Executive Summary

I had a thought today that I would like to know the answer to. With so much publicized research being done on the properties of breast milk (antimicrobial, stem cell properties, brain development and so on), where is the research into real lactation problems? Where is the safe approved drug to increase milk supply (Metclopramide isn’t really ‘safe’ and Domperidone isn’t really ‘approved’), where are the actual diagnoses for supply problems? Maybe companies would rather head toward synthesizing the properties of breast milk rather than helping to fix bodies to produce it. After all it’s only several hundred thousand women a year, and formula does exist (my tongue is so far into my cheek it might poke through…)

I don’t know. I suspect there is not a satisfactory answer.

So I leave you with this. A short guide to various posts that are intended to be helpful.

I need help:

How to interview a Lactation Consultant

11 things a Lactation Consultant should know how to do (IMO).

Do I need help?

I find my tongue tie resources out of date, though you can see my experience here. For better information I would urge joining this Facebook group. They maintain lists of providers and are fairly knowledgeable about what is to be expected. If a provider is not on their list people can often recommend local alternatives (for instance I know of at least 4 laser tongue tie release places in New Zealand now, but none has made the general list. Do see the New Zealand Tongue Tie resources page instead.)

I need to combination feed-how do I do this?

The big fat Combo feeding FAQ

Walking the line

Benefits of

With low supply

SNS tutorial

Nipple confusion

Managing long term

Formula

Solids

Weaning

Body Image

What is causing this?

Able

Potential causes

Birth complications

Rare vs Undiagnosed

My most popular post

Making Milk beads

And the rest of my life.

I think I no longer feel bad, because it isn’t something I did wrong. It’s purely a medical issue.  A medical issue that some people would have me believe is my fault. A medical issue I cannot get satisfactory treatment for and that is largely undiagnosed. That makes me mad.

I lie. I still feel bad and somewhat inadequate, but I no longer feel guilt. I do wonder how much of my feeling bad is a normal level for someone suddenly faced with a non-life threatening failure of a body part. Somehow I can’t imagine people feel a mix of loss of gender identity and self loathing after losing a kidney or having a splenectomy. Or losing a finger or a limb. I’m sure there are other mixed feelings but I wonder how often self hatred/loathing/failure is a part of that.

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Let’s talk formula

Because someone needs to.  So here it is from me- someone who wanted to breastfeed and supports breastfeeding where reasonable, yet used and uses formula for medical reasons. Maybe that makes me a mostly neutral party. Maybe not.

First off- everything I learned about formula is self-taught or I learned from a Lactation Consultant. A good LC, on seeing that you want or need to use formula should be able to give you some pointers. Theoretically all formulas should be pretty much the same, brand name or budget. The WHO is supposed to regulate the ingredients and basic proportions. However-sometimes things are not so straightforward.

What you want out of a formula is to have it be whey based. Not casein based. You want the from birth formula. The follow-ons  marketed from age 6 months + are not as well regulated and unnecessary (though they are often cheaper…). If your child requires supplementation beyond 1 year, full fat cow milk can be given (or mixed with formula if you are concerned about diet or intake).

Cow milk is recommended because growing brains need fat. If your child does not like cow milk to drink (mine didn’t), just be sure to supplement with other high fat foods alone or in cooking. Food such as- avocado, cheese, coconut oil or cream, peanut or seed butters, butter, cream, lamb, olive oils, and so on. For extra calcium try various vegetables like kale, alfalfa, etc and fish like sardines, salmon etc.

Back to formulas. Whey or milk solids should be the first ingredient. Maltodextrin is a common additive and should be around the 3rd-5th ingredient. It is sometimes seen as the first ingredient- this is not necessary and may make your baby eat more- its a carbohydrate that is digested quickly.

If you are combination feeding you do not need any special formula. Any birth to 12 month one that suits you is fine.

This sort of thing

4seURmZ

Image credit

Is straight up predatory marketing. I was always ambivalent about formula companies being big and bad and preying on the breastfeeding mother, but yeah. Not after seeing that. I’m pretty sure people are eating it up too. I’d hate to be more cynical but I’d imagine that if the one on the left cost more people would be paying for that too.

Let me reiterate: You do not need anything special to combination feed. No formula is better than any other. In fact less is often more.

Some reading on safe formula use can be found here http://info.babymilkaction.org/infant_feeding/formulafeeding

Cooking with Milks

Another consequence of my second child being such a fuss butt was that when I went back to work she refused a bottle. I feel like a meme belongs here.


Anyhow, in two children I’ve learned to use up my milk. It was hard to come by, be damned if I’m going to tip it down the drain.

Milk jello.
This sounds so grody, but it’s a reasonable option. I tried it first with formula, but it will work well with expressed milk too. A half and half mix with powdered or concentrated formula will likely work best for technical reasons.
Add gelatin to boiling water and dissolve. This is the technical reason I mentioned. Gelatin dissolves a lot slower in milk than water. So you could boil your breast milk and dissolve gelatin into it. But it will take longer. Add appropriate amount of formula for the amount of water the gelatin is dissolved in. Add your milk. Pour into containers and allow to set. I found 14g (1/2oz) ad 200ml far too firm. My baby could pick it up but couldn’t really suck bits off. I doubled it (you can melt it back down in a double boiler set up. If you don’t have a double boiler a frying pan with water and a pot in that will work just fine) and it was still a bit too firm. Follow the directions on the package. Use within 3 days.

Milk custard.
One version requires your child able to have eggs so after solids are more established perhaps. You can omit the egg and make the custard more of a roux instead though if you do that I would definitely make it in a pan stove-top.
The smallest amount is about 100ml of milk, 1 egg yolk and 2 tsp of corn flour or corn starch(I wonder if you could use tapioca/arrowroot or other flour for this instead). You can even do this in the microwave. Mix ingredients and whisk. Heat for 1 minute in your microwave and whisk again. heat for 30 seconds and whisk again. Repeat until it starts looking thicker around the edges. It should be setting up by this point. If doing in a pan just heat and whisk until setting up. Cool and serve or put into containers to set. To double it use 200ml milk 1 egg yolk and 2-3tsp flour. After that you will need another egg. Also more flour. Feel free to add extras-fruit, sugar etc. This was intended to get fluids into my non-drinking kid so I started out with basics. Keeps for 2 days.

Muffins
This is what I did with all my lipasey milk from my first child. She wouldn’t drink it so I baked with it.  I also made some jewelry…

Anyhow.
1/2 cup flour, 1 small egg, 1/2 cup milk, 1tsp baking powder, 1 tbl oil and whatever fruit, spices and extras you want to put in there. This recipe doubles as a pancake recipe. Our favourites were apples and cinnamon, pumpkin, lemon zest, berries etc. Keeps for up to a week and can also be frozen.

Human milk proteins, carbohydrates and fats are still good, so if you need to use up some old or slightly off milk cook with it. I use these techniques on milk that for example is lipasey, has not been drunk all day at daycare etc.

We also found soaking some bread in the milk worked well. Pretty much the cereal principle, but for the Baby Led Weaning self-fed child.

After 3 weeks of fussing, losing weight and playing around we found a sippy cup (just a cheapo plain one) that she would take that made daycare happy. But I’m still pumping milk and occasionally need to use some of it for non-drinking activities.

Take 2: When you think you know what to do and are so very wrong.

Now that we have put the SNS away at home, a little earlier than with the first kid, I should get what I learned from my difficult second child down somewhere.
Well I say difficult, but she was difficult only because of my milk supply issues.
She developed very minor jaundice early on. Not enough to worry anyone but enough to get really really sleepy.

By 6+ days old we had to institute a waking and feeding schedule and we had to continue waking her for feeds until well over 2 months of age. Yay baby sleep you might think. Yes, on one hand this was nice because my first did not sleep and instead ate all the time. Sleep also makes it possible to do hard things. Like lots of pumping. But with low supply you do want an eager baby stimulating your supply. So every 3 hours I had to wake her up and then came the 1-2 hour long ordeal of keeping her awake through feeds just in time for the next feed to start. Every 3 hours 24 hours a day. Blargh. Wet cloths, undressing, blowing in her face, and even icepacks on her feet. And because she was so sleepy and not able to get enough from me part of this routine came to involve force-feeding with a bottle. She came to hate the bottle. In fact she hated anything not a breast in her mouth. Maybe having her tongue tie and upper lip tie lasered at 3.5 weeks oversensitized her but she developed into an orally particular baby.

As I knew how to use the supplemental nursing system I was eager to do that rather than bottles, but she became quite particular about the tube in her mouth. The medium tube which had a faster flow was not acceptable and occasioned screaming if it even touched her. The small tube was never fast enough initially (not that she seemed to care…) and often feeds would take over an hour to complete (even into her 4th+ month). Instead of latching her with the tube near her upper lip I started sliding it into the corner of her mouth around 7-8 weeks and that was the only thing that would work. If she detected it she would fight to get it out, preferring plain breast but of course that wasn’t an option. She developed aversions to one breast and for a while even one position because of association with the tube and I had to exclusively use it on the other one.
She made feeding my first look easy. Sure with number one I had low supply and I was learning as I went but after working out the initial technical problems and difficulty it became routine and predictable. Not so this time. Things were always irregular and a struggle if not an outright fight. I was tracking her intake, output and weight gain until nearly 7 months, where I pretty much stopped the tracking with my first by 3-4 months as things were so routine. The part that bothered me most was that she could not be trusted to self regulate with milk. she would stop and if we let her do that she would not gain appropriately so there were minimum intake volumes she had to meet. This often required waking her up and trying to get more milk into her. So it was a chore.

Things that helped with this difficult baby?

  • Primarily putting the tube in the corner of her mouth. Here is a short and not very good video.

She so very much hated the texture of the tube that putting the tube against her upper lip lost us some breastfeeding positions for a while as she came to associate them with tubes in her mouth. The latch wasn’t great but it was hard to fight about drinking and fight about latch. Especially when she preferred to slip down.

  • Using the NG (naso gastric) feeding tube in a bottle. I was at the point where she would not feed in several positions, would not take the Medela SNS tubing the ‘right’ way and would not take a bottle and I thought I would have to finger feed her or start syringing milk into her mouth. Its a very frustrating position when you want and need help but you know that you know more about alternative feeding methods than any professional you might ask for help. I got one of these NG tubes-which by the way is fairly stiff and inflexible- and stuck it in the corner of her mouth…and away she went. It wasn’t bothering her.

So I then learned how to sneak the SNS tubes into the corner of her mouth. The SNS medium tube is far more flexible than the NG tubing but not nearly as thin and flexible as the small SNS tubing (case in point I have been through multiple small tubes as they develop pinholes just from regular use. At least 2 per child. I have not had to replace the medium SNS tubing through 2 children, but then I don’t use it every day either). But I learned to stick both of them in the corner of her mouth. And things worked. Mostly. Sure feeds took 20 minutes for ~60ml supplement on a good day (and 40-60 minutes on a not good feed- keep in mind this is after 10-20 minutes of regular breastfeeding). And the tube would wiggle and it would need a lot of adjusting (this is why I was happy I had the Medela SNS because when liquid is being consumed you can see air bubbles. Not possible with NG tube in a bottle method), but it worked. But maaaan was I glad to put it away.  No excitement that I was finally meeting her needs (+solids), just relief to be done with such a tedious fussy feeding regime. She’s been fine with plain breast. Which was part of the problem, as that is what she preferred and was not an option because of my supply.

Lesson learned. Never think you know what you are doing.

Milk and casting resin jewelery tutorial

Updated at the bottom-after 4+ years!

 

I was curious about this and I had some left over milk that my kid will not drink. I think it got all lipasey in the freezer and it’s past it’s best by date anyhow. Besides, she’s suspicious of anything not water in cups. So I had loads of milk to play with (I’d tried to donate it a while back but we got crossed signals and I didn’t try again). I live in New Zealand so the artist that does commissions in the US is not an option for me. Plus I’m a naturally curious person and I’ve done resin casting before (though of scientific specimens). So be warned, this is a long picture heavy post. The step by step procedures (with pictures) are at the end, after I explore some things that didn’t work (or worked not so well), so if that’s what you want, skip on down. I’m not going to do any commissions (as I said, I live in NZ), this is just a starter guide for those interested in DIY milk-resin work.

I found this but I thought I’d try a few other things as well

I tried plasticizing milk via the vinegar-casein method and it really did not work. My milk separated some, but the globules did not stick together. They were so tiny that they just passed through my ultrafine cheese cloth.  I’m not sure how it’s been done by other people. I know the Etsy artist who does commissions in the US and a French design company both have plasticized human breast milk. I know the Etsy artist uses relatively small quantities, and from looking at her work I’m quite curious as to how that much precipitate comes from the volume of milk she requests. I’ve made cheese in the past and I know how cow milk precipitates, so I’d expect even less from human milk. Perhaps some sort of dehydration method. Well, whatever it is, it’s an interesting trade secret.

This is my milk after adding rather a lot more vinegar than the cow milk plasticization recipe called for (and lemon juice when the vinegar failed to do anything).

Still pretty liquid. The image doesn’t show it well, but there were tiny tiny precipitates in there. They, however, did not stick together. I left it sit for a bit with not much change. And they went right through 2 layers of ultrafine cheesecloth. So chalk that up as a failure.

Anyhow, on to things that did work, in various ways.

So what you need:

  • Polyester clear casting resin. Mine is called Klear Kast. I bought 500ml of it (about 2 cups). You can get this from craft stores and even auto body hobby shops. Make sure it’s clear. There are some resins that are white and opaque when they harden. By the way, this (500ml) was an excessive amount even for experimenting. 250ml (1 cup) should be more than enough for any milk casting project alone. You’ll even have enough with that for some other small projects. Only buy more if you plan on doing some deep casting (like making paperweights or something).
  • Moulds. There are special resin casting moulds. They are kind of a heavy duty thicker translucent plastic. Again, check a craft store. I suppose you could try some of the cheaper chocolate or candy ones. I can’t really see any reason why not to use a chocolate or candy one. The resin does get hot and will melt things (left over resin setting melted the little plastic medicine cups I had mixed it up in), but surely something you pour molten candy or chocolate into would hold up? I don’t know. Use at your own discretion. The chocolate/candy moulds tend to have more intricate designs, which you may not want for your resin project.
  • Small plastic or paper cups for mixing in-disposable.
  • Popsicle sticks (or some other wide thing to stir with, aka something disposable eventually)
  • Gloves, face masks and a well ventilated work area.
  • Toothpicks
  • Your milk (you don’t need much if you know how you want to use it, otherwise if you want to play around you may need more-also consider playing around with cow milk if your milk is in short supply). I’ll include volumes of how much I used for each process. Make sure you pasteurize your milk (by heating on the stove or microwaving it until it’s nearly boiling) before using. Otherwise any bacteria in there can continue to grow and turn your project all kinds of colours you may not have intended.

Things you don’t need but may want depending on what you want to do

  • Commercial resin spray- (I found cooking oil left a bit of a cloudiness to some of my castings). I’d say you may only need this if you are working with a complicated mould. All of my shapes came out without using it.
  • Dyes if you want them.
  • Pictures, other beads, mementos, glitter etc.
  • Modelling clay. I bought Sculpey (I let my daughter pick a color, she picked sparkly blue) because I had an additional idea in mind. If you just want milk shapes, you can get any, preferably oil based,  kind.  If you might want coloured shapes as well, get something that you can bake like Sculpey or Fimo. If you aren’t a very good sculptor, I’m not an artist, but I have done some sculpting, there are push moulds available for this type of clay.
  • Plastic wrap
  • syringe or eyedropper-disposable is best. You’ll likely want one for your milk and possibly another one for resin use. I got through all my testing, though I reused some, with less than 5 disposable droppers.

So the numbers are 1: My thawed microwaved milk, 2: toothpicks, 3: my casting resin, 4: toilet paper for wiping stuff up (didn’t have paper towels), 5: That’s a straw for getting out air bubbles (didn’t need it), a wide handled scoop which proved to be very handy for stirring things since I didn’t have any popsicle sticks, and plastic bags (for cleanup, but also because I didn’t have plastic wrap), 6: plastic droppers for dropping milk, 7: My clay shapes, 8: my mould, and 9: my plastic medicine cups for mixing in.

So here’s the thing. Preparation is key. Get everything you might want and do a dry run, without resin made up, before you make your resin up. The resin brands vary and some have as few as 3 minutes of working time once the catalyst is added/ the solutions are mixed.

You should make up your resin in very small batches as it will harden up and be unusable if you forget something or are doing anything layered. Stir the resin and the catalyst/hardener with a popsicle stick in the plastic cups (while wearing your gloves and mask in your well ventilated area). The directions on mine has how to make up various volumes. The smallest was 1 ounce (30ml), so I pre-measured that volume with a marking pen on the side of one of my plastic cups. Everything has clothespins on it because it was windy and stuff was blowing away.

There are a few ways to do this. You can have abstract patterns, swirls etc, or you can have shapes.

To make abstract swirls, layers you mix the milk in (along with dyes, glitter, other beads etc) right before you pour it in the mould. It will not mix well. Use a popsicle stick or toothpick to mix it as it’s in the mould even. You can also pour a layer of resin (or dyed resin), wait for it to set, and then pour a milk mixed layer, set, pour another layer etc for a layered look.

Here are some results where I mixed about 10-15ml of my resin with around 4ml of milk. I mixed it really well and after a bit got it to be only bubbly looking, but of a uniform color. I poured that into a few moulds. On the left picture you can see that from the 10-15mls with added milk I got 4 (3 shown here) whole shapes and a few partial dribbles (shown in other pictures below). The right picture is a closeup of the bubbly appearance of the mix. I have no idea how this will hold up long-term, but after a few hours it was solid enough to remove from the mould. It was however tacky and flexible for several days. In subsequent tests of this method I had gummy shapes after letting the pour set overnight. So when you mix your milk and resin you will need to A) add extra catalyst, B) allow it to set for several days. Generally, after 2-3 days the gummy ones had set fairly well and hardened off after a week. I don’t think this in itself is a good long-term piece of jewelery. The milk resin cast shapes seem a bit brittle in texture. Maybe embedded in resin or coated with another clear coat they would be fine. I did find that it casts up much harder (not gummy) if you increase the amount of catalyst. I made several milk mix castings that are white, bubbly and opaque this way. This will only work if you have the kind of resin where you add a smaller amount of catalyst, rather than the kind where you mix equal volumes of two solutions.

          

To make shapes:

Mould your shape out of modelling clay. You are going for a bas-relief effect within your resin mould. So if I were to make a heart I’d make it sort of flattish and only finish it on one side. Make sure it is nice and smooth. You also want it to be smaller than the perimeter of your mould, so there will be resin all along the edges. A deep shape also works better than a shallow one.

Here are the shapes I made. I kept it simple and smooth-edged. So hearts, starts, moons. Make sure you measure them to your mould. Will they fit inside?

Now  wrap your model in plastic wrap. I used freezer bags and rubbed out the lines. Plastic wrap is a lot better since the freezer bags tended to un-cling (from themselves, the clay etc).

Pour your resin to the level you’d like your shape at, or halfway. Deeper holds the milk resin mix better and makes more of a contrast in the finished product.However, you don’t want your resin to go over the top of your clay shape. It will be very difficult to remove. So a deep, but straight edged shape is best. Now, while the resin is still liquid, use toothpicks to hold the model in place, shape and plastic wrap side in the resin.

Allow the resin to set for at least 24 hours (cover it with something, like a clean box, and set it out of the way. You pretty much can not bring this stuff inside unless you like the smell of varnish and paint thinner. So garages are cool. If you don’t have one, put a box upside down with rocks on it over this outside for the night). Now,  remove the plastic wrapped modeling clay, which should pop right out (but you may need to dig out), and dropper, pour, or syringe your milk-resin mix in there. See below for what happens if you use straight milk (even frozen). Allow your milk resin mix to set for at least a day, if not several days. Now, pour (or dropper, droppers work well for this) another thin layer of clear resin on top (you can always make up more), sealing the milk in and fill the mould the rest of the way.Don’t be afraid to overflow your mould a bit. You can sand off any imperfections later on. If you want to do a layered thing, maybe a photo or other memento you can put the photo in first or after the milk, but there should be a layer of resin between them.

So here are the various photos and what I did

Round 1:

From top, clockwise: Milk resin mix large oval, resin with clay shape large oval, milk resin mix small oval, milk resin mix long bar, resin with milk resin mix swirled in long bar, resin with clay shapes rounded rectangle, resin with milk resin swirl hexagon, milk resin mix heart.

Shapes held in place with toothpicks-solidifying

   

Set up, in the mould, after.

These were the initial ones I did where I put the clay (oiled in one case) right in the resin. I thought the oil, or the oiliness of the clay would allow it to come out. Alas, after much digging I only got most of it out. And blue dusty stuff everywhere.

Here they are after removing as much of the clay as I could (still blue tinted, as you can see. So unless you want that, use plastic wrap!):

With milk in:

I put milk in the recessed bits and froze it overnight, then poured clear resin on top of it. The milk when it thawed rose up through the second layer of resin. So that’s why you don’t use plain milk. These would have turned out great if I’d used a milk resin mix. It’s a shame these had the clay sticking issue (and the further milk issue) as these turned out very crisp.Well, lesson learned, experimentation and whatnot.

After less than an hour:

After several hours:

So that’s why I recommend mixing the milk and resin before putting it in the bas-relief shape. It’s a bit bubbly looking, but produces a slightly cleaner end product. You can see the results of putting a previously cast milk-resin shape into a larger shape above the heart in the second picture above. See below for finished versions of everything I tried. Still only 4ml or so of milk (which can actually make rather a lot of castings with the 10-15ml of resin).

Here’s round 2 in the mould:

Clockwise from top: Clear resin with previously cast milk-resin embedded in it, bas-relief resin with pure milk shape (used straight clay, had to dig out, left blue residue), clear resin with clay shapes embedded, bas-relief round 2 with plastic wrapped clay 1, bas-relief round 2 with plastic wrapped clay 2, milk resin mix squares (2 of them), bas-relief resin with 2 pure milk shapes (again, blue residue), clear resin with milk-resin swirled in it (hexagon), bas-relief round 2 with plastic wrapped clay 3, 2 drop shaped milk resin shapes, and 2 long rectangular milk resin shapes, trapezoid clear resin with swirled milk resin.

Here are the results from a more successful round.

Here are the processes and finished products from all rounds:

So what ultimately worked well.

Bas relief casting and pouring a milk resin mix (~4mls milk to 10-15 ml resin) into the recessed shape.

How to do:

  1. Mould your shape (that you want to be made of milk) out of clay and wrap it in plastic wrap.
  2. Make sure the shape fits in your mould (resin shape) and pour resin prepared per manufacturers directions into your mould.
  3. Place your shape supported by toothpicks into your mould, and make sure it is about halfway submerged in the resin. You don’t want it to be too much more than halfway or it will be difficult to remove.`
  4. Allow to set. After 4-6 hours you may be able to remove your shape, but allow to set at least overnight before doing the next steps.
  5. As you can see I’m reusing some of the plain milk experiment ones.
  6. Do any cleanup (removing errant clay, plastic wrap etc, any scraping you feel necessary and so on)
  7. Prepare a small amount more resin per manufacturers directions. Pour a smaller volume of it into a separate cup and add milk. I used 10-15ml resin and 4ml milk and had way more than I needed. I found 4ml milk in 10-15ml resin gave a uniform whiteness that still hardened up if I used extra catalyst. I also found that increasing the catalyst increased the setting speed. Mixing the milk and resin before adding the catalyst often gave a smoother mix.
  8. Stir up the milk resin mix until fairly uniform. It may mix well and it may retain a bubbly appearance (like oil and water)
  9. Pour (or dropper with a disposable dropper) some of this milk resin mix into your shape. Allow to set (You can pour clear resin over the top of this, but you risk the milk floating out) for a few hours if not overnight.
  10. A few examples
  11. Make up more clear resin per the manufacturers instructions and pour another layer, fully filling your mould, over the top of your milk resin mix. Allow to set at least 24 hours or per manufacturers instructions.
  12. Drill any holes and you have jewelry.

Here are some examples of this technique. You’ll notice some surface imperfections from resin rundown, but those are easily sanded away with a fine sandpaper. Cast resin polishes up well. You’ll also notice that some of the milk shapes are quite light. This is due to the shapes not being deep enough. This is after something like 4 or more separate shape runs and over a month of work, so I was getting a little tired since I had some I liked fairly well. Now that I (and you) know what to do I’ll adjust my future shapes accordingly. Deep, and well away from the walls of the mould.

Setting a milk-resin mix shape into a larger clear resin cast

  1. For this you will need a smaller mould whose shape fits inside a larger mould.
  2. Prepare a small amount of milk resin mix. I used 4ml milk to 10ml resin which made several castings.
  3. Stir until well mixed.
  4. Pour into first mould. Allow to set at least 48 hours (this will be tacky and flexible when you pull it out)
  5. Pour clear resin into second mould
  6. Place milk resin shape into second mould. Push into position with toothpicks.
  7. Allow to set
  8. Drill holes and you have jewelery

I actually like the way this one turned out best in terms of opaqueness and general appearance. Too bad I didn’t have many interesting shapes that fit into other shapes!

Swirling milk resin mix into resin

  1. Make up some clear resin per manufacturers instructions
  2. Pour off a small amount to a separate cup and add your milk. Stir to mix.
  3. Pour some clear resin into your mould shape of choice, but do not fill.
  4. Pour some milk-resin mix into the mould.
  5. Use a toothpick to swirl however you like it
  6. Pour more clear resin on top
  7. Allow to set per manufacturers directions
  8. Drill holes and you have jewelery

Here are some various examples of this technique.

Now that I have spent over a month testing things (getting resin on my brand new camera 😦 at least it’s only on the screen) and writing this post here are some more photos of my finished products. Here are some of my favourite results:

There are 6 (3 matching pairs) cast milk resin mix,  3 swirled resin mixes (2 small ovals and heart), 2 bas-relief cast shapes (oval with heart and trapezoid with heart), and 1 cast milk resin inside clear resin (oval in oval).

A close up of the non-solid milk resin cast ones. Same as above.

These all still need some minor sanding and drilling…but no drill yet so I can’t show off finished products.

Other tips. If you wanted a dyed layer decide if you want an opaque or transparent dye and where you want it. If you want an opaque dye, for example, behind your milk shape, you’d proceed as I described until step 9, then dropper a circle (or other shape) of dyed resin on top of the milk resin mix, let that set, then finish off with clear resin. Similarly if you want the whole thing translucently dyed, just use that instead of clear resin. If you want beads, glitter, a photo or other memento do a mock-up of how things will fit together so you know what order to put things in the resin.

 

Edit: Hey I see this post is getting really popular. I’ll try and put up some pictures of my resin cast milk over a year after I made them.

 

Edit 2: So it’s now been over 4 years, I’ve moved nearly every year, have 3 kids 4.5 years apart, and I have a job, so have been busy.

BUT! I dug these out (I still haven’t done anything with them. I have plans involving dremel tools, drilling and mounting them on some wood- we’ll just see if I ever have time for that). It’s November 22nd 2015.

They have yellowed. I put them on a black background to show maximum contrast. But only to an ivory kind of colour. I still think they look quite nice. Especially for being left in various boxes stored away for so many years.

I tried to pick ones that I showed above.

So here they are, with and without flash.

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On congratulations, extended breastfeeding and weaning

I was asking around for weaning advice some time ago and someone said to me ‘you’ve done well to get so far, most women would have given up’. I was kind of flabbergasted. There are a few ridiculous things about that statement. This is an irritating topic for me because I’m reluctantly pushing weaning rather than allowing self weaning. But the idea that breastfeeding success is measured on length seems ridiculous to me. Ridiculous because after you work out the issues it is often far far easier to just let things happen than it is to actively wean. It’s laughable that after you get to 6,7,8 or more months that at some point you can still ‘give up’ breastfeeding. For one, it’s generally much easier by that point, and two, no, sorry, by that point you have a semi-autonomous person who has their own wills and desires to contend with. Also, that ‘most women’ phraseology drives me crazy.

To put this more in perspective: I’ve been breastfeeding for close to 16 months now. The first 8 were a struggle with me either trying to up my supply, or simply using the SNS multiple times a day. The past 8 have not been difficult at all. OK, not difficult in the same ways. Or rather, only difficult because I want different things than my baby at this stage. Like sleep. Yet there have been rather a lot more congratulations on getting ‘so far’ since I hit 12 months rather than dealing with the initial issues. I’ve noted before that serious issues seem to make people’s brains shut off. They either armchair quarterback it (you could have done better) or their eyes glaze over. I don’t really bring it up (except for here), because there’s no really good response I can think of. Basically anything anyone is likely to say is shooting themselves in the foot. I guess the point I’m making is I find these congratulations for extended breastfeeding so ridiculous because it’s not anything I did or didn’t do. It’s not some superstar parenting ability that kept us breastfeeding, it was me being lazy. As far as I’m concerned preferring the boob is mostly my child’s personality. I’d argue that while extended breastfeeding is an excellent parenting tool, parenting without the tools that breastfeeding affords one is more difficult. So here’s a tip of the hat from me to all those parenting without using breastfeeding or any simulacra thereof.

Honestly, stopping is proving to be more difficult than I bargained for. How hard? Put it this way, I wanted (well not wanted, but, well, planned…) to stop around 4 months ago. And I started gearing up to start 6 months ago. Well, I did, but my child really did not. I wasn’t willing to take it away from her at that point, so I let it go. Then two months ago I stepped it up a bit more and we’re still not there.

I tried asking around for weaning tips, but no luck. I have a difficult child in this respect as she will no longer take a bottle and dislikes all milk in any container but me. I mostly got the ‘not allowing your child to self wean is cruel’ type of responses, but I also got a fair amount of ‘I gave my kid a bottle/cup with cow milk and that was that’. Not really any help on either side. Then there were the people who told me to let my child cry it out for a few nights in regards to night weaning. Again, not helpful. My child does not respond well to being left like that. So here’s what I’ve learned about dealing with the difficult to wean child.

First, make sure your child is difficult. Try offering substitutions, cups of milk, bottles, etc. Maybe that will work for you and you won’t need the rest of this advice. Otherwise…

Start with don’t offer don’t refuse. This, depending on the child’s age will probably cut down on a few feeds right off the bat. Mine actually took a few months (I started don’t offer don’t refuse around 9-10 months) before she realized she could ask. Then she picked up again as she explored her new found skill. But it’s a good starting point. If you’ve already done that then…

Set associations. Baby sleep books talk about setting sleep associations, so I thought, why not set breastfeeding associations. We set associations that breastfeeding only happened on the couch and in preparation for bed (or in bed). We’d also had a breastfeeding to sleep association which was a nightmare for a few months until we broke it. It’s all well and good until your child gets too big to comfortably or easily put down when they fall asleep. Then it’s significantly less of an easy sleep aid. Read: feed to sleep for 10-20 minutes, hold for 15 minutes until you’re sure (haha) they are asleep, put down, baby wakes up, repeat for up to 3 hours. Yargh. If you’ve got one of those and you don’t want it, or you don’t want to develop one I can recommend Elizabeth Pantley’s book The No Cry Sleep Solution.

Consistency is key. This is where I’m really having a hard time because I’ll do things to make the  baby toddler sleep in my sleep. Which includes my best laid plans of wearing a shirt and a bra to sleep, I’ll wake up part way to find myself already feeding the baby. I’ve been really good about following our other rules for breastfeeding. Only after dinner, before bed, etc, but bets are off when I’m being a sleep deprived zombie.

Age: Weaning after 8-10 months for us has unfortunately been one of those things you have to want to make happen. Why 8-10 months? There are a few times in a child’s growth where weaning from the breast is thought to be easier. Around 9 months and around 18 months are two of those times. These are when babies are more likely to go on nursing strikes, have a lot of developmental things going on and cut down on breastfeeding naturally. At 12-13 months there is a growth spurt and in addition to eating like a horse, your breastfeeding child will give you a blast from the past, cluster feeding. So, what I’m saying is that if you miss that 9 month window, you may find yourself in a difficult situation from a weaning perspective after 12 months. Why? Because of the 12 month growth spurt and molars the child may have re-established breastfeeding as a source of comfort.

Distraction. Day weaning has been loads easier for us than night weaning. When she asked during the day I’d refuse, she’d cry for a bit, I’d give her a hug, a snack or drink, and within 5 minutes all forgotten.  It’s hard getting past those initial 5 minutes, but once you’re out the other side it’s easier to keep on doing it. After the first few times it’s like an ‘oh is that all?’ moment.  That has not worked for night times as the element of distraction is not there. If your child sleeps through the night or will take a bottle or cup at night this will be much easier for you. Mine does not and will not, alas. Pacifiers have also found some limited success here. My child has not been terribly interested in them (mainly as she can’t keep them in her mouth), but I’ve found them a nice oral distraction (though she mainly chews them-we have these wholly silicone ones) when she just wants a little comforting sucking.

Being firm, with limits: A lot of applying some of these things is knowing your own child’s limits. I found that mine might fuss for 5-10 minutes when not given the breast, but then would move on. I set a personal limit of 15-20 minutes. If after 15-20 minutes fussing and demanding of breast was still going on then I would accommodate her wishes.

Tough titty, the big guns: This is where you start the hardline tactics when the others have failed. When nothing else has worked. This is where I’d put allowing my child to cry it out, but then the goal is no boobies at night so that didn’t seem quite appropriate.  Things you can try include lemon juice or vinegar on your nipples. This totally didn’t work for us. I felt really mean, but then mine was all, yum, lemons (she will chow down on whole lemons including the peel if I let her). Doh.  So when I feel like I’ve exhausted my options and what I’m comfortable trying I revisited some things that I’d previously failed at.

What finally worked: So I revisited consistency. I made sure I had a bra on and a long shirt and tried that. As long as I was firm I could rub her back back to sleep and it worked fine. Also a water cup is key here. You may be able to bribe them with a drink of water if they are thirsty. Mine takes it some times, other times she just screams and hits me in the face.  Such is life. So once I got that working I had really bad insomnia for a few nights because I didn’t have those fancy breastfeeding sleepy hormones. But it got us through the no feeds between 8pm and 5am week. She still wakes up, but getting her back to sleep isn’t that bad. Reposition in her bed, tuck her back in, rub her back, maybe turn on a lullaby toy…

I met her halfway (really I wanted to sleep some more) and decide that she can have a feed any time after 5am that she wakes up. That one however will be the next to go. I thought, hey, the bed time feed is kind of nice us time, let’s keep that one and work on the middle of the night ones.  I also knew how to deal with the bedtime feed because I’d already dealt with it in a different form when I removed the nap time feeds, so I wanted to save that one for last. Now I know, sort of, how to deal with the sleep-time feeds.  Weaning is a fairly individual process, much like defining your breastfeeding relationship.

It’s sad. I’ll be able, most likely, to write down the day we stopped breastfeeding. After what we went through to get here I can’t help but feel awful. If it were not for my pesky lack of ovulation this post would not be. I’ve armed myself with some extra information for next time, but I do suspect that our feeding issues have something to do with it. Even at 16 months she is an inefficient feeder, sometimes staying on the breast for 30-40 minutes for her single feed of the day. Perhaps next time, with oral issues attended to early, this will not be a problem.

Before this post came out I got an 11th hour pardon. Literally one week remaining in the weaning plan and my cycles seem to be starting up again. It seems that our week or more of no feeds between 8pm and 5am was enough to get things started. We’re down to one feed before bed and I’m happy enough with that for now. Stopping is no longer in our immediate future. But, these are still good tips for weaning. Extended breast feeding doesn’t have to be about complete surrender of control.

How can you say no to this?

How to interview a lactation professional.

I’ve thought about this some, but then it came up in the comments for another post. A few of my posts reflect ideas I’ve had on this topic, so I’m going to expand on those as well as adding some new thoughts.

This should probably be broken into two groups: Prospective mothers (expecting), and/or those requiring generalist help and current mothers who have experienced a problem.

Let’s cover expectant mothers first.

If you are expecting your first baby, or your first baby you wish to breastfeed, you want to make sure you have an adequate amount of support. You should be focusing first on what resources are available to you.  This means checking with your hospital, your birth care provider, your pediatrician (if you are in the US for example), your local LLL chapter as well as seeing what private lactation professionals there are in your area. You should focus on how to access the services and what the cost will be to you. Having knowledge of where to find these resources is just as important as a birth plan, and for much the same reasons. The goal is to educate yourself to make informed choices. In addition, trying to find a lactation professional when you are desperate for help does not allow you to make informed choices. Try not to wait until you are desperate.

General questions to ask:

  • What are your qualifications? Here is a lovely guide I found on what all the titles mean.
  • How long in practice?
  • Is there any particular area you have additional expertise or interest in? (If you’ve got low supply and you are talking to a IBCLC specializing in oversupply she might not have the resources to give you the best help. If you are surveying what is available in your area then this is information worthy of noting down.)
  • What are your working hours? Do you work out of any hospitals or clinics?
  • What are your fees? What are your followup policies?
  • What breastfeeding challenges have you seen, treated, or overcome yourself?
  • Do many of your clients meet their breastfeeding goals?
  • If I experience a problem outside your area of expertise do you feel you have relevant resources to refer me elsewhere? What would you consider outside your area of expertise?
  • If I experience problems it will likely be a very emotionally turbulent time for me. Have you had experience supporting decision making and coming to a consensus about ways to resolve the problem (your provider should be willing to have a back and forth with you and if you decide that enough is enough support you in that as I refer to in this post).
  • What kinds of issues have been most difficult for you to help mothers and babies with and why? (as in, do they find the mother’s determination lacking, are surgical referrals difficult to get, etc. This is should act as a sounding board for their typical experience, if they have professional peeves as well as how understanding they may be to your situation)
  • How do you generally balance a mother’s well being with her initial desire to breastfeed? How do you manage situations that do not meet expectations and goals?

I also think that pursuant to this list, some of the general things you should ask a lactation professional if they have experience in are:

  • Do you have experience identifying lip and tongue ties, including posterior ties as well as other oral abnormalities like bubble palate? Are you confident identifying these types of abnormalities?
  • Do you have experience identifying a breast with  insufficient glandular tissue?
  • If you are a first time mother at risk for breastfeeding difficulties (PCOS, diabetes gestational or otherwise, history of thyroid disorders, lack of breast changes) you should certainly mention that. An appropriate response to my view would be a physical examination of the breasts as well as a wait and see with potential aggressive treatment if desired. Go the other way if you are told that any of those things will not matter.

Now for mothers who have previously experienced issues or are currently experiencing issues.

You’ll want any of the above that seem relevant as well as the following.

Specific questions:

Most of these are fairly situational so choose or adapt any that seem appropriate to you.

  • My issue last time was X. Will you help me explore solutions for that? How will you do that?

I’ve found some sounding board questions quite helpful to see how much recent research has been kept up with. You might ask if they know about the link between PCOS and breastfeeding issues, thyroid problems and breastfeeding difficulties, or even a more general tricksy question-what medical factors are you aware of that influence milk production in the mother and milk extraction or digestion in the baby?

  • What are your guidelines for supplementation in the infant.?

This is a personal preference one. The answers may range from over 7-10% weight loss, to watch the baby. I’d be wary if they say that supplementation is almost never necessary. If they say that I’d follow up with askance for some clarification i.e. in general or among your clients? What techniques do you use then for managing babies with milk extraction issues or mothers with milk production or ejection issues?

  • If supplementation becomes necessary which methods will you support me with? Are there any you will not support?

If you used donor milk last time and plan to should it become necessary again you’ll want a professional that supports you in that. If you used formula and prefer that, again, support. If you want to use bottles, you’ll want support in managing that, if you don’t you’ll want tips on other feeding methods.

  • As my issue was X last time can you give me some realistic expectations on what management of this issue will look like on a daily basis and what difficulties I am likely to face?

If they tell you you’ll need to pump 15 times a day as well as do some other things and this does not seem sustainable to you because of other children then bring that up. Discussion about an action plan is key.

  • Make sure to mention things you did or tried previously and whether or not you feel they worked as well as whether you’d be willing to do them again.

For instance, I tried domperidone and it inhibited my letdown reflex, and I am open to supplementing via SNS if it can be demonstrated to me that an oral abnormality is not the issue etc. You don’t need the frustration of reinventing the wheel and to avoid that the LC will need as much information as you can give her.

Warning signs:
  • Being told to wait and see or being told that every baby is different when you’ve experienced issues previously. Wait and see is a reasonable approach for some things but not if you want to be proactive. With some things it’s important to act quickly.
  • Your LC should never touch your breasts without permission.
provide support and encouragement to enable mothers
to successfully meet their breastfeeding goals

So if your goal is to breastfeed for 2 months then move to combination feeding for the next year she should be able to give you strategies on how to do that. She should also be supportive of your goals and willing to have an open and non-judgmental conversation with you. If your goal is to exclusively breastfeed with contraindicating issues she may (unpopularly) explain that that may not be possible, but give you long term management tips.

Note: there are a range of breastfeeding topics I do not have much experience with. Issues like oversupply, feeding multiples, flat or inverted nipples, breast size issues, prematurity in the infant, allergies in the infant, and reflux as well as others so I can’t give examples of more specific questions relating to those issues. However I can say that if any of your concerns are brushed off without explanation that is cause for alarm.
Overall you want to be having a conversation. Figuring out if this is the right person to help you if and when you need help.

When do you need help, and what kind do you need?

I found this interesting little scoring chart for self assessment and when to seek help. I mentally scored our first few weeks and came up with a score of 21. Low end of normal, me mostly getting points from my inherent nipple shape, and not having rock hard boobs, but having scores of 1 and 2 in multiple areas. I had 5 1’s and 5 or more 2’s. I think we can safely say that milk consumption by my child was an issue. But there’s not so much information on delineating milk transfer issues from milk supply issues. It seems there’s a lot of focus on either supply or latch and positioning. But looking at that list above I can mentally tick off causes for the troublesome symptoms listed, probable latch/oral abnormality issue, potential milk supply issue and so on down the list.

I was chatting with a woman months ago and she mentioned some really classic tongue tie symptoms: clamped nipple, serious damage and pain, baby losing weight despite her experiencing engorgement, baby who would only latch if propped up just the right way, and baby slipping off the breast. I said, tongue tie, get it checked, and go to a dentist if your LC doesn’t agree, here is a list of ones in your area. Here’s some pictures. She ignored me (as people do, after all, who am I?) because her lactation consultant focussed instead on propping the baby up just so, having the right amount of pillows, sitting just so in a special chair. So she was able to feed the baby with someone there to make sure everything was just so. Not so much when she didn’t have help. It still hurt, but it was tolerable. For a while. Then she started pumping to give herself a break. Then she had to do the whole song and dance over getting her baby to take the breast again. Finally, after several months of this she finally got a tongue tie diagnosis.  During this time she was concerned about her supply. Her baby wasn’t gaining quite right. I kind of wanted to bang my head against the wall and say it’s not your supply! Or at least it wasn’t… Ah well. It seems somewhat common to ignore the potential oral issue in favour of finding a positioning, or latch technique, fix.

Supply issues are a common worry. Here are some common features that low supply and milk transfer can share:

  • Long feeding times (in excess of 40 minutes with short breaks and few substantial sleep periods)
  • Poor infant weight gain, or loss
  • Poor infant output
  • poor infant test weight
  • dehydration
  • apparent lack of milk in the breast (poor engorgement, not full feeling)
  • Lack of appropriate sucking or swallowing motions (mine was a big flutter sucker)

What features are unique to low supply?

See, that’s the thing.  I can’t think of any that do not benefit from first ruling out milk transfer issues.  Low supply is certainly real, as well as more common than it’s made out to be, but a lot of the probable symptoms benefit from a wait and see approach (apparent tubular breasts or IGT), or can be caused by ineffective milk transfer. There isn’t a whole lot you can do before birth to assess probable low milk. Breast shape and placement are good markers, but breast changes from days 2-5 post-partum and physical examination of the infant for sucking ability are better indicators. Hence the wait-and-see.

So what features are more commonly associated with milk transfer issues?

  • Latching issues. Anything from slipping off the breast, to pain, to tissue damage.
  • infections or blocked ducts
  • nipple shape-coming out of the infant’s mouth compressed or inherently flat or inverted
Most breastfeeding assessment tools have audible swallowing as a consideration. I thought my baby was swallowing audibly, but it was a very quiet noise. I was told to listen for a ‘keh’ type noise and I did hear that, but it was infrequent and not associated with actual volume swallowing. I was also told to watch for muscle movement near the ear. Again, sort of saw something, but not really anything vigorous. A better diagnostic tool  is either watching, or (unless your baby is nursing upside down) putting a finger under the chin. The chin should be moving, and larger chin movements mean more milk in the mouth.
The take home message is if your baby is not eliminating, gaining, growing appropriately you should first rule out milk transfer issues.
So when do you need help and what kind do you need?
On call, wait and see type help during pregnancy:
  • When your breasts do not grow, become painful or otherwise change during pregnancy.
  • Flat or inverted nipples, large breasts
  • When you have PCOS, thyroid disorders or other autoimmune disease.
  • If you had a short luteal phase (8-10 days or less), excess spotting before or after menstrual periods. This is a sign of low progesterone.
These are all things that may be a risk factor, but may turn out just fine. You may want to discuss the issues with your chosen care person, but waiting and seeing is a good course of action. You should have an evaluation between 2-3 days postpartum to assess breast changes as well as a potentially earlier evaluation of infant sucking ability. This is in addition to the more standard 5 day weight check
What are you looking for? Breast changes, such as visible veining, becoming warm, itchy, heavy, swollen or engorged.
Active help which with you can discuss issues prior to the birth:
  • Any kind of breast surgery
  • Previous breastfeeding issues
  • Diabetic, gestational or otherwise
  • Other mother medical issues, or expected baby medical issues
Where should you get help?
This is highly variable. You need to find out, before you need it, what type of help is available to you and when. Will your hospital or birth place have a lactation consultant available to you? How is your local LLL group? Do they have resources for you? Are there breastfeeding support groups in your area? Make a list of private lactation consultants and call them to check their fees and help availability. If you want to rule out milk transfer issues I recommend finding a pediatric dentist or laser dentist in your area. Even an oral surgeon. Call them and ask about tongue ties, diagnosis, treatment and consultation. Focus on how you can access the services.
When you have problems:
This is where your handy list and pre-emptive work will be useful. When you do encounter issues, pain, excess weight loss and so on, you have a list of contacts. It’s much easier to put together that list before you need it than scramble around trying to find places to get help in the middle of your problem. Or with a newborn at all. And if you don’t need it, all the better.

What is an appropriate level of care?

The main issue seems to be not enough care, or flat out bad advice, but I’ve seen stories of women being overwhelmed by the care they receive. Though they may not realize it at the time, or even later, to me –an outside observer it seems like there was a hint of a problem and their help became overenthusiastic in presenting solutions. Told to do this, pump with that, strap this on, and it leaves them so overwhelmed they stop. It’s quite rare to see someone saying they felt they got just the right amount of care and support. I read one woman’s story where her lack of engorgement when her milk came in caused her care providers to overreact and start her supplementing. Her baby never lost weight or anything, but that one worrying symptom was focused on and it caused her a world of problems getting fully back to breast.

For some an early aggressive approach may be appropriate. Some women do have the drive to do anything and everything and come out feeling relief at being helped, no matter the eventual outcome. Some do not. And there is nothing wrong with that. Quite the opposite. It’s really quite unfair to expect someone having gone through a major life change to be able to tackle such a large and unexpected problem- often with very little warning or emotional support. I think however, that the issue is presentation. Knowing why you are doing things, not just following medical orders. Knowing what your day will look like and how long you can be expected to work before you see results, as well as what those results are going to look like.

On the more common flip side you have a lack of access to care.  Just that lactation professionals can be difficult to see in the first place, let alone finding another one for a second opinion. People often take what they can get, if they can ‘get’ at all. It’s not like when you have a family doctor with a poor bedside manner. When that happens you start looking for another one. With a lactation specialist you start out paying high private rates,  dealing with referral wait times,  or have limited access.

I think the idea of presentation and informed choice is very important. If you present a woman with: ‘pump 8 or more times per day’ she doesn’t know what or why or how. If you present a woman with: ‘pump 8 or more times per day. Just for the next few days, ok? It’s important to remove milk to stimulate the production of more. Let me show you some techniques for effective removal. Keep a log, and after a few days your supply should be increasing. I’ll check back with you in a few days and see how it’s going. Then if it’s not working or you are having other difficulties we’ll try something else if you want, ok?’ it all seems much more manageable.

Here is what I think an appropriate level of care should look like:

  • Is there an issue or not?
  • Discussion of the issue with examination of causes
  • Discussion of options as well as potential solutions
  • If solutions are preferred then outlines of duration, technique and expected outcome of chosen solution.
  • If solution works, tips on maintenance. If solution does not work, repeat discussion of options and potential solutions.
  • Repeat as necessary, combined with a discussion of the diagnosis.

The goal should be have the woman come away understanding the choices that were made as well as being an active participant in them. Because she’s a person too, not just a malfunctioning baby feeding device.

Wouldn’t that be nice?

The Big Fat Combofeeding FAQ

I see a lot of people combination feeding (combining both formula and breast milk in various ways) either out of necessity or desire. Many professionals either disregard the impact this practice can have on one’s supply of breast milk, or believe that combination feeding is unworkable. Many people who start combination feeding without proper knowledge may find themselves stopping breastfeeding prematurely. I had a lot of questions when I started so here are the questions I see asked most often and some answers.

Why combination feed?

  • Work

Perhaps you have a job where pumping is not an option, either due to social considerations, the nature of the work, or simply that you are unable to pump  enough to feed your baby while you are apart.

  • Supply

If you suffer from a low supply or milk transfer issues you may wish to breastfeed but be unable to do so exclusively.

  • Preference

You may prefer to have a family member do one or more feeds per day via a bottle.

Is combination feeding hard?

Yes it can be. Depending on when and how you start, as well as your personal biology and situation, it can also be a good alternative to stopping breastfeeding completely.

How do I do it?

  • Frequency

How often does my baby need formula? This is something that will depend on your circumstances and why you are combination feeding. If you are doing it for work or other separation from baby then you should feed your baby as normal when you are together and have a caretaker feed them as much as they would like during the day. If you are combination feeding due to low supply then you need to figure out how much milk your baby can get from you and offer the balance. There are calculations for this, but I did it by breastfeeding first and allowing my daughter to take as much as she wanted via at breast supplementer.

  • Amount
Breastfed babies often take smaller volumes than fully formula fed babies. The average breastfed stomach volume is 2.5oz to 6oz. Don’t worry if your combination fed baby is not taking a full 5-9oz. This is normal. The entire time my daughter was combination fed her usual volume intake per session was 3.5oz, or around 100ml.
  • Supply

How do I keep my supply? The best way I’ve found to do this is to have rules about combination feeding. You need rules because you are beating back biology. Producing breast milk is a resource heavy process. This is why it burns 20+ calories per ounce/30ml. So your body would naturally prefer to not burn those calories and store them for later. You need to challenge your supply to some extent. A one off break in routine (you are ill and need sleep so you do not breastfeed the baby at the normal time) will not ruin your method, but a consistent pattern of breaking your rules will erode your supply (I’m too busy/tired etc to maintain my rules). This is especially important early on (before 3-6 weeks) before your supply stabilizes. My maxim for this is formula feed on a schedule and breastfeed on demand.

  • Method

How you combination feed will depend on a few factors. Why you are combination feeding, the age of the child when you start, and your schedule.

If you are combination feeding for low supply or milk transfer issues and your child is not very old I highly recommend trying an at breast supplementer.

If your child is older (6 weeks +) and you have supply issues and the latch is fine then you may have better success with a bottle. Of the people I know who have combination fed long term using bottles they started after 6 weeks. If using a bottle I recommend using teat that most replicates your personal let down. Many people find a slow flow teat to do the trick, but if you have a fast let down (not usual in low supply), you may find a slightly faster teat works better for you. I don’t know if any of the specialty teats marketed as breastflow or otherwise will help with nipple confusion. We used a newborn flow (single hole) Avent teat for home and daycare until 12 months.

If you are combination feeding due to work or other separation from baby or preference you may find bottles or cups more appropriate for your situation.

  • What’s the best formula for combination feeding?

Short answer-there isn’t one.

Long answer-The WHO (World Health Organization) mandates that all commercially available baby formulas have similar ingredient lists. Not to say they are all the same. There are variations. The best way to see which is right for you is to give your child 2 weeks on it. If after 2 weeks (or you are experiencing some other major issue) it is not working, feel free to try another brand. I know that’s not very helpful. Sorry. Some formulas have more protein, some have more iron. What you do want, especially if your baby is under 6 months old,  is a whey based formula. The casein based formulas are not suitable for younger babies. Things like hungry baby milk have a higher proportion of casein than whey as it’s more difficult to digest. Here are some articles on that: Gut floraChoosing a formula #1, Choosing a formula #2

  • Is there some kind of magical breast milk formula balance?
No there isn’t. Any amount you can give will be beneficial. Formula doesn’t do any ‘cancelling out’ of the benefits of continuing to receive breastmilk. You may be interested in reading about the benefits of combination feeding.

Personal considerations Your biology

A sensitivity of a woman’s supply is highly variable. Some women can miss a pumping session or feed and find their supply tanking almost immediately. Others stop breastfeeding completely and still leak milk weeks down the line. You’ll need to determine through observation where on that continuum you lie. Generally though, you will not see significant changes in under 3 days. That means, that after your supply is established it will take 3 days of dropping a feed for your body to get the hint and slow down production. This also means that it can take 3 days to see an increase. This is not necessarily applicable during the early stages. Before 3-6 weeks milk supplies are much more variable. Small things like pumping in addition to feeding can cause your supply to increase, and skipping feeds early on can cause your supply to dry up very quickly. Engorgement will also slow down your milk production. The fuller your breasts are the slower you produce milk. A consistent pattern of engorgement will decrease your supply during that time frame. You will need to tailor your combination feeding plan to work with your body.

Poop- what is normal?

Considering one of the main ways we communicate with our babies is observing poop this is a pretty important consideration.

There seem to be fair number of resources on what normal breastfed poop is like and what normal formula fed poop is like, but what about a baby receiving both?

  • Appearance:

This is very dependent on what your formula looks like (as poop) and how much your baby has.

For example, my baby was on three different formulas. Formula #1, which my baby was on from 2 weeks to 2-3 months was a probiotic formula. This formula started off coming out as yellow, but eventually progressed to coming out green. The consistency started off as loose and semi-solid and progressed to being more like modeling clay. The second formula was used in various emergency situations and not regularly. The color was yellow, the consistency semi firm, similar to paste. The Third formula was used from 2-3 months until no longer needed. The color was yellow and the consistency was like mashed potatoes.

  • Frequency:

A breastfed baby, after several weeks of age, may poop as infrequently as once every 10+ days. A formula fed baby may need treatment for constipation if poop is less frequent than every three days. A combination fed baby may fall somewhere in the middle. I found mine would go daily, or more, at first but by several months of age had progressed to every 3-5 days. No one could answer my questions about how frequently my baby should be pooping so we were treating her for constipation with diluted fruit juices and sugar water. After pushing a bit more some of my health care professionals decided that since she was not in pain during the bowel movements, the consistency was not hard or pellet like that the 3-5+ days was fine.

So I’ll pass that on. As long as the consistency is not hard or pelletlike, the child is not in pain from pooping and is not unduly uncomfortable from not pooping then it is not a major concern. This is also dependent, in my opinion, on how much formula your child is receiving on a daily basis. The less formula, the longer you may wait between bowel movements, more then less. My child was receiving 300-400ml (12-14oz) of formula daily, so about 1/2 her expected intake.

Update: In response to a some search engine hits I get I’ll expand on this to cover the other end of the spectrum. Breastfed babies, instead of not pooing, can also poo upwards of 10 times a day. And this is normal as well. If your combination fed baby is pooing frequently there is unlikely to be any cause for concern. Normal breastfed baby poo is fairly liquidy, seedy and yellowish.  What is not normal even for the combination fed infant is dark poo (after the meconium has all passed), ongoing greenish poo that may be frothy, excessive mucus (again, this may be expected around teething), and of course blood. Green poo is  ok for a few days as it can be a sign of illness, and is also normal after vaccinations and if you are giving a probiotic formula. The other ones may merit a doctor visit.

Important things to consider

  • The importance of establishing your supply.

The first 2-3 weeks are important for your development of prolactin receptors. It’s very important to feed on demand during these times so that you will have an adequate supply later on. After 2-4 months your supply stabilizes, your breasts soften and milk production becomes less hormonally controlled and instead based on what is removed. The amount of prolactin receptors you created early on can help you maintain your supply long term.

  • Breast milk is use it or lose it

As mentioned earlier breast milk is a system with high production costs. If your baby isn’t using it (emptying the breast) your body will make less. Your body is lazy and wants to do as little work as possible.

  • Your baby is a person too and may not cooperate with best laid plans!

Your baby may decide they don’t care for the at breast supplementer, or like the bottle, or don’t like the bottle or any number of other things. Or you know, maybe they just aren’t that into breastfeeding as they get older. Early on when we were using bottles and breast my child went through some breast refusal which is what prompted me to swap to an at breast supplementer. Then when she went to daycare at 4 month she had to be retrained to take bottles. Now at 14+ months she will not take a bottle from me.

  • How your baby can help

Consider this if you find yourself losing your supply: if your baby increased your supply once they can do it again. Sure it means clusterfeeding, but it can come back up.

Managing being away from baby

  • Pump or no pump?

To pump or not to pump will depend on several factors. How touchy your supply is should be one of them. However, you may be combination feeding because you cannot or do not want to pump during the time you are away. While dealing with low supply I pumped at least n or n-1, where n is the number of feeds my baby would have had, times during the day when I was apart from my baby. I managed between 30-50ml per session from both breasts combined. I was away from my baby from 8am until 5pm+. From 4-6 months I pumped 3x per day (10am, 12pm, 2pm), from 6-8 months I pumped 2x per day(10am, 2pm) and from 9-11 months I pumped 1x per day (12pm). At 11 months I stopped pumping during the day and fed from the breast when at home. During this period my first day home was full of frequent feedings as my daughter increased my supply again.

If you are unable to pump you may find some benefit in hand expressing during bathroom breaks. This will continue to stimulate your milk production and help prevent blocked ducts and mastitis.

  • The 5 day work week

I had a part time job so I only had a 3 day work week. For those with a 5 day work week (or longer) you will find that by midweek your supplies are decreasing. If you are pumping add an extra session later in the week. You will also want to encourage you baby to eat from the breast as much as possible at the weekend, or on other not work days to maintain your supply. It may go without saying, but I’ll say it anyhow, but the longer you can give your baby time to establish breastfeeding the easier it will be to maintain when back at work, whether pumping or not.

Nipple confusion and flow preference

Nipple confusion is thought to be most prevalent the younger the baby is.  From reading I’ve done it has a few other factors as well including how good the latch is (if bottle milk is vastly easier than breast milk for the infant to obtain then bottle milk will be preferred) as well as the milk flow from the teat. I’ve mentioned it previously, but many people find a slower flow teat helps preserve the breastfeeding relationship. I find that whatever is closest to your let down (slow or fast) will keep the confusion to a minimum. The times when you are most likely to see issues with swapping between breast and bottle are any of the growth spurts (10 days, 3 weeks, 6 weeks, 12 weeks, 4 months, etc), although the 6 week one is the worst. The other one where people doing breast and bottle are likely to hit issues is around 4-5 months. This is an incredibly fussy time with teething, sleep regression and similar and if breastfeeding is not well established as both a comfort and food activity then babies may not be willing to expend the effort to continue. This outlines some details on nipple confusion and how to prevent it.

  • Momma vs not-the-momma

Babies will form different rules for different people. They may expect only breastfeeding from their mothers, and refuse a bottle, but happily take a bottle from another family member or caretaker. I found that preserving our breastfeeding relationship depended early on on how my baby knew to get food from me. Because I had to start so early I had to be very strict with what rules we followed so that we could continue breastfeeding. After we started using the at breast supplementer I did not give my baby bottles. She had bottles from dad and bottles at daycare but mom=boob. If you do want them to take bottles from the breastfeeder I recommend waiting until after 6-8 weeks to introduce them, and certainly by 8-9 months.

What’s the deal with growth spurts? 

This is a new subsection in response again to search engine hits. So what do you do with a combination fed baby having a growth spurt? Be aware that typical growth spurt ages are 7-10 days, 3 weeks, 6 weeks, 3 months, 4 months, 6 months, 9 months and 12 months. This is on average. You may miss or not notice one, or have an extra one (we had an additional one at 9-10 weeks).  During this time babies are unsettled and may want to eat frequently either for comfort or out of hunger. I found during these times that it wasn’t strictly necessary to increase the amount of formula, but it was necessary to give smaller more frequent feedings. As our typical supplementation pattern was 7am, 12pm, 4pm, 7pm, (with breastfeeding sessions at those times and also at 10am, 2pm and several times overnight), during growth spurts breastfeeding became more constant between 9am and 11 am, and also between 1pm and 3pm. At times I split the 12 pm supplementation into two sessions, with smaller amounts at 11am and 1pm.  Do be aware that this is temporary and your baby will be fussy.  Try to stick to your schedule and plan and get through it. Growth spurts and teething are times when your combination fed baby will be more likely to refuse the breast.

Other tips:

If you can, avoid mixing expressed breast and formula milks. Why? Because if your baby doesn’t drink all the breast milk you can re-refrigerate it and reuse it at the next feed and you can’t do the same with mixed or straight formula milk.