155. The Top Off Trap: Why Your Baby Prefers The Bottle Over The Breast

Of course your baby prefers fast flowing milk, over the work of the breast but if your goal is to latch your baby then you'll need some help. I want to teach you how to balance both breast and bottle. (Without one overtaking the other).

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Read the full transcript here:

Welcome to the Breezy Babies podcast. This is episode 155. The Top Off Trap. Could you use more confidence as a parent? Welcome to the happy place for boobs and babies, you're in good hands. Breezy Babies is where we ease your transition into parenthood because it's a bumpy road, am I right? I'm your host Bri the IBCLC. And if you'd like to make life as a parent more breezy, you're in the right place. I'm here to deliver small bite sized tips and tricks so you can crush your parenting and lactation goals. I'm honored to be on this journey with you. Let's go. Hello, friends, happy summer, I hope you're having a great summer break. If it is summer break where you live. And when you're listening to this podcast episode, we are transitioning pretty well, from school to summer break. It was kind of interesting when we like the last week of school and the first week of summer, I had almost no lactation consultations. It was kind of weird, but also kind of nice that I could just enjoy being with my kids during that time, you know, seeing all their end of year stuff and kind of you know, figuring out that transition into the first week of summer. And now it's starting to pick back up again and get a little busier. So that's been all good. The last couple of consults that I've had have all been about today's podcast topic. So I actually didn't have this on my schedule to talk about today, I was not planning on talking about the top off trap, I had a couple other guests lined up and a couple other topics that I had planned. But I have three clients in a row who are all dealing with this exact same thing. And I know that if they are dealing with it, there are many more out there many more of you listening, who are dealing with this as well. And this topic is key for meeting your lactation goals. And it's a trap that I see so many families fall into hits, you know, a lot of times relatively easy to pull out of. But sometimes we just get so stuck in this spiral that we just we don't know how to stop, we don't know how to get out of it. So that's what we're going to be talking about today that top of trap. I'll explain a little bit more about exactly what that means. Because if you're not in the lactation world, you probably have no idea. And that's okay. You're not supposed to know that's why we have people specially trained a lactation to help you with these sorts of things. Before I get into that, though, I wanted to share just a little thought with you, my Instagram made friend and Hannah, you're listening Hello, she sent me a podcast kind of recently kind of was a little bit ago as well. Sometimes it takes me some time to you know, work these things into what I'm talking about. And her name might sound familiar because she was a guest on this podcast a little bit ago. She was on episode 124. She talked about how to survive having a baby in the neonatal intensive care unit, because that's what she has. She is a NICU nurse. She sent me this podcast and said it made me think about you she was talking to me made her think about me. And this podcast was all about a mindset mentor. And he was talking about what to do when the crap hits the fan and it sprays all over the wall. Have you ever had a situation like that before? Pretty much what he talks about how in situations like this Kay crap hits the fan sprays all over the wall. And usually before we get to that point, there's kind of this progression of the whisper the brick and the truck. So she thought of me because this kind of applies a little bit to how I got into private practice. And I'll explain why. So this was the example that he gave in this podcast episode he talks about your health. Okay, so if your take your health, a whisper might be just the thought coming to your mind of hey, maybe I should go to the gym more often. Okay, that would be like a little whisper. The brick would be a health a health scare like oh, you have a big health scare someone in your life has a big health scare and you're like, oh, I should really take my health more seriously and really make it more of a priority. The truck carry the check is like Have a heart attack. It's something that we've kind of missing the other whispers and bricks before that, and now we have a full on heart attack. It's like being hit by the truck. It's basically like the worst thing that has ever happened to you before. But what he talks about is how it actually could be the best thing that ever happened to you. So my friend and was thinking about me, because this is kind of how I got into private practice, I was with a different lactation company, I was a consultant for them. And for years, towards the end of when I was with them, honestly, for at least a year, I had this feeling of like, you need to go, you need to leave, you need to do your own thing. And I was like, no, no, no, no, that's not good. That's, I can't leave, I can't do this on my own, it won't be good. If I leave, I have a team here. And, and I just pushed it down. And and eventually, if you heard my story before, we got hit by the truck. And it was a big blowout, things did not end well. There was a lot of legal threatenings, it was a big mess, honestly led to a full year of stress in my life that was really hard. This also was happening around the exact same time that COVID was starting. So that already was stressful time and add all of this unrest and, you know, being forced to leave and legal complications, it was a really big mess. So from that situation, I have learned to listen more carefully when the Whisper comes, okay, I don't want to wait for the brick. And I certainly don't want to wait for the truck again. Now, am I happy with where I am with my business. With private practice with building my own team 100%, I would not change going back to that in any way. It has been such a good fit for me and I I'm so happy with where I'm at. But I do wish I could have gotten here from the whisper and not from the truck. So I thought that would be helpful to share. You know, this could apply to so many different things in your life. But if you will have been ignoring the Whisper says your sign to listen to the whisper and act on it because the signal will keep coming and it's not as comfortable when it comes a little bit stronger.
So Alright, that's enough about that. Let's get back to the top up trap the what we are going to be talking about today, if you have ever felt like you were not making enough milk, you were giving your baby formula or expressed breast milk, maybe donor milk in a bottle, then this podcast episode is for you. Okay, because what can happen when you number one are feeling like you are not making enough breast milk. And then number two, you start to give formula, express breast milk or donor milk in a bottle, then what that leads to is a third thing of your baby getting extra full feedings. And then that leads to the next thing of your baby is not as interested in the breast at the next feed. And then we start the whole process over again because now you really feel like you don't have enough milk. Because your baby's not interested in sucking, you're not hearing any swallows, then they take in even more with the bottle. And you just start this downward spiral. Okay, it all starts with the top off trap. Babies who are fed like this are not interested in the breast because guess what? Feeding at the breast, it's work. It's a lot harder than a bottle. A bottle oftentimes is free, fast flowing milk. As soon as your baby sucks, bam, there's milk, they're ready to go. That's not exactly how it happens at the breast K, your baby comes to the breast they suck, suck suck. You know, it takes a little bit of time and stimulation for your milk to let down for the milk to come to your baby. It's a very different feeding process than a fast flowing bottle. Okay, so how we deal with that is paste bottle feeding. I'll talk about that a little bit more in this podcast episode. But basically you want to mimic how you feed your baby with the bottle the same way that they feed at the breast. Does your baby do a full feeding and chug milk in two minutes flat At the breast, probably not some babies do, some babies do. Right? If you have fast, let down a lot of milk supply, maybe your baby does eat that fast. But most babies that I see, especially young babies, they need at least 15 minutes on each breast. And feeds are pretty slow. And that's what you would want to try and mimic with the bottle so that your baby's not getting frustrated at the breast. Now, is this a podcast episode about why you should never give formula or express best breast milk or donor milk or anything in a bottle? No, that's not what this podcast is about. I've worked with so many clients who they have to give their baby some express milk or formula in a bottle. And we have to do that as part of their plan to get back on track. Maybe their baby has had a huge weight loss. And, and or maybe they have a tongue tie and they're not able to effectively work at the breast and latch of the breast right now. So while we're addressing those issues, feeding with a bottle can be a great bridge to get you back to the breast. Okay, not always necessary. But it definitely can be a great and helpful tool. We just want to make sure that this great and helpful tool of giving a bottle is not sabotaging your lactation goals. So again, bottles are quick rewarding. I saw a family the other day that was using a size three nipple. And their two weeks old was downing two to three ounces in a bottle with every feet. And they couldn't figure out why their baby was asleep when they tried to bring their baby to the breast and they were not interested in the breast at all. Okay, I see this all the time, especially for families that had a rocky start. Maybe things didn't go according to your birth plan, you are really susceptible to falling into this top off trap. For example, if you had a C section, especially an unexpected C section, if your baby was in the neonatal intensive care unit, or like a special care unit, you're really susceptible to falling into this top off trap. If you had a traumatic birth and unsupportive medical staff or pediatrician, I wish that these things I just listed were all the rare rare exceptions that almost never happened. But unfortunately, they happen all the time. Now, do remember the cascade of interventions. I had a previous podcast episode on this. And I talked about how the way that you deliver your baby matters. Having a birth plan matters because the way that you deliver your baby, it will affect your lactation goals too. If you have a lot of interventions, and that leads to a C section and your baby being in the NICU. Now that doesn't mean that you will not meet your lactation goals. It just means it's going to be a little bit harder getting back. In fact, just yesterday I met with another client. She lives at a state so I've been meeting with her telehealth. She met with me prenatally. She has free consults through her insurance. So we met prenatally. We talked all about her birth plan. And you know what she was envisioning for her birth she wanted an unmedicated delivery. She wanted to do skin to skin right after she wanted to latch her baby on do exclusive breastfeeding. And we talked about all this. And we also talked about what to do for Plan B. Everything doesn't go exactly according to plan. So we talked about how to express breast breast milk how to give baby that colostrum if they're not latching and the latching can come later. And I'm so glad that we had a chance to meet prenatally because guess what? Her birth didn't exactly go as planned. She had an unexpected C section and her baby had to spend some time in the NICU. But I just have to say I was so impressed. I met with her about a week after she delivered and she even had to be readmitted for a little bit. It just It was a hard situation. But when I met with her she was doing so well. She was had transitioned her baby back to the breast her milk supply was great. She had done an excellent job of protecting her milk supply while she had to be away from her baby during that time period. And she was doing so good. I just had to give her all the praises. I was like usually in this situation we're picking up all the pieces. But even though she went through that hard situation at a Good base knowledge, she really just was doing so so well, still a couple little things that we were working on. But you know, again, if, if things don't go according to plan, it doesn't mean that all is lost, you're gonna need a little bit extra help, and possibly even from an ibclc. In fact, that is my tip number one when it comes to the top off trap. Tip number one is get help and support because it can be a long and lonely road back. Again, my client before I, I truly believe the only reason that she was doing so well at one week is because we had met prenatally and she had known Hey, even if things don't go exactly according to plan, I can do X, Y, and Z until we are able to be reunited and able to latch on my baby again. in that meantime, she had had to use a breast pump, she had had to use a nipple shield, but she knew that she could still get back to her lactation goals because she had that base knowledge and that base competence. So you may be able to get help from the lactation specialist in the hospital. And maybe your pediatrician will care about your lactation goals and not just your baby's weight on the scale. Maybe maybe
not. You know, I see these two situations kind of fall through, you know, have the bottom fall out all the time. So I would like to say that yes, you will have lactation help in the hospital. I would like to tell you that. Yes, your pediatrician will absolutely have your same lactation goals. But I also have seen that that's not always the case. Does that mean that all staff in the hospital is bad? Does that mean that pediatricians are bad? No, they're not. It's just that lactation is not at the top of their list of importance. And it's also certainly not at the top of their list of training and expertise either. I will add that my client who was doing so well, she did meet with an ibclc, who was on staff at the hospital, she did have that available. Side note, not all hospitals even have an ibclc on staff. But she said that her hospital staff was so supportive, and the whole time she was there, they said, We know that breastfeeding is so important to you, we're going to do everything we can to make sure that this happens for you. Amazing. Oh, I just I can't even tell you how happy that makes me to hear that. And I also believe that's another huge reason why she was doing so well at one week after her baby was born. So me meeting with an ibclc, especially in your home. One of my favorite reasons to do that with my clients is that we can do a way feed wave. So I was telling you that like the last three of my clients that I've met with, they have all fallen into this top off trap where they had to supplement for, you know, a big weight loss or something in the beginning, which PS if you get a lot of IV fluids while you're delivered while you are laboring, then of course, your baby is going to lose a ton of weight after being born. So if you were given a lot of IV fluids, you can ask your hospital staff to take a weight closer to 24 hours and not right after birth. Because of course your baby is going to lose a lot of water weight if you're getting pumped full fluids while you were laboring. Okay, that was an that was just a little side note. But I had a couple of clients who their baby was having weight loss. They had to supplement and then they were only interested in the bottle, they were not interested in the breast. But we actually did a weight feed way. So that means that we weigh the baby, then we latch the baby, and then we weigh them again and we can see exactly how much they transferred during a feed. And that is such helpful information because just the client that I saw most recently, that baby actually transferred 40 milliliters and I would consider for that baby's age 460 milliliters to be a full feet somewhere around there. So pretty much this baby almost got a full feed at the breast even though baby had been supplemented with bottles with every single feed. So that was such helpful information for us to be like oh, we can totally pull back on supplementing with the bottle because look at how well baby's doing at the breast. So we spend less time with the bottle more time with the breast came. In fact, that's actually tip number two, spend less time with a bottle more time with the breast. This has to happen if your baby is constantly getting full feeds with a bottle they will never be interested in coming to the breast and I know that it feels scary to spend less time with the bottle. I have clients all the time who are really scared to do this, especially if their baby was in the NICU or special care unit. These parents all come out with the feed as much as possible. mentality for whatever reason, it must be because it's pushed and pushed as goals to release their baby from the hospital. No weight gain, no going home. And honestly, I've seen the expectations for feeds to be set at absolutely unrealistic levels, I'm talking about a three day old is being forced to take two plus ounces and a feeding. That's not normal. Now that being said, it is important that we wait to drop those top ups until your baby is gaining weight steadily. We also want to make sure that your baby is having plenty of wet and poopy diapers. I also like my clients to have their baby back to birth weight. If it's been 10 to 14 days. Then at that point, if baby is back to birth weight, we have so much wiggle room to wean off the bottle and work towards the parents goals of getting baby back to the breast. If your baby is getting two to three ounces per feed every two to three hours with the bottle, then of course they're not going to be interested in the breast. In fact, this is exactly what was going on with my recent client. And we set up the goal to decrease the supplementing by a half ounce every two days that just was a good fit for them and their situation that we came up with together. And a lot of times it's very smart almost every time in fact, with babies, we always do baby steps. Okay, if a baby is used to taking two to three ounces for every single feed, it's probably not going to serve that family well to say, Oh, just stop the supplementing cold turkey never go back again. Most of the time, we want to take baby steps down. During that time, we can continue to watch wet and poopy diapers and weight check ins are really helpful and important as well. I generally see clients in situations such as this at least three to four times for consultations. If not five to six times or more. I usually see them every week or every two weeks until their baby is completely back on track and taking full feeds at the breast. Again, there can be other things that are tying into this. Like if a baby has body tension. If a baby has a tongue or lip tie, that's gonna even take more time and more work to make sure that that baby is able to do full feeds at the breast. Okay, tip number three is consider useful tools. Okay? Some examples of this are a nipple shield, SNS paste bottle feeding, you might not know what all of these things are no worries, I'll kind of break it down and explain a little bit more. First of all, paste bottle feeding. I kind of mentioned this in the beginning of the podcast episode. But this just mimics a bottle feed to it mimics the bottle to the breast. So we want the feed time to be about the same if a baby's just chug, chug, chugging with the bottle, and then they're eating slowly at the breast which a lot of new babies do, then, of course, they're not going to be happy when they come to the breast. So we want to slow down feeds. Maybe it could even be useful for certain families to pump right before latching just enough to get the milk kind of flowing. So that when baby comes to the breast and sucks, there's milk there, and it's a little bit more closely to what they get with the bottle. So sometimes we do bottle first breasts second, sometimes the opposite. It really just depends on the clients that I meet with how their baby is acting, how they're doing with weight gain. I mean, there's just a lot to put into the puzzle. There's just no one size fits all. So pace bottle feeding. definitely work with an ibclc to learn how to do that so important for breastfed babies, and really all humans. Anytime that we eat quickly. It's so easy to overeat.
Have you ever done that at a meal, you sit down and you're just like II and then all sudden you're like, who I am really, really full. We like feeds to be nice and slow. Then we can tell when we're starting to get full and slow down instead of realizing 1015 minutes later that we're actually stuffed. A little overflow. A nipple shield is a little clear shield that goes over your nipple. And the reason for this is that it feels more like a bottle in your baby's mouth than a breast, a bottle and a breast are very different feeling in a baby's mouth. So sometimes this little nipple shield that goes over your breast can feel a little bit more familiar to your baby who's used to a bottle and that can be a really helpful bridge to get you from bottle to breast. I don't recommend introducing these less than 24 hours I don't recommend introducing these without the assistance of an ibclc because you do have to take it away later. Most people don't like to use these and long term because you have to keep them nearby you have to keep them clean and it's kind of a pain. So you know, those are for using with a professional same with SNS, this is supplemental nursing system. And this is just a little tube that gives your baby some formula or express breast milk. While they're at the breast just to give them a little bit more of an incentive. I personally don't do SNS a lot with my clients because I feel like they can be a little a little much a little burdensome, a little overwhelming for clients. So it can be a good fit for some and maybe not for others. But again, if it helps you get back to the breast then it is a useful tool. So overall, you're just you're going to need a plan you have to pull off the bottle. And a little pro tip here, you can still practice with a bottle and get your baby to to go between breast and bottle without falling into this top off trap. If you want your baby to take a bottle but you don't want to fall into this trap, then just think of you know practice time with a bottle as almost just like giving a little snack, it's not going to be with every feeding maybe it's just once a day you practice with a bottle until your baby's used to taking it and then keeping it fresh every few days or you know every couple of weeks every baby so different. Also, you can practice with just a bottle nipple and unscrewed bottle nipple, no milk flowing. I actually recommend this if your baby is full on refusing a bottle. And last little tip right here the magic window to introduce the bottle three to four weeks. Okay, so again, you know overall I just want you to to hear that you can have both it doesn't have to be breast or bottle. You can have both but we just don't want to sacrifice your goals of having your baby feet at the breast by getting stuck in this top off track top off trap of your baby just preferring the bottle only and not wanting the breast at all. So again, my top three tips today were number one, get help and support because it can be a long and lonely road back. Tip number two is spend less time with a bottle more time with the breast. And tip number three was consider useful tools such as the nipple shield SNS paste bottle feeding. I hope this was helpful for you. Again, I know that there are so many people who are dealing with this top off trap. It is no coincidence that my last three clients in a row have all been dealing with this exact same thing. If you know of a family in your life that is struggling with a bottle struggling get to get baby back to the breast then could you do me a favor and share this podcast episode with them. Thank you so much for listening in today. I'll be back next week with more tips and tricks for you. I hope you have a great week and we'll talk to you later. Bye. If you would like more help check us out at breezy babies.com. It's the happy place for boobs and babies where you can take an online workshop on topics from breastfeeding to baby gas. Learn baby massage, get a pumping plan before returning to work and even get one on one lactation help from our IBCLCs we meet with families both in home and also all over the world via secure video and guess what? These lactation consultations might even be covered by your insurance. Click the link in the show notes or visit breezy babies.com to see if you qualify. Also connect with us at breezy babies on Instagram and YouTube. And last if you love what we do, please leave us a review on Google or Apple podcasts.

Summary

• The top off trap. 0:00
• How to get out off the top of trap. 2:17
• What does it mean to have a health scare? 4:38
  • The difference between a whisper and a brick.
  • The best thing that ever happened to you.
• The top-up trap. 7:18
  • Listen to the whisper and act on it.
  • Top-up trap, formula and donor milk.
  • Why feeding at the breast is harder than a bottle.
  • Why bottle feeding is not necessary.
• Bottles are quick rewarding. 11:21
  • Bottles are quick and rewarding.
  • Top off trap, c-section, traumatic birth and unsupportive medical staff.
• Get help and support from a telehealth provider. 13:12
  • Another client met with me prenatally and discussed her birth plan.
  • Get help and support.
• Lactation help in the hospital. 16:04
  • Lactation help in the hospital and in the pediatrician.
  • Hospitals have IBCLCs, sometimes.
  • The top-off trap, weight loss after birth.
  • Spend less time with the bottle and more with the breast.
• Weight gain and supplementing. 20:07
  • Expectations for feeds should not be set at unrealistic levels.
  • Consider using useful tools.
• Examples of nipple shield, nipple shield and bottle feeding. 22:34
  • Nipple shield, sns, paced bottle feeding, etc.
  • No one size fits all approach.
• What is a nipple shield? 24:19
  • Nipple shields and sns, supplemental nursing system.
  • The magic window is three to four weeks, for introducing a bottle.
  • Get help and support to get back to the breast.
  • Check out breezybabies.com