Talking Formula Shortages with Kelly, IBCLC: Podcast Episode #141

Kristin and Kelly discuss the formula shortage and share resources to help families during this stressful time.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you get your podcasts.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello.  This is Kristin.  I’m co-host of Ask the Doulas and owner of Gold Coast Doulas, and I’m joined today by Kelly Emery.  Welcome, Kelly!

Kelly:  Hi, how are you?  Good morning.

Kristin:  Great.  Good morning.  So I would love for you to introduce all of your amazing skills and trainings to our audience as an RN and international board-certified lactation consultant.

Kelly:  Yeah, I am a registered nurse, and I’m an IBCLC, like you said, a lactation consultant.  It is the highest certification that there is in lactation.  And I, a long time ago, like back in the ‘90s, I was a doula, so I was a certified doula, as well, both postpartum and birth doula, and then that kind of morphed into lactation.  I went back to nursing school, and yeah, I’ve been doing this I guess about 27 years.  Yeah, helping moms breastfeed, yeah.

Kristin:  You helped me with my kids, and I’ve taken your breastfeeding class.  It’s amazing.  Such a great resource.  And yeah, you were a doula before doulas were even known, especially in the postpartum end of things.

Kelly:  Yeah.  There were two of us.  There was one in Zeeland and me, and we found each other, thank goodness.  We worked together and we encouraged each other, but people didn’t even know what the word doula was.  It was so much different back then.  It’s so refreshing to see it explode nowadays.

Kristin:  Yes, for sure.  So we are going to chat about the formula shortage, since that is, you know, the biggest news item, and as far as Facebook group activity, I’m seeing so much interaction and so many questions related to feeding options.  So I would love to hear your perspective on things.  I know it all started with the recalls through Abbott, and then just supply and demand.  It reminds me of early in the pandemic with toilet paper.  So people are stocking up, which then creates even more of a shortage.  So what are your thoughts?

Kelly:  My first thought is just my heart goes out to these poor parents.  Not only to have a baby during the pandemic, but now this.  It just makes my heart break that any mother in this very wealthy country would have to worry about this.  It really stinks, and I feel sorry that it’s going on.

Kristin:  Exactly.  So I would love to hear your thoughts on safe and unsafe options for families if they’re really struggling to find formula on the shelves or to afford some of the premium prices.  I know we can now get European formulas due to the shortage, and some of those costs can be prohibitive for a lot of families.

Kelly:  Yeah, it is expensive.  First of all, reaching out to WIC if you are on WIC and also to your pediatrician to see if they have any, because things change daily.  So to see if they have any recourses that can – any samples, anything at all that they can help you get by until this passes.  If you are lactating right now, like if you have any milk at all, or if you wanted to relactate, that would be, again, getting in touch with a lactation consultant or a lactation person through WIC, as well, if you’re a client of WIC.  Reaching out to find someone that specializes in lactation and so they can help you relactate if that’s what you choose to do.  If you don’t choose to provide breastmilk, like pump or lactate or relactate or any of that, and you wanted to use formula, I would recommend making sure that you follow the package instructions.  One thing that’s really not recommended at all because it can cause electrolyte imbalances and just really bad things happening medically is to water down the formula.  Totally understand why someone would want to because it makes sense that it would go longer, but it’s not recommended for the baby’s health to do that.

Kristin:  Totally agree.  So I’m also seeing a lot of activity from people about, you know, using milk or goat’s milk and saying that they did that back in the day in the ‘70s or ‘80s.  What are your thoughts on some of this information that’s being shared widely on social media?

Kelly:  Yeah, it is true.  I’ll tell you – I mean, I was born in the ‘60s, and I did have cow’s milk with – and I shudder to think now.  I mean, things were really bad.  I had cow’s milk with chocolate milk in it.  Like, that powdered chocolate milk, and I tell that story to moms just thinking, like, yes, I did make it through, but I was hospitalized.  I was failure to thrive.  I had a lot of – it wasn’t just a great thing.  It wasn’t as wonderful as oh, chocolate milk, that sounds great.  It’s not what an infant at that stage needs before 12 months.  You know, there’s so much brain development going on and other things that their kidneys can and can’t process, and so many medical things that we know now that we didn’t know back in the ‘60s and before then is that if your breastmilk is the number one choice, your own breastmilk.  Donor milk would be choice number two, and then formula that has been specifically designed for infant development and brain development and all that would be option number three.  So the home recipes of goat milk and all of that, it’s not recommended right now or any time, actually.  I mean, yes, I know back in maybe 1920 they did it, but it doesn’t mean that it was safe.

Kristin:  Thanks for clearing that up.  And a lot of people are looking for donor milk from either milk banks or trusted resources.  People are also selling their breastmilk.  And so what are your thoughts on finding safe donor milk as an option?

Kelly:  Yeah, that is something that has been done since time began, is mothers would share their milk.  If it’s not their sister or their aunt or somebody in the village was always lactating, and they would help that way, especially if the mother died in childbirth.  You know, someone would step in because we didn’t have formula.  And so that is an option.  I know that a lot of moms are looking for that.  They’re looking at their sisters or their cousins or even on the internet for human milk for their human babies, so I totally understand that.  But you should have a good conversation with your pediatrician or lactation consultant or somebody about the risks and benefits.  There’s always risks and benefits to getting milk that’s not yours, like providing milk to your baby that’s not yours.  There’s screening that typically is done.  Like, when you – there is a milk bank.  There are milk banks out there that you can sometimes purchase it, but I think those milk banks are typically for babies who are in the NICU right now and that they have a shortage themselves, so it’s going to be – the last I knew, it was, like, $5 an ounce to get that.  So it’s pretty cost-prohibitive to purchase human milk from a milk bank where they’ve gone through the screening process, the pasteurization and all of that.  So looking on the internet to get it, like, I totally would not recommend buying it.  The reason being is as this generation knows, what you’re seeing on the internet is not always the truth, and it could be someone who is saying, oh, I’ve got this milk, and I just want to be paid for it, which I totally get that, but it could be someone who’s just diluting it down with cow’s milk or putting something in it.  You know, unless you have a lab that you can really see what’s in it.  There have been cases of that where unfortunately, you know, motivated by money, if someone has ten ounces of milk they’re producing, and maybe they’re pumping ten ounces and they want to sell that, but then they add ten more ounces of cow’s milk.  Then they’ve just doubled their profits.  So just be very, very careful about getting into that sort of situation.  And then again for screening, you know, there are some things that can – diseases, disorders, that sort of thing – that can get through the breastmilk to your baby.

Kristin:  And also medications can.

Kelly:  Yeah, medications that you don’t know, maybe someone that is taking an antibiotic or an antidepressant that’s not compatible.  Most of them are, by the way, but some sort of psychiatric medication that maybe they’re embarrassed to tell you that they’re taking, but they are taking it.  And that they don’t reveal that to you, and now that’s in this milk.  So those are, of course, rare conditions.  Most people who are wanting to donate milk come from a very good place, you know, a very good heart, and they just want to help other women.  That’s the majority of people, you know.  But sometimes they may not know that they have a disorder or disease, either, or an infection.  You know, something like that.  They might not even know that they have it and then are passing it on to you, as well.  So just something to consider.  Like, their lifestyle, what medications they take, have they been screened for different diseases, and all that.  Just a very candid conversation about that.  There is another thing that I don’t see a lot of people talking about, the ability to kind of pasteurize your milk.  And there’s an Academy of Breastfeeding Medicine International, actually, but it’s just made up of physicians who are interested in breastfeeding, so it’s pediatricians and family medicine docs and obstetricians, and they do come up with protocols around breastfeeding and all of that.  So they do have an academy – or they do have a protocol on informal milk sharing that people can check out, and it’s just the Academy of Breastfeeding Medicine.  There’s a 2017 physician statement on informal breastmilk sharing for the healthy term infant.  So they can definitely Google that or I can give you the link for that.  But there is a process, too, of basically home-pasteurizing any kind of donated breastmilk.  So it’s like you – it’s a flash heating method that also would kill certain bacteria and viruses that would potentially be in it.  Now, it may affect some of the quality of the breastmilk, but it would still be preferable than definitely, like, goat’s milk or something like that or watering down your milk.

Kristin:  So let’s talk more about getting supply up for breastfeeding moms or relactating if you have weaned and want to be able to create milk for your baby.

Kelly:  Yeah, that would be the ideal.  The ideal situation is helping with relactation, which I actually have during this crisis is helping moms relactate.  Sometimes it’s a pain in the butt, but sometimes they’re very effective of using an SNS at the breast, which is a little tube that runs alongside your breast, and it has formula or donated milk in it, but it gets the baby back to the breast and thinking that there’s milk coming out.  Because there’s nothing like a baby at your breast to help bring back your milk supply or increase your milk supply.

Kristin:  Agreed, versus a pump, for sure.

Kelly:  Yeah.  I mean, the baby has to be willing and open to latching, of course, after they’ve already been on – but they’re a part of this team, as well, so they have to latch on.  But if they latch on and they start getting a flow of some sort of milk, then usually they will stay there, and when they stay there, they are stimulating the nipple and the breast to bring more milk.  It’s not an overnight thing where all of a sudden your milk is going to come right back up, but usually over time of doing that, moms can see an increase in milk supply, and then you would gradually decrease the milk that you’re supplementing with, and then the baby takes over from there.  Now, if the baby won’t latch, even if you do have, like, a supplemental nursing system, then there’s pumping.  Then that would be another option to do is to do pumping about 8 to 12 times a day.  It’s a pretty big commitment, but you really have to call up that milk.  You know, there are certain stretch receptors on the areola and the nipple that need to be stimulated to send a message to your pituitary to release certain hormones that help drive milk supply.  So somebody or something, like either the baby or the pump, stimulating mom on a pretty regular basis to help your pituitary know, oh, yeah, you want some milk?  Okay.  I’m going to get right on there.  And then your milk starts coming up and up and up.  That would be kind of the first line of process, I guess, of trying to get the milk back up, if it’s low or if they wanted to relactate.

Kristin:  Excellent info.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  So as far as – I’ve been getting questions from clients who are currently pregnant or students in our Becoming a Mother course and wanting to ensure that they have a good supply with this shortage and worried about, you know, supplementing.  What is your advice to have a strong start with breastfeeding and how can you prepare from, say, that 36 week mark on?

Kelly:  First of all, I would get prepared with knowing how your breasts work.  I am a huge proponent of really understanding your body and how lactation works, in your baby but also in your own body.  Knowing from inside out.  It’s something that we don’t really learn a lot about in our sex ed classes in middle school is our breasts and how they work.  When you get a better understanding of how milk supply is driven and how this works as a mammal – like, we’re all mammals, you know, but we don’t really – we kind of skip over the fact that we have these breasts on us that are kind of just hanging there waiting for our baby to be born.  But then things kick in, but then it’s hard to learn something – I mean, you can learn it on the go, but I highly recommend getting at least some sort of basic knowledge ahead of the time, like right now before your baby comes, so you can hit the ground running.

Kristin:  Right, like taking your breastfeeding class so you fully understand.  It’s very comprehensive.

Kelly:  Yeah.  Yeah, I have a three-hour class both in person through Gold Coast Doulas on that Saturday Series but also if they can’t make that, there’s a course that I have that you can, course by course, take it at your own pace and learn, and I go deep into the anatomy and physiology of how this all works.  So getting prepared ahead of time, and then even ahead of time getting the number of a good lactation consultant that you can call right away.  So breastmilk in the first two weeks is a pretty critical time for getting your milk supply up and running.  It’s not impossible if you wait longer, but the first two weeks are a pretty important time for stimulating your milk supply, getting baby on.  Like, a lot of things go on when you’re first starting.  So having somebody there to kind of help guide you and answer your questions and just kind of review things with you is just so important.  Like, most of the moms I work with later on, they say invariably, I wish I had called you sooner, just because learning something ahead of time is always the way to go if you can.  And then if you are going to give birth in a hospital, to make sure that you ask for lactation help there, as well.  Like, right from that first latch, ideally in that first hour after delivery, getting some help and setting the stage there while you’re even in the hospital, if you’re going to be in the hospital.

Kristin:  What are your thoughts on expressing milk and trying to get your milk to come in?

Kelly:  You mean, before baby?  Before baby’s born?  There’s a little bit of – like, if you have gestational diabetes, or if you have some – there’s a little bit of research out there saying that it sometimes helps.  Not only can you collect it and save it later if baby needs to be supplemented – and this study was done, that I know of, anyway, was moms who had gestational diabetes or type 1 diabetes, as well, or type 2.  Any kind of, like, insulin resistance or diabetes like that.  And then if the baby – because if you do have diabetes after your baby comes out, they probably will be checked for blood sugar to make sure that they’re handling the transition out of the womb into the big bad world, you know, with their blood sugar.  So then you can use your milk to supplement with instead of formula in those cases if you have it.  So it’s also kind of good not only to collect breastmilk and save it for later, but also you getting really confident with hand expression and how to handle your breast, because that’s another thing we probably have never done is hand expression on ourselves.

Kristin:  Exactly.

Kelly:  So, like, just getting comfortable with it, getting used to it, knowing where to put your hands and all that.  Those sorts of things are another benefit of doing it.  As a disclaimer, you should talk to your midwife or your doctor ahead of time if you’re at risk for – you know, I wouldn’t start pumping eight times a day, that’s for sure.

Kristin:  Right, definitely not.

Kelly:  Remember those stretch receptors I was telling you about.  Like, when we are manipulating our breast like that, we are releasing oxytocin which makes your milk let down, but it also contracts your uterus.  So if you have any kind of, you know, situation where it’s not safe to have sex, like any kind of bedrest –

Kristin:  Bedrest, yes.  Heart conditions.

Kelly:  Yeah.  You would definitely want to talk to your doctor ahead of doing that, but usually it’s completely fine and safe to do it.  But if you have any special situations, to run it by.  But yeah, that’s – some moms wish to do that, and some don’t.  And, you know, the nurses hopefully in the hospital will show you how to hand express, too, so there’s that on the job training that you’ll get, like, right afterward, as well.  But again, if you can be prepared ahead of time, it’s always recommended.

Kristin: Yes.  I mean, especially if baby gets, you know, sent to the NICU and you’re struggling with, you know, trying to get your supply in.  I know you helped me a lot when my daughter was in the NICU with glucose issues, so just trying to develop my supply when she was, you know, started out with enhanced formula.

Kelly:  Yeah.  It’s tricky, and just being prepared for everything.  And you just get – if your baby is born early or if there’s some sort of medical issue, you’re just kind of swept away into so much stuff that the nurses and doctors and everybody has to do.  It can be overwhelming.  So it’s overwhelming to learn a new skill at that time.  If you already know how to work your pump, if you already know how to do hand expression, if you kind of already have some sort of, you know, bearing about you to do that, then it usually is less stressful.

Kristin:  Very helpful.  And so a lot of your tips that you discuss as far as relactating are also helpful for increasing supply again.  Seeing a lactation consultant, pumping in addition to feeding.  Any recommendations on when to pump if you are currently breastfeeding?

Kelly:  Yeah, whenever it’s feasible.  I always start there because moms are going to – I can give a million recommendations, but if it’s not really going to work into her lifestyle – if she has six kids and she’s homeschooling them all and her mother has dementia – you know, like, there’s so many things in a woman’s life that sound good on paper, but if it’s not really something that she can realistically, you know, do in her life, then that’s – any recommendations I give are going to fall flat.  So it’s kind of whatever – the more stimulation the better.  So however she can work that into her life.  Some moms say, you know, getting out of the shower, I’m already naked there.  I can – if I have a hand pump, I can do that, or if I can hook up to a pump while I’m drying my hair.  Or sometimes I have moms recommend that they feed on one side, then when they switch baby to the other side, they single pump on the one they left off on, because they have to sit there anyway, you know, feeding on side two.  You might as well be kind of doing some extra stimulation.  It’s almost like you have twins at that point, you know, putting another baby on the other side, if you can maneuver it.  So we work with ways to help moms maneuver that.  That’s one strategy.  The only one that I don’t recommend is pumping, of course, right before latching, because then the baby’s going to get frustrated if you took out a bunch of milk.  So usually it’s afterward, and I tell moms afterward – I mean, if baby’s content at that time and your shirt’s off anyway.  Even if you just jump on for five or ten more minutes, that’s going to do something for kind of calling up the extra milk.  Even if you don’t get a lot out, it will snowball if you do it over time, you know?

Kristin:  Exactly.  I’ve also had questions related to supply and illness, so whether it’s COVID or food poisoning or the flu, and so there’s so many different, you know, sources and answers, but students in the Becoming course are asking me questions about, say, you know, food poisoning, or someone is wondering if they have the stomach bug or COVID, can they still feed their baby; things like that.

Kelly:  Oh, yes, 100%, you can.  Any virus that you get, and COVID included, your body is going to make antibodies against it, just even the common cold, and then put that into the milk for your baby.  There’s no reason that you have to stop breastfeeding at all.  And even with food poisoning – that is not – that bacteria that was in your food that made you sick like that is not going to get to the baby.  Now, one of the things with food poisoning, especially, or if you get sick with any kind of flu or any kind of thing where you stop eating and drinking and you’re vomiting and you have diarrhea and it’s really bad, you can get dehydrated pretty quickly.  Then your milk supply will go down.  I’ve had some moms even just recently that they got sick and they recovered from it, but their supply took a hit.  And then I still ask them, well, how many times – I always ask how the baby’s peeing and pooping and all that, but I ask mom how many times are you peeing and what color is it, and they say, well… I say, are you peeing at least six times a day?  That’s kind of my minimum.  “Oh, no, like maybe three times a day I’m peeing, you know, and it’s really dark and concentrating.”  Well, that’s going to be a quick, easy, free fix is to increase your water intake.  If your pee is dark – not that you have to flood yourself with water to make breastmilk, but being at least hydrated will help your milk – I mean, being dehydrated will decrease it, usually.

Kristin:  Absolutely.  Certainly.  I mean, I have a friend who’s had COVID in her entire family, and she was breastfeeding, and baby was the only one to stay healthy.  So it can really be a benefit to baby’s immunity and also keep your supply up if you’re worried about the formula shortage and so on.

Kelly:  Yeah.  Yeah, I mean, as long as the mom’s up for it.  If she’s really sick, that makes it difficult, but other family members – you know, even if she can lay in bed and someone can bring the baby to her all the time and take care of the baby, that would be beneficial for the baby.

Kristin:  Very helpful.  So how can our listeners and clients and students find you, Kelly, outside of, of course, through the Gold Cost website and of course our breastfeeding class?  You have a back to work pumping class.  And with Gold Coast, you do in-home and in-office consultations?

Kelly:  I do.  I do telehealth, as well.  I have a website, and I do classes every other month through Gold Coast Doulas, starting to do them in person, which is great.  Haven’t done that in a while.  So those are, you know, depending on COVID numbers, but that’s one way that they can see me in person, which is great because they can ask me questions that way.  And then I have, yeah, like the online course where they can take it at their own pace, and they would have access to it for years, so they can always go back and say, oh, what did she say about mastitis, or what did she say about weaning or whatever, you know.  And that’s always helpful.  But yeah, I’m just around the West Michigan area, but with telehealth, I’m everywhere.

Kristin:  That’s amazing, so anyone can see you regardless of where they live or take your course.  You’re also a big part of our Becoming a Mother course.  You have quite a few expert videos on different feeding-related topics, so we’re thrilled to have your expertise there.  And also as far as other topics, I would love to chat with you in the future about that – not only your back to work pumping class, but we’ll have to do a podcast on transitioning back to work and, you know, workplace regulations regarding women and pumping and so on.

Kelly:  Yeah, it’s always something on a women’s minds, you know, and it’s changed a little bit during COVID that moms are staying home, but now they’re starting to go back sometimes or do a hybrid model, and there’s a lot of questions that come along with that with pumping.

Kristin:  Exactly.  And we should mention that you take insurance, self-pay, health savings, flex spending, all of those things.

Kelly:  Yes, all of those things, and I’m adding and starting to add more insurance companies as I go along, too, so trying to figure all that out so there’s more options for everybody.

Kristin:  That’s amazing.  So how can our listeners who want in-person lactation support find a trust IBCLC in their area?

Kelly:  Yeah, you can go uslca.org.  If they’re in the United States, of course.  So uslca.org.

Kristin: Perfect.  Very helpful.  Well, thank you so much, Kelly.  It’s been great to chat with you about this important topic, and I hope our listeners and readers find some of the support that they need during this time.

Kelly:  Yeah, for sure.  Thank you so much for having me.

Kristin:  Thanks.  Have a great day.

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