, how your baby sleeps will literally affect everything. Everything, everything, everything. And I'm not saying that to be dramatic. I'm saying that because it is true what you do, where you go, when you can go, all of those things are going to revolve around when your baby eats and when your baby sleeps. Okay? And the sooner you can learn about those things and how to help get your baby on a schedule and a system that of course meets their needs but also meets your needs too, the sooner you will feel better about that newborn journey in that postpartum life.

(46:29): Now, of course, it's going to take some time to figure these things out. You're both getting to know each other, and this isn't something that you can necessarily educate yourself and to perfection completely, right? There's going to be an element of figuring things out on the job, but you want to go in the job armed with some information. So start learning about these things like feeding and sleeping when you're still pregnant and you have a little more time, a little more brain space, and that is just going to help set you up for an easier time transitioning into motherhood. And speaking of motherhood, Hillary's example of her fourth pregnancy is just a beautiful example of how every birth is different. Her fourth one was very different. Also, her experience with breastfeeding with her fourth child was very different. She gave herself grace in that process, and I want you to do the same.

(47:27): Give yourself some as you go through the journey of birth and motherhood and breastfeeding and all of those things, it's going to be different every single time. It's going to be different every single day, potentially go with the flow of what is presented to that. Nothing is set in stone. And please, please remember to give yourself grace. Okay? So there you have it. Please share this podcast with a friend. Also subscribe to the podcast wherever you're listening to me right now. And I would love it if you leave a review an Apple podcast. I read those reviews. I'd love to hear what you think about the show, and also do shout outs from those reviews from time to time. So please do that for me as well. Do check out the birth preparation course. Again, that's drnicolerankins.com/enroll, and you can get a bit more of a discount with the code, Dr. Nicole. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.