Tanya:

A couple of weeks ago. On the first episode of season three, we talked to Kristen Ross about how she approached exclusive pumping for her twins. So in a similar vein, I wanna share a conversation with another client who combo fed her baby and what was at the root of her decision making around this, where she started and where she landed also in. Also, interestingly enough, she too is a new member of the birth world. Having recently sat her exam to become a certified lactation counselor. I think you will hear right away as I did that. She wasn't talking to me in the voice of a new mom. She was wearing her professional hat already. So it's clear that she's about to become a huge asset to her community. I'm so excited to have her today. Oh, and a gentle reminder that nothing we discuss on this show should ever be considered medical advice. Please speak to your local provider about anything that comes up in this show that resonates with you and your needs and your healthcare. Andrea, thank you so much for joining me today.

Andrea:

Hi. Yeah. I'm so glad to be chatting.

Tanya:

I know it's been a long time since I've seen your face, but not that long, because you called me to have a chat, which I'm sure we'll talk about a little bit later on. So at least I got to see your face one time since you finished the program. So do me a favor. Let's start by having you tell our listeners a little bit about yourself, whatever it is that you feel comfortable sharing as an introduction, and then we'll, we'll take it from there.

Andrea:

Yeah. So my name's Andrea, I actually live in Indianapolis. I'm in gorgeous Colorado right now. Visiting family, but my husband and I during COVID found out we were pregnant and then also found out that the house we just bought had to be completely demolished. So we, you know, knew we needed some help postpartum. I remember looking for kind of like COVID resources like baby was coming and we weren't really sure what boundaries we needed to set with family or like what we were comfortable with related to COVID. And that's kind of how I stumbled upon upon youth. And immediately was like, yes, you know, I know my own mental health and I just wanna set us up for success after a really, really wild year in pregnancy. You know, one of those times where you're like, this is a hallmark, this is a hallmark year and that's before we had the baby so we have my son Sullivan in February of 2021.

So he is almost a year and a half. I think he's almost, I always have to look at the date now. It's so funny. Like before a year I could tell you exactly how old he is and now I'm like, oh, he is like a year and a half almost when I look at the date. And yeah, it's been so many things from the first few months that we have just applied over and over and over again because babies change so fast and you're constantly kind of relying on those skills. So that's why I'm like super excited to talk about everything I learned from working with you.

Tanya:

Yeah. Well that is why one of the things that I share with people and I've probably said so many times on this podcast is I just, I really encourage people to stick with a spirit of experimentation. And I remind people to think in two week intervals because everything changes so fast that the second your brain says, oh my God, this is forever. This is the rest of my life. You can't cope. But if you think sometime in the next two weeks, the situation is very likely to evolve into something else. It could be better. It could be worse. Right. We don't know. So I tend to ask people like, is this sustainable? What we just put into place for the next two weeks? Right. That's kind of my motto these days. And I don't know if it was that clear at the time we were working with each other.

I've gotten more and more clarity. The more people that I do this with. Okay. So I actually want you to tell us, well, let me back up and say, yeah, you were eager from my understanding of this to share your story with our listeners. I believe that you reached out to me and said, Hey, if you ever wanna talk about combo feeding, I wanna do it. Yep. And with that said, I would love it if you would tell me and our listeners why you were so eager to share your story, because I think it'll help frame the conversation and also keep me with my COVID brain on track for the goals of this conversation. Yes.

Andrea:

Yeah. So I am super passionate about combo feeding, partly because I think in our early postpartum, you know, you're just like so fresh and like nervous and scared. You're just overwhelmed as a new parent and combo feeding really became this way where I got to like choose what we were gonna do, like how we are gonna feed our baby, what our lifestyle was gonna look like, you know, day to day, how you feed your baby really does impact. Like how do I leave the house? How do I travel? You know, what do our nights look like? And so I'm, I love sharing the story. My, my son had quite an interesting feeding journey early on. It took about, he was his four month appointment where he was on a growth curve and combo feeding really was that key to, I don'unno relieving our anxiety and just helping him thrive and, you know, get back on the weight gain that he needed to be on. And it happened in a way that also felt like we could impact that, you know, before it felt like so overwhelming and combo feeding was this key that as he, you know, grew and reached a year, we still were able to two week intervals or, you know, maybe more like a month really manage just yeah. What our life looked like and, and how he was able to progress.

Tanya:

I have my memory from my perspective. And I also think of your story in two segments and we'll kind of get to that later. Yeah. I think about this in terms of the early days, weeks, maybe even months loosely where you didn't have a full understanding of what was causing some of the issues yeah. That Sully was having. And then there's the time period after. And once you understand your confidence grows, and part of the reason I think this discussion is so important, I think it's important from where you sit to talk to people about how combo feeding can work for people and why it can work for people from where I sit. I see it as part of our job is transparency is really being open with families about what we see going on involving as many helpers as we can. Yeah. And helping people get that clear picture because you growing in confidence with the situation was one of the most empowering things for me to see.

Andrea:

Yeah. Well, and I think that is also, I mean, we, it felt like it was such a great partnership because something, my husband and I talked about while we were pregnant, just we just wanna be present as parents. Like it is so hard when you're overwhelmed. Like you just feel like you are going day to day. Sometimes you're not actually present and there. And yeah, I completely agree. I think we reached this transition where I could look back and be like, wow, we had a lot of support. We had a team. And so it all, all kind of started looking back at my lactation care in the hospital. I won't, I won't go too far into this, but I was not a fan looking back now. I didn't know it at the time, but my lactation support in the hospital was pretty poor.

No one ever fully observed a feeding. I realized no one sat with us and watched a full feeding, which is kind of a red flag for me. For lactation support. That's huge. But baby had some jaundice. Sully had some jaundice when we came home after going to the pediatrician and we supplemented with formula, got his weight back up. He was not back to birth weight yet, but my supply was in and I was able to pump, I think I was like pumping quite a lot actually. I mean, I remember being maybe like a month and a half, two months in and I was pumping like five ounces per side in the middle of the night. So my supply was definitely, definitely an, oh, I should also add, I had a breast reduction like five or six years before having Sully. And so I think that really with my lactation support in the hospital, that was their overarching concern was that I had had surgery. And so we weren't, and I knew this going in, like I was totally fine with not being able to breastfeed at all. You just don't know where that anatomy is at. What's recovered, what hasn't possibly after surgery. But that really, I think in the first month clouded the lactation support I received at the hospital and maybe my pediatrician a bit as well because they expected a delay or a low supply.

Tanya:

And then I think for me though, well, I'm, I'm remembering this as you say it, I was so thrilled at your milk supply. Yeah. That I remember thinking like, well this is odd. We're having this problem. And we thought we overcame the most obvious issue and yet that didn't end up being it.

Andrea:

Yeah. And so, Sully's weight loss at the beginning was, is like pretty typical, like not uncommon. He was, we saw the pediatrician on day. It was like four or he was born in the afternoon. So I'm always like, was it day four or five of life. And he was down 10%. So the rule of thumb is normally around 7% that you start supplementing, but 10%, it wasn't anything absolutely crazy. You know, like he had clearly been getting food and whatnot. So we knew there was something there and we just thought it was a bit delayed. We supplemented over the weekend and his weight gain, he was going up at an increment that he should be gaining. It was then from, it was like the weeks, two, three and four. It was his one month appointment that things had started going downhill. And at his one month appointment, I believe he was 12% lost still. So he was actually smaller at his one month appointment than he was on day, like four of life.

Tanya:

And that must have been terrifying.

Andrea:

Yeah. It's like, you don't really know why. And I will also add, I am horrible with numbers. I've like math dyslexia. Like it means numbers don't mean anything to me. And so I remember at first being like, why is the nurse like so quiet. She went from being, you know, like happy and bubbly to like, like I couldn't do the, the math that this was a, a huge loss and I didn't remember what he was before. So so yeah, so it was kind of a shock and we were like, well, what's going on, because I'm feeding this baby all the time, which is now I know is a super common if you're having some weight loss issues, oftentimes these babies are feeding constantly and they're very sleepy. So I was feeding him like 12 to 14 times a day, but they were really long feedings, which is the main thing that I think was a red flag.

Tanya:

Well, another thing that might be a confounder here, because again, I'm assuming, I can't remember every moment of our interactions that we were talking about babies peas and poops occasionally. Yeah. And I'm sure your pediatrician was too. Yeah. And so you had a baby that was meeting our general criteria while still losing weight.

Andrea:

He was. Yes. And it's so interesting too. So I, I haven't mentioned this yet, but I just finished the center for healthy children's breastfeeding lactation course for certified lactation consultants. And they mention a suggestion. I don't think there's been research yet about in the first month of life, not relying on wet diapers. So I was induced and he came out this like super chunky, well hydrated baby. I mean, looking back at his newborn photos, he was full of fluid. And so I, I now wonder I'm like, well, was he still just, you know, were the, a lot of those diapers still just fluid from induction and from pregnancy and labor and everything as well. because he was, he came out chunky. I mean he came out full of big cheeks that he then lost.

Tanya:

So it's funny that you mentioned that as you were starting your story, I didn't wanna interrupt you. So I wrote it down that I wanted to circle back to this, but when you talked about 7% versus 10% weight loss, I wanted to, I think you probably know this. It sounds like exactly what you're saying, but for our listeners, I want to share this piece of information that I think everyone needs to know, but it doesn't account for what, what you found at the month visit. That's just too far out for that's true. That's yeah. Babies that are born. And since most babies in the United States are born in hospitals and most people who have babies and hospitals have IV fluids. Yep. Some wonderful person I'll have to go pull the study and put it in the show notes, did a great study showing that people that get a certain amount of IV fluids will ultimately increase their baby's weight, but only the fluid compartment, which makes perfect sense.

So then they're gonna pee off more and that's why sometimes we use 10% as a marker instead of 7%, because we need to create some wiggle room here for why a baby might lose more and still be normal with that said your trajectory right. Had this really slow path towards, like you said, four weeks, you're looking at 12% weight loss and you're like, what's going on here? Right. So that's where the real homework starts for you in terms of the detective work that you had to do to get to the bottom of this.

Andrea:

Yeah. And it, I would say too, it's also, it was also hard because we got one weight in the hospital. So we also didn't have a lot of data. Like I've heard about people getting 24 hour weights or discharge weights because we were there over 48 hours in the hospital. We just got like nothing. And then we found out his Billy Ruben was super high. So we knew he wasn't eating enough as well. And and looking back like, oh I wish I knew to ask for that. You know, you don't, you don't know and you can't go backwards, but we just, yeah, we didn't have a lot to work with. We had like his birth weight, you know, his first pediatrician appointment one month. And from there we saw a lactation consultant in person. And I think that was like the real key because we knew something wasn't lining up.

And I remember talking with you, Tanya, that probably that day, that afternoon after his pediatrician appointment. And you're like, there has, you know, there has to be another piece that we're missing because we know your milk supply is there. And I was nursing constantly, which kept it there. Thankfully, you know, I had that ability. Yeah. Or that my body had that ability to, despite my surgery that nursing him constantly kept it there. But that he wasn't able to receive it. So I found a lactation consultant before giving birth. And I think also that was huge because you can do a lot over virtual, but when you, you know, have something like this, you need to quickly have someone you can call that, you know, you know, as reliable. And so I had found through someone in our pediatrician's office wonderful lactation consultants to the indie area, with their IB CLCs, with lots of experience, extensive like additional trainings.

And so we were able to see it was Monica. I think we saw her within like two days, which I remember feeling like forever, you know, like when your baby has something that's, you're like, I don't know what's going on. I'm feeding them like 14 times a day. That two days felt like a lifetime. But she was able to come in and assess physically what was going on with Sully. And I remember her doing a breast crawl. That was like the first thing we did, she showed up and he's like screaming and she's like, hold on. You're like, don't feed him yet. We need to get a weight. You're just like, hold on one second, because again, constantly feeding this child. And she put him on my stomach to see was he even, you know, able to move up towards my chest or show interest in feeding because he was just scream. You know, he was just screaming like there weren't really any feeding cues. I would say when you have a baby who's really sleepy. I mean you're constantly feeding them, but really you're feeding them by the clock. You're not feeding them by cues.

Tanya:

Right, and you're dealing with...

Andrea:

Setting a timer

Tanya:

Yes. And you're dealing with a baby who's conserving energy, right? Yes,

Andrea:

Yes. Yeah. Yeah. It's really hard. You know, even slightly under fed babies can be extra sleepy. I mean, newborns are sleepy, but then underfed babies, it just really, really, really makes it hard for them to stay awake for a full feeding. Even if you get those early feeding cues, you know, rooting. And I'll also say like I, I had this baby on my chest, like all the time, you know, I was just, it was winter. I was like topless at home with a baby on my chest all the time, trying to look for these feeding cues. And, and yeah, he was very tired. And so we fed based on the clock once we know his weight loss was going to be a major issue and so constantly setting alarms and that, I mean we set alarms, I set alarms until he was like five months because it became a pattern and like a way of like, this is how we have to feed him for quite a while. We'd set alarms. And I remember too, when the lactation consultant came in person, she said, you really like, you can't trust that baby. I remember she left. She's like, he's kind of lying to you because he's just so tired that he can't show you correct cues. And that was also correct fullness cues. I remember because you know, he was so tired. He just kind of collapse.

Tanya:

He would fatigue during a feeding for the wrong reasons.

Andrea:

Yes. Yeah, exactly. And I'd say there's probably without a weighted feed. I don't really know how you would've been able to tell, you know, unless you're checking his weight before and after to see how much he was consuming because he, I mean, he was just like that tired and culturally we think, oh, sleepy babies are good babies. And that's what every new parent wants. We were, you know, doing fine. Like we weren't like, oh my gosh, what is this screaming child? We brought home like most of the time that was absolutely not the case. So the fact that she was able to come in and say, you know, you're doing everything right. You're just getting, you know, you're not getting the cues on when to feed him because he's not able to give them to you. Let's set an alarm let's, you know, track more.

We did, I did a few more weighted feeds after she had left when we got a scale which really helped give us some peace of mind just because otherwise it felt like I don't know what I'm doing for a little bit. But the other big thing that we learned when our lactation consultant came was that Sully had a really restricted mouth. And so because I had a breast reduction, I have like pretty limited sensitivity. And you know, if you've never breastfed a baby, like you don't know what it's going to feel like completely different stimulation than anything else. And so I didn't ever have any nipple pain. I didn't have any nipple bruising cracking, bleeding, nothing. And I couldn't feel very much. But he wasn't able to remove milk appropriately because his mouth was so restricted. So the combination of my reduction and then also his kind of oral impairment was just this like perfect little storm. And if our lactation consultant wasn't, you know, extra trained to come in and look at his mouth and say, this baby has like no suck reflex. I, I could not tell that he was not sucking enough to remove milk.

Tanya:

So you're using some language that I think our listeners might need expanded upon because you're not saying the words, tongue tie, but you're saying restricted. Yeah. So I want you to elaborate on what you learned about Sally's mouth and what that really means. Yeah.

Andrea:

Yeah. So I say I, I try not to use the word tongue tight only because I think that is not descriptive enough to describe everything I learned. Like you mentioned if you had looked at his mouth, you'd say, yes, it's tight. His tongue is really tight on the bottom of his mouth and his upper lip could not flange at all. because it was restricted. But I say he had oral restriction because he could not move his tongue appropriately. So he couldn't he had a number of reflexes that would not, you know, fire or whatnot to feed. And so we learned this later when working in feeding therapy, I use "oral restriction" because I think it describes more of what was actually happening. He was not able to move his mouth to remove milk. It had nothing to do with what his mouth looked like, which is often what you hear with tongue tie.

People look in a baby's mouth and say, oh yeah, it's tied based on a visual. We later learned even after he had a revision from working with a speech language pathologist, he had so many other reflex issues in his mouth. So babies really early on like Preemie babies feed off of reflexes primarily. It's not, I mean it's a learned skill, but it's kind of how you can dream feed up until, you know, maybe they're four months and all of a sudden dream feeding is like no longer a thing. He was never able to do that because he didn't have the space in his mouth for his tongue to remove milk. And he also didn't have the reflexes to have enough suck or have enough mobility to feed essentially, because he also couldn't use a bottle. I haven't mentioned that yet, but he could not use a bottle either. He would just dribble out the sides of his mouth because he had no suck. He couldn't form a seal at all, even on a bottle nipple, a variety of bottle nipples. So it was, it was much more than saying, oh he had a tongue tie, we sniffed it and it was fine. Like it was an actual retraining of his mouth that needed to happen through, through another professional that we ended up seeing.

Tanya:

So I will link our listeners to a previous episode from season one, it's actually two episodes. There's a client who had a baby that had multiple revisions and it didn't solve the problem. We followed that episode with one of my favorite lactation consultants who is a tongue tie expert. She actually calls herself the tongue tie expert on Instagram and she unpacked that for us a bit in a following episode. So I think that that is information that if this is interesting to you, as you're listening to Andrea, you may wanna go back and check out those episodes. I'm also going to pause and tell our listeners something I wasn't going to get to till the end. But Andrea, you are sounding so knowledgeable and professional that I would be remiss if I didn't point out now. And we can go back to your story here in a minute. That you are making some like professional shifts in your life that involve lactation because of your experience. And I have to say it is so clear to me how much knowledge you have already gained. You're speaking like a professional and not like a mom.

Andrea:

Oh yeah. Thank you.

Tanya:

So let's pause there and talk about how that came to be. And then I actually have some more specific questions about your baby and your situation. So we can kind of look at the trajectory of how this has played out, but tell us a little bit about how you decided that you wanted to make this professional shift and where you're at in the process.

Andrea:

Yeah. So I really felt drawn to getting a, you know, a certification. So I'm starting, I sat for my certified lactation consultant certification like two weeks ago. So I have a few more weeks before I'll get the results back, but I really have this passion for working with combo feeding families. Because you know, Sully's journey, it was a four month feeding journey. It was long, you know, it was so long and I, you know, didn't really interact with the world. But then I made a lot of new mom, friends who had their own breastfeeding journeys and some of them weren't going great. And they felt like they had to give up on breastfeeding. You know, they felt like they were failing. And I was like, oh, I was just there. And we were like in the thick of it and you absolutely don't have to do that.

I mean, I did not tell them this because we were friends at the time, you know, new friends at the time. But like looking back, I was like, they did not have to give up because pumping wasn't working at work, you know, they didn't have to give up because they were having a surgery coming up and they felt like, you know, breastfeeding was still right for their family, which is exactly how I felt. You know, I was like breastfeeding just because my child is an inefficient feeder and it's taking him four months to be able to efficiently breastfeed and bottle feeding for a while that wasn't going great either. You know, it didn't feel like that was a solution. There's just so much more nuance and having the, the chance to say this is what works for my family. That was so much more valuable than anything else to say.

You know, breastfeeding works for my family. It really does. Like it takes a long time and my child is, you know, having to learn a lot of new skills to feed, but it works for my family. You know, formula also works for my family because my child needs more nutrition and triple feeding was burning me out. So I needed to have another source of nutrition for him. And so that, that power was, I mean, that's just like indispensable. That was that's the like ability to have perspective as a parent that my husband and I always wanted to have.

Tanya:

Yeah. Wow. That's quite the answer. And I feel like it hasn't been that long since we had this conversation about what direction you were gonna go, but you have plowed through the work and gotten it done quickly.

Andrea:

Yeah. Well I did, thankfully had a good time.

Tanya:

That's amazing. I'm so impressed. Like I didn't know we were gonna talk today and you were going to have already sat your exam. I mean, yeah. I really had no idea that it was coming that fast. So I was planning to like wrap up on the note of like, you want to make this professional shift and meanwhile you are like in it girl, I'm so proud of you.

Andrea:

Well, I learned so much through... I mean I was a, history major in college, so I read a lot. I do a lot of research. That's just kind of how my brain works. Even if it's not numbers, like research is my thing. And so we had used all of our insurance, you know, free lactation consultings on the bulk of the work that Sully needed to do the bulk of what we needed the absolute professionals for. But combo feeding took so many twists and turns and I was scared that I was accidentally weaning. You know, like how many times I told my husband, that's it, we're done. You know, we're not breastfeeding anymore, whatever. And that wasn't the case. And you know, I went to, to read more about how, how breastfeeding works and just what options I have and how formula works. And that, that again, that's why I think combo theme can be so empowering because there's so many varieties and ways it can look for every family that I went. I went to the books and then, you know, it was easy to get through my lactation course. Thankfully I did, I must have read the right things because I did go quite a bit faster. Yeah.

Tanya:

Yeah. So I definitely want you to unpack the various ways combo feeding can look for people, but before we do that, I wanna finish your personal story. Yeah. And what I feel like we haven't really talked about yet and there may be other pieces that you want to add in and I might be jumping ahead, but we've talked a lot about the breastfeeding piece of it. But other than mentioning that he had trouble with bottles I'm not yet clear as you tell the story on how the, how, and when formula becomes part of the equation, I'm having memories from our conversations about multiple feeding methods that you tried, but these other feeding methods can be super exhausting. And I can't imagine that any of those remained the way you fed him throughout. So tell us a little bit more about the use of formula and all of that. Yeah.

Andrea:

Yep. So initially we did actually we didn't use formula. After speaking with our lactation consultant, she saw, you know, how hard it was for him to take a bottle and we fed him with a bottle like you would feed a prey. So we had to hold, it was so hard for me cause I have much smaller hands than my husband, but you would hold his cheeks on the side and you would support his chin to bottle feed him. And she said, you know, I like it just took so long and it was quite a setup. It was very awkward to, to get. Right. And so she had me using an SNS, I believe from the beginning because he was so much calmer at the breast. And so we had a, I used like the made clip on a supplemental nursing system as an SNS where I would pump after a feeding and fill up a bottle, clip it onto my shirt and then use, it's almost like a teeny tiny feeding tube into his mouth, which is also very difficult because his mouth did not function correctly.

So you had to line it up just right. You know, you couldn't, he didn't have a suck reflex. So you couldn't just put the tube in his mouth, you really had to line it up. Right. And he would get extra nutrition through that. And so that was how we triple fed for a while at first. So I would nurse him each side. I think we did 20 minutes a breastfeeding. I would use the SNS and then we'd do like 20 minutes of pumping or I would do a bottle of pumped milk afterwards. But that got really hard. Triple feeding. The one thing too. I wish I looking back and I remember being like, when is this gonna end? Like triple feeding just felt like never ending. So after his revision, he had his tongue released by a pediatric dentist who specializes it in our area, his tongue and his upper lip after that breastfeeding was going well. So we completely exclusively breastfed for about two weeks until his weight did not keep going up. It went up for a little bit and then it really started to I'd say plateau. I don't think it completely started dive bombing like it had before, but it really plateaued.

Tanya:

Right. But plateauing at that age is right. We expect babies to be growing rapidly up upwards of an ounce a day. Right. So that's a big deal.

Andrea:

Yeah. Yep. And so, so we're like, okay, got a call, the lactation consultant again, she came back and said, okay, there is a lot of inconsistency in how much he is transferring. So before it had been like half an ounce after his revision, it was like four ounces. And then a week later he was back to maybe half an ounce. It was so variable. And again, that's because later we learned, he just didn't have, he didn't have reflexes. He didn't have any like strength in his mouth to feed consistently 10 times a day. And so again, we were triple feeding and I think sometimes that's where I started using formula. It was maybe around like the third month where I had been triple feeding for on and off, you know, depending on where we're at in the story on and off for like three weeks.

And that was where I was like, okay, I don't think I can pump every single time after a feeding. And so we would use formula in the evening. You know, when my supply would've been naturally a bit lower, I could eat dinner, which was like key, because there's just no time to even like eat. I mean, I would like maybe shower for like, like a five minute shower. I remember taking like power shower. But using formula allowed me to like eat dinner or like just not have a baby on me 24 7. And so I added some formula in, but I wasn't combo feeding. I was just saying, I don't wanna pump this session. You know, I wasn't saying this is how we're choosing to feed our baby. It was, oh, I'm not pumping. So I have to use formula. And I was just like barely keeping up with how much supplementation he needed from pumping because it was, I mean pumping like eight, 10 times a day after every feeding was again, there's no time I left in the day.

And so that is where I, I think we stayed at that through talking with the, working with the feeding therapist, the, the SLP that we worked with for maybe like five weeks, I was still trying to triple pump or sorry, triple feed by pumping I'd even like rented a symphony pump, which I did love. It was fantastic. I felt so spoiled. But I, I was dedicated to try and make the pumping work. And finally I was like, there is not enough. There's just not enough energy. I mean, we were at like three and a half months now and I was just so burnt out. So I would like stay up till 11 and pump and do his exercises and his stretches and hang out and then wake up again at like two because we got one, four hour stretch. So like we fed him like a newborn up until four months because we are still setting the clock.

Like he still really couldn't be trusted yet. He wasn't efficient enough. And so that formula became just a, oh, I need a little break. It wasn't, this isn't working for me anymore. This isn't sustainable. We don't know when he's gonna be completely feeding efficiently. It felt more like I'm not doing everything I can be doing. It was, I don't know, not like a cop out, but it didn't feel like failure. It just felt like a, oh, I need a break kind of thing. I wasn't really recognizing that the triple feeding was so unsustainable for me at that point, having done it for like two months then, like I wasn't, I didn't have the perspective to say we need a long term solution. Yeah. And I think that's where our relationship kind of ended or our, you know, our plan our postpartum plan with Tanya ended was okay, what is the long term plan? Because I was just getting so burned out and that's where we said let's look at. Well, no, actually I did not say let's look at combo feeding. I remember sobbing on the phone to you and say, okay, we're gonna wean and you said, oh man, I totally forgot this. Yeah. I was convinced that we were just gonna completely wean and do formula that's right. And you said, you know, just go one feeding at a time. And that's how we ended up combo feeding. That's right. Oh wow.

Tanya:

Well the way I usually unpack this is let me preface this by saying it's not uncommon for many of my clients to have a moment or a few moments where they think they want to stop, but I've had so many people hit a sweet spot in a creative way that I encourage people never to we and cold Turkey.

Andrea:

Yeah. I mean, I was nursing so much. I don't think that would be advisable anyways.

Tanya:

Totally. But in the process of aiming for a slow wean, I have watched so many people end up giving their babies weeks and or months or even years more of breast milk than they ever imagined just by slowing their role. Like, I'm not telling you, you can't wean. I'm not telling you, you shouldn't wean. I'm just saying let's get rid of one feeding a day until you hit your sweet spot or whatever the case may be. It sounds like I unpacked it a bit differently for you based on your situation. But yeah. You know, the other thing that you've talked about that I'm sure listeners will have lots of unique feelings about, and I'm sure that you, with your training also have more perspectives than just your own, but you know, I've watched triple feeding and the SNS, the supplemental nursing system kind of be the death of people sometimes with breastfeeding, because something ends up pushing people over the edge.

If we don't unpack it right. And support them. Right. Right. So all of these things are fine and they're wonderful tools. I'm not suggesting we shouldn't use them of course, but they only really work in the short to medium term. They are not forever solutions. What is it that you have come to think? Is there some sort of a, I know that I'm being generic in saying this, but is there some sort of a generic plan that you kind of have devised in your mind as like, this is my average starting place of how to handle someone in this type of situation. And then of course we individualize from there.

Andrea:

Yeah. I think with triple feeding, there needs to be lots of follow up support. And that's because I don't think as a parent, I had the perspective to say this wasn't working for me. Like I was just truly trying to get through 10 feedings a day, triple feeding. Like I couldn't look past that. And so I think tons of follow up support because otherwise you're like, well, this is what our lactation consultant said to do. This is what we're doing like done. And two weeks go by and mentally as a parent, you're in a completely different place after two weeks of triple feeding than you were when you were shown this option. I think the other thing would be I'm really into like feeding goal setting. And that's because I think that was the key that came outta combo combo feeding for me was, you know, what are our goals for how we feed them?

Like in, in the sense of how is it working for our family? My husband and I laughed, but my, my husband cooked meals for like four months. Like I couldn't even, I mean, once we started combo feeding and the evening gave me so much more freedom, because he could feed the baby completely without me breastfeeding at all. You know, what does it look like for your family? And I think with triple feeding, if you don't have a partner who has a work schedule, that's convenient at the time my husband was working from home. So he could help me wash pump parts. You know, he could prep everything for me and make it work. But you know, is that long term what we want our family to look like, you know, is that our day to day. And so I think goal setting outside of just is the baby getting enough nutrition per day.

You know, that can't be your only goal because the, the feeding parents' mental health is so important, you know, their partner's mental health is also so important. My husband didn't like doing all of one thing and I didn't like doing all of another thing. That's not how our normal dynamic is in our relationship and our lifestyle. And so I think of looking back on triple feeding, I should have known, or I, I wish I had the perspective to say, you know, this isn't working for us as a whole long term, you know, past that like four or five weeks, it should have been what's, what's good for us as a family. And if that meant me not pumping that, you know, that's what we ultimately decided me not pumping that getting rid of that was key because it just the time constraint of washing everything and we had multiple pump parts, you know, but washing everything and keeping track of how much do we have for the next feeding. That was a strain that letting go of that, that was like the freedom to use formula that helped our family get back into balance.

Tanya:

I remember that actually, because it was interesting to me that you thought I'm ready to quit and wean. And then at the end of the day, the thing you got rid of was pumping and you continued to breastfeed. Yeah. So interesting.

Andrea:

I think I gave up counting ounces too. I think for a little bit there's there's that ounce with triple feeding because you're like, oh, I have to fill up the SNS or I have to fill up the bottle. Yeah. So there's also with pumping, let go of the ounce, the ounces. Yes. And that stress. Yeah.

Tanya:

That's a theme that's coming up a lot as we talk about breastfeeding on this podcast is there's a time and a place for data and early on in the early weeks, sometimes we need data, but we've gotta let it go around the time that I was taking care of you. I was also taking care of someone who happens to be a nurse. And I think she got, I think this was tied into a bigger picture of anxiety and other things, but she got pretty caught up in doing weighted feeds on her own at home. And it was like every feeding was a weighted feed. And that was crazy making. And it was a lot of, a lot. It took a lot of work on all of our parts to get her, to let that piece go in a way that she could still feel safe. And so it's this fine line between using data appropriately and then overusing it to the point where we're not necessarily creating anxiety. Cause I it's a chicken or the egg. Right, that can be very hard to unpack. Yeah. So I'm curious how your feeding plan evolved once you introduced solids. Like how did he do with solids? And how did that change things?

Andrea:

So we worked with an SLP an infant feeding specialist for a bit after he had already started gaining weight at a, at a consistent, you know, expectable rate. Because we were worried about solids and so she gave us lots of tips and we were very proactive. And introducing straw cups, he had a, I call it a, we call it his chewy tubes or chewy toys like a tea shaped toy that he would put, he could like put in the back of his mouth and practice moving his tongue from side to side. It gave him a chance to chew on things from a really early age and get more jaw strength. And so we, we tried for like, so that was around like four months to six months to continue with the feeding therapy at home. She had given us, you know, things to look for and exercises things to introduce sooner.

So that then at six months when he was ready to start solids that he had more draw strength. And he really, I mean, he had to build up quite a lot of muscle in his jaw and mobility in his tongue to be able to, to eat other foods. But from there, you know, we presented things like you would for pretty much any other baby. We exposed him to new foods. We got him involved in the kitchen. We had an appropriate high chair. So he was sitting comfortably and and just followed his lead and still, you know, that's pretty much how we feed him. You know, if he, he wants to eat something or doesn't, we're getting more into the toddler years where I'm like, wow, you ate, you know, all of your bread before you ate your broccoli. Funny how that works.

But we really, we continue to follow his lead if something was making. And similarly, if something was making us uncomfortable, if it was a new food where I was like, oh, maybe this is too much of a challenge for him at this point. You know? And if I was uncomfortable with it, we tried it another day and I removed it from the plate, but we really tried to give him lots of opportunities before he actually was eating food to build up the strength that he needed. We also, for a while there, from like six months to a year, he would often have his tongue out of his mouth because he didn't close his draw. because again like that draw strength for him was really key. He wouldn't close his mouth, so we'd stick his tongue out. And so we are told to use straw cups and so we use a lot, a lot of straw traps so we could practice, you know, pinching his lips together.

And I mean, and we'll look back at pictures and be like, oh man, Sully, he's just got this tongue hanging out of his mouth all the time. I'd be like, put your tongue in your mouth, put your tongue in your mouth. Obviously he doesn't know. But we, we continued with, you know, our support staff and I could message our SLP with questions as we went. But we did see, you know, feeding beyond, beyond just milk and that was important because also then changed how he nursed. We, I think around when we started salt was when he primarily started nursing to sleep because it that's just kind of what worked for us. And we said, you know, what, whatever balance he wants to take, if he was, you know, really high on solids for a week, you know, maybe getting a little bit more solids and maybe he nursed a little bit less and I just had to be okay with that.

And honestly, what happened is he came right back around and got right back onto breastfeeding. Like, what normally happens for breastfed babies, he really kind of followed a lot of those trajectories, incorporating solids with breast milk and then bottles like while he was awake. But for a while it was a little bit of a dance and we just kind of followed his cues and he knows his body best. You know, I present opportunities to breastfeed just like I present opportunities to have macaroni and cheese at lunch like we did today. But, but we just kind of followed his lead. And I think that was now having much more of a toddler that is also like very, it gets more difficult, but very key that he knows what he needs. And when it comes to food, when it comes to breastfeeding, when it comes to bottles, like he knew,

Tanya:

I love that. I present opportunities to breastfeed. I love that. Where are you at now?

Andrea:

Yeah. So we I chose to wean him at four 14 months. It was important to us. Again, we'd worked so hard to build up his oral skills and we talked to the pediatrician and our SLP about dropping bottles at a year. So he was already weaning his bottles. He like, wasn't finishing them. And I was like, cool, we're just gonna cut this out, add it into a straw cup instead. But when I cut those out around 12 months man did his interest and breastfeeding really go up. It was like, we'd be out in public and he'd be coming over asking to nurse. I was like, dude, we're at music class. Like you nurse to sleep. Like, what are we doing right now? You cannot lift up my shirt and nurse in the middle of music class.

Like that's just a boundary that like, he's never, he was never interested in that before. Like why are you doing this now? So at 14 months I was like, this is not working for me anymore. And that's why I told my husband, I was like, you know what? I am equally a part of this relationship and it is not working for me because he would keep me there like a pacifier. And it totally makes sense. Now when my son falls asleep, he wants to like grab my face and put it by his face. Like literally like cheek to cheek. He just grabbed me and like squish me. So, you know, breastfeeding was comfort to him and I was totally okay with nursing him to sleep. But at 14 months I said, I am no longer interested in being this part of your sleep routine.

I need to not be the only person who puts you to sleep all the time. And so I weaned him cold Turkey and I was shocked. I got engorged, you know, like I did in the early months. I was like, wow, I forgot about this. Yeah, it wasn't super comfortable. But I held strong for, for two days and said, you know, this isn't an option anymore. I would hold him and, and tell I, I insisted on still being the person to put him down and say, you know, I can hold you. I can sing to you. Like I am still here, but, but nursing is not an option anymore. And I just kind of affirm. He was very upset at first and then it got so much easier. And after that it was just like, okay, mom, mom is an equal part of this relationship.

She is still here for me. There are other ways. And again, I know I keep coming back to why I love combo feeding, but you learn, there are so many ways to comfort your baby. When you combo feed, if it's, you can choose to breastfeed them for comfort or you can choose to, I love taking a shower actually with my son. That's my favorite parenting hack right now it's to take like a 20 minute shower and he just plays like on the floor or we sing together. You know, we, I give him foot massages. Like you learn, I can choose to breastfeed or I can choose all these other ways to comfort my child. And when I decided to wean him, that's exactly what I told him is there are all these other ways that I know I can be here for you. And those are things we still use today, right?

Like putting your child to sleep. And we still very much a baby a year and a half. But I feel so much more comfortable with our breastfeeding journey because I feel like I had a lot more say, and in those early months, you, it did not feel like I had a say. And I think that's just because I said I'm gonna exclusively breastfeed and I didn't let myself think outside the box or I was, I was maybe I think I had a bit of analysis paralysis for a little bit. I was like, just so in again, triple feeding, making it 10 feedings a day, day after day pumping, like I didn't really have the capacity to think what, what else could we be doing? But once we turn that corner, like, I'm so proud of looking back and for future children too, like if we don't breasted at all, like that is totally okay with me.

And I mean, that's why I said going in, I would think, I think initially when I was like three months postpartum, I'd be like, no, like I'm a, I'm a breastfeeding parent. Like I will always breastfeed all of my children. Like this works for us. I enjoy this. But you know, looking forward, I'm like, you know, there are so many ways I could feed a child and thank God we live in 2022 and I get to pick, you know, the variety of ways to feed my child. Like that is such a beautiful, powerful thing. And I get, I get to choose to be a part of that. You know, I choose to say, yes, I have options. And this is what's gonna work for me. But initially I just thought, oh, well I'm a breastfeeding parent. I kinda locked myself into that. Now I'm like so proud that I said, let's look at something else. You know,

Tanya:

You know, what's so interesting to me in listening to you talk with, you know, this much remove from your early days is, you know, you started your journey as someone who had had a breast reduction and didn't know if you could breastfeed. So you had made peace with not breastfeeding. Then you found you had a great milk supply and you were like by golly, Im an exclusive breastfeeder. And that it evolved into what it evolved into. So it's just, it's a representation. I think of all the ways in which we evolve as humans, as women, as mothers, you know? And it's so interesting to hear this bit of your story. One more question about your specific situation and then I wanna make sure that you add in anything that we may have missed yeah. That you think is critical. Other than the lactation consultant and speech language pathologist, are there other specialists that ended up involved that I'm not remembering?

Andrea:

So we also worked with a physical therapist. We did myofacial release for Sully. He did. I think he only ended up needing like three sessions and it was, it was pretty intense. She even worked in his mouth just touching different parts of his mouth that his tongue literally could never reach before. Like he had never had the sensation of, you know, like his back molars being touched or anything like that. So that was the role that she played. He did have a lot of tension from partly from his, his mouth, but then also I think, you know, he kind of had some torticollis going on. So she really helped integrate what the, the feeding therapist was doing alongside us. And we went with PT. Some people go with a chiropractor, but our PT was covered by insurance and our SLP was not. So we chose to invest it.

It's hard to find a feeding therapist in our area. So we chose to invest in the feeding therapist and use our insurance for lactation and PT. It would definitely add our pediatrician as part of our feeding team because he, I mean, he, so he was my pediatrician and my mom went to this practice. Like it is an old school practice, but I love it so much because he was interested in hearing about what we were working on. So oftentimes when you hear of babies going through some of these feeding challenges, you know, formula can be suggested as the best option, he understood that that wasn't gonna be the best option for, for Sully because taking bottles was not working. So he, I would also say he was because if he had raised concerns or said no to something, I think I would've double checked a lot of our other support, but the fact that he was able to learn and listen alongside us, I would definitely add him to our team.

Tanya:

Yeah. And I wanna harp on that point for a minute for the providers that are listening in on this episode is that sometimes we as providers, we don't have to know it all. And I think that we get ourselves caught up in this feeling of like, needing to know it all. And that can come out in various ways, depending on someone's personality, it can come out as authoritarian. It can come out, as you don't know, you're the patient, I'm the provider. It can come out in a lot of different ways, but all patients, clients, people, parents, families want from us is our openness and understanding and being able to say, wow, I've not seen anyone do it this way before, but I'm interested in following along and I'll monitor the health of your baby while you do it. And I trust you as the mother to make these decisions.

It goes so far. And I think we providers have to do a better job of accepting that we don't know everything, nor are we responsible for every single decision in every moment of things, right? Like, especially I'm a midwife after 28 days of a newborn's life. I am not legally responsible for the baby anymore. I'm not allowed to be my training. Doesn't allow me to be the primary care provider for a baby after 28 days of life. So that I think midwives, it's easier for us sometimes to be collaborative and be open-minded because of some of the parameters around what we do and, and who we are, the experts around. But I think that can be harder sometimes for other professionals who feel an even greater responsibility to quote know it all.

Andrea:

Yeah. I will also add, we saw a different pediatrician once for a weight check and I, he, he was, you know, our pediatrician was out of the office that day and he didn't have our full story, but we told him he has a tongue tie. We just had it released. And I remember him being like a tongue tie, like are, you know, like, are you sure? Like I remember feeling this like, oh, but our pediatrician knew my son's weight history. I showed him, you know what? It looked like him taking a bottle. He knew there had to be more to the picture. So if this other pediatrician had just said tongue ties are a fad, he doesn't know the whole story, you know, taking that time to say, what's working for this parent. That was huge. And it was fine. It was just a wait check. I wasn't bothered by it, but it was a very different experience than our pediatrician who was supportive, who knew our story, who knew what our feeding goals were and, and whatnot. So, yeah, I think that's, that's super clear.

Tanya:

Yeah. so is there anything else about your story that you wanna share that we maybe have missed in jumping around a little bit?

Andrea:

I think the main thing I would add is just like, if you don't have, if you don't know someone who has combo fed, like I only had one friend who had a baby before me and she had this magical, perfect breastfeeding experience. Like she really didn't have any breastfeeding education with her second child. She now has. Your second versus your first sometimes breastfeeding. But that was all I knew was just like she had her baby. That was it. And if you don't have friends who feed in a variety of ways, I highly encourage you to find other parents that formula feed, find parents, that combo feed, find parents that exclusively breastfeed because the amount that we have shared. I think I mentioned briefly a friend who pumping, wasn't working for her, they completely switched to formula, you know, and we have great talks about different things, but having a diversity, I think of friends who feed in different ways that has also been really helpful in our feeding journey because they, they ask good questions sometimes, maybe better questions than family.

And I think it's kind of enriched all of our parenting journeys to understand our, our kids look great. You know, I see them all the time. They're close in age, they're all growing, doing their own thing. They all have their own personalities and how we feed them has nothing to do with that. They're gonna be who they're gonna be. And we get to parent the way we get to parent. But having the diversity and friends I think was also really, really helpful. And that was something I remember when finishing our work with you Tanya, you were saying, okay, go find the community that you need. Like go find you're friends and that, I mean, I rejoined the world, but that helped.

Tanya:

Yeah, totally. Alright. So my last question for you is, and this is where you can really get to put on your professional cap. My last question for you is can you, in very clear terms, unpack the variations of what combo feeding can look like. And I mean, combo feeding for idiots, if it were a book, like what's the easy way so that people I'm very literal and sometimes if things aren't spelled out for me, I kind of, it feels really theoretical and heady until I've heard like, oh, now that I see it spelled out, now I can take it to the next level myself.

Andrea:

Yeah. So combo being is using breast milk and formula and in various ways. So you can feed at the chest. I think you could also pump and add formula and breast milk into a bottle. I would also call that combo feeding. It's the, the purchasing a formula prepping a formula that to me, distinguishes combo feeding. And if that is one bottle a day, if that is eight bottles a day and you're really just comfort nursing, that's still combo feeding. It could be that you nurse first and then you give a bottle, maybe you nurse one side and then give a bottle. Maybe you nurse both sides and give a bottle. Maybe you give a bottle during the day and then nurse to sleep. That's what ended up working for us for a lot of parents too. If pumping isn't working at work or are also nurses who work at night, we have a lot of nurses in our family who work at night and they use formula at night and then they nurse during the day or vice versa, you send formula to daycare.

So you don't pump at work. And then you come home and nurse your baby. It really, and that again, that can change throughout the course of their year. We know they, babies need breast milk or formula up until 12 years or 12 years, gosh, 12 months of age. And so, you know, maybe for a little bit you send formula, maybe you send breast milk to daycare. Maybe you say, you know, I cannot do the middle of the night feedings anymore. Maybe use a formula bottle at night. For a while too. I think I was comfortable nursing outside of the house. It was just finding the time sometimes to nurse, you know, when we are away from the house. And so if we were like running to the store, I would take a bottle of formula with me. And then I would just nurse immediately when we got home. And that, I mean, if your supply allows it like minded, I could have like that much variability, even in a day, it's just formula and breast milk. And however, however it works for you.

Tanya:

Yeah. And how I work that out with people when they aren't exclusively breastfeeding or that's not their goal or they've changed, their goals is simply a gentle reminder of the way supply and demand works so that they never accidentally go too far in one direction. And then go, if I had only known that I was gonna screw this up, I may have made a different choice, but as long as they understand supply and demand, I'm just constantly checking in and saying, are you comfortable with the amount of breast milk and the amount of formula or the amount of pumped milk or whatever it is that's at play? Are you, are you comfortable with this or is this sustainable for you? Is this helping with your mental health, your sleep, whatever the issues are, you can't ever look at feeding in a vacuum when we do, we cause much greater problems. And I think, you know, for you, that was that first month or a little more, when you were triple feeding and realized it wasn't sustainable, and that's what we have to be on the lookout for as providers and as clients coming into this with just enough knowledge to know that the sky's the limit in terms of your decision making, but you're gonna need support to make it happen. Because when you're in the thick of it, you cannot make these decisions for yourself.

Andrea:

Need someone to ask you.You need someone to ask you, is this working for you? Are you getting enough sleep? Cause that was the other thing. I only got four hour stretches of sleep for, you know, like four months. But then also I was constantly feeding during the day. So like there wasn't time to do anything else. And so having someone ask, you know, are you sleeping enough? I remember you asking that quite often. And then also I think as like a provider saying, like checking in later, like I love that we get so much lactation support at the beginning, but man, like six months, nine months, like, I, I mean we chucked in with ourselves. Like I felt like we had that skill, but coming back and saying, you know, is it still working for you? Cause again, like I reached 14 months and I was like, nursing is breastfeeding is not working for me anymore. And I was able to say that I think a lot of people have guilt even weaning at two years because they think they still should keep going because they can and I also think of for combo feeding parents with, with low supply who, you know, have to incorporate formula, they're not producing enough to nurse exclusively. Do you have to max out your entire supply for 12 months? You know, is there a tipping point when you say I am okay. Losing a little bit to gain somewhere else in my life.

Tanya:

Absolutely.

Andrea:

With low supply, it's so hard because you're like, this is what I have. I wanna give all of it. That's how I felt exclusively breastfeeding, but can that sustain for 12 months?

Tanya:

Yeah. On the note of support, I just wanna point out that. And you did, you became so confident in who you were in this area that you didn't need to check in with me at some point. You like you just, when you got it, you got it. But in terms of that support piece and using support later on my program has actually evolved because of the ongoing connections that I have to clients and people like you who have stuck out, stuck it out and stayed in touch with me. In that you know, now in the program wraps up, first of all, everyone chooses when they end the program, it's now a monthly subscription program. And people are in control of when to turn it on and when to turn it off. But when they go to turn it off, they can go one of two directions we can go to just texting only if that is the piece of it, that's helping the most or they can turn it off and just schedule visits whenever they need them.

And that allows people to kind of like stick with it. And I totally have people who check in with me at six months at one year. Yeah. I'm ready to wean. I need help doing that. I don't have a period yet and I want another baby, what do I do, Tanya? Right. Like all of the different things. There's so many variations of what comes down the pike and people need to talk about these things. So it's no longer the case that it's like 12 weeks programs over. I just wanted to like point that out because when Andrea was in the program, it was like my earliest iteration of this program and it was 12 weeks.

Andrea:

I was so not ready.

Tanya:

I know.

Andrea:

Anyway, I was so close. I was so close though. We made the big changes and the clarity came, but yeah. It's and it's also like, I remember being like 12 weeks goes so fast.

Tanya:

Yeah.

Andrea:

12 weeks. It's also fast. Like I don't know if I'm there yet.

Tanya:

The days are long and the years are short. And you know I pulled that one out when my daughter turned 22 this year. Like I don't, it's it's crazy. And these cliches that are so obnoxious right. That we roll our eyes at, for half of our lifetime. And then suddenly we fall on the other side of the equation and we find ourselves saying and believing them and it's so crazy. So it's nice to hear you acknowledge, even with this little bit of distance, like that 12 weeks went so fast. But again, in the moment, if we asked you to think beyond two weeks, you would've been hard pressed to do it. Yeah.

Andrea:

Yeah. And also though, in the same sense, like the first four months as we were going through this feeding journey, like, and I remember you telling us, you said you are gonna make leaps and bounds as parents. If you stick, if you stick with it. And that's exactly what happened. We came out as like completely different people, so much more competent parents, you know, so much more perspective. And, the, the impact of those early days is so profound.

Tanya:

Andrea, I am so thrilled to have you as a birth worker now and a lactation consultant. And I am so thrilled that I'm gonna get to keep a close eye on your journey. It are you, I know you're not quite up and running yet. because you just took your exam. I just wanna double check. Is there a way for listeners to learn more about you or are you not quite there and I can just update them in the future.

Andrea:

Yeah. So not quite there yet. I will say I think I have picked a name at least, and that would be combo feeding support because when I was looking for combo feeding knowledge, that's what I typed into Google and I found absolutely nothing. So while I would be so thrilled to work with breastfeeding, exclusively breastfeeding families, exclusively formula feeding families, those combo feeding families to me are just like the little like the lost feeding parents. And so combo feeding support will be, will be hopefully me one day on the internet.

Tanya:

That's awesome. I think you should reserve the URL right now. If you haven't already.

Andrea:

Right. Good. My vacation ends tomorrow.

Tanya:

Oh wow. Well thank you so much for taking the time to tell your story and share your growing knowledge base because you know a lot and you're gonna help so many people.