Written by Christopher Kelly
Dec. 3, 2014
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Julie: Hello and welcome to The Paleo Baby Podcast. I'm Julie Kelly and today I am joined by Krista Gray. Krista is an Internationally Board Certified Lactation Consultant. Krista also serves as a La Leche League Leader and has over thousands of hours of experience supporting breastfeeding moms. That's a mouthful.
In 2011 she was selected as the sole international recipient of the annual Health-e-Learning scholarship for lactation studies. She is a mom of four and cheerleader for breastfeeding moms everywhere. Hi, Krista. Welcome to the show.
Krista: Hi! Thanks for having me. It's great to be --
Julie: Awesome. I'm so happy to have you. I know as a breastfeeding mom myself there is a lot I want to ask you. But, first, can you tell me and the listeners a little bit more about how you decided to become a lactation consultant and what's kind of inspired you to be a leader in breastfeeding advocacy?
Krista: Sure. Well, my first child is a girl. She's eight now. I didn't have many hiccups breastfeeding her, but I did have some. Breastfeeding is natural and it's normal but it's not always easy and I think as women we need help and we need some support in that. So I had some really great help and support. After getting, going, and breastfeeding her and it was going well, I thought to myself, just kind of in the back of my mind, "You know, one day I think I would like to be able to help moms in this way." That was just kind of back there I think after the birth of my first child.
Second time, I was living in Egypt. I was pregnant; I found out it was twins. Long story short, they ended up being born in Egypt two months early. We were headed home to the States and four days before I got on the airplane I just spontaneously went into labor, ended up having an emergency C-section and I was even more determined that breastfeeding was going to work since the birth had not turned out how I'd hoped that it would.
I was just very determined. I had a lot of strikes against me. There was zero lactation support in Egypt and I ended up doing it. I succeeded. I never had a supplement and it was just a really great success story and it was really empowering and wonderful. My babies, they thrived and they did great. Their pediatrician in Egypt came back to me and said, "Would you mind bringing me pictures of them each month for the first year of their life? I'm going to hang it on the wall and show Egyptian mothers that they can breastfeed and their babies will grow and this is what they need to do." I said, "Sure" of course. The next time I went back in, he said, "By the way, I want you to start working in my hospital as a lactation consultant six days a week."
Julie: Oh, wow.
Krista: Half the day. I said, "Oh, no, no, no, no." I have little twin preemies at this point. So, anyway, we kind of negotiated it and I did start volunteering in his hospital just a few hours a week and at that point is when I began my formal studies to become an International Board Certified Lactation Consultant.
I say my fourth baby was my inspiration because I did a lot of studying when I was pregnant with him and in those early days nursing him. He's two and a half now. I am still nursing him but I am past I guess the books and the studying on a day-to-day basis and get to do the more fun practical of helping moms succeed in breastfeeding their babies.
Julie: That's fabulous. But you haven't had -- I mean, not all of your breastfeeding has been challenge-free. I just remember reading in your blog.
Krista: I feel like I have experienced the whole lot of different things and I think that it helps me really be in tune with other moms. I've had low milk supply. I have had oversupply. I have dealt with tongue-tie and lip tie, multiple bouts with mastitis, nipple blebs, nursing preemies which in itself -- a premature baby has a whole other host of issues -- nursing multiples which is a whole nother set of issues.
So I've had a lot of different experiences personally as well as professionally so it gives me I think a good perspective when I'm helping moms. It's not just from the books or helping other mothers but it's what I have experienced in the day in and day out of it too, that I can really give some good practical help and advice.
Julie: Where do you think we are as kind of in society right now? What's a good snapshot of how you think breastfeeding is perceived and also kind of how do you think women relate to breastfeeding right now? I know it's gone through quite a bit of ebbs and flows in the last 15, 20 years. Where do you think we are right now?
Krista: Well, I have an interesting perspective having lived in Africa and in Europe and now in America and having breastfed and breastfeeding and living in these countries. As far as America is concerned, I'd say that we are in some ways a bit behind some of the other places in the world and just in Western nations and the normalcy of it. At the same time, breastfeeding initiation rates are higher than they have been in decades so that tells me that moms have gotten the message that breastfeeding is the best way they can help their children and they want to do it.
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Where we are really lagging in America is our rates when you look at six weeks out, three months out, six months out, and especially a year and they are pitifully low; worse, some of the worst in the world. I don't think it's a lack of desire. I think it's a lack of support.
I said earlier that breastfeeding is natural and normal but it doesn't make it easy and I think where we're failing as a society, as a culture is helping moms to succeed in what they want to do. It's one thing to say, "This is what's best" was breastfeed your child but we don't come from a culture of support. It's not like they have grown up around everyone else doing it around them and they have seen how to do it, they've seen what to do when there're problems. There's just not support system and moms need support in order to succeed.
Julie: Yeah. It seems like there is also a little bit of a disconnect with, yeah, like you said, the normalcy of it in society and normalizing it. I feel like every time I nurse my daughter in public, I am making some kind of a statement. I especially felt that in the early days.
I have three young brothers and my mom has raised them very -- nursed them in front of me. I watched all of them be born so I kind of have a different perspective of a lot of new moms. I was lucky enough to be exposed to that so I wasn't nervous about doing that in public. But I wonder if you think that that's something that a lot of moms feel, that kind of every time that they nurse in public or in front of a man that isn't their husband that they are making some kind of a statement, whether they want to be or not.
Krista: Yeah. Absolutely. I think that that sadly is one significant factor in why breastfeeding rates aren't what they need to be at six weeks, at three months, six months out. There's quite a few factors in that and one of them is just the maternity leave and those issues but another one is this nursing in public. You can't expect to nurse a child as frequently and often as a baby needs to be nursed and always be home.
Julie: Yeah.
Krista: We have to go out. We have to do things. Life goes on. And there are stares; there are glares; there are grunts and people leaving. It's very awkward and the new mom is made to feel like she needs to cover up and hide it and not do it and that does not help her to be able to get on with life and nurse her baby which are both two very normal, natural things that can and should occur at the same time.
Julie: Yeah. What are some things you think -- I mean, system-wise, where are we failing in terms of the support? I mean, is it just at the hospital level? Obviously, there are social things that we could support each other with but I mean on the systems level, where could people apply a little bit of pressure in their communities system-wise to try to get more support in hospitals and things of that nature?
Krista: That's a great question. I think systemically, a lot of hospitals are moving to the baby-friendly status which is having very good lactation support in the hospital.
Julie: Uh-hmm.
Krista: Not every hospital is there yet but there is a big push in our country to move there so I think the 24, 48, 72 hours after birth I think having support at that point in the breastfeeding journey is improving. I think where we're really still failing moms is when they go home. I mean, most moms are going home before their milk has ever come in, before they realize there's ever going to be a problem and then we are asking them to just go for their regular pediatrician visits. Pediatricians are skilled and experienced in taking care of babies, not --
Julie: Breasts.
Krista: -- in breasts or breastfeeding.
Julie: Yeah.
Krista: And they don't know where to turn for help. They don't have licensed lactation consultants for the most part who are on staff with them, and their experience and their ability to help depends largely on what their experience was nursing their own children. Interestingly enough, doctors are very high risk breastfeeding. They have some of the highest initiation rates and some of the lowest rates at six weeks and three months --
Julie: Wow.
Krista: Because of the nature of their profession -- lots of hours, returning to work early, lots of other things in there but all that to say they don't have great experiences in general with breastfeeding success so they are not able to impart their wisdom for their patients to help them. So there's just not a lot of support after a baby is born as far as breastfeeding.
Julie: Yeah. I was lucky enough to find a pediatrician that had one of their staff -- she was a nurse practitioner and I chose her specifically because she was also a lactation consultant.
Krista: Right.
Julie: It was huge. I mean, I didn't have any trouble nursing but at the same time I was on my own. At the time, I lived a little bit further from my mom so I didn't have that kind of constant, you know, someone looking over your shoulder just telling you you're doing it right.
Krista: Right.
Julie: So it was nice to just even at that -- those first few checkups to just have somebody say, "Okay, let me watch you nurse for a little bit and see how it's going." That was hugely helpful, just giving me the confidence that I was doing everything right. Even though I kind of knew I was, it was just nice to have that backup so I definitely encourage women to try to find someone that they can see in those first few weeks or come to them that could help them. That would be huge.
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Krista: And I think that's a really great point because you weren't having trouble and think about how important it was to have someone be able to come alongside you and say, "You're doing great. What you're doing is working and it's right." Now, put yourself in the shoes of other moms whose babies might not be gaining weight as fast as the pediatrician wants to see. Now they're questioning their ability to feed their baby, take care of their baby, then there's not the support to help her be able to do what she needs to do or to say, "You know what? This isn't an issue with your milk supply. This is an issue with X, Y, or Z." We need more licensed lactation consultants that are readily available for moms to be able to have that support so that they can succeed just like you were able to and --
Julie: Yeah. Well, it seems like that's just like this pressure too of like there's just like a little window so if something's not going right and if you don't have help and you've got the pediatrician who obviously their focus is the baby not the mom and the breastfeeding, telling you, "Oh, you're not doing it right," then you feel like you've got your very limited window to get it right. So I can see how that would just be a breakdown, right?
Krista: Absolutely. I mean, every mom wants to do what's best for their child. They want breastfeeding to work but you have a whole culture that's putting weight on you that says, "You know what? If it doesn't work, formula is a really great option. Turn to it especially if your baby is not thriving, not doing exactly what --" Every other child is because we know we all have to fit into this plan and it's a lot of pressure, and then you second guess yourself and you think, "Well, if I keep breastfeeding and my baby is not thriving, it's all my fault."
Julie: Yeah.
Krista: And so it's just a lot of pressure that many moms face without support.
Julie: Yeah. What are some of the other thing -- I mean, in our practice, we talk a lot with our clients about nutrient density and nutrition. I'm really interested in the idea of preconception nutrition and health and kind of getting ready for baby and kind of tackling it a little bit more head on than people are used to tackling it, right? A lot of times, babies have surprises and we can't do that but there's a lot of people now, especially as women are having babies later, that get to a place and they say, "Okay, now I'm ready. Next year, I'd like to have a baby."
So what are some things that you think further up the line in terms of health and nutrition that can kind of set a woman up for success in terms of the likelihood that she'll be able to breastfeed? How early is too early to start getting ready to breastfeed?
Krista: Well, I'm a huge advocate of health and nutrition and taking care of our bodies and eating nutrient-dense quality foods and getting rid of the junk and the processed foods and those things. So I think that there is a lot of benefits to that not just for pregnancy, birth, and breastfeeding.
Julie: Uh-hmm.
Krista: But for a woman going through the stages, I don't think it's ever too early. I mean, we always need to prepare our bodies and be as healthy as possible because during the child-rearing years there are lots of surprises that people have. Most people aren't lucky enough to be able to say, "Next month I'm going to get pregnant."
Julie: Right.
Krista: So I think we need to be prepared as women in the child-bearing years for that. But I do want to say before I talk more about nutrition that no matter a woman's diet, even when it's poor -- and, yes, there are times that I cringe and I think, "Oh, don't eat that" -- her milk is still superior to man-made formula that is dead, it is not a living substance. Her body is going to take from itself to make rich, good quality milk.
Julie: Yeah.
Krista: That's not to say that her milk will necessarily be as great as this woman who really takes care to eat very nutrient-dense, healthy fats good foods but that milk is still going to be better than formula.
Julie: Yeah.
Krista: So just want to throw that out there because I --
Julie: No, I think that's great. I heard a really interesting lecture at AHS from a professor who has spent his whole life studying breastfeeding and breast milk specifically. That was one of the most interesting tidbits that I took away from the whole thing, this idea that breast milk is a living entity and that it changes every single day based on what the mother eats, based on your hormones, based on this so a baby getting your milk every single day is basically getting a picture of nutrition every single day and it's so much different than -- your formula doesn't change. It's completely static. It's not a living organism so it doesn't ebb and flow with the hormones of the mom and the micronutrients, the macronutrients, the microflora, all of that. I think it's fascinating.
Krista: Yes. Absolutely. It really is and so I don't ever want a mom to think, "I can't eat this way so I can't breastfeed."
Julie: Oh, yeah. No, not at all.
Krista: Because that's absolutely not -- not caring at all about your health or your nutrition, your breast milk is still going to be far superior --
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Julie: Yes, I completely agree.
Krista: -- than anything manufactured.
Julie: We hear a lot about foods, you know, like a lot of article like "Top Five Things You Can Eat to Support Healthy Lactation." What are some things that you work with with moms like when you see them struggling with low milk supply, for example? I've heard that a lot of women and especially in terms of reasons why they didn't continue to breastfeed past three months, six months, et cetera as, "Oh, my supply wasn't that great" or "My milk never really came in." What do you do when you're working with a woman in that situation?
Krista: Well, the majority of time, a mother's milk supply is not low because of her nutrition. It's low because of lactation mismanagement, things like scheduling feeds or saying your baby can only eat at these times or should eat at these times. You know, different lactation mismanagement problems. If there truly is a mom who has low milk supply, there are things that we can do to bring it up no matter why she has low milk supply.
But if it's low milk supply because of insufficient glandular tissue, we can only wet a sponge so much and then it's wet and then it's not going to get wetter. We can only help her increase her supply and we can do it a lot more effectively through managing lactation well, helping the baby to feed frequently and effectively.
But there are anecdotally things that you can take to help increase your supply. One thing that we say is oatmeal, eating a bowl of oatmeal a day. Now, that's not necessarily Paleo and it's not grain-free and there have not been a lot of scientific studies to show that but moms who eat oatmeal say, especially when they are pumping, "I definitely notice an increase in output." So if there's a mom that for whatever reason has really low supply and who wants to try to increase it, maybe doing that for the short-term. Fenugreek is another item.
But, in general, the best ways to increase milk supply and not by saying, "Oh, this is my magic bullet. I'm going to eat a bowl of oatmeal," having a baby eat frequently and effectively and taking care to eat nutrient-dense foods, get plenty of sleep, drink water to thirst, and eat whole nutritious foods.
Julie: That's great. We also work a lot. A lot of the things that we work with with clients stem from stress and I wonder if you see stress playing a role in how women kind of whether or not they are successful with nursing, like is there ever a situation when you see a woman that's so overwhelmed they are just kind of overburdened by the stress of nursing, that that's impeding her ability to nurse?
Krista: Absolutely. A resounding yes. Every time, I mean stress is always going to affect her milk supply. Just her inability to relax and help her baby relax, her baby feeds off of her stress and can notice it and sense it and then it makes the whole situation and the environment much more difficult to breastfeed in. Yes.
Julie: Are there any kind of myths that make you kind of cringe when you're trying to help a woman breastfeed and maybe she's got really specific ideas about what she's supposed to do? Is there anything that you see that you want to throw out the window, that you wish you could tell all moms that they should stop worrying about because it's not worth it?
Krista: I typed up my top 40 and I have it on my website.
Julie: Okay, good.
Krista: There's got to be 40, the 40 myths. But probably the one that I face on a daily basis is all of these parenting and scheduling books, that your baby needs to eat a complete meal and then wait three hours and after that meal you need to be awake and then you can sleep -- all of this. The baby has not read this book.
Julie: Yes.
Krista: Babies have been in the womb eating 24/7 and being rocked and cuddled and touched and warm and held and now they are born into this strange new place and they just want to be held and cuddled and nursed all the time and that's very normal.
Julie: Yeah.
Krista: It's very natural. And to say that, "My baby just ate so she can't be crying because she's hungry" is ridiculous. That's probably why she is crying. It's about as effective to schedule eating as it is to say, "Well, I can only go to the bathroom today at 6:00, 9:00, and 12:00." It doesn't work that way.
Julie: No, not typically. Not typically. I want to move towards the -- because I have some people that want you to talk a little bit about the weaning process. But before that, there's a lot of mixed conversation about how long. For a long time it was, oh, 12 months, like a year, it needs to be a year and then it was, oh well, nine months is good enough to get the majority of the nutrition that you need. How long is long enough to nurse?
Krista: Oh, I'm so glad you asked that. I love answering this question. Breast milk never loses its benefits no matter how old the baby is. There is never a point in time where it's, "Well, this probably isn't very nutrient-dense anymore." It's really not necessary.
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The best course is to allow a baby to wean when he or she is ready which just anthropologically, historically, culturally is somewhere between the ages of two and seven with the vast majority would self-wean between three and four years old.
Julie: Uh-hmm.
Krista: Now, that's very different than our mindset here in America, even with the American pediatric association saying that babies should be breastfed for 12 months and then beyond if they would like to continue. But that's really a very early statement of how long a baby should nurse. If you look at the World Health Organization and most other pediatric associations in first world nations, they all say that babies should be breastfed for a minimum of two years and then beyond as mother and baby wish to continue, that there are still always benefits.
I feel like in America, the reason that we say 12 months so often is because it's very, very challenging for a mom who just gets a few weeks or a couple of months in maternity leave. They're going back to work. And now we are saying you need to continue breastfeeding for the next two years and pumping and all of these things. I think it's just a lot easier to help them get to the one year mark. You've kind of done what you need to do and go on.
I don't think we are doing justice for moms. They don't even realize that -- in our country, you get to 12 months and that's like the Cadillac status. You have made it. We don't even share the information that really, no, you're halfway there to the minimum.
Julie: Yeah. It's painful. I mean, to your point. I think you posted this and then I saw it also floating around in Facebook that I think it was in a Washington Post, it was like the letter to the president about going back to work and just kind of the travesty that is the maternity leave situation in this country.
I think I'm fortunate enough. We own our own business and I can work out of the home and most days I get to just spend with my baby but just my heart breaks for all of my friends and acquaintances that I have known who have had to go back to work so soon after having a baby. Just that post was -- I'll put the link to it in the show notes so people can read it if they want to.
Krista: It's quite hard. It is. My heart breaks with the moms who are faced with having to go back to work so early. I feel like the single best thing that we can do as a country, as a nation, as a society to be more healthy and to decrease our healthcare costs is to encourage breastfeeding -- full-term breastfeeding.
Julie: Yeah.
Krista: That's the single best thing we can do. If we were able to allow moms to have much longer maternity leaves so that they can breastfeed longer, I think financially it would really pay off.
Julie: Yeah. I mean, there's productivity if she is there too. I mean, if you have both parents working and then a kid that hasn't been breastfed and is ill all the time and especially when they are exposed in day care situations and things like that to more germs and -- yeah, I mean it's just one thing begets another so here's hoping that that…
Krista: Yeah.
Julie: So we talked a little bit about weaning. One other thing that you talked about I loved on your post on co-sleeping because this is a hot subject, to kind of take a step away from breastfeeding for a second. We'll just dive right into the fire with co-sleeping.
I liked your post on it a lot because I think you have been through the gamut so I really appreciated your experience with it and kind of how you've done it. So would you talk a little bit about your approach to co-sleeping and sharing a bed with babies?
Krista: Sure. Yeah, we've done everything. From my first daughter, it was very much we were trying to do what the experts said and keep her out of our bed. When you're breastfeeding, you're going to fall asleep out of exhaustion with your baby and so creating a safe sleeping environment is really important.
Julie: Uh-hmm.
Krista: You know, to our fourth baby where we just very involved. We were setting up a crib and saying, "This is his bed [0:24:18] [Indiscernible] with us." Ironically though, he was the child that, after six or seven months, decided that he wanted his own space and would push on me and kick on me and want to be moved after nursing.
So we've done it a lot of different ways and currently we have all of our mattresses on the floor and kids can kind of come and go as they wish. It works for us. I think finding what works for you is important but for the longevity of the breastfeeding relationship, having moms and babies together so that mom can fall back to sleep… We have so many great hormones that we produce to help us fall back to sleep so lying down while we are nursing is a really good thing for both mom and baby.
Julie: Yeah. One of the things you talked about in that, if people followed the Safe Sleep 7 bed sharing principles. Can you talk a little bit about what the Safe Sleep 7 are and how people --
[0:25:08]
Krista: Yeah, absolutely. It's interesting. I'm just going to do a plug. This is La Leche League International's newest publication. But the authors of it didn't set out to create a book on why you should sleep with your baby. They just set out to create a book on the research of sleeping and to help breastfeeding moms kind of make their own decisions. What they found as they looked at the research was completely overwhelming that for the vast majority of moms and babies sleeping together -- breastfeeding moms and babies -- was safer than any other sleeping arrangement.
So they said that if you meet these Safe Sleep 7, these seven criteria, that this is really the safest option. But mom and dad need to agree that it's okay for baby to be in the bed. You want to have a flat surface that doesn't have cracks and crevices for a baby to roll in or to be able to roll off the bed. You don't want covers that could suffocate babies so just very clean, lightweight blankets as sleeping surface. You don't want pets nor animals in the bed with you.
Julie: Uh-hmm.
Krista: No drugs of any kind, anything that could impair your ability or even make you fall into a deeper sleep than you normally would. No tobacco. No alcohol. Exclusively breastfeeding. Because we know that when you're exclusively breastfeeding, moms, even your sleep patterns, your breathing patterns are in unison with your baby and babies arouse naturally and normally. When you have formula, it's almost like the system has to work harder to digest it and you fall into a deeper state of sleep that's very unnatural and it can be very unhealthy.
So meeting these criteria then, it's a lot safer to sleep together than it is to be separated because then the sleep is not in unison, the breathing is not and moms and babies don't always wake at the same time which is one of the things that is a problem with SIDS is that we don't know what's causing this but the babies are in this deep sleep and then they are not arousing. Whereas, when moms and babies are next to each other, even the breathing helps the baby to arouse.
Julie: Oh, yeah. That's really interesting. I've never really heard of that before so I think that's something interesting to consider instead of just -- I feel like there's a lot of fear mongering around having the baby sleep --
Krista: It sure is. You got to get the message out for those who fall in the high risk categories, high risk categories being formula feeding, alcohol and drugs, other pets and things in the bed or having a spouse or partner who is not at all supportive of it. But once you take those risk factors out, the biggest one being exclusively breastfeeding, if you're doing that then sleeping together is actually very natural, very normal and historically, even today in most cultures, it's still what's done.
Julie: Looking back over all of your experience especially with your own kids, is there anything -- I'm sure there are lots things. Could you list maybe the top three things that you wish you had known as a new mom, also as kind of a mom of multiple kids and then a mom that's weaned some kids? Is there anything you could -- tips that you can give the moms out there? I know there's categories but, you know, the top three things you wish you had known in those stages that you know now?
Krista: Yeah. The experts aren't always right. Your baby has not read those books. So go with your mommy instincts. I think that's the biggest thing I like to tell moms is you have those mommy instincts for a reason. Go with them. If your instinct is to take that baby and lay down and sleep with her while you're breastfeeding, do it or whatever it is that your instincts are telling you to do. I think that that's really big.
The experts aren't always right. If your doctor is telling you things that you are not comfortable with, don't just listen to them because they have an M.D. behind it. Find a doctor that is more in tune with your way of parenting and what you believe. Not every doctor believes the same things and has been educated in the same way, and doctors coming out of medical school today are not educated in breastfeeding. It might be half of a day during their whole four years.
Julie: Right. It's the same thing with nutrition.
Krista: And with nutrition and so find someone that you're comfortable with and that is comfortable with the way that you're wanting to parent and is not always going to be saying, "You can't do it this way. You can't do it this way. Don't do it this way" because that's hard when you're a mom of a new baby and you haven't been through these stages before and the medical advice is telling you that what you're doing is wrong.
Once you have your first baby, your second baby and you're on down there, you have experience that can also lead you and so you're much more comfortable to "buck the system," and say, "You know, I'm just going to drop that advice." But when you're a new mom, it's your first time around, it's harder to do. So picking your healthcare professionals wisely is also I would say a really important thing to do in there.
[0:30:02]
Another thing that I think I felt a lot of pressure on always with my first was you got to start solids, you got to feed your baby. And, you know, you don't. Your baby is going to eat. Start when your baby is ready and if it's not until they are closer to a year, that's okay too.
Julie: Uh-huh. That's huge. Gosh, we could talk for hours and hours and hours I think.
Krista: Breast milk is the most nutrient-dense food that your baby can eat so replacing it with anything else is an inferior item, even nutrient-dense foods.
Julie: Uh-hmm. Yeah, if they're not ready, they're not ready.
Krista: You know, with six months, seven months, eight months old.
Julie: Yup. That's huge. That's really a big topic. Well, I have loved talking with you. Where can people find out more about you? How can they get involved with you or get help if they need it with nursing?
Krista: Okay. Well, you can find me a few ways. I am on Facebook, /NursingNurture; I'm on Twitter, @Nursing Nurture; and my website is www.nursingnurture.com. All of them have contact information for me in any of those ways to email or call. I do do obviously consultations in homes locally but I also do Skype and Face Time consultations with women around the world.
Julie: That's fabulous. Wonderful. Well, it's been great having you here today, Krista, and I hope to have you back because I think we could talk about a lot more than we've talked about today.
Krista: Thank you very much, Julie.
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