While breastfeeding is optimal, there are times when supplementing with formula may be given by choice or necessity. Formula feeding your breast fed baby is a GOOD choice when needed and you should feel supported in how you are feeding your baby, especially if breastfeeding is still the end goal. If you are offering your baby formula, safe preparation, handling, and storage are important to know about.

• Wash first: Use hot, soapy water to clean all bottle parts (and your hands!!!) before mixing formula
• Follow the directions: Formula makers have different mixing guidelines, so check the instructions if and when you change formulas. Most manufacturers use the same recipe: 1 level scoop of powder for every 2 fluid oz of water. ALWAYS add the water first to the bottle. If you add the powder first and then try to fill with water to the ounce line, you’ll be using less water than directed as the powder displaces that space.
• Measure accurately: Too much powder might cause an upset tummy for baby. DO NOT ADD EXTRA SCOOPS to increase calorie count. You’ll also be increasing every nutrient in the formula which can cause baby to get too much protein or other nutrients. It also decreases the amount of water baby is getting which can lead to hydration. Calorie fortifying should only be done under the direction of a pediatrician or pediatric nutritionist. Adding more water than directed can make baby sick
• Check for clumps: Look at the formula after mixing to make sure there are no clumps. They can get stuck in the bottle nipple. Use a fork to separate clumps and shake again
• Time it: Mixed formula stays good for 2 hours at room temperature. You can mix up one bottle at a time, or mix a full day’s worth in a pitcher and refrigerate it for up to 24 hours, pouring individual bottles to feed from one large batch
• The right temperature is anywhere from cool to lukewarm. If your water is safe, it’s OK to mix powder with room temperature water right from your tap. NEVER put a bottle of formula or breast milk in the microwave. This can create hot spots that would burn baby’s mouth

To warm formula:
🥵Use boiled or hot water while mixing the formula, no additional heating needed
🚿 Run the bottle under very warm or hot water for a few minutes
🔥Fill a pan with hot water. Remove it from the heat. Place the bottle in the pan for a few minutes
🍼Use a bottle warmer
💧After warming the bottle, shake it vigorously to make sure there are no hot spots in the formula. Test it by squirting a drop on the inside of your wrist. If it’s hotter than lukewarm, let it cool down before feeding it

BREAST CHANGES
When you’re pregnant, breast tissue for making milk increases, accounting for the size increase you experience during that time. On day 3-4 after birth when your milk transitions from colostrum to mature milk, your breasts engorge. This means extra blood (hello veins) and fluid fill the breast to support making milk. This additional blood and fluid are what help make you aware of that full breast feeling before each feeding. Your uterus doesn’t tell your breasts how many babies were born, so the body is prepared to make milk for 1, 2, or even 3 babies and often initially makes more milk than is needed.
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Around 6-8 weeks, your hormones shift and the extra blood and fluid in your breasts go away (not your milk supply decreasing). You may no longer feel that full/empty sensation between feeds, but still be able to see lots of milk, because your body knows baby is on a full milk diet and going through multiple back to back growth spurts. You may occasionally engorge if you go too long between feedings or if you skip a pump session.
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Between 11-14 weeks, your body has finally figured out how many babies it is feeding based on how often the breast is emptied. Your breasts will go back to their prepregnancy size while still making just enough milk for baby. Congratulations on your mom boobs. They no longer feel full/empty, making them feel like pancakes and leaking often slows or stops. You have not lost your milk supply, your body is more efficient at making milk and will consistently make what is routinely emptied. You are still maintaining a full supply as long as you’re continuing to feed on demand or (routinely pump).
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Don’t be alarmed when these changes happen. This is the normal process that every body will go through

TONGUE TIE
“It’s only a minor tie, they’ll grow out of it”, “They’re gaining weight fine, try a nipple cream or shield”, “At least they’re still getting your milk from a bottle”, “Breastfeeding just isn’t for everyone” “Baby is gaining weight just fine, you can deal with the pain”.

Parents tell me they hear lines like this from their health care providers. That just isn’t right and it makes me so upset. We have to remember that breast/chestfeeding is the biological norm and if a baby is struggling to latch there is always a reason. The number one reason I see for nipple pain and damage is tongue tie (after we’ve worked on position and latch).

While nipple tenderness is normal for the first week after birth, nipple pain and damage should NEVER be considered “normal” or part of routine feeding. Weight gain is only a piece of the breast feeding puzzle, and while it’s an important one, it only focuses on half of the breast/chestfeeding dyad. Offering your milk is important, but for some families the container it comes in can be VERY important. Unfortunately nipple pain and damage have been normalized by society and even by some health care providers. If a health care provider tells you there is no tongue tie and not to worry about nipple pain and damage because baby is gaining weight well, they should also be referring you out to a lactation specialist (IBCLC) to get to the root of why you’re having that pain and damage. Keep looking for your answers.

We are not symmetrical beings. Even though on the outside we have two eyes, two ears, and two hands, if we were to measure both, one would be slightly larger, rounder, flatter, etc than the other. Breasts are not symmetrical. For some breast differences are hardly noticeable; in others it can be drastic. They usually won’t cause issues with breastfeeding

Milk supply is often higher on one side versus the other. Possible reasons:

• One breast will physically have more alveoli and ducts than the other. Let downs can trigger differently and each side can have different flow rates and milk volumes. Milk can also taste different from one side even in the same feeding. Our bodies are incredible and mysterious
• Breast surgery (implants or reductions), scars from nipple piercings, or traumas can alter milk production
• Nipples can be completely different sizes, shapes, or lengths (inverted/flat) which make it easier for baby to latch to on one side. When it’s easier to latch on one side, we subconsciously start on that side more, increasing supply on that side
• Some babies have tension in their body from intrauterine positioning or from birth trauma. Baby may feel more comfortable being held on one side or in a certain position so we put them on that side more often. (Tummy time and manual therapy like chiropractic or CST can help)
• You may have a conscious or unconscious side preference. Handedness can play a role. One side often just feels more comfortable to hold baby on for extended periods of time, often leading us to feed more often on that side which increases supply.

How to balance your boobs:

• Start feeding on the slacker side more often since baby usually removes more milk from the first breast offered which naturally boosts supply
• End feedings on the slacker side
• Pump the slacker side more often. Either for a few minutes after some feedings or occasionally add pumps on just one side between feedings
• Do nothing!! Celebrate your anatomy and use it to your advantage

I often get asked how I became an IBCLC. Here’s my journey:

When I was 10 years old I told my mom I wanted to feed babies for a living. In high school I looked into becoming a nurse, but realized nurses in the NICU do more than just feed babies. Much of their job is shots, IVs, and other intensive medical procedures which I really didn’t want to do. I was on a competitive speech team in high school and my coach was a speech pathologist. She told me you could feed babies as an SLP. I shadowed some therapists in the NICU and was hooked. I became a speech pathologist because the same things you speak with, you eat with. I’ve been a speech pathologist in a hospital for over a decade with a specialty in feeding and swallowing disorders. In working in the NICU setting, I realized I wanted a more intimate approach to working alongside families as they worked to feed their babies. I became a board certified lactation consultant and have really fallen in love with what I do. There’s nothing better than empowering families to reach their feeding goals, wherever they are in their journey. Speech pathology has given me a unique lens for approaching breastfeeding and I’m grateful or my unique journey into working with breastfeeding families.

I started with the 90 credit hour program through Lactation Education Resources to become a CLC. I worked part time as an SLP in acute (with adult patients) and NICU (with babies). I then took the 45 credit hour course to be CLEC through UC San Diego. They brought Virginia Baker to my hospital in Los Angeles to teach the course live which was awesome. I was then hired by my same hospital to work per diem (on call) as a lactation consultant to help me get my hours with the expectation to be able to sit for the IBCLE exam to become board certified. I was able to sit under pathway 1 since breastfeeding was a large part of my role as SLP in NICU and in postpartum as a CLC. It took me the full five years to get all my hours and coursework done.

A few years ago my husband encouraged me to start my own lactation consultant practice. He could see my passion for working with families and my frustration at the hospital system. I launched my private practice in 2017. In teaching prenatal breastfeeding classes at several local natural birth centers, I was able to Network with midwives and doulas to help local families meet their feeding goals. I started taking more courses and conferences on evaluating and managing tongue and lip ties, meeting local dentists and helping families address ties in their babies.

I’m thrilled that after 14 years in the hospital setting I’ve finally reached my career dream. This past Friday (July 2, 2021) was my last day working in the hospital and I’m now full time in my private practice helping families feed their babies.

When you are nursing, you need to consume extra water in order to stay well-hydrated.– The IOM points out, “Given the extreme variability in water needs that are not solely based on differences in metabolism, but also in environmental conditions and activity, there is not a single level of water intake that would ensure adequate hydration and optimal health for half of all apparently healthy persons in all environmental conditions…” in general, lactating people need ~13 cups of water/day, but your body can use water from many sources, including veggies, fruit, soup, water, fruit/veggie juices, milk, tea and other beverages. The foods you eat accounts for about 1/5 of total fluid intake.

How much water should you be drinking while breastfeeding? There are some ridiculous answers out there. If your milk supply has dropped, helpful people may suggest chugging tons of water. Your lack of water intake is most likely not responsible for your decrease in breast milk and drinking too much water can inadvertently harm your milk supply.

When you drink too much water, your body tries to restore the electrolyte balance by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases milk supply.
🍉Water dense foods can be just as hydrating as plain water from the tap. The general rule is: drink to thirst, eat to hunger.
💧Keep a full water bottle by your favorite nursing spot 🛋. There is nothing more frustrating than desert mouth when you are stuck in a chair in the middle of let down with your babe.
💦Strategically place water bottles where you will see them as a reminder to drink: in your diaper bag, in your 🚗 car, by your desk at work and next to your 🔑 keys.
⏰If you really have mom brain, set an alarm for every hour and try to sip a few ounces each time the alarm goes off.
🍑Eat foods that have a high water content, such as melons🍈 🍉 , cucumbers 🥒, salad 🥗 and 🥣 soup
🧉Spice it up by adding fruit, a small amount of juice or a squeeze of lemon or lime to your water
☕️Coffee, tea and soda will dehydrate you, so try to limit caffeinated beverages

Breastmilk is 88% water. Babies do not need additional water, even in hot weather. Too much water, especially in the first 9 months, can be dangerous.

Under 6 months, water can be dangerous:

• In the first days after birth, water may increase bilirubin levels (jaundice) and cause excess weight loss
• Fills baby up without adding calories, resulting in weight loss
• Makes baby less interested in nursing, which may delay milk coming in or prevent establishing an optimum milk supply
• Increases the risk of diarrhea and malnutrition

Older babies

• Too much fills baby up, sabotaging milk supply from not nursing enough
• Breast milk has the nutrition and calories babies need to grow – water does not.
• Breastmilk has all the water your baby needs, even in very hot weather.
• At 6 months, baby can learn to use a cup at the same time as starting solid foods. Giving a few sips of water a couple of times a day (no more than 2-3 ounces per 24 hours) is fine and can prevent constipation
• Breastmilk supplies plenty of fluids and older babies (9+ months) who breastfeed without restriction can get the fluids they need through breastfeeding. Some may need a little water with solids to prevent constipation (4-6oz/day).

If you feel you must give baby (6-12 months) water, offer limited amounts in a cup (not bottle) and only after baby has satisfied hunger with breastfeeding.

The breast only makes one type of milk. But how milk is released from the breast can change the fat content throughout the feeding. Foremilk is the higher water milk that gets to baby first to rehydrate the baby. Hindmilk is the creamier, higher fat milk near the end of a feeding/pumping session that helps baby grow and feel satiated. Babies need both for healthy growth and development.

There is no switch that gets flipped during the feeding, it’s a gradual change throughout the feeding. Like turning turning up the heat on the thermostat. The room will gradually feel warmer as time passes.

Depending on your nursing pattern, it’s possible for fat content to be higher at the beginning of a particular feeding than it is at the end of other feedings. The longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you’re starting off with a higher fat content.

Having a true foremilk/hindmilk imbalance is rare but can happen. It usually happens when:
🤱🏽A robust oversupply
🤱🏼An overactive let down
👼🏼Baby is being limited in their time at the breast
👼🏼Switching breasts too quickly in the feeding 📝 Combination of all of these

Signs of an imbalance include
💩 Really watery, foamy, green poops
👼🏼Baby nurses often and transfers high volumes of milk but doesn’t gain weight as expected

How to help:
🥛Regulate the over supply (bring it down to just what baby needs). This may include reducing pumping.
🥛Shake your breasts and do some massage before feeding. Milk is a liquid. By shaking prior to feeding you can activate the fat to flow faster
🥛Feed baby one side until they are finished on that side. You may need to block feed, or offer one breast for a set amount of time, to help increase fat content from that side
🥛 Work with a qualified IBCLC to figure out the root of the imbalance and get feeding back on track

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

Watch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.

The dreaded witching hour. Have you heard of it? The time typically in the evening when baby is inconsolable. On and off the boob. Doesn’t want to settle. Cries and nothing works. Can last for two hours or more. You may think you’re doing something wrong or you don’t have milk. You check your breasts and milk is still there. You become panicked when baby will take a bottle but refuses the breasts. Babies have been doing this as long as babies have been around. You are not alone. It usually starts around 2-3 weeks and can last 6 or more weeks. We suspect it happens when baby has been over stimulated throughout the day and now doesn’t know how to self soothe. Most likely they wanted to sleep but missed the magic window and now their still developing brain goes haywire.
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Unfortunately it also coincides with a natural dip in supply at the end of the day which gets baby ready for sleep at night. However most mamas blame their breasts and a perceived low supply as the cause of the crying and often reach for a bottle. If this happens every night for multiple nights, moms body thinks baby doesn’t need that milk and what was a perceived low supply turns into a real one. What can you do instead?
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Know what’s actually going on! If your baby normally takes the breast through the rest of the day and over night, DON’T BLAME THE BREAST. If you know around the time the baby becomes fussy each night, try to jump the gun and get baby down for a nap before the fussiness begins. If the baby is already in a meltdown, offer the breast. If baby won’t take it, don’t push it. Rock, cuddle, snuggle, bounce and soothe. It may take you a few days or even weeks to figure out how your baby likes to be soothed, but this too shall pass. If baby is making lots of wet and poopy diapers and latching well the rest of the day, don’t blame the breast as the culprit for your baby’s melt down.
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My little peach went through this for over a month until I figured out it always happened around dinner time when I was trying to make food for my older daughter and had the baby in the kitchen with me. I changed my routine to put her in her sleep sack in her bed twenty minutes before dinner prep and it changed the whole mood of the night. She outgrew it around 9 weeks.
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Are you in the witching hour phase? You’re not alone.