The Sex Reimagined Podcast

Dr. Emily Spaeth: Navigating Sex After Birth and Breastfeeding

• Leah Piper, Dr. Willow Brown, Dr. Emily Spaeth • Season 2 • Episode 69

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SHOW SUMMARY

In this intimate conversation, lactation consultant and pelvic health expert Dr. Emily Spaeth unpacks the pleasure and sensuality of breasts, especially after giving birth. Going beyond nourishment, she explores how breasts can be a source of enjoyment and personal reclamation postpartum.


We got candid about...

  • Struggling with exhaustion, bodily pain, and messy emotions as new moms
  • Overcoming shame & guilt to ask for support
  • Getting creative about intimacy with your partner when baby is clinging!
  • Learning your post-baby turn-ons and new erogenous zones
  • Healing from difficult breastfeeding journeys
  • Making decisions about breast implants or reductions in light of future feeding plans

EPISODE LINKS 

KING & QUEEN OF HEARTS. Leah & Willow's King & Queen of Hearts Intimacy Toolkit is on sale. Buy Now. 10% off Coupon: KINGANDQUEEN10.

THE MALE GSPOT & PROSTATE MASTERCLASS. This is for you if… You’ve heard of epic anal orgasms, & you wonder if it’s possible for you too. Buy Now. Save 20% Coupon PODCAST20.

THE VAGINAL ORGASM MASTERCLASS. Discover how to activate the female Gspot, clitoris, & cervical orgasms. Buy Now. Save 20% Coupon: PODCAST 20

LAST 10x LONGER. If you suffer from premature ejaculation, you are not alone, master 5 techniques to cure this stressful & embarrassing issue once and for all. Buy Now. Save 20% Coupon: PODCAST20.

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Willow:

Welcome to the Sex Reimagined podcast. I am Dr. Willow Brown, your Taoist sexology expert.

Leah:

And I am Leah Piper, your Tantra expert, and we have a lovely doctor here today. Dr. Emily Spaeth is an expert in all things pregnancy, birth, postpartum, and babies and boobs. She is the founder and CEO of Be Well Baby PDX, and she is a wealth of knowledge. If you have had children. If you want to have children, if you have just been through it with children, you want to tune into this episode.

Willow:

We talked all about boobs and pregnancy and breastfeeding and how to reclaim the pleasure of your own body postpartum, and it was just such an enlightening interview. You're gonna love it, especially if you're thinking about having babies or you have had babies and you're Feeling not so in love with your breasts anymore. There is a solution for you my friend.

Leah:

That's right. So you know what to do. Tune in, turn on and fall in love with Dr. Emily.

Announcer:

Welcome to the Sex Reimagined Podcast, where sex is shame free and pleasure forward. Let's get into the show.

Willow:

We are here with Emily Spaeth and we are talking all about boobs today and I'm so excited because who doesn't love boobs? I mean, everybody

Emily:

I love boobs.

Willow:

We all got nourished by boobs when we first started our life, hopefully. And I think there's just this wonderful, they're just this amazing shape and they're, you know, they're nourishment, but they're also sexual and pleasurable. And I think that, um, women in particular have a tendency to give up their breasts for others, for someone else's pleasure, for someone else's nourishment. And I think there's a real reclamation of our own pleasure with our breasts that, that could be happening worldwide. Let's start an epidemic of, uh, breast pleasuring for your own pleasure and your own self.

Emily:

I love it.

Leah:

So, Emily, I can't wait to hear what your Genesis story is and how you came into this type of career and, you know, made boobs your passion.

Emily:

So I am a doctor of physical therapy and I work in the peripartum space. So not only am I treating people's physical therapy needs, but I also am an international board certified lactation consultant. And then my background really started as a yoga teacher and a massage therapist. So I have this like incredible foundation of knowledge, Eastern and Western. And I worked in the neonatal ICU for many years, taking care of babies. And as a physical therapist. And I saw this enormous gap in how we cared for the family around that trauma. It was just incredible. And so I very slowly started my own practice. And recently went 100 percent full time into my own practice supporting families with their physical therapy needs, lactation needs. Um, but also with education because I know that there's so much out there for families and it's just like so many blogs and not a lot of really tangible information. So I have a sex after birth class that I teach that is It's super popular and it's just one of the biggest questions that I get is about boobs. Like I'm feeding my baby with these boobs, my boobs hurt, how am I supposed to feel sexy around my boobs, you know? And so that is where I came to you and wanted to talk to you about boobs.

Leah:

Yeah, wow, that's, that's so fascinating. There's so many questions that are popping up, like, um, I mean, I'm assuming you're called in because women are having a hard time nursing a hard time with lactation. They're having a hard time with pain. The baby's having a hard time, um, versus people who are having an easier time, like the baby's latching and everything seems to be going okay. What's like the top problem that you're solving for people, for these families?

Emily:

Right now it seems to be all about latching and pain around latching. I run a free lactation support group every week. And so I do get some of those moms who are doing okay, you know. And they just want to come and be around other parents who are breast or chest feeding and really be able to commiserate about everything.

Leah:

Have community.

Emily:

Yeah, absolutely. And I think there's a sense of really needing, like deeply needing that community. And I love being able to provide that space. And that's sort of the genesis for my course that we were talking about sex every week and, and how, how challenging it is to want to use your body in that way again, after a birth. And, you know, trying to help with the process of coming back to like, how did you create your baby? You know, like it's all the same. It's all together. And there's just a lot of shame and guilt around feeling sexy, when you have a newborn.

Willow:

I always say that the postpartum period, you know, lasts about a year. Like all of your oxytocin is going to your infant for that first year. So it's hard to redirect it to yourself, to your partner. And it's hard for partners because they're like, when are we going to ever have sex again? You know, I still find you hot and sexy. I'd like to go for it. And So I think that there's, um, You know, getting that support during that first year, especially. You know, to, to just share stories with other women and to get ideas about how to move back towards sexy times with your partner. Um, when to even do that. I mean, because there's, you know, very little time when you've got a newborn on your hands and everything feels a bit chaotic and, um, unsettled. So it's, you know, even if you have like a step one, step two, step three of like how to kind of get yourself back into, um, back into your own pleasure and feeling your own body. I think also with sexuality a lot of times we expect that we're going to go back to sex the way it used to be. But we're so transformed, we're so different, we're so changed that, um, sex is going to also feel different. It's going to be different and probably going to need a lot more foreplay and we might need a bath beforehand. You know, we might need some nurturing before we can actually get our sexy times on. So, I'm so curious, like, what you, what you guide women, I'm assuming it's all women who come to this sex after birth course of yours? I'm wondering, like, what kinds of things you guide them through.

Emily:

Yeah. So a lot of what we talk about is here's what happened to your body in pregnancy. I don't like to dumb things down, so I really, like, get into the anatomy and what is physiologically happening to your body. I think parents want to know that information.

Leah:

Well, I want to know that information, but I'm not going to have a kid. So, like, what is, what is happening to the anatomy? What does change? Because this is, like, foreign to me, and I'm really curious.

Willow:

Everything. Everything changes.

Emily:

Yeah, but throughout pregnancy, first of all, your organs are being completely moved around in your body. There is, you know, your uterus sits right on top of your bladder, and if you look at sort of Cartoon images of what's happening week by week, you see that by week 8 your bladder goes from this like nice little rounded position to smooshed, completely flat. And then your rib cage has to expand, your diaphragm flattens out a little bit, and all of your intestines move up in your body and back and away. And your stomach is smooshed, everything is smooshed and moving away from the uterus where the baby is growing. And then with birthing, there's this, it depends obviously if you have an abdominal birth or a vaginal birth, but if you're having a vaginal birth, you, your body has to make way for this creature to emerge and it's it's physiologically designed for that. So it there's all of these hormones including the relaxin hormone which helps to create a little bit more laxity in your muscles and in your joints. And all of that leads to the space created for the baby and we sit a lot in our culture now, so birth has gotten harder. But it it ends up being this incredible journey through the pelvis and our vaginal tissue is designed specifically to stretch and then come back. Like, that tissue is designed for that. I was telling my five year old daughter about it the other day, and she was, like, fascinated. eyes wide, you know. it's magic, you know?

Leah:

So I'm just imagine that women are feeling so stuffed, so compressed so... like is it stuck feeling? Like when your bladder and your organs are all smushed? I mean sounds pretty unpleasant.

Emily:

a little bit, but I think the biggest change is that you just feel big. And your breast tissue is changing, the pigmentation of your skin is changing. So your areolas get really dark and sometimes they grow bigger. And the reason for that is so that the baby can find the breast tissue because they see contrast really well.

Leah:

Well, who knew? I always wondered, like, those nipples are a thousand different ways. I mean, do those nipples come back because they look, they get so dark and so big. I'll never forget the first time I was a kid and I saw my cousin nursing, and it was like, your nipples didn't look like that before. I was shocked. And I, and I felt awkward. I wanted to ask questions, but I felt like it was too personal to ask questions. So, you know, all these years I've been going, what goes on with the nipples? Please, Emily.

Emily:

It's all, it's all just so that the baby can find the nipples. And you know what? A lot of times they do go back. So sometimes they don't. I feel like no matter what, when there's any kind of large amount of weight gain, the tissue's just not quite the same.

Leah:

Oh, right. Sure.

Emily:

You know? But the pigmentation usually changes.

Willow:

Yeah, and also as we age, the, um, you know, our estrogen levels start to decline, so that kind of like, coming back to, like rubber banding back into the shape and the form that we once were starts to shift and change, I mean, that's why we get wrinkles as we age. Like these hormones make a big difference in our bodies. And, um, you know, even the pelvic floor, like if there's an episiotomy or if there's, um, a big tear. Sometimes it can be really useful to, to get in there and to release the scar tissue postpartum, but, but, a while after postpartum. You know, like a good nine months to a year afterwards to really help the vagina come back to its elastic state. And sometimes we need to do Kegels and those kinds of exercises as well. And I think that's so interesting. I didn't realize that that's why the nipple darkens so that the baby can actually find it and see it. So that's really fascinating. And, um, and I think, and I think, you know, when, when women get let down, it's kind of like that. It's a, it's an interesting sensation. You can tell us more about it, Emily, about like how the sensation of it comes forward. And then just the pleasure of breastfeeding. I'm sure it's, there's a lot of hormones and oxytocin flowing through your body when you're doing that. And you're just feeling so connected to this little human being in your arms. And it's just, That's a whole nother level of pleasure and we don't think about it as like sexual pleasure, but it's sensual pleasure for sure.

Emily:

Absolutely. Absolutely, and I think that's where some of that shame and guilt comes in. Because as, so a letdown can feel really different for different bodies, and some bodies don't feel what a letdown feels like. Sometimes it's a little bit painful, or there's this like sharp, tingly sensation as the milk starts to let down. But there is this... release of oxytocin through your body. The same hormone that is released as you're birthing and as you're having an orgasm. So it's all the same kind of process and I think for a lot of people just being given permission to really enjoy that can be incredibly beneficial. There's The other thing that is really amazing, you mentioned estrogen and progesterone and those, all of those levels changing as we age. And that is true, but it's also true the instant that you birth the placenta, everything, like every hormone that you've been building, building, building, building throughout your pregnancy just like

Leah:

Oh, really?

Emily:

And that's what helps to initiate breastfeeding. The hormones of breastfeeding will reduce your libido and they'll lead to vaginal dryness. So, no wonder! Yeah, and you know what? I, I don't know exactly why, but if I had to guess, just physiologically, biologically, like, I don't want to be making another baby right away when I'm trying to learn how to feed this first one, you know?

Leah:

plus I'm imagining that the vagina needs to heal. And so it also may just be like, okay, we're unplugging this urge. We're unplugging the ease of this to happen again so that we can take a pause and we can focus on the aliveness and the wellness of this baby, feeding this baby, and all those sex hormones can take a break so that the vagina can regenerate and, and the focus can be on survival.

Emily:

Absolutely. And not only the vagina regenerating, but all of those organs we talked about that moved out of the way and the uterus coming back down to size. It's so important for the longevity of your body. And I do also provide pelvic floor therapy and One of the things that is really common is that people don't give themselves enough time to heal. They will go for a run at week three because you're supposed to get back to your body or whatever. But realistically, we need that time and space to allow our organs to return to their original place.

Leah:

When is a more appropriate time to have sex, get back to your, um, regular, Self care routine with an exercise or, um, you know, taking time out. It's got to be, I'm sure women feel a lot of shame and guilt also about taking care of themselves. And it may be that the family or the baby is so demanding that that becomes, feels like it's impossible. So I guess that's like, those are a number of questions in one. First, I just want to know what is the appropriate time that you'll start to feel like having sex again.

Emily:

Okay, so a lot of physicians will tell you vaginal delivery, six weeks. Abdominal delivery, eight weeks, you're good to go. But I have yet to meet a postpartum person who's ready to go at six weeks, or even eight weeks. And I think that one of the biggest, the biggest pieces of advice that I end up giving over and over and over again is, Are you ready? Are you ready? Do you feel ready? Do you want this? Um, and one of the barriers is, yes, I want it, but I'm afraid. You know, I'm scared it's going to hurt. So I always start with, and this is my caveat. I am not a sex therapist. This is for you guys. But I always start with communicate with your partner. Just talk to them about your fears. Tell them that this is a scary moment for you and you're worried about whatever it is. It's usually, I'm worried it's going to feel different for you? I'm worried that it's going to feel different for me. Maybe I can't orgasm anymore. What if you feel bad because you can't give me an orgasm, you know, there's so much. And then what if my boobs leak milk? What if you touch my boobs and I don't like it?

Leah:

Yeah. What if it feels different? And what if it's never going to feel the same again for you? You know, I can just imagine all sorts of vulnerable, tender... feelings would arise. And I also think people seem to think that sex is only penetrative sex with penises going into vaginas, but there's lots of ways to make love. There's lots of ways to give each other sexual satisfaction and pleasure and connection and, and to reinvigorate those hormones that get released during intimacy, especially sexual intimacy and orgasm. And this is, I think, a time to get really creative. You know, I think if couples can look at this from a place of curiosity instead of judgment, judgment for themselves, uh, you know, everything's changed, they'll never be the same again. Judgment of their partner for their neediness, for their, um, frustration. And just get really curious. And I think sometimes just the conversations can be so incredibly satisfying and so bonding that that urge to feel like you have to have this friction to make sure you're safe and still okay in your relationship could be diminished the fear of that or the frustration of that. Um

Emily:

Totally agree. I think that there's a lot of um, you know, giving permission to just masturbate with each other and see how that feels. Or even like take sex out of it, takes anything about sexuality or orgasm out of it and just touch each other, you know. Give each other a massage and you know, try a couple of different things and if that feels good, keep going. You know, if it doesn't feel good, that's enough for today. Let's try again tomorrow. And then the big question I always get, what if the baby wakes up?

Leah:

Oh, really? Okay Well, then the baby wakes up, right?

Willow:

Yeah, I mean, that's a thing too is like how do you help women who are like, I just, I need to have my baby nearby me all the time. You know, I mean, I think it's, there's this idea that you can't be in a lovemaking situation with your partner or in a sexual situation with your partner and your baby has to be in a different, completely different space. But I think it's really sweet if the baby can be right there on the bed. I think that you know, again, coming back to like, feeling the pleasure. The sensual pleasure of breastfeeding. And like letting that be what it is, without having to put labels on it, or judge it, or shame it in any way. It's like, we're just sexuality is

Leah:

that you're being inappropriate or abusive.

Willow:

Yeah, and sexuality isn't a separate part of who we are as human beings. It's like, it should be a more integrated part of who we are as human beings. So, how do you guide women who are like, uh, I

Emily:

So, if women are having that question of like, what if my baby wakes up, you know, in the middle of sex, and we're about to orgasm, and then the baby starts crying? My first thing is to just go for humor. Like, laugh about it. It's great. You know, if you... It's, and it's like, if you're really close, just finish, that's great, it's fine, you'll get your baby in a minute. But if you've just gotten started and then the baby starts crying and needs to eat, laugh about it, feed the baby, and try again, you know?

Leah:

great advice. I love that.

Emily:

Give yourself, give yourself some grace and like, less pressure, less pressure always.

Leah:

That's such great advice. You know, I, I, some of the best advice I got before I got married just around, you know, arguments and fighting and nitpicking and poking each other and all that stuff. You know? If you can laugh at yourself, laugh at the thing that started to go a little wayward, you started to get a little, you know, cranky, bitchy, pokey, sharp, and then just go, Oh, yeah. Look at me, you know, you know, and then make fun of it and go, well, I guess I got to do this to you now, you know, and I swear it's really helped in the harmony of my relationship of avoiding turning into the Bickerson's and just kind of going humor can save those moments and, and then you are having a shared experience versus this isolating, separate, angry experience. Because I imagine a lot of new moms feel isolated. And I imagine that's at the root of postpartum depression. What can you say about women who are really struggling with postpartum depression?

Emily:

Oh my gosh, it is so common. And you know, it's really interesting, I've been seeing a lot more postpartum OCD, which looks a little bit different than you might imagine. It's like those thoughts that just keep coming in of like, you know, having to check on your baby every five minutes to make sure they're bbreathing. Or imagining the terrible things that could happen when they're 17.

Leah:

Right

Emily:

And I think that our society is inundated with social media, with information, with other people's scary stories, you know? And that it's really, it is okay to separate yourself from that for a time. It probably won't be forever. And it's absolutely okay to take a break from that kind of input. I do think that really... being able to have an open communication with your partner before you have your baby about the possibility that you'll, you know, there's the baby blues type of title, which is just, you know, you're crying every day at four.

Leah:

Right.

Emily:

And then there's actual postpartum depression, which is much more, it's a clinical diagnosis. And I think that having those conversations and really solidifying your relationship with your partner and solidifying your communication tools, even... I love the idea of like having a code word with your partner, having to do with sex, having to do with your mind space, all of it, just that like, I'm not okay right now. That little cue that they're like, okay, we need to come together, I need to ask more questions, I need to provide more support. Um, and really, as a pregnant person, kind of finding that community where you know where you're headed for a postpartum support group after the fact. You know where you're headed for therapy if you need it, you

Leah:

Yeah, I've had a family member and a couple of friends really get hit hard with postpartum depression and one of the things that they would share is like, I feel like nobody gets it, nobody understands, no one can even grok, like how much suffering they're in. And they feel so alone and they're so afraid of being judged. And, and I think part of that is, is also judging that no one understands and, and frankly, I didn't understand. I mean, I know depression, a close relationship with depression, but I don't, I don't know the, the fear that is residing in that space. And so if you're a family member or a friend, um, or a part of, you know, a different community and you're this person who's suffering in this way confides in you. What's the best way to show up for them?

Emily:

Don't say, Oh, you have a new baby. You're so lucky. Just enjoy your baby. That's what you don't

Leah:

Right. I bet that's what everyone says too. Like you have this miracle. Yeah Why can't you be happy? Just look at the baby.

Willow:

Well, one of the things that happens, you know, when, as you were saying before, Dr. Emily is like, when you do have the baby all of your hormones drop back down to baseline. You've been building up all of these hormones inside of your system for nine months. It's like an extended period cycle, right? Because we build up those hormones and then when we bleed, everything drops down back down to baseline. And so we get that moment of like woah like the blahs or the depression or it can come in different layers or in different, you know, degrees. But that is a real thing that we're, that we need to pay attention to. As we're, and so I love what you're saying, like set yourself up with support groups, set yourself up with therapists and set yourself up with, uh, an endocrinologist.

Emily:

Yeah. totally. I love the idea of getting your thyroid checked, but actually like every aspect of your thyroid, not just the one, because that is a super, super common postpartum experience of just like your hormone levels are crazy and your body is trying to adjust. I think there's also um, a misconception that taking any kind of antidepressant is going to affect your baby through your breast milk, and that is the case. It might. But when you have a clinical diagnosis and you have a physician who gives you the prescription that you need for the anxiety or depression that you are experiencing, they will tell you the risks to the baby and they will not give you something that you aren't allowed to breastfeed while you're taking, you know? So there, there are so many more options. I think you feel paralyzed in that time and there are so many more options for you when you're a breastfeeding person. And you want to be taking care of your mental health at the same time.

Leah:

Okay. so just to go back to what you don't do is say, you know, Oh, but you have this baby, you know, don't you feel this or that when you look at the baby and blah, blah, blah. I imagine that maybe the next appropriate thing to say is, well, share with me what it feels like.

Emily:

Yes, so that's the other aspect is just listen and hear what they're saying. Active listening is one of the biggest things that you can give somebody who's struggling and just being there with them. And asking them, Oh, what do you need? Is not going, they don't know what they need. They don't want to have to come up with an idea of something for you to do for them. What they probably need is just your presence. And for you to not dismiss or belittle any of the emotions that they're feeling.

Leah:

And if you're feeling stuck with, okay, I'm going to try to listen, but you feel like you need to still say something, just say, so tell me more about that. So tell me

Emily:

That's a great

Leah:

Or, you know, what's that, what's that like for you? And, um, yeah, I'm so glad you're sharing this.

Emily:

yeah, you don't have to fix it. And if you are a person who's never birthed a baby and you've never had a postpartum experience and you can't really relate in that way, I, Googling yourself postpartum support groups in your area is amazing. There's also a lot of Facebook groups and online postpartum support groups. And for some people, I know, like, for very specific situations, like, non binary people who are going through IVF treatment for prolonged periods, like, there's a group for that. There's, there's, like, really specific niche things out there that can be really... supportive and helpful to just know that you're not alone in your feelings. And as a postpartum person, you don't, you're not going to do that. You're, You might

Leah:

You may not be resourced to, to do that. Yeah. Yeah. You might, that's where maybe you can be resourceful as a, as a supportive person in their life.

Willow:

I want to shift a little bit and ask about, um, like the period of time when you stop breastfeeding, because this is always just like, women are like, should I do it for a year? Should I do it for two years? Some women do it for four years, you know, like what's too long? What's too little? And then what's the process of reclaiming your breasts for yourself when it's time to, to cut the cord, so to speak, on the breastfeeding?

Emily:

That's a great question. I think there's sort of this arc where, especially after a first birth, you have really tender breast tissue. It's, it's uncomfortable and it really feels like these will only ever be for feeding my baby. And then eventually your body gets used to it, your not as sensitive anymore. And I promise if anyone is in that like first four weeks listening right now and you're in pain it doesn't last and it shouldn't be painful go see a lactation consultant. But the the real you know, meat of breastfeeding when you can just be out in public and feed your baby as a six month old or whatever. That's great. There, the recommendation from the American Academy of Pediatrics, the CDC, and the World Health Organization is to breastfeed your baby up until two years. Or as mutually desired by the dyad. That's like the specific language they use. So mutually desired is the key. That like you want to continue breastfeeding and your baby wants to continue breastfeeding. And the AAP, the American Academy of Pediatrics just changed the recommendation to two years. It used to be one. And so they're really seeing the benefits of breast milk for

Leah:

Interesting. Why, why did they change that? Do you know what the benefits

Emily:

are? I think, well, oh my gosh, do you want to come to one of my other classes?

Leah:

We could do a whole podcast episode just on the benefits of, uh, breastfeeding a little longer. Yeah.

Emily:

Oh my gosh, so the general benefits have to do with, first of all, the breast tissue has a life, has a life cycle, and if a body goes through full transformation of making milk and feeding a baby, that's the full life cycle of the breast tissue. And by going through that, you're at a decreased risk for cancer, you're at a decreased risk for lots of different types of cancers, which is really interesting. Um, you're at a decreased risk for cardiac conditions and all kinds of amazing... Health benefits. Um, and mental health benefits, yeah, yeah, mental health benefits as well. Um, there's also benefits for the baby, so the baby's gut health is really amazing. Um, and the baby's bonding and attachment with the caregiver is... Really wonderful. Um, breast milk has antibodies in it. It's like a living substance. So it's incredible for immune support. And in communities with water that's not clean, breastfeeding a baby is the best possible thing for their health. In a disaster situation, breastfeeding a baby, it's it's kind of unfair, but it doesn't really matter how hydrated you are. You're still going to produce breast milk for your

Leah:

baby. that's awesome. So what about like, I mean, look, we live in the West where most women are working, they don't have the luxury to stay at home, and they have to go back to work after six weeks. You know, And they don't have the privilege to be able to breastfeed their baby, during the day. They, they will likely pump if they can. I know that there's other milk banks, so that if you're having a problem with lactation, you can still get, or if you're a family who adopted, or you're a family, and you don't have milk, you know, you, there are milk banks, which I think is totally cool. You can still get breast milk. But what are some of the solutions? What about the shame and the guilt that you feel if, if you, if you decide that nursing isn't for you and it feels like an impossible thing to overcome and you decide not to, what do you do then?

Emily:

Yeah, so I've actually had a number of clients who are, they come to me and say like, I just had these twins and I'm not going to breastfeed, help me dry up my milk. You know, and that is 100 percent what I help them do. There's absolutely not a... ounce of trying to convince them to breastfeed in that scenario because the mother's mental health is so much more important as a baseline for the health of their babies than anything else. So, there are body image reasons that you might not want to breastfeed. There are like personal boundary reasons. There's sexual trauma. There's so many reasons you might not want to breastfeed. And I think listening to that and really knowing in your body, what is right for you is important. There's also the the aspect of like, I wish I could breastfeed, but I can't and I don't have the supply. Or I don't, you know, I have insufficient glandular tissue. There's so many things, so many weird reasons that you might not be able to breastfeed at all. And I think taking that guilt and shame away and just, you know, being so, being so,

Leah:

of their

Emily:

Yeah. Oh yeah,

Leah:

and to unplug from whatever the societal norm or even what the community has to say. Because I think the other thing I hear from moms is other moms are so judgmental.

Emily:

yeah. Oh my gosh. They really are.It's amazing. Like they think that the way that they did it is the only way to do it, and it's the right way and it's really, it's really hard to be a mom in our society. You know? There's also, like all of the social media has a different. Rule that you need to follow and a different, different, yeah,

Willow:

And all the books out there, all the literature on how

Emily:

making shh,

Willow:

you know, how to mother and how to parent and how to co parent and how to, You know? it's like you really have to find your own way with this stuff and, and listen to your own.

Leah:

Yeah, so how do you juggle both? Let's say I'm, I have to go back to work, it's been eight weeks, my maternity leave is over, and I want to keep breastfeeding, but I've got logistical issues, so maybe we breastfeed at night and we bottle during the day. What, what's the solution there?

Emily:

hmm, Yeah, so you pump. So pumping is a full time job and I think somebody put this to me the other day as, um, like, if you if you try to explain this to a man in a way that they could understand that every time that they needed to have a cup of coffee and every time they needed this cup of coffee it was actually every two to three hours. They had to take all their supplies, the coffee maker, the coffee beans, everything into a little closet with no window. And they had, they had to grind the coffee beans, plug in their coffee maker. Oh, but they forgot water, so they have to go get some water and come back. And then they have to make the coffee. And then they have to wait there for about ten minutes until it's ready. And then they have to, you know, enjoy the cup of coffee. And then they have to clean everything and put it all away. And they have to do that every two to three hours. Laughter.

Willow:

there's a really a big like. there's there's really, like. a big giving up of your time and your space to properly pump and to properly breastfeed to, to really, um, nourish your infant from your own body. I mean, I think that's one of the sort of initiations into motherhood that, that women experience, you know. Of course the delivery is a huge, the pregnancy, the delivery, but then the breastfeeding, there are all these initiatory stages in it. Kind of just goes on for like two to three years, really, you know.

Leah:

More like 18 years. I mean, it's initiation after initiation after

Willow:

It goes on and on, exactly.

Leah:

for 50 years, then they get married, then they go to school, then they have their own baby. I mean, it's just like initiation after initiation. What a riot.

Willow:

Yeah, and it's like, who are you after, after all of that? Like who, who are you becoming? I think so. That's something I would love to touch on two is like, how do you support women who are like, God, I'm going through like the biggest transformation of my adult life, becoming a mother, becoming something I've never been before. If it's their first time and, um, and letting go of who they used to be. I think there's just so much in there that is, um, is full of challenge and full of medicine as well.

Emily:

Change is the hardest thing that we all do and as you become pregnant and then birth your baby and have your postpartum period, it is one of the biggest transformations and it can be very traumatic. It is, uh, there's so much unpredictability and especially for people who are more type A and who are career oriented, I almost feel like our societies become more type A. Like everyone just wants to control everything and you can't control birth and you can't control the personality of your baby and that's hard.

Leah:

Totally.

Emily:

So I think that one of the big things about going back to work and pumping at the same time is that people who don't pump can't possibly understand the sacrifice that that is. And Being able to take that in and really feel that in your body and feel this almost sense of power that you have because you are every, by every three hours asking your colleagues to cover for you in whatever way, you know, it depends if you're a healthcare worker, that's a huge deal. If you're, uh, CEO, that's a huge deal. If you run your own business trying to pump and,

Leah:

Yeah, if you're a laborer, if you work in factories,

Emily:

yeah.

Leah:

of that is a huge deal.

Emily:

Oh my gosh. And a lot of times, you know, if you work at Target, maybe they don't have a place for you to pump. Legally, they have to. So. You know, make sure that they, you have rights. Yeah. Um, but if, you know, a lot of times around that four month mark, your breast milk supply starts to dip because people are going back to work and pumping and not having enough time to pump. So really thinking about, you know, what is your priority? And Don't kill yourself trying to pump enough milk for your baby if that's not really your priority. But just somewhere in your brain you learned I have to only give breast milk to my baby for the first year, you know, like think about what is going to really help you. I've had so many clients who I just suggest, you know, do you want to give a little bit of formula or do you want to increase your milk supply? Because there's you have a choice There's not like you don't have to kill yourself trying to pump and pump and pump and pump and pump and never ever ever use formula just because you're wanting to exclusively breastfeed, you can, and, and I will help you do that. And any lactation consultant can help you do that. Giving yourself that permission that like, it's okay to take some pressure off. It's okay to prioritize your career if that's what you want to do. That's, you know, there's so much guilt around that. And I think that It's really important to support people with what they want, and that always starts with a question that they usually don't know the answer to. So it takes... a little bit of time to figure out what, what do I want out of my life.

Leah:

What is the most ideal time to reach out to a lactation specialist? If you could give like a, a time frame.

Emily:

you know? So if you've never had a baby before and you've never breastfed, I would do a prenatal appointment with a lactation consultant because then you know them and maybe you don't like them so you go find another one to do a prenatal appointment with. You know, you, you want to make sure that you're vibing with the person who you're going to be working with and who's going to be potentially like touching your boobs or telling you to Teaching you how to hand express. It's a weird thing to milk yourself, you know, and so there's a lot of Trust that you build in that prenatal appointment where you learn about breastfeeding, you are kind of getting to know this person, and then they can tell you, here are the reasons that you would want to contact me after birth. and I really love Just, I see babies on day one or two of life, and that's usually because a midwife has noticed something that's not great, and so I get pulled in really quickly. And the earlier the better for a lactation consultant or a physical therapist. I think, oh yeah. Always.

Leah:

What about doctors versus midwives?

Emily:

That's a

Willow:

That's another podcast episode. Yeah, yeah, yeah, exactly, exactly. So, I want to talk about two, um, women who have had breast implants, and where are they at with breastfeeding? Like, what is the possibility, the probability for them, and how does that all work? Mm hmm,

Emily:

that's such a great question. I love it. So, we have two kind of varieties, a breast reduction or a breast augmentation. And there are a lot of different types of surgeries that you can have, um, with different entryways and different, you know, surgical incisions. Um, and, Each of those has its own sort of outcome. Any time that the nerves to the nipple are cut or damaged, that will reduce the likelihood that you can have a milk supply. But frequently, more and more plastic surgeons are, um, Really trying to keep the breast tissue safe and keep the breastfeeding ability safe. Um, but it will affect breastfeeding in some capacity,

Leah:

How, what, what, what's the, what's

Emily:

It'll reduce the yeah, it'll reduce your supply, usually. Um, because the, a lot of times, you know, no matter how careful you are, you're cutting through some nerve. And so, they're, the connection between the brain, which is where prolactin levels start to increase. And then all the way down to the breast tissue might be severed in some

Leah:

So it's not really about the implant as much as it's about the incision.

Emily:

Yeah, and any, um, like with a reduction, any removal of, of

Leah:

Yeah, because for women who have, um, who do a lift or who do, who have reduction surgery, there's typically an anchor, an anchor and a lollipop scar, which means they cut around the nipple. There's a, there's a scar that goes from the bottom of the nipple all the way down underneath the breast. And then there's a, a moon crescent moon shape scar underneath the breast in order to change the shape of the breast itself, um, which I can imagine create obstacles with all that scar tissue. Now there are women, there are surgeries that also put in implants without cutting anything with the breast and they go through the armpit or they go through the belly button. is that a reduced risk to nursing

Emily:

That's a great question. I would imagine, not being a plastic surgeon, that a belly button would... Not have as big of an impact, um, as the axilla, as the armpit, because you have a A bunch of breast tissue that actually goes up. It's called the tail of Spence. It's like a, you know, lovely name for a tail of Spence that goes up, um, and into your axilla. So there might be some breast tissue there that is affected by an insertion from that

Leah:

Okay, I know that other breast implants are there's a very teeny scar at the bottom of the breast underneath the breast and then there's Other breast implants where they do cut around partially part around the nipple to put the implant in but again

Emily:

that lollipop. Yeah, that lollipop scar is the one that tends to affect breastfeeding the most because they're really removing

Leah:

right, right, And then they

Emily:

and then putting it back

Leah:

right. Yeah. Okay, so if you're thinking about breast reduction or if you're thinking about augmentation and you haven't had babies or nursed yet, these are, you know, smart things to think about. There are other things that you can do in order to enhance your breasts. There are incredible Taoist massage techniques that Dr. Willow specializes in that really help with Yes, breast health and everything. And then there's also fat grafting, which is a different form of, um, bringing more volume to the breast tissue without implants. So, uh, lots of options. We are not experts when it comes to augmentation, but I have had an augmentation. I have had a lift. So, um, I've had also, I've had to have corrective surgery. Due to bad plastic surgery, so my breasts have been through it but, um, hey, It's just the way of the world.

Emily:

The other thing to consider is if you are considering having babies and wanting to breastfeed them, like Be patient. And then once you've actually seen like what deflated boobs look like after they don't have any milk, we didn't quite get there. We were talking about like that transition to no more, to no more breastfeeding, but they sometimes just get a little like deflated looking.

Willow:

Yeah, I love, like I've worked with so

Emily:

I'm gonna need to talk to you after I breastfeed this baby, Willow.

Willow:

worked with so many postpartum women who once I get them, I mean, it is a full practice. It's not an easy fix. It takes at least seven to 10 minutes a night, you know, to do this practice. But when women do commit to doing it, they definitely notice a difference in not only the size, but like the roundness, the fullness, the lift of their breasts is, is much more, um, um, And much closer to what it was pre breastfeeding. So, and it also depends on how many children you have breastfed as well. You know, I've had women who, who've had five children and they've breastfed all of them and they were just like, I just need a boob job. You know, I was like, well, God bless, go get one then. Like, do what you need to do to. Feel like you're in your femininity and in your sexiness and your body. and, I think that's, you know, there should be no shame around any of it. Like no shame in not getting a breast job after breastfeeding five children and no shame in getting one. It's just like, it's a personal choice and this is the world that we're living in and so

Emily:

your nipples change, too, sometimes, with breastfeeding. Like, your, the shape of your nipples, maybe your nipples get bigger, and maybe as the milk starts to come out, like, there are different levels in your nipple. Like, it's, it's always so different for every body, and sometimes those changes don't go away, and it's something that's dissatisfying, and it's absolutely okay to... You know, do what you need to do to feel amazing in your

Leah:

and also just a cautionary tale, like, don't feel bad if you didn't premeditate this before you started to have children and you got a boob job at 16 years old. You know, maybe that was your sweet 16 present and all you wanted that year was to have the boobs of your dreams. Like, all of it's okay

Emily:

And to not feel defeated, because there is so much that you can do and there's so much help that is out there. And so there's, there's not only, you know, mental health support, but there's actual tangible lactation support If you've had a breast reduction or a breast augmentation 10, 20 years ago, and now you're wanting to breastfeed, like there are ways to help enhance your breast milk

Leah:

So, what if you can't afford it? What if you can't afford an expert? What are some, some other resources that are either low cost or free?

Emily:

I do. Yeah. I have a free group. I'm in Portland, Oregon. So if you're in Portland, Oregon, you can come to my group. I had someone ask me just one of my yoga clients the other day. Do you know of any postpartum support groups? And I was like, okay, well on Mondays, you could go out here on Tuesdays, you could go over here. Wednesdays, you know, so there's in Portland, there's one every day of the week that I could

Willow:

Same as Santa Cruz. Certain places are full of them. Yeah.

Emily:

Totally, um, there's also online support groups that exist. And so like Googling free online support group, I a hundred percent recommend doing that. And also just experimenting, find your people. Because not every group is the right group, you know, some groups are like very home birth heavy and some groups are like exclusively c section heavy, you know. And you really want to find your people and, and who you can relate to and really feel open to share.

Leah:

Insurance cover some of these services?

Emily:

That is something that I was going to say if you need a lactation consultant, IBCLC, International Board Certified Lactation Consultant Services, should be covered nationally. There should never be a time that you can't get lactation support. Quality of the lactation support depends, though, you know. Not everyone is also a doctor of physical therapy and a yoga teacher and a massage therapist. But! But there are some incredible lactation consultants who just work at the hospital and I think if you are doing a hospital birth you can demand a lactation consultant be there postpartum to take a look at your latch and make sure that things are going well and give you some advice if you haven't been able to have any prenatal lactation training. um, there's also like hundreds of thousands of Instagram accounts that IBCLCs run that are really amazing, that have great resources.

Leah:

That's great.

Willow:

Do you have any online, uh, you know, support groups? I know you're training sex after birth. It's an online course. So there's some support in there, correct? Um, but do you have any, any, any other online offerings for women?

Emily:

So, I teach a prenatal and postpartum together yoga class, and at the beginning of each class we always share. And I feel like those cohorts get really close because of that. There's also questions in the middle of class, I'm very casual when I'm teaching, so there's always like a question that pops up like, this hurts here! Is that okay? You know, and those sorts of things just draw the group closer. Um, that's not a free offering. And then I also teach all of this education that's on demand. So I have a first latch class where you can learn infant reflexes and kind of the language of a baby. I think a lot of people don't know, just basic, really easy things like this, I'm, I'm showing you with my hands and we're being recorded, so I'll tell you what it looks like, but it's a finger splay, that like, this stop sign right in front of the baby's face. A lot of times parents are like, oh, they're gonna, they're giving me a high five or something, and that is a very clear stress cue that's just saying, I need a minute, my brain is taking in a lot of information, give me a second. And it's an opportunity to kind of bring the hands to midline and just, you know, soothe the baby for a moment, give them some containment with your hands to simulate the uterus. So, I have a lot of classes like

Leah:

That is so great. Thank you so much for being on the show and for enlightening us on breast health and nursing and latching and postpartum life and postpartum depression and all the goodies you brought to the table. If you want to hear some other information about birthing and the process of birthing and in some other interesting information about breasts and nursing, check out our first episode ever was with, Sherri Winston, the great Sherri Winston. so be sure to check out our show notes because we have all of Dr. Emily's resources there, her, website, her free gift, her, information about her courses and how to get in touch with her.

Willow:

Yeah. And so it's been such a pleasure. It's been so much fun having you on the show, Dr. Emily Spade. Thank you so much for coming and for sharing your wisdom with our audience.

Emily:

You're so welcome. It was absolutely my pleasure to talk to you all today. And my business is BeWellBabyPDX and you can find me on all of the social media.

Leah:

Awesome. Well, we can't wait to have you back on the show. We already discovered there's a couple other episodes that we need to tune in with you. So, we'll see you on the flip side. Love, love, love, everyone.

Announcer:

Now, our favorite part, the dish.

Leah:

Dish, dish, we're going to dish about boobs! The wonderful world of boobs and breastfeeding. What was your take on this episode?

Willow:

I kept wanting, to be honest, I kept wanting to move it more toward pleasure and sexuality. Which is funny cause I, I think cause I've done so much birth work and I've done, you know, I've, I've been in the lactation world for a long time and um, so I felt like we were, we were erring on the side of, you know, all of that, which is great. Really important and we don't talk about it a lot on our podcasts. So great information for our audience. I think that, you know, reimagining sexuality and sensuality is, you know, we did touch on it a bit of like how, what does it mean to like make love when your babe, your infants on the bed next to you? What does it mean to actually enjoy breastfeeding and to actually get like stimulated and turned on and then to take that turn on and turn it into medicine in your own body and then to take that into your partnership. So I kept wanting to kind of gear it in that direction, but I, I still love that. Um. Everything that came out during that interview was just such good information. So important for women to know, especially if you haven't had a baby yet, but you want to, or, you know, you're thinking about a boob job, you might want to think again before, uh, before you have a baby and breastfeed. So I thought that was a really, um, she's just packed full of info. That's great.

Leah:

Yeah, it'll be fun to do another episode with her. We talked to her after we, um, you know, press stop on the record button for the episode to, to go, okay, we, let's do another episode, like all about sex and, and postpartum sex. So it'll be fun to have Dr. Emily on. Where we can really dive into the sexuality part of it. But I think the thing to remember, it almost feels like jumping the gun to go there before the recognition of this whole birthing process, this whole nursing process is fraught with sometimes disinformation is fraught with isolation. It is fraught with embarrassment and shame about what you feel like isn't working in your body. And we forget that all of this has to do with sex. Every single part of the birthing process is relatable to sexuality. It's relatable to partnership and relationship and intimacy. And including our relationship to our breasts as they're being transformed, as they're being used to take care of another being. And all the... The stuff that goes along with that, all of it is connected to sexuality. And I think the thing that people don't get is that every part of our life is actually connected to sexuality. And we often, when we are in these years where we're in relationship and we're in our careers, we put sex to the wayside and we stop valuing it. It's this important part of our expression and this important part of our fucking joy and stress release and we as women I think we tend to think that sex is just for our partners and we forget that we are an active participant in the kind of sex that we want and The kind of sex that we give.

Willow:

Absolutely. Yeah, I think that, um, we can reclaim that for ourselves and really, uh, take that into the forefront of our experience. But that does require knowing your own body, knowing your own turn on, knowing your own pleasure. And you know, in a postpartum body, that's all going to be different than it was before. So there is a level of curiosity that you need to bring into your, um, rediscovering, like what's pleasurable for you now, what's going to turn you on at this point. I mean, it could be watching your, your partner, like chest feed the baby. That might be a turn on for you. I don't know. You know, but just exploring and being open to like, what. is what lights you up at this point and also that requires energy. Having that curiosity and being able to explore knowing your own sensual turn on and arousal and pleasure does take energy and when you haven't been sleeping for you know six or seven hours straight for weeks and months on end you don't have that energy. So give yourself a break, give yourself a pause and, and take the time. I always tell women like postpartum is a year, you know, it's a year period of time where you really just, you're going through a massive transformation. So give yourself a break, give yourself some space. Everything will find its way to where it needs to go. And you know, that's just true in life in general. Whenever you're going through any big transformation or transition, it's like, just give it some space to do its thing. Life takes care of life. So if you can sit in the trust and the faith of that, everything will unfold.

Leah:

You know, here's an invitation to our audience. I would love to find a male expert who helps men support their partners through this postpartum experience. Because that is never talked about, is a man's journey of becoming a new dad, a man's journey of trying to support their partner as they're having a baby. The feelings of frustration, of Feeling jealous of the baby, of feeling left out, of feeling abandoned, of feeling neglected, and feeling needy and hungry and missing that pussy, you know? It's like, I want to know who's out there supporting men and giving them the skills that they need to be the best partner, to their partner who's going through all this massive physical and emotional change. How can they show up in better partnership? I would love to have that episode. I'd love to have that interview. Is anyone doing that out there? I

Willow:

think I might know someone. I think I might have someone.

Leah:

Oh, really?

Willow:

Yeah. He's got a podcast as well.

Leah:

Oh good, we can do a swap. So let's get

Willow:

Yeah.

Leah:

the show.

Willow:

Alright, y'all.

Leah:

All right. Well, we hope you are having a fabulous day or night wherever you are tuning in. may your life be filled with love and we will catch you on the flip side. Love, love, love, love.

Announcer:

Thanks for tuning in. This episode was hosted by Tantric Sex Master Coach and Positive Psychology Facilitator, Leah Piper, as well as by Chinese and Functional Medicine Doctor and Taoist Sexology Teacher, Dr. Willow Brown. Don't forget, your comments, likes, subscribes, and suggestions matter. Let's realize this new world together.

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Dr. Willow Brown

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Leah Piper

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