June 19, 2025 • 31 mins
Planning for a birth that makes breastfeeding easier? Check out my FREE guide on setting yourself up for breastfeeding success:https://bit.ly/los-birthpractice-workbook
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In this supportive and informative episode of Lo’s Lactation Lab, host Lo Nigrosh addresses one of the most emotionally charged decisions new parents may face, supplementing with formula. Whether this recommendation comes from a pediatrician, hospital staff, or concerned family members, the moment can be filled with uncertainty, guilt, and grief. Lo provides clarity on when formula supplementation is necessary, how to assess your unique situation, and how to make empowered choices that align with your feeding goals. This episode is a must-listen for anyone navigating the complex terrain of infant feeding in real-time.
Lo Nigrosh is an International Board Certified Lactation Consultant (IBCLC), childbirth educator, and birth doula who guides parents through the challenges of feeding their babies, from prenatal planning through weaning. With a reputation for blending clinical expertise with heartfelt compassion, Lo helps parents feel confident, informed, and supported no matter how their feeding journey unfolds.
Expect to Learn
#breastfeeding #breastfeedingjourney #breastfeedingstruggles #breastfeedingsupport #postpartum #postpartumsupport #ibclc #childbirtheducation #IVfluidsimpact #smartfeedingchoices #postpartumnutrition
Become a supporter of this podcast: https://www.spreaker.com/podcast/lo-s-lactation-lab--5834691/support.
Follow Lo Nigrosh:
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In this supportive and informative episode of Lo’s Lactation Lab, host Lo Nigrosh addresses one of the most emotionally charged decisions new parents may face, supplementing with formula. Whether this recommendation comes from a pediatrician, hospital staff, or concerned family members, the moment can be filled with uncertainty, guilt, and grief. Lo provides clarity on when formula supplementation is necessary, how to assess your unique situation, and how to make empowered choices that align with your feeding goals. This episode is a must-listen for anyone navigating the complex terrain of infant feeding in real-time.
Lo Nigrosh is an International Board Certified Lactation Consultant (IBCLC), childbirth educator, and birth doula who guides parents through the challenges of feeding their babies, from prenatal planning through weaning. With a reputation for blending clinical expertise with heartfelt compassion, Lo helps parents feel confident, informed, and supported no matter how their feeding journey unfolds.
Expect to Learn
- Emotional and psychological impacts of being told to supplement with a formula
- Clinical reasons for supplementation might be recommended, and how to evaluate them
- How to protect your milk supply and determine if pumping is a viable alternative
- Tools and strategies to feed safely and effectively with formula
- How to choose the right formula and what to consider for your baby’s health
- [00:00] - Introduction and Overview
- [04:06] - Making Peace with the Right Choice for Now
- [07:55] - When Formula Supplementation Is Recommended
- [13:23] - Personal Story: A Scare With Galactosemia
- [17:33] - Perceived vs. True Low Milk Supply
- [20:04] - Identifying and Addressing Low Milk Supply
- [22:39] - Flange Fitting, Pumping Tips, and Bottle Feeding
- [26:20] - Selecting the Right Formula for Your Baby
- [30:22] - Final Encouragement and Support
- LinkedIn: https://www.linkedin.com/in/lo-nigrosh-16371495/
- Website: https://www.quabbinbirthservices.com/
- Facebook: https://www.facebook.com/quabbinbirthservices/
- Apple Podcasts: https://podcasts.apple.com/us/podcast/los-lactation-lab/id1614255223
- Spotify: https://open.spotify.com/show/2F54fe1szmemB9n7YUJgWv?si=2eea7f1cfba64867
- YouTube: https://www.youtube.com/@loslactationlab3967
#breastfeeding #breastfeedingjourney #breastfeedingstruggles #breastfeedingsupport #postpartum #postpartumsupport #ibclc #childbirtheducation #IVfluidsimpact #smartfeedingchoices #postpartumnutrition
Become a supporter of this podcast: https://www.spreaker.com/podcast/lo-s-lactation-lab--5834691/support.
Follow Lo Nigrosh:
- LinkedIn: https://www.linkedin.com/in/lo-nigrosh-16371495/
- Website: https://www.quabbinbirthservices.com/
- Facebook: https://www.facebook.com/quabbinbirthservices/
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
So the first thing that you should do when you
are told to supplement with formula is to reach out
to an IBCLC and hopefully a private practice IBCLC who
sees babies from birth all the way through waning, and
not just somebody in the hospital, because their job description.
Speaker 2 (00:20):
Is just a little bit different.
Speaker 1 (00:21):
They are really in those beginning stages of helping people
latch their baby, make sure they're transferring in the beginning days,
teaching positioning and latching. Before we begin, I want to
share something special with all of you expecting parents out there.
As an internationally board certified lactician consultant, I've seen firsthand
how a little planning can go a long way to
(00:44):
helping you achieve your baby feeding goals. That's why I'm
offering you my free ebook. It's called Birth Practices to
Support Breastfeeding and it's a workbook, So check out the
link in the description below. Hi, and welcome back to
Lowe's Lactation Lab. My name is low I'm an internationally
board certified lactation consultant, a birth doula, and a childbirth educator.
(01:09):
Here to talk about how you can go from pregnancy
all the way through weaning and feel really good about
meeting your breastfeeding goals or changing your goals and meeting
those as new information arises.
Speaker 2 (01:24):
Today we're going to.
Speaker 1 (01:25):
Talk about what happens when somebody says you need to
supplement with formula. This can happen in the hospital. This
can happen on day one. This can happen before you
leave the hospital because it's been a few days and
baby's not losing weight. This can happen at your pediatrician's office.
(01:47):
This can happen with well meaning family members who see
you suffering trying to produce enough note for your baby.
We constantly are being told, why are you stressing about
fee being breastmolk to your baby when we have another alternative.
Speaker 2 (02:03):
We have formula now, So we're gonna talk about that.
We're gonna talk.
Speaker 1 (02:07):
About what to do when formula is recommended, and how
you can tune into your own inner compass to decide
is that the right choice for your family and your
baby given your unique situation.
Speaker 2 (02:22):
So, before we get into the nitty gritty of.
Speaker 1 (02:25):
Low milk supply and supplementation, I want to start by
talking about the emotional impact of supplementation and of low
milk supply.
Speaker 2 (02:36):
So many well meaning.
Speaker 1 (02:39):
People who suggest switching to formula say things like my
baby was fed formula, or I was fed formula and
I'm fine, Like so many people do it, it's not
worth stressing. Your mental health matters most, And these things
(03:01):
are true. They're not wrong when they say I switched
to formula and it was the best thing I could
do for me because that was the best thing that
they could do for them, Or my baby is fine
or I am fine. These things are all true. There
is a lifetime of choices that you are going to
(03:22):
be making for your child, and then as your child
grows up that they are going to be making for
themselves that can positively or negatively impact long term health outcomes.
So whether or not they receive formula in the beginning
of their life is just the first of many choices.
And each time we come to a decision about what
(03:45):
is best for our babies, we have to decide what
is best in this moment, given my situation, what I
can handle, what my finances are, how much support I
have to reach my goals, how much time and energy
I have to do the things that will help me
get to my goals. The fact remains, though, that you
(04:09):
are allowed to grieve when something isn't going the way
you want.
Speaker 2 (04:16):
It to go.
Speaker 1 (04:17):
It's okay to feel sad that breastfeeding is painful, or
that baby is not transferring your enough milk, or that
your milk supply is low for whatever reason. It's okay
to feel really sad, and it's okay to say to somebody,
I will seek your opinion when I want it, but
(04:37):
right now I am making the decisions.
Speaker 2 (04:41):
That feel right for me.
Speaker 1 (04:42):
I've said this before on other episodes, but I think
it's worth repeating that when we do something that is
really hard and it doesn't pertain to motherhood or parenting
or feeding our babies, we get celebrated.
Speaker 2 (05:00):
For doing that thing. If you go to law school, if.
Speaker 1 (05:03):
You accomplish running a marathon, if you go after some
big position and you're able to do it, people celebrate that.
But when we work hard to achieve a goal that
we have set when it comes to parenting or feeding
our babies, we often get shamed for doing the hard thing.
(05:29):
And the hard thing might be different for different people.
For some of you, when you were told you know
what you should supplement with formula, you were washed over
with a sense of relief, and for others of you,
when you got told you know it's time to supplement
with formula, whether or not that was actually clinically the
(05:53):
correct advice, you experience a sense of deep sadness and
greet and that's okay. Just because you're experiencing grief does
not mean that you have to experience guilt or shame,
because in the moment when you have to make the
choice about what is going to be the best decision
(06:15):
right now for your baby, sometimes it's not the one
you envisioned or the one that you hoped for. Initially,
many of my patients come to me not wanting to supplement,
and after having an initial consultation and after reviewing all
the clinical information, they decide, yeah, you know, for now,
(06:41):
this is the right choice for me. And I always
like to remind my patients that just because you're making
a choice now doesn't mean that has to be the
same choice you make in the future. As long as
you are getting good clinical information that is going to
guide you towards feeding your baby, protecting your supply, and
(07:05):
figuring out the root causes of why baby isn't transferring milk.
Or why your milk supply is low.
Speaker 2 (07:13):
So when you're.
Speaker 1 (07:14):
Working with somebody who is able to do that, then
you can make a decision now and then work towards
mating your original goal later on down the line. But
it's important to remember that in all of these situations,
when somebody is recommending to feed formula, it's because they
(07:34):
know that the number one goal when it comes to
feeding your baby is to feed the baby. So if
you are not able to feed the baby with your
own milk, then yes, we need to find another way
to feed that baby. So let's talk about when that
might be appropriate. So there are multiple reasons why you
(07:58):
might be asked to supplement with formula. One baby isn't
transferring milk well, and the way that you would know
that is because there's not enough peas, there's not enough poops.
Maybe baby is incredibly sleepy and they're not waking for feeds.
Maybe you're getting close to that ten percent weight loss,
(08:21):
or maybe you've surpassed that ten percent weight loss.
Speaker 2 (08:23):
So when the baby's born, they take.
Speaker 1 (08:25):
That initial weight and then all babies are going to
lose weight initially in the first five to seven days,
but they should then start regaining it, and we're looking
to make sure that they don't pass that ten percent. Now,
there is a caveat here, which is if you have
had a medicated berth or you have been induced, you
(08:50):
have likely been on IV fluids and IV fluids in
the same way that you swell up. When you've been
on IV flu you might even gain up to ten
pounds from day one of having IV fluids to day
two of having IV fluids. That's common to see a
big weight gain if you're tracking your weight.
Speaker 2 (09:10):
For whatever reason.
Speaker 1 (09:12):
So just like you swell, the IV fluids do cross
the placental barrier, and the baby can swell as well.
And we're talking about even just a few ounces. That
makes a big difference when we're tracking that ten percent
weight loss. So one of the things that you can
do to ensure that you're getting accurate information to be
(09:35):
able to make decisions about supplementing is to ask for
a twenty four hour weight to be recorded into the
baby's chart and to use that as the weight that
you are tracking the percentage of weight loss. So if
you have had IV fluids for longer than a few hours,
then that might be something that you want to discuss
(09:57):
with your care provider, and that might be the something
that you discuss pre natally if you are able to.
Is it possible to track that weight from the time
that baby has hit twenty four hours, because that can
make a big difference between whether baby has had a
seven or an eight percent weight loss or a ten
plus percent weight loss, and we don't want that birth
(10:18):
weight to be inflated if we're really trying to manage
lactation care well. So other reasons that formula might be
suggested as supplementation are that sometimes when baby has high
billy ruben jaundice, people will suggest formula because the more
(10:40):
that a baby eats, the more they are able to
clear out that billy ruben from their system, and so
often formulas suggested that time painful breastfeeding raw nipples. Sometimes
a parent gets the point where they say, I cannot
latch this baby onto my body one more time. This
hurts so badly, and none of the care providers are
(11:02):
able to help make positional or latching suggestions that decrease
that pain.
Speaker 2 (11:08):
That might be a.
Speaker 1 (11:09):
Reason why formula is suggested. If there are any contraindicated
drugs in the system, then that might be a reason
why formula is offered. There's a caveat there, though, because
most of the time the providers are giving information based
on the drug insert and drug companies do not want
(11:33):
to be sued. And because there are very few studies
with breastfeeding diads, then they just rule out breastfeeding diads
and just say there aren't any studies on this, so
it's not safe. So the best place to go for
that information is doctor Hale, who is a doctor, a
(11:55):
pharmacologist who researches the safety of medication. His team runs
the Infant Risk Center, so you can call there, and
then doctor Hale also has an app. He has one
for practitioners, but he also has one for patients. It's
called Mommy's Milk, and I do believe you have to
pay for that app, but you can go on and
(12:16):
you can search information and it gives a ranking system
about the safety of medications, which are often very different
from the insert. We see very frequently that providers are
telling parents that they have to either wean or pump
and dump because of a medication, and often it's actually
(12:37):
not contraindicated and the risk of introducing formula is probably
greater than the risk of the medication because the transfer
rate is so low in that medication, So that's something
to think about. There are some illnesses which are contra
indicated for breastfeeding, and this would be something you would
(12:59):
want to discuss with your IBCLC or.
Speaker 2 (13:01):
Your care provider.
Speaker 1 (13:03):
So anytime there are a lesions on the breast that
might transfer, say herpes to the baby, we would that's contraindicated.
There are some rare genetic disorders which are contraindicated for breastfeeding,
and that would come up in the infant screening. That's rare,
but it does happen now and then I'm actually my
(13:24):
daughter when she was born, she triggered the newborn screening
for galactosemia, which is a rare genetic disorder which does
not allow the body to process any lactose at all,
even that in human milk. And so these babies they
have other developmental delays and other difficulties associated with glactosemia.
(13:48):
And there are two types of glactosemia, but.
Speaker 2 (13:52):
My daughter triggered it.
Speaker 1 (13:53):
I had to go off of human milk for a
few days until I could get into a geneticist, a specialist,
and we were able to do further blood work and
it turns out that she's a carrier of galactosemia, but
she does not have galactosemia. So that's one example of
a situation where it's a no brainer. Of course, I
(14:15):
needed to switch my daughter to soy formula, which doesn't
have lactose and I continued to pump for about four
days while we waited for that specialist appointment.
Speaker 2 (14:25):
I was heartbroken. But then I went in to see a.
Speaker 1 (14:28):
Provider who was familiar with these genetic disorders. And this
is actually interesting because this is a case where the
first provider I called told me it was going to
be about six weeks till I could get in and
do the genetic testing.
Speaker 2 (14:43):
And I had a newborn. My infant was two to
three days old.
Speaker 1 (14:46):
She had been fully breastfeeding since the day she was born.
We get this newborn screening test back it comes up
positive for galactosemia.
Speaker 2 (14:56):
My primary care provider called me.
Speaker 1 (14:58):
She sent me to this specialist, and when he told me,
I said, oh my gosh, is there anything we can do.
That's a long time for me to be trying to
maintain my milk supply.
Speaker 2 (15:09):
Six weeks is a long time to.
Speaker 1 (15:11):
Wait to see if she has this, because honestly, she's
showing none of the signs of her body but not
being able to process lactose, and I really think that
probably something is going on with the genetic screening. And
he said to me, do you want your baby to die?
And this is a shane tactic that many providers make
(15:33):
when they are trying to get you to make the
decision they want you to make. They make you feel
guilty for not putting your child's best interest as they
see it. First, breastfeeding was not just about me. It
was about her too, And I knew that having early
(15:54):
introduction of formula for a long time would a make
it much harder for me to get her laft after
six weeks of no latching. Be very hard to both
feed my baby as regularly as a newborn needs to
be fed and protect my milk supply. So if we
were going to find out in six weeks that it
was fine and I could go back to feeding, that
(16:16):
would be a much harder thing to do. I had
a toddler at the time or a preschooler at the
time that I was still having to care for. It
was going to be hard, and so I found a
different specialist. I explained my situation to her. She understood
my concern and she said, you know what, if you
can suspend breastfeeding, body feeding giving your milk to your
(16:40):
baby until Monday.
Speaker 2 (16:42):
We were at a Thursday.
Speaker 1 (16:43):
I think I can get you in on Monday, and
once I get my eyes on her and we do
the initial blood work, then maybe.
Speaker 2 (16:50):
We can have a conversation about going back to body feeding.
Speaker 1 (16:52):
And I felt way more comfortable with that. Of course,
I wanted to make sure that my daughter was safe
and I didn't want to wait six weeks, so I
had to find another provider who understood the importance of
body feeding to me and to understood why I would
not want to wait six weeks. And once the screening
(17:15):
got back, that's when we learned that she was a carrier,
but that she did not have it herself, and we
were told that we could go back to body feeding,
as was my original goal. So the other reasons you
may be asked to supplement is you have low milk supply. Now,
there is a difference between true low milk supply and
(17:38):
perceived low milk supply, and part of this is based
on cultural expectations. We expect babies to take large amounts,
We expect them to sleep for long periods of time,
We expect them to be able to sleep when we
(18:00):
put them down. We have confused ideas many of us,
about how long it takes from mature milk to come
in versus that initial colostrum, and what that means for
what the baby should be experiencing while we're.
Speaker 2 (18:18):
Waiting for that full milk supply to come in.
Speaker 1 (18:21):
So there is normal newborn behavior which often gets mistaken
for hunger, so cluster feeding that gets mistaken for oh,
the baby's not transferring milk, not being able to be
put down, which we're carry mammals, so our babies expect
to be on our bodies at all times. That is
(18:43):
normal biologically human behavior, but culturally we like to be
able to put our babies down so they can sleep.
Or if they're transferring small amounts or queueing frequently, more
frequently than what we imagined they should.
Speaker 2 (18:58):
Be or even what nurses expect them to be doing.
Speaker 1 (19:02):
Then we assume they're not transferring enough. So the way
that you know that they're transferring enough is again, do
they have enough peace? Do they have enough poops. Are
they looking relaxed? Are you able to hear swallows when
they are at the breast? Are they staying awake or
(19:22):
actively nursing even if their eyes are closed for longer
than a few minutes, or do they just fall asleep
right away? Are they hard to wake up to feed?
So there's a lot of things in those early newborn
days that get confused with low milk supply. And then
as time goes on, if babies are in lower percentiles,
(19:46):
and I'm not talking lower than four percent, I'm talking
like twenty percent lower, sometimes pediatricians are suggesting we supplement,
even though the nature of a growth curve means some
people are going to be on the low end and
some people are going to be on the high end
of that growth curve. But there are some reasons why
(20:06):
people have true low supply. I have some episodes on that.
In fact, I had an episode with Catherine where she
was experiencing low milk supply, and there's two episodes with her,
and it was hard for her to determine the root cause.
But if you work with an internationally board certified lactician consultant,
(20:28):
if you work with one of us, we can help
you figure out what is the cause. Is it an
ineffective latch, is it insulin resistance? Is it some other
underlying medical difficulty that is getting in the way of
producing enough milk that we can find working in conjunction
with your care provider by getting blood work and then
(20:51):
analyzing those results. So sometimes low milk supply can be
managed with better lactation management.
Speaker 2 (21:00):
Other times you need to work.
Speaker 1 (21:02):
A little harder with your IBCLC to figure out what
is it going to be that's going to increase your supply.
Speaker 2 (21:09):
So the first thing that you should.
Speaker 1 (21:11):
Do when you are told to supplement with formula is
to reach out to an IBCLC and hopefully a private
practice IBCLC who sees babies from birth all the way
through weaning, and not just somebody in the hospital, because
their job description is just a little bit different. They
(21:32):
are really in those beginning stages of helping people latch
their baby, make sure they're transferring in the beginning days,
teaching positioning and latching, but often they're not in the
weeds as much dealing with patients who have been told
to supplement, or if you've been told to supplement in
the hospital and you haven't seen the IBCLC, then go
(21:52):
ahead and ask and see if they can help you
figure out another way to manage your molk supply and
help your baby transfer. The second thing you want to
do is supplementation my next best decision, or is pumping
and feeding my milk to my baby my next best decision.
And depending on your initial goals, on what pumping is
(22:17):
like for you, on how you feel about formula in
the first place, on how supportive other family members are,
this answer is going to be different. But if you're
experiencing low milk supply or if baby isn't transferring milk,
we want to help to stimulate the.
Speaker 2 (22:36):
Body to produce enough milk.
Speaker 1 (22:38):
Now, if you start pumping and you are not getting anything,
or you're just getting teeny tiny amounts not enough to
feed the baby, which, by the way, in the initial
three days or so, while we're waiting for that mature
milk to come in, it's it's maybe five millileters. It's
like a teaspoon, so you do not need a lot
(23:00):
in an individual session.
Speaker 2 (23:01):
But if you aren't able.
Speaker 1 (23:03):
To get a lot of milk out when you begin
that pumping, then you should reach out to an ib
sales seat who is trained in pumping and who understands
proper for land sizing. And I'm going to give a
shout out to another clinician, Janette mass It from she
owns Babies in Common. She put out the first clinical
(23:23):
research study in conjunction with another clinician and a researcher.
Many other types of providers are not providing good information.
Even the pump suppliers themselves are not providing good information
about getting good fland fits.
Speaker 2 (23:38):
So you need to go.
Speaker 1 (23:40):
Over for land fitting with a good provider and go over.
You can also do a lot of skin to skin
if baby is able to transfer milk but it's just
not enough, you may just need to get skinned skin
with baby more and increase the frequency of feedings. Once
you've decided, so you've been told you need to supplement
(24:02):
with formula, you have a conversation with your partner, with
your supporters, with your providers, and you decide, you know what,
I'm going to pump and feed that milk to my
baby instead. I always recommend you do this with an IBCLC,
especially if you want to go back to body feeding
at some point. For some people, they are able to
pump enough just to provide a little extra supplement to
(24:25):
the baby, and they might only need to pump a
couple of times a day and that's enough to get
the baby back on track with their weight gain or
their milk transfer. For others, they need to pump so
much that then it becomes overwhelming to both pump and
to body feed, and so at this point we first
feed the baby, then we protect milk supplies. So my
(24:48):
recommendation is usually to body feed for fun, for comfort,
for nurturing.
Speaker 2 (24:53):
If pain is not the primary reason why you are needing, to.
Speaker 1 (24:57):
Supplement and focus the main nutritional feeds on the pumping
and the bottle feeding, but not trying to body feed
at every feeding while you're working on your milk supply
or getting baby to there are other things you can
do like use a supplemental nursing system and SNS increase
your supply which allows you to feed at the body.
(25:22):
But extra milk, whether it's your milk or the formula,
is coming through a tube to your body.
Speaker 2 (25:30):
Now. You also want to make.
Speaker 1 (25:32):
Sure that you learn paste bottle feeding techniques and that
you are feeding quantities which matt what your baby would
be getting from your body.
Speaker 2 (25:41):
So if you are feeding.
Speaker 1 (25:43):
Entire two ounce bottles on the first two days at
every feeding, just know that your baby is being primed
to expect that amount when they wouldn't be getting that
amount for three to four weeks at any individual nursing
session in that first day of life. They get two
(26:04):
ounces in an entire day of feeding when they body feed.
So making sure that you're using paste bottle feeding techniques
and that you're feeding quantities which match up with what
the baby would be getting if they were body feeding. Now,
when it comes to which formula you should feed your baby,
(26:26):
that is such a personal decision, and formula companies do
a very good job with marketing. They have billions of
dollars to spend on marketing to make you feel like
the formula you are choosing is most like human milk,
(26:47):
and it's just not. We don't even know everything that
is in human milk, but the things.
Speaker 2 (26:54):
That we do know, there is just no comparison.
Speaker 1 (26:58):
Formula is artificial milk. We need it sometimes, just like
we need it for little kittens who can't nurse from
their parents for whatever reason. But it is not the
same in any provider, even if they are an IBCLC
who is telling you this is the best formula. I
(27:20):
would check to make sure they do not have a
brand deal or some sort of partnership with that formula company,
because there are predatory formula companies who start to pay
providers to advertise.
Speaker 2 (27:36):
Their brands of formula.
Speaker 1 (27:37):
We see this a lot on social media, and it
actually violates both the World Health Organization Healthy Baby's Code
and it violates the IBCLC Code of Ethics.
Speaker 2 (27:51):
So it is totally fine for an.
Speaker 1 (27:53):
IBCLC to go through ingredients of various formulas and help
you determine what's for you.
Speaker 2 (28:01):
But that's what I would start with.
Speaker 1 (28:02):
I would look at your options and I would decide
what's most important to you.
Speaker 2 (28:08):
Is it the ingredient list? Is it the source of
the ingredients? Is it price?
Speaker 1 (28:15):
Is it what's easiest to access in your area. So
in choosing the initial formula, you have to decide which
of those things matters most to you. And then you
look at the prices of various formulas. You look at
the ingredients list of various formulas.
Speaker 2 (28:34):
You look at where they source those ingredients.
Speaker 1 (28:36):
You may look and see have there been any recalls
of the various formulas recently, what are their factory practices,
What are the incidents of what is called neck or
necrotizing intro colitis. It's a serious gastor intestional condition, primarily
affecting premature infants. This is where the lining of the
(28:58):
large intestine or the colon comes inflamed and damage and
it leads to tissue death. And it's the leading cause
of death from gas ro intestinal disease and premature infants,
And often the use of formula is the cause. And
there are actually major lawsuits out right now with some
formula companies because they were fed formula without giving the
(29:21):
choice for human milk, including donated milk, and formula feeding
is a risk factor because it can contain bacteria that
causes infection and inflammation. So that's something you might want
to look at as you're making the decision, and then
look and see what are your other options. Is there
(29:41):
a friend you could get donated milk from. Is there
a milk bank that you might be able to purchase
milk from while you are trying to increase your supply.
Speaker 2 (29:51):
There's a lot of things.
Speaker 1 (29:52):
You could do to figure out how you're going to supplement.
So decide on your formula, try it with your baby
in and proper quantities, preferably working with your IBCLC. And
if the baby seems to take it well, that's great.
If you notice that baby tends to be a little
fussier or upset when they take the formula versus your milks,
(30:13):
and you may have to decide is there something in
that formula that is bothering your baby and try different
options as you're working to get your milk supply up.
So there is a lot that goes into the decision
of whether or not you supplement with formula when that
was not your initial plan. And I urge you if
(30:33):
you are being told this, reach out to me. I
would love to help you.
Speaker 2 (30:38):
Make these decisions.
Speaker 1 (30:39):
We can book a telehealth console, you can do it
right from my website, and I can help you feel
really good about making the next right decision without shame,
without guilt, while I cheer you on to help you
make your next right goal.
Speaker 2 (30:57):
You've got this, see as soon
So the first thing that you should do when you
are told to supplement with formula is to reach out
to an IBCLC and hopefully a private practice IBCLC who
sees babies from birth all the way through waning, and
not just somebody in the hospital, because their job description.
Speaker 2 (00:20):
Is just a little bit different.
Speaker 1 (00:21):
They are really in those beginning stages of helping people
latch their baby, make sure they're transferring in the beginning days,
teaching positioning and latching. Before we begin, I want to
share something special with all of you expecting parents out there.
As an internationally board certified lactician consultant, I've seen firsthand
how a little planning can go a long way to
(00:44):
helping you achieve your baby feeding goals. That's why I'm
offering you my free ebook. It's called Birth Practices to
Support Breastfeeding and it's a workbook, So check out the
link in the description below. Hi, and welcome back to
Lowe's Lactation Lab. My name is low I'm an internationally
board certified lactation consultant, a birth doula, and a childbirth educator.
(01:09):
Here to talk about how you can go from pregnancy
all the way through weaning and feel really good about
meeting your breastfeeding goals or changing your goals and meeting
those as new information arises.
Speaker 2 (01:24):
Today we're going to.
Speaker 1 (01:25):
Talk about what happens when somebody says you need to
supplement with formula. This can happen in the hospital. This
can happen on day one. This can happen before you
leave the hospital because it's been a few days and
baby's not losing weight. This can happen at your pediatrician's office.
(01:47):
This can happen with well meaning family members who see
you suffering trying to produce enough note for your baby.
We constantly are being told, why are you stressing about
fee being breastmolk to your baby when we have another alternative.
Speaker 2 (02:03):
We have formula now, So we're gonna talk about that.
We're gonna talk.
Speaker 1 (02:07):
About what to do when formula is recommended, and how
you can tune into your own inner compass to decide
is that the right choice for your family and your
baby given your unique situation.
Speaker 2 (02:22):
So, before we get into the nitty gritty of.
Speaker 1 (02:25):
Low milk supply and supplementation, I want to start by
talking about the emotional impact of supplementation and of low
milk supply.
Speaker 2 (02:36):
So many well meaning.
Speaker 1 (02:39):
People who suggest switching to formula say things like my
baby was fed formula, or I was fed formula and
I'm fine, Like so many people do it, it's not
worth stressing. Your mental health matters most, And these things
(03:01):
are true. They're not wrong when they say I switched
to formula and it was the best thing I could
do for me because that was the best thing that
they could do for them, Or my baby is fine
or I am fine. These things are all true. There
is a lifetime of choices that you are going to
(03:22):
be making for your child, and then as your child
grows up that they are going to be making for
themselves that can positively or negatively impact long term health outcomes.
So whether or not they receive formula in the beginning
of their life is just the first of many choices.
And each time we come to a decision about what
(03:45):
is best for our babies, we have to decide what
is best in this moment, given my situation, what I
can handle, what my finances are, how much support I
have to reach my goals, how much time and energy
I have to do the things that will help me
get to my goals. The fact remains, though, that you
(04:09):
are allowed to grieve when something isn't going the way
you want.
Speaker 2 (04:16):
It to go.
Speaker 1 (04:17):
It's okay to feel sad that breastfeeding is painful, or
that baby is not transferring your enough milk, or that
your milk supply is low for whatever reason. It's okay
to feel really sad, and it's okay to say to somebody,
I will seek your opinion when I want it, but
(04:37):
right now I am making the decisions.
Speaker 2 (04:41):
That feel right for me.
Speaker 1 (04:42):
I've said this before on other episodes, but I think
it's worth repeating that when we do something that is
really hard and it doesn't pertain to motherhood or parenting
or feeding our babies, we get celebrated.
Speaker 2 (05:00):
For doing that thing. If you go to law school, if.
Speaker 1 (05:03):
You accomplish running a marathon, if you go after some
big position and you're able to do it, people celebrate that.
But when we work hard to achieve a goal that
we have set when it comes to parenting or feeding
our babies, we often get shamed for doing the hard thing.
(05:29):
And the hard thing might be different for different people.
For some of you, when you were told you know
what you should supplement with formula, you were washed over
with a sense of relief, and for others of you,
when you got told you know it's time to supplement
with formula, whether or not that was actually clinically the
(05:53):
correct advice, you experience a sense of deep sadness and
greet and that's okay. Just because you're experiencing grief does
not mean that you have to experience guilt or shame,
because in the moment when you have to make the
choice about what is going to be the best decision
(06:15):
right now for your baby, sometimes it's not the one
you envisioned or the one that you hoped for. Initially,
many of my patients come to me not wanting to supplement,
and after having an initial consultation and after reviewing all
the clinical information, they decide, yeah, you know, for now,
(06:41):
this is the right choice for me. And I always
like to remind my patients that just because you're making
a choice now doesn't mean that has to be the
same choice you make in the future. As long as
you are getting good clinical information that is going to
guide you towards feeding your baby, protecting your supply, and
(07:05):
figuring out the root causes of why baby isn't transferring milk.
Or why your milk supply is low.
Speaker 2 (07:13):
So when you're.
Speaker 1 (07:14):
Working with somebody who is able to do that, then
you can make a decision now and then work towards
mating your original goal later on down the line. But
it's important to remember that in all of these situations,
when somebody is recommending to feed formula, it's because they
(07:34):
know that the number one goal when it comes to
feeding your baby is to feed the baby. So if
you are not able to feed the baby with your
own milk, then yes, we need to find another way
to feed that baby. So let's talk about when that
might be appropriate. So there are multiple reasons why you
(07:58):
might be asked to supplement with formula. One baby isn't
transferring milk well, and the way that you would know
that is because there's not enough peas, there's not enough poops.
Maybe baby is incredibly sleepy and they're not waking for feeds.
Maybe you're getting close to that ten percent weight loss,
(08:21):
or maybe you've surpassed that ten percent weight loss.
Speaker 2 (08:23):
So when the baby's born, they take.
Speaker 1 (08:25):
That initial weight and then all babies are going to
lose weight initially in the first five to seven days,
but they should then start regaining it, and we're looking
to make sure that they don't pass that ten percent. Now,
there is a caveat here, which is if you have
had a medicated berth or you have been induced, you
(08:50):
have likely been on IV fluids and IV fluids in
the same way that you swell up. When you've been
on IV flu you might even gain up to ten
pounds from day one of having IV fluids to day
two of having IV fluids. That's common to see a
big weight gain if you're tracking your weight.
Speaker 2 (09:10):
For whatever reason.
Speaker 1 (09:12):
So just like you swell, the IV fluids do cross
the placental barrier, and the baby can swell as well.
And we're talking about even just a few ounces. That
makes a big difference when we're tracking that ten percent
weight loss. So one of the things that you can
do to ensure that you're getting accurate information to be
(09:35):
able to make decisions about supplementing is to ask for
a twenty four hour weight to be recorded into the
baby's chart and to use that as the weight that
you are tracking the percentage of weight loss. So if
you have had IV fluids for longer than a few hours,
then that might be something that you want to discuss
(09:57):
with your care provider, and that might be the something
that you discuss pre natally if you are able to.
Is it possible to track that weight from the time
that baby has hit twenty four hours, because that can
make a big difference between whether baby has had a
seven or an eight percent weight loss or a ten
plus percent weight loss, and we don't want that birth
(10:18):
weight to be inflated if we're really trying to manage
lactation care well. So other reasons that formula might be
suggested as supplementation are that sometimes when baby has high
billy ruben jaundice, people will suggest formula because the more
(10:40):
that a baby eats, the more they are able to
clear out that billy ruben from their system, and so
often formulas suggested that time painful breastfeeding raw nipples. Sometimes
a parent gets the point where they say, I cannot
latch this baby onto my body one more time. This
hurts so badly, and none of the care providers are
(11:02):
able to help make positional or latching suggestions that decrease
that pain.
Speaker 2 (11:08):
That might be a.
Speaker 1 (11:09):
Reason why formula is suggested. If there are any contraindicated
drugs in the system, then that might be a reason
why formula is offered. There's a caveat there, though, because
most of the time the providers are giving information based
on the drug insert and drug companies do not want
(11:33):
to be sued. And because there are very few studies
with breastfeeding diads, then they just rule out breastfeeding diads
and just say there aren't any studies on this, so
it's not safe. So the best place to go for
that information is doctor Hale, who is a doctor, a
(11:55):
pharmacologist who researches the safety of medication. His team runs
the Infant Risk Center, so you can call there, and
then doctor Hale also has an app. He has one
for practitioners, but he also has one for patients. It's
called Mommy's Milk, and I do believe you have to
pay for that app, but you can go on and
(12:16):
you can search information and it gives a ranking system
about the safety of medications, which are often very different
from the insert. We see very frequently that providers are
telling parents that they have to either wean or pump
and dump because of a medication, and often it's actually
(12:37):
not contraindicated and the risk of introducing formula is probably
greater than the risk of the medication because the transfer
rate is so low in that medication, So that's something
to think about. There are some illnesses which are contra
indicated for breastfeeding, and this would be something you would
(12:59):
want to discuss with your IBCLC or.
Speaker 2 (13:01):
Your care provider.
Speaker 1 (13:03):
So anytime there are a lesions on the breast that
might transfer, say herpes to the baby, we would that's contraindicated.
There are some rare genetic disorders which are contraindicated for breastfeeding,
and that would come up in the infant screening. That's rare,
but it does happen now and then I'm actually my
(13:24):
daughter when she was born, she triggered the newborn screening
for galactosemia, which is a rare genetic disorder which does
not allow the body to process any lactose at all,
even that in human milk. And so these babies they
have other developmental delays and other difficulties associated with glactosemia.
(13:48):
And there are two types of glactosemia, but.
Speaker 2 (13:52):
My daughter triggered it.
Speaker 1 (13:53):
I had to go off of human milk for a
few days until I could get into a geneticist, a specialist,
and we were able to do further blood work and
it turns out that she's a carrier of galactosemia, but
she does not have galactosemia. So that's one example of
a situation where it's a no brainer. Of course, I
(14:15):
needed to switch my daughter to soy formula, which doesn't
have lactose and I continued to pump for about four
days while we waited for that specialist appointment.
Speaker 2 (14:25):
I was heartbroken. But then I went in to see a.
Speaker 1 (14:28):
Provider who was familiar with these genetic disorders. And this
is actually interesting because this is a case where the
first provider I called told me it was going to
be about six weeks till I could get in and
do the genetic testing.
Speaker 2 (14:43):
And I had a newborn. My infant was two to
three days old.
Speaker 1 (14:46):
She had been fully breastfeeding since the day she was born.
We get this newborn screening test back it comes up
positive for galactosemia.
Speaker 2 (14:56):
My primary care provider called me.
Speaker 1 (14:58):
She sent me to this specialist, and when he told me,
I said, oh my gosh, is there anything we can do.
That's a long time for me to be trying to
maintain my milk supply.
Speaker 2 (15:09):
Six weeks is a long time to.
Speaker 1 (15:11):
Wait to see if she has this, because honestly, she's
showing none of the signs of her body but not
being able to process lactose, and I really think that
probably something is going on with the genetic screening. And
he said to me, do you want your baby to die?
And this is a shane tactic that many providers make
(15:33):
when they are trying to get you to make the
decision they want you to make. They make you feel
guilty for not putting your child's best interest as they
see it. First, breastfeeding was not just about me. It
was about her too, And I knew that having early
(15:54):
introduction of formula for a long time would a make
it much harder for me to get her laft after
six weeks of no latching. Be very hard to both
feed my baby as regularly as a newborn needs to
be fed and protect my milk supply. So if we
were going to find out in six weeks that it
was fine and I could go back to feeding, that
(16:16):
would be a much harder thing to do. I had
a toddler at the time or a preschooler at the
time that I was still having to care for. It
was going to be hard, and so I found a
different specialist. I explained my situation to her. She understood
my concern and she said, you know what, if you
can suspend breastfeeding, body feeding giving your milk to your
(16:40):
baby until Monday.
Speaker 2 (16:42):
We were at a Thursday.
Speaker 1 (16:43):
I think I can get you in on Monday, and
once I get my eyes on her and we do
the initial blood work, then maybe.
Speaker 2 (16:50):
We can have a conversation about going back to body feeding.
Speaker 1 (16:52):
And I felt way more comfortable with that. Of course,
I wanted to make sure that my daughter was safe
and I didn't want to wait six weeks, so I
had to find another provider who understood the importance of
body feeding to me and to understood why I would
not want to wait six weeks. And once the screening
(17:15):
got back, that's when we learned that she was a carrier,
but that she did not have it herself, and we
were told that we could go back to body feeding,
as was my original goal. So the other reasons you
may be asked to supplement is you have low milk supply. Now,
there is a difference between true low milk supply and
(17:38):
perceived low milk supply, and part of this is based
on cultural expectations. We expect babies to take large amounts,
We expect them to sleep for long periods of time,
We expect them to be able to sleep when we
(18:00):
put them down. We have confused ideas many of us,
about how long it takes from mature milk to come
in versus that initial colostrum, and what that means for
what the baby should be experiencing while we're.
Speaker 2 (18:18):
Waiting for that full milk supply to come in.
Speaker 1 (18:21):
So there is normal newborn behavior which often gets mistaken
for hunger, so cluster feeding that gets mistaken for oh,
the baby's not transferring milk, not being able to be
put down, which we're carry mammals, so our babies expect
to be on our bodies at all times. That is
(18:43):
normal biologically human behavior, but culturally we like to be
able to put our babies down so they can sleep.
Or if they're transferring small amounts or queueing frequently, more
frequently than what we imagined they should.
Speaker 2 (18:58):
Be or even what nurses expect them to be doing.
Speaker 1 (19:02):
Then we assume they're not transferring enough. So the way
that you know that they're transferring enough is again, do
they have enough peace? Do they have enough poops. Are
they looking relaxed? Are you able to hear swallows when
they are at the breast? Are they staying awake or
(19:22):
actively nursing even if their eyes are closed for longer
than a few minutes, or do they just fall asleep
right away? Are they hard to wake up to feed?
So there's a lot of things in those early newborn
days that get confused with low milk supply. And then
as time goes on, if babies are in lower percentiles,
(19:46):
and I'm not talking lower than four percent, I'm talking
like twenty percent lower, sometimes pediatricians are suggesting we supplement,
even though the nature of a growth curve means some
people are going to be on the low end and
some people are going to be on the high end
of that growth curve. But there are some reasons why
(20:06):
people have true low supply. I have some episodes on that.
In fact, I had an episode with Catherine where she
was experiencing low milk supply, and there's two episodes with her,
and it was hard for her to determine the root cause.
But if you work with an internationally board certified lactician consultant,
(20:28):
if you work with one of us, we can help
you figure out what is the cause. Is it an
ineffective latch, is it insulin resistance? Is it some other
underlying medical difficulty that is getting in the way of
producing enough milk that we can find working in conjunction
with your care provider by getting blood work and then
(20:51):
analyzing those results. So sometimes low milk supply can be
managed with better lactation management.
Speaker 2 (21:00):
Other times you need to work.
Speaker 1 (21:02):
A little harder with your IBCLC to figure out what
is it going to be that's going to increase your supply.
Speaker 2 (21:09):
So the first thing that you should.
Speaker 1 (21:11):
Do when you are told to supplement with formula is
to reach out to an IBCLC and hopefully a private
practice IBCLC who sees babies from birth all the way
through weaning, and not just somebody in the hospital, because
their job description is just a little bit different. They
(21:32):
are really in those beginning stages of helping people latch
their baby, make sure they're transferring in the beginning days,
teaching positioning and latching, but often they're not in the
weeds as much dealing with patients who have been told
to supplement, or if you've been told to supplement in
the hospital and you haven't seen the IBCLC, then go
(21:52):
ahead and ask and see if they can help you
figure out another way to manage your molk supply and
help your baby transfer. The second thing you want to
do is supplementation my next best decision, or is pumping
and feeding my milk to my baby my next best decision.
And depending on your initial goals, on what pumping is
(22:17):
like for you, on how you feel about formula in
the first place, on how supportive other family members are,
this answer is going to be different. But if you're
experiencing low milk supply or if baby isn't transferring milk,
we want to help to stimulate the.
Speaker 2 (22:36):
Body to produce enough milk.
Speaker 1 (22:38):
Now, if you start pumping and you are not getting anything,
or you're just getting teeny tiny amounts not enough to
feed the baby, which, by the way, in the initial
three days or so, while we're waiting for that mature
milk to come in, it's it's maybe five millileters. It's
like a teaspoon, so you do not need a lot
(23:00):
in an individual session.
Speaker 2 (23:01):
But if you aren't able.
Speaker 1 (23:03):
To get a lot of milk out when you begin
that pumping, then you should reach out to an ib
sales seat who is trained in pumping and who understands
proper for land sizing. And I'm going to give a
shout out to another clinician, Janette mass It from she
owns Babies in Common. She put out the first clinical
(23:23):
research study in conjunction with another clinician and a researcher.
Many other types of providers are not providing good information.
Even the pump suppliers themselves are not providing good information
about getting good fland fits.
Speaker 2 (23:38):
So you need to go.
Speaker 1 (23:40):
Over for land fitting with a good provider and go over.
You can also do a lot of skin to skin
if baby is able to transfer milk but it's just
not enough, you may just need to get skinned skin
with baby more and increase the frequency of feedings. Once
you've decided, so you've been told you need to supplement
(24:02):
with formula, you have a conversation with your partner, with
your supporters, with your providers, and you decide, you know what,
I'm going to pump and feed that milk to my
baby instead. I always recommend you do this with an IBCLC,
especially if you want to go back to body feeding
at some point. For some people, they are able to
pump enough just to provide a little extra supplement to
(24:25):
the baby, and they might only need to pump a
couple of times a day and that's enough to get
the baby back on track with their weight gain or
their milk transfer. For others, they need to pump so
much that then it becomes overwhelming to both pump and
to body feed, and so at this point we first
feed the baby, then we protect milk supplies. So my
(24:48):
recommendation is usually to body feed for fun, for comfort,
for nurturing.
Speaker 2 (24:53):
If pain is not the primary reason why you are needing, to.
Speaker 1 (24:57):
Supplement and focus the main nutritional feeds on the pumping
and the bottle feeding, but not trying to body feed
at every feeding while you're working on your milk supply
or getting baby to there are other things you can
do like use a supplemental nursing system and SNS increase
your supply which allows you to feed at the body.
(25:22):
But extra milk, whether it's your milk or the formula,
is coming through a tube to your body.
Speaker 2 (25:30):
Now. You also want to make.
Speaker 1 (25:32):
Sure that you learn paste bottle feeding techniques and that
you are feeding quantities which matt what your baby would
be getting from your body.
Speaker 2 (25:41):
So if you are feeding.
Speaker 1 (25:43):
Entire two ounce bottles on the first two days at
every feeding, just know that your baby is being primed
to expect that amount when they wouldn't be getting that
amount for three to four weeks at any individual nursing
session in that first day of life. They get two
(26:04):
ounces in an entire day of feeding when they body feed.
So making sure that you're using paste bottle feeding techniques
and that you're feeding quantities which match up with what
the baby would be getting if they were body feeding. Now,
when it comes to which formula you should feed your baby,
(26:26):
that is such a personal decision, and formula companies do
a very good job with marketing. They have billions of
dollars to spend on marketing to make you feel like
the formula you are choosing is most like human milk,
(26:47):
and it's just not. We don't even know everything that
is in human milk, but the things.
Speaker 2 (26:54):
That we do know, there is just no comparison.
Speaker 1 (26:58):
Formula is artificial milk. We need it sometimes, just like
we need it for little kittens who can't nurse from
their parents for whatever reason. But it is not the
same in any provider, even if they are an IBCLC
who is telling you this is the best formula. I
(27:20):
would check to make sure they do not have a
brand deal or some sort of partnership with that formula company,
because there are predatory formula companies who start to pay
providers to advertise.
Speaker 2 (27:36):
Their brands of formula.
Speaker 1 (27:37):
We see this a lot on social media, and it
actually violates both the World Health Organization Healthy Baby's Code
and it violates the IBCLC Code of Ethics.
Speaker 2 (27:51):
So it is totally fine for an.
Speaker 1 (27:53):
IBCLC to go through ingredients of various formulas and help
you determine what's for you.
Speaker 2 (28:01):
But that's what I would start with.
Speaker 1 (28:02):
I would look at your options and I would decide
what's most important to you.
Speaker 2 (28:08):
Is it the ingredient list? Is it the source of
the ingredients? Is it price?
Speaker 1 (28:15):
Is it what's easiest to access in your area. So
in choosing the initial formula, you have to decide which
of those things matters most to you. And then you
look at the prices of various formulas. You look at
the ingredients list of various formulas.
Speaker 2 (28:34):
You look at where they source those ingredients.
Speaker 1 (28:36):
You may look and see have there been any recalls
of the various formulas recently, what are their factory practices,
What are the incidents of what is called neck or
necrotizing intro colitis. It's a serious gastor intestional condition, primarily
affecting premature infants. This is where the lining of the
(28:58):
large intestine or the colon comes inflamed and damage and
it leads to tissue death. And it's the leading cause
of death from gas ro intestinal disease and premature infants,
And often the use of formula is the cause. And
there are actually major lawsuits out right now with some
formula companies because they were fed formula without giving the
(29:21):
choice for human milk, including donated milk, and formula feeding
is a risk factor because it can contain bacteria that
causes infection and inflammation. So that's something you might want
to look at as you're making the decision, and then
look and see what are your other options. Is there
(29:41):
a friend you could get donated milk from. Is there
a milk bank that you might be able to purchase
milk from while you are trying to increase your supply.
Speaker 2 (29:51):
There's a lot of things.
Speaker 1 (29:52):
You could do to figure out how you're going to supplement.
So decide on your formula, try it with your baby
in and proper quantities, preferably working with your IBCLC. And
if the baby seems to take it well, that's great.
If you notice that baby tends to be a little
fussier or upset when they take the formula versus your milks,
(30:13):
and you may have to decide is there something in
that formula that is bothering your baby and try different
options as you're working to get your milk supply up.
So there is a lot that goes into the decision
of whether or not you supplement with formula when that
was not your initial plan. And I urge you if
(30:33):
you are being told this, reach out to me. I
would love to help you.
Speaker 2 (30:38):
Make these decisions.
Speaker 1 (30:39):
We can book a telehealth console, you can do it
right from my website, and I can help you feel
really good about making the next right decision without shame,
without guilt, while I cheer you on to help you
make your next right goal.
Speaker 2 (30:57):
You've got this, see as soon
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