How much does it cost to formula feed for one year?

TLDR: the short answer is that in 2023, it costs approximately $2500 per year if you’re feeding your baby a basic powdered formula. For ready-to eat, it’s about $3300. If you need hypoallergenic or other specialty formulas, it could be $5000+.

To calculate the cost of a particular brand of formula:

For ready to feed: Take the cost of the container, divide it by the number of ounces in the container. That’s how much it will cost for each ounce baby drinks. Now multiply that times 10,000 for the number of ounces baby will drink in a year.

For powdered: Take the number of ounces of powder in the container and multiply it by 6.5 ounces, because one ounce of powdered formula makes 6.5 ounces for the baby to drink. Now, take the cost of the container and divide it by that number of ounces of drinkable formula you can make. That’s the cost per ounce. Multiply by 10,000 ounces for a year’s worth.

All the details behind that summary:

If you want more insight into my estimates, read on. If you just want to know how to save money on formula, scroll to the bottom of this post.

I thought this answer would be trivial to look up. I did a Bing search for “how much does it cost to formula feed a baby for a year?” Here are answers from the top results in a Bing search.

• $1642 on average, based on calculator: KellyMom (from 2016)
• “Families who follow optimal breastfeeding practices can save between $1,200–$1,500 in expenditures on infant formula in the first year alone” – US Surgeon General (document from 2011)
• Parents in 2021 said $1000 – 2000 a year, citing that Surgeon General statement.
• Baby Center cost calculator: implies $183 per month [equivalent of $2196 per year). But on another page on Baby Center from 2022: ” $400 to $800 is the average monthly cost” [that’s $4800 + a year)
• One of the top Bing search results is this page from Breastfeeding Center of Ann Arbor, that says the cost of formula feeding is “Between $1,138.5 and $1,188.00” but that assumes formula is 7 to 14 cents an ounce, so I’m not sure when it’s from.
• Pricer says “Four cans are what an average baby would consume in a month, this costing around $55.” [annual equivalent: $660.)
• Romper has a 2018 article someone’s actual spending of $1942 for one year.
• And Smart Asset’s very confusing article says $821 – 2920 depending on the brand you use, then two lines below that shows calculations of $4927 – 10,493.

If we put together all these answers from the top several results of a Bing search, you learn that formula will cost somewhere between $660 – 10,400 for the first year. Not very helpful, right?

So, I decided to do the math myself. It’s harder than you’d think…

How many ounces of formula does a baby consume in a year?

The standard rule of thumb is that a baby 0 – 6 months who is eating only formula should consume 2 – 2.5 ounces per day per pound that they weigh. (So a larger 4 month old baby is eating more than the smaller 2 month old was, obviously.) As you add in solid foods, formula is still their biggest source of nutrition, but they’re also getting some calories from solids, so the daily formula consumption actually goes down a little from 6 – 12 months.

I could have looked up how much an average baby weighs at each month, and how much that meant they would eat each day that month, but that would be a lot of work, I used Kelly Bonyata’s estimates of how much formula babies need per day – they seemed reasonable. So, first month at 21 ounces a day, second month at 26.5, next four months averaging 32 ounces a day, then 3 months at 28 ounces, then 3 months at 25 ounces a day. That totals up to 10,035 ounces per year. (We’ll ignore for now that you probably spilled some and certainly had to dump some when your baby didn’t finish a bottle.)

How much does formula cost per ounce?

So, you can’t just look at the per ounce cost that shows on the store shelf or online comparisons. Powder will always look like it’s more expensive per ounce then ready-to-drink, but it’s not really!

Forbes magazine made this mistake in their article on the best formulas. They say Similac Pro-Total Comfort Infant Formula “is the most cost-effective formula on our list.” It lists it as 30 cents per ounce. To feed a baby for one day, you’d need 25 ounces of that ready-to-feed product, so that’s about $7.50 for one day. Just below that, Forbes lists Gerber Good Start Gentle Pro, which it lists as $1.48 per ounce, which to Forbes’ apparently uneducated eye looks more expensive than the Similac. But that one ounce of powder makes 6.5 ounces of liquid formula for baby to drink once you add water. So for one day, you’d need 3.8 ounces of powdered formula, which would cost $5.69 for a day’s worth of formula. Much more cost effective.

How many ounces of powdered formula make one ounce of formula for baby to drink?

If you’re curious about the math that got me to 1 ounce of powder = 6.5 ounces of mixed formula, here it is: If you’re buying powdered formula, using this container as our example, there’s 20 ounces of powder (that’s a weight measurement) which is equal to 566 grams. It says that for two ounces of water (a volume measurement), you add 8.7 grams of powder. (note: this actually makes slightly more than two ounces of formula for baby to drink… that’s a math error we’ll ignore to make up for that spilled and wasted bits we mentioned before…) So, in a 20 ounce / 566 gram can, you have enough to make 65 2-ounce bottles, which is 130 ounces that baby can drink. So every ounce of powdered formula makes ~6.5 ounces of formula for baby to drink. Or the way Joshua Bartlett does the math, “you end up using 0.3 oz of your formula to make about 2 fluid ounces of formula.” In that linked article, he also has helpful calculations for parents about how many servings are in a can of formula / aka how long will a container of formula last.

Per ounce costs of recommended brands:

I looked at what brands are recommended by Forbes and Baby Center. (Note: I’m not saying I recommend these brands particularly – I’m just using recommendations that the average parent would find online.) I priced some of those on Amazon* for sake of getting a basic estimate.

All purpose powdered formulas:

Gerber Good Start Gentle Pro. $30.49 for 20 ounces of powder which would make 130 ounces of drinkable formula, so 23 cents per ounce of drinkable formula. The 10,000 ounces a baby would drink in a year cost $2345.

Enfamil Neuro Pro. $52.49 for 31 ounces of powder which would make 201.5 ounces, so 26 cents per ounce, or $2611 for a year.

All purpose ready-to feed: Similac Total. $62.69 for 6 32 ounce containers. Amazon thinks it’s $1.96 an ounce, but that’s wrong. Because the price is for 6 32 ounce containers not just one, that’s 192 ounces, so it’s 32 cents per ounce, or $3,265 per year.

Hypoallergenic ready-to-feed: Similac Alimentum $12.79 for 32 ounces. 39 cents per ounce. $3996 for one year.

Hypoallergenic powder: Neocate Syneo Infant $51 for 14.1 ounces of powder, which would make 91.7 ounces of drinkable, so 55 cents an ounce, or $5561 per year.

So, that leads to my best estimate that to formula feed a baby for one year would cost $2500 – 5000.

How can you reduce the cost of infant formula:

• Choose generic store brands over the brand names that spend a lot on marketing. All formulas have to meet the same FDA standards.
• Buy powder, not ready-to-eat. Only buy hypoallergenic or other pricey formulas if your doctor says that it is necessary.
• Be a smart shopper: by shopping around to different stores, buying on sale, clipping coupons, or getting bulk or subscription discounts you can reduce these costs.
• if you are a low income parent, you may qualify for WIC (Women, Infants and Children program) or SNAP (often called food stamps) to help with the cost of formula feeding. Check to see if you’re eligible for WIC. Check if you’re eligible for SNAP. Local food banks or other programs may also have resources for you if you can’t afford formula.
• If you are planning ahead and have not yet had your baby: perhaps consider breastfeeding? Breastfeeding is basically free – the lactating parent may just need to add a few extra calories to her diet to support milk production plus vitamin D supplements for baby. If you’re wondering whether breastfeeding is right for you, take a class or read about it (we cover it well in a book I co-author) just to see whether you think it’s a possibility for you.
  • If you already had your baby but you aren’t currently breastfeeding, it can be possible to induce lactation – check out these articles: Inducing lactation – even if you never breastfed, or relactation if you have breastfed in the past, even for a short time.)

One key: never try to save costs by diluting formula with extra water! Your baby will not get the nutrients they need and their growth and development may suffer. Also, do not use homemade formula recipes you find online – most are nutritionally inadequate and some are actively harmful.

Learn more

• Why is infant formula so expensive? is a good summary.
• What if we continue to have formula shortages and it’s hard to find formula? Recommendations from HHS. And more info.
• Overview of formula feeding info from American Academy of Pediatrics

*Note: the links to the formula brands above are Amazon affiliate links. If you click on those and then purchase anything on Amazon, I do receive a small referral bonus which supports this blog.

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Breastfeeding Class Curriculum

I created a PowerPoint for a 2 hour long breastfeeding class that reflects all the current research-based lactation advice. I have included recommendations for breastfeeding video clips to use. (And here’s info on how to download them and embed videos in your PowerPoint.)

You can download this and use it in your classes. Hope it’s helpful! (To download it, go to the menu button in the bottom right corner of the slideshow image, click on the down button and choose download. You can then save that copy to your own computer and edit however you choose.)

Here’s a PDF of just the slides, if that is helpful. It doesn’t include the notes with more details on what to say about each slide.

Changes in Lactation Advice

If, like me, you’ve been teaching birth education for many years, it’s important to keep up on how advice changes or evolves as new information is learned. There have been huge shifts in lactation advice over the past 10 or so years, so I will summarize those here to the best of my understanding. I am not a lactation consultant and never have been, so IBCLC folks, please let me know if I’ve got anything wrong or am mis-interpreting the data.

I have created a PowerPoint curriculum for a breastfeeding class that you can download, which reflects this updated advice.

Antenatal Milk Expression

We once advised parents against a lot of nipple stimulation during pregnancy, concerned that it might start labor. That’s changed. It is now reasonable to recommend hand expressing colostrum started at week 36 of pregnancy unless care provider considers someone high risk for preterm labor. It can help milk volume increase sooner after birth. Those who might want to express: people with diabetes (any type), PCOS, high blood pressure, obesity, breast hypoplasia, history of low supply or previous breast surgeries. It may also be helpful if they are expecting multiples, or a baby with a cleft lip, palate, IUGR, Down Syndrome or other complications that might lead to them needing special care after birth and increase the chance that formula or supplemental feeding would be recommended. It can also be helpful for any expectant parent to help them feel more confident about breastfeeding.

I also do feel that overall, we are seeing more attention on hand expression than in the past. There are helpful videos showing how to do hand expression at: https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html  and https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/.

Learn more:

• Patient Education: University of Washington Medical Center Lactation Services, “Expressing Milk Before Giving Birth,” University of Washington Medical Center. (2019) https://healthonline.washington.edu/sites/default/files/record_pdfs/Expressing-Milk-Before-Giving-Birth.pdf
• Research showing no risk to antenatal milk expression: Della Forster, et al, “Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME])” Lancet, 389: 10085 (2017). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31373-9/fulltext

Laid Back Position

When I first trained 20+ years ago, we were teaching cradle, cross-cradle, football and side-lying positions. About 10 years ago, I started hearing more about sitting up / straddle hold and more about the laid-back position. (Laid-back is a semi-reclined position, like resting on a deck chair by the pool.) Now, most research and practice seems to be leaning toward this (combined with infant-led latch) as the best option.

Colson describes the Biological Nurturing approach: “Mothers lean back and place the baby on top so that every part of the baby’s body is facing, touching, and closely applied to one of the mother’s curves… Nursing in a laid-back position… promotes neonatal locomotion by releasing up to 20 primitive neonatal reflexes which act as breastfeeding stimulants. BN is quick and easy to do; there is no lining up of body parts and no “correct” breastfeeding procedures…” Note: in this position, the parent does not support her breast, and gravity holds baby in place, so it can free up one or both hands.

You can find videos with more information about how to use the laid-back position and baby led latch at Laid-Back Breastfeeding: https://www.biologicalnurturing.com/sample-of-biological-nurturing/ and https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/how-to-breastfeed/attachment-techniques

This approach significantly reduces cracked and sore nipples. (Milinco, Wang.)

Learn more:

• Suzanne Colson, “Biological Nurturing: the laid-back breastfeeding revolution,” Midwifery Today 101: 9-11. (2012) https://www.midwiferytoday.com/mt-articles/biological-nurturing/
• Zhi Wang, et al, “The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis,” BMC Pregnancy Childbirth, 21(1): 248. (2021) https://pubmed.ncbi.nlm.nih.gov/33761882/
• Mariarosa Milinco, “Effectiveness of biological nurturing on early breastfeeding problems,” International Breastfeeding Journal, 15:21. (2020)  https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-020-00261-4

Baby-Led Latch / Symmetry?

There is also an increased emphasis on letting the baby take the lead in latching on. This increases duration of exclusive breastfeeding, decreases nipple pain. (Baby-Led Latch: Caixin Yin, et al. “Effect of Baby-Led Self-Attachment Breastfeeding Technique in the Postpartum on Breastfeeding Rates,” Breastfeeding Medicine, 16:9. (2021) https://pubmed.ncbi.nlm.nih.gov/33913745/). This video illustrates an infant led latch. https://www.breastfeeding.asn.au/resources/baby-led-attachment

There is a lot less talk about the old method (using U-holds and C-holds to shape the breast like a sandwich before latching, tickling baby’s lip till mouth is open wide, then rapid arm movement to get them to latch on). It’s more about just bringing baby’s nose near the nipple, touching the nose or upper lip with the nipple so the baby tilts up, opening mouth wide and taking a big mouthful of nipple.

Jack Newman describes the ideal latch as asymmetrical, where more areola is covered by the bottom lip than the top, and where the chin indents the breast, but the nose never quite touches the breast. (When Baby is Latching Well: Jack Newman and the International Breastfeeding Center. “Latching and Feeding Management”, 2021. https://ibconline.ca/information-sheets/latching-and-feeding/)

Conversely, Pamela Douglas has a very different view based on her reading of ultrasound images of latch. She prioritizes a symmetrical face-bury, where the nose is against the breast. She also says there should be no visible lips, because if you can see lips, there is drag on the nipple which causes pain. (This idea of neutral lips is different than the flanged / “fish lips” I was once taught.) She has a video at https://possumsonline.com/video/how-babies-breastfeed that highlights her concept of gestalt breastfeeding. (Pamela Douglas, “A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding,” BMC Pregnancy Childbirth, 22:94. (2022) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808964/ see additional file 1 in that article for details on gestalt method.)

Nipple Soreness

Of course, a good position and good latch continue to be key to reducing nipple soreness. Where I used to see recommendations that if the latch isn’t good, you should break suction and try again, more recommendations now say that most latch issues can be fixed by: tucking baby in closer to the parent so there’s no gap between them and making sure baby is aligned (ears, shoulders and hips in a line.) “Adjust the body, adjust the breast, adjust the baby” – microadjustments in each can fix the latch.

Yeast Infection?

Some breastfeeding parents with persistent nipple pain during and between feeds also may have shiny pink nipples with white flakes of skin. In the past, this was often diagnosed as a yeast infection and treated with antifungal medications. But there’s no evidence that candida causes the nipple pain, and antifungal treatments are no more effective at treating it than doing nothing.

• Pamela Douglas, “Overdiagnosis and overtreatment of nipple and breast candidiasis,” Women’s Health, 17. (2021) https://pubmed.ncbi.nlm.nih.gov/34269140/.
• Esther Jimenez, et al “Mammary candidiasis: a medical condition without scientific evidence?” PLoS One, 12:7. (2017) https://pubmed.ncbi.nlm.nih.gov/28704470.
• Ryan Colton Betts, et al. “It’s Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain,” Breastfeeding Medicine, 16:4. (2021) https://pubmed.ncbi.nlm.nih.gov/33305975/

Ointments?

In the past, I have been told to recommend lanolin, hydrogel dressings and other moist wound healing approaches. Current research indicates that hydrogel, lanolin, antifungal creams, Vaseline, expressed breast milk and all-purpose nipple ointment are no more effective at reducing nipple pain than it is to do no treatment at all, and some may actually delay healing due to moisture related damage.

Most nipple pain reduces to mild levels by 7 to 10 days postpartum no matter what you do or don’t do.

• Nipple Pain section: Pamela Douglas, “Re-thinking lactation-related nipple pain and damage” Women’s Health, 18. (2022) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966064/
• Nipple pain ointments: Cindy-Lee Dennis, et al, “Interventions for treating painful nipples amongst breastfeeding women”, Cochrane Database. (2014) https://pubmed.ncbi.nlm.nih.gov/25506813/

Anatomy / Engorgement / Mastitis

We have a new understanding of breast anatomy based on ultrasound imaging vs. cadaver study as past models were based on. A summary is here: “Anatomy of the Lactating Breast,” Medela. https://www.medela.com.au/breastfeeding-professionals/research/breast-anatomy. And the research: D. T. Ramsay et al., “Anatomy of the Lactating Human Breast Redefined with Ultrasound Imaging,” Journal of Anatomy 206, no. 6 (2005): 525–34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571528/

Here is an image from the Ramsay article with an artist’s impression of breast anatomy – note how this differs from older illustrations showing “bunches of grapes” in the alveoli and lactiferous reservoirs.

We have learned there are not sinuses / reservoirs that store milk in the breast. Only about 1 – 10 ml can be expressed before a let-down. So, getting a good latch so you get a good letdown is essential.

Plugged Ducts?

We used to teach about plugged ducts, saying that milk was clogging a duct, and we had all sorts of advice for placing baby’s mouth so it lined up with the lump, and massaging as the baby nursed, or using a vibrating device like an electric toothbrush to relieve that. Based on new learnings about breast anatomy, clogged ducts are not actually possible. “Ducts in the breast are innumerable and interlacing and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘‘plug.’” (Mitchell, et al) And deep tissue massage to relieve a clogged duct can worsen edema, inflammation and pain.

Parents should be taught that slightly lumpy breasts are normal, and that localized inflammation is just that, and can be treated similar to how we treat engorgement.

Engorgement

For engorgement, ice and ibuprofen to reduce pain and inflammation are recommended. Cabbage leaves are no more effective than ice. Heat (e.g. warm compresses and showers) may provide comfort but can also worsen symptoms. If using hand expression or pumping to treat engorgement, express only enough milk for comfort and/or to help baby latch on. Over-pumping can worsen engorgement.

Mastitis

If the symptoms are pain, redness and a short-duration fever, that is considered inflammatory mastitis, and likely not an infection. It can resolve on its own with continued breastfeeding, rest and plenty of fluids.

If the fever, pain and inflammation continue for more than 24 hours, it could be bacterial mastitis, an infection. They should check with a lactation consultant or care provider – antibiotics may be recommended at that point.

To learn more about all the topics in this section, read: Katrina Mitchell, et al, “Academy of Breastfeeding Medicine Clinical Protocol #36, The Mastitis Spectrum,” Breastfeeding Medicine, 17:5. (2022) https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Paced Bottle Feeding

When giving a bottle to any baby, but especially one who is primarily breast-fed, we can use a method called Paced Bottle Feeding. Many parents hold the baby horizontal on their back and the bottle vertical, so the nipple is filled with milk. Baby takes in a lot of milk really fast this way, which might seem efficient, but can lead to over-feeding or increased spit up. It also teaches a baby to expect this fast flow and “flow preference” might be the true “nipple confusion” as baby gets used to fast flow. With paced bottle feeding, instead we hold the baby vertical and the bottle horizontal so they’re taking milk in more slowly. When they pause a bit in sucking (as they would at a breast), you can tilt the bottle completely horizontal to give a rest. When they resume sucking, you tilt it up just a bit so they get more milk. Check out these videos: https://www.youtube.com/watch?v=OGPm5SpLxXY and https://www.youtube.com/watch?v=TuZXD1hIW8Q.

Comments

If you have comments on anything you read here – about any surprises you see, or any misinterpretations you want to clarify, please comment below!

AV Aids – Breastfeeding Videos

Here are a collection of helpful videos to use in class or 1:1. Note: I always download any videos I want to use in class, because I don’t trust that the internet connection will always be perfect at the moment I want to use it. To learn how, read “Incorporating Video into PowerPoint.”

For each video, I captured a still image to help give you a sense of what it looks like. In each section, they are in order from clips I think would be most helpful for educators to least. FYI, I have also created a PowerPoint curriculum for a breastfeeding class which includes recommendations for which videos to link to and what clips to use.

Laid-Back Position, Baby-Led Latch

Baby-led attachment (laid back position) : 7:39 video overview from Australia. You might use just the segment from 2:30 – 4:20 that shows the process. https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/how-to-breastfeed/attachment-techniques Also at https://vimeo.com/273450509

Laid-Back Breastfeeding – 2:38. starts with 30 second still image of laidback position: https://www.biologicalnurturing.com/sample-of-biological-nurturing/ also at https://vimeo.com/210224351

A 53 second video showing baby-led latch in laidback, from Australia. Includes b brief image of nursing twins. https://www.breastfeeding.asn.au/resources/baby-led-attachment

A 21 second video that shows breast crawl – baby-led attachment in a laidback position (resolution not great…) https://thenaturalparentmagazine.com/baby-led-latching/2/

Latch

How to check if baby is latched well. 1:44 from the UK. I would use :20 – 1:20 clip. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/breastfeeding-positioning-attachment.aspx#close Also at https://www.youtube.com/watch?v=hKVxVfCGHqw

Attaching Your Baby at the Breast – from Global Health Media. Nice hunger cues at 3:09 – 3:40 (great lanugo too). Nice latch at 5:17 – 5:47 though I wish she laid-back instead of being so upright. https://www.youtube.com/watch?v=wjt-Ashodw8

Animation of an effective latch: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/latching-on. A similar (but different narration) video is at https://www.youtube.com/watch?v=jyOt9aB6sOo

Jack Newman’s International Breastfeeding Centre site has several helpful videos, including “Baby 28 hours old assisted latching.” The video resolution isn’t great on that one, but really nice view of suckling in action. “Good Drinking” is also quite good. https://ibconline.ca/breastfeeding-videos-english/

No narration – just a view of a nice latch and good suckling: https://possumsonline.com/video/baby-transfers-milk-beautifully

Additional Positions for Breastfeeding

Several positions: 9:26 From Global Health Media – shows diverse parents in developing countries. https://globalhealthmedia.org/videos/positions-for-breastfeeding/. Also at https://www.youtube.com/watch?v=RiEa0NrpSek

Hand Expression

This full video is 7:33, but I would use just the 2:09 – 4:15 section of it. With massage, I would emphasize this is gentle, not firm massage – firm massage can cause inflammation. (I’ve heard it described as “gentle… like petting a cat.”) https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html or at https://www.youtube.com/watch?v=613yqVEtu3I

Hand expression from Unicef UK. Shows specifically how to teach expression using a breast model. https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/. Also at https://www.youtube.com/watch?v=K0zVCwdJZw0.

“Basics of Breast Massage and Hand Expression”. I would use 1:03 – 2:48. Note: she has her hand right at the nipple vs. the inch or so back from the areola shown in the video above. http://bfmedneo.com/our-services/breast-massage/

Overviews

If you don’t teach breastfeeding during your class, but want to share a link with students to get that info on their own, these are all good comprehensive resources. There are also good clips from each I could use in a class.

Breastfeeding in the First Hour: An 11:49 overview of getting breastfeeding off to a great start. https://med.stanford.edu/newborns/professional-education/breastfeeding/breastfeeding-in-the-first-hour.html

First Droplets has a 15 minute overview of Breastfeeding in the First Hour. https://firstdroplets.com/?fbclid=IwAR1ptT-uUB6DpkA21C8Io8Ht-WvFvkKlZHlcMTv6NHpCE33qyfmjucaT1uI (or https://vimeo.com/348861789) They also have great short videos on specific topics like latch: https://firstdroplets.com/downloads/

Nancy Morhbacher has a 30 minute long video on Natural Breastfeeding (laid-back, baby-led latch). https://www.naturalbreastfeeding.com/ Also available in Spanish.

Paced Bottle Feeding

This method can be used by anyone who bottle feeds. It is especially helpful for breastfeeding parents to help avoid “nipple confusion” which may be primarily “milk flow preference” – where if babies get used to a really fast bottle feed they may be reluctant to return to slow breast milk flow. This process slows it down to mimic breastfeeding.

You could just use the clip from :29 – 1:49. https://www.youtube.com/watch?v=OGPm5SpLxXY

And in this one, I would use 1:43 – 3:03. https://www.youtube.com/watch?v=TuZXD1hIW8Q.

More Resources

For Parents: In my podcast, there is an overview on how to breastfeed your baby. At that link, you can listen to it, or read the transcript.

For Professionals: A lot has changed in lactation advice over the past ten years. Find a lactation update here.

A New PMAD Handout

When we last revised Pregnancy, Childbirth and the Newborn, I struggled with including the list of all the risk factors for PMAD. It’s important information to have, and yet, I worry about someone who has a lot of those factors reading through it and getting more and more discouraged, and worried that there was no way they could avoid PMAD given their complex history. I wanted to find an approach that could empower rather than defeat.

Yesterday, I played around with a lot of metaphors…

• a seesaw where the more risk factors you have, the more protective factors you need to balance them out
• a budget metaphor
• a fill the bucket metaphor where the risk factors drain the bucket
• a floating object metaphor… if you have a lot weighing you down, you need a lot to buoy you up so you don’t feel like you’re drowning

Finally I found a metaphor I liked… I created a handout where I try out the baggage metaphor…. if you know you have a lot to carry, then you can plan ahead (pack it well), build your strength (by learning coping skills), get a luggage cart (learn about resources) and ask for help to carry it.

Here’s the free printable handout, feel free to use it any time, anywhere.

packing-for-emotional-journeyDownload

I also updated two other handouts: One on what you really need to buy for babies, and one on planning with your parenting partners how you’ll divide up responsibilities after the baby is born.

Newborn Cues Video

The TL; DR: Expectant parents often wonder how they’ll know what their babies need, and new parents often wonder why their baby is crying and what they could do to figure out their needs before they cry. Newborn cues are instinctive behaviors that babies display which help us to figure out what they need. This YouTube video (which you are welcome to share in classes or in one-on-one appointments, or link to from your website) provides an overview of newborn cues. (Here’s a link you can share: https://www.youtube.com/watch?v=RiV_uXOg6Bg)

The Story Behind the Video

As a first-time parent back in 1993, I was clueless.. it seemed like my baby would go from 0 to 60 from happy to miserable in a moment. Years later, I watched videos of his early days, and saw that he was giving SO MANY cues about his needs that I missed until he escalated to screaming. So, when I started teaching newborn care classes in ’99, I always incorporated information about newborn cues.

Back in 2010, I put together some YouTube clips as a “Name that Cue” activity to use in my classes. I put it on YouTube for my ease, and in case anyone else would find it helpful. Now that video, and excerpts from it and updates of it have been viewed over 2 million times!

The video linked above is the newest version, where I’ve incorporated feedback I’ve gotten on previous versions and added a couple more clips. I’ve also set it up so it will be easy to create translations of it into other languages, and I’m currently recruiting educators whose native language is something other than English to help me create translations. (contact me at janelled at live.com if you’re interested in helping!)

No Narration Option for Classes

For birth educators or others who are using this video in an educational setting: That video is designed to be watched independent of a class or educator. It’s 20 minutes, which is a lot of time for a class. If you prefer, I have a 13 minute version here with no narration that you can show and talk through it with your students. https://youtu.be/-rpVYSfuknU

Video Segments – Cue by Cue

In 2014, I created segments that covered only one set of cues at a time. Here’s links to those, if you prefer them.

• Quiet Alert and Engagement Cues: https://youtu.be/M_8PYhGsO2A
• Disengagement and Signs of Overstimulation: https://youtu.be/QaTqoIP04dE
• Tired Cues: https://youtu.be/r-tiSlS1EW0
• Hunger Cues: https://www.youtube.com/watch?v=ABAXgubx58Q
• Gassy Cues: https://youtu.be/gAupFs8Kwts
• Full Cues https://youtu.be/En50oEsm6BE

Teaching about Cues

In my podcast episode on Caring for Your Newborn, you can see how I integrate teaching about cues into the information I give on newborn care and feeding.

Setting Expectations for Parenthood

In a journal article on “Mother’s Expectations of Parenthood“, authors Lazarus and Rossouw address the influence of unreasonable prenatal expectations of parenthood on the development of postpartum mood disorders. They make recommendations for antenatal classes that I think are worth consideration for childbirth educators:

“Current antenatal classes focus mainly on the birthing process; however… it is the transition that occurs once the mother is at home that is pivotal in the development of depression, anxiety, stress, and low-self esteem… An education program focusing on compromised infant, support, and self-expectations during the first year post birth should be created and incorporated into existing antenatal classes… This type of education program should perhaps emphasize the potential realities of having a child (such as a difficult and painful birthing experience or a baby with a more difficult temperament) but, most importantly, it should normalize the ambivalence and doubt that a mother may experience post birth, and stress the importance of reaching out for help and talking to others if she experiences even the smallest difficulty during the transition to becoming a new mother.

“This education program could also highlight how current social norms for new mothers as “super mums” is… not merely unattainable but rather it creates an environment that promotes the development of depression in new mothers, given that women feel strongly obliged to isolate themselves and conceal their true feelings when they are experiencing difficulties and/or depression post birth. These behaviors only succeed in further feeding the symptoms of depression by avoiding the issues at hand… If a healthy shift to new motherhood is to transpire, it is the rule rather than the exception that this transition may be accompanied by some degree of grief and loss and changes in mood.”

As a childbirth educator, or doula, do you encourage your clients to think about their expectations and be certain that they are realistic?

In my post on “Failing to Meet Your Own Expectations“, I offer some questions parents can ask themselves about their expectations for their parenting, and some ways to re-frame them to be sure they are attainable goals.

Support and Sanity Savers Handout

I’ve created so many resources over the years that I sometimes forget about some. I got an email today reminding me about this one I wrote back in 2003, with two other educators (Tawnya Ostrer and Jamie Olson)… I looked back and, you know, it’s pretty good! So, I updated it, and will share it here.

This is a handout to be used in a childbirth education class or with doula clients, which encourages expectant parents to plan ahead for practical support, emotional support, and peer support. It also includes a letter that they can give to friends or family members who ask how they can help.

Postpartum Support and Sanity Savers – PDF

Postpartum Support and Sanity Savers – Word (you are welcome to edit the document to substitute your local resources for the Seattle area resources I list. Otherwise, please use as written, with copyright info intact.)

And here’s a related handout to help them plan for a division of labor after birth: Baby Care Plan

Partner and Family Support for Breastfeeding

Today, I did a presentation on Partner and Family Support for Breastfeeding. Here’s a brief re-cap – and be sure to check out the handout linked from the bottom of the page!!

Research on how Partners and Family Members influence choices about whether to initiate breastfeeding and how long the baby is breastfed

• 2/3 of women have decided before pregnancy that they plan to breastfeed due to the influence of family, friends, health care providers and the media.
• 1/3 make the decision during pregnancy, and their strongest influences are: 1) care providers, 2) partners, 3) books and classes, 4) other key friends / family.
• A few months down the road when making decisions about how long to breastfeed, their partner, family and friends are much stronger influences than professionals
• An expectant parent is more likely to decide to breastfeed and to continue nursing if she believes that key people in her life are supportive of breastfeeding.
• The presence of a partner / father increases chance she will initiate BF. But if he then gets very involved in day-to-day baby care, her BF duration can actually go down, because he ends up taking over some of the feeds.
• Having an involved grandma sadly reduces the duration of breastfeeding, and can reduce initiation, especially if grandma didn’t breastfeed herself.
• However, research shows we can turn this around. If we engage in conversations with partners, and offer written materials targeted at partners and family and classes for them (especially peer led classes) which focus on the importance of breastfeeding, then it is more likely that she will initiate and continue breastfeeding.
• If those conversations / classes / materials ALSO include information telling the partner or family member that they play a huge role in her choices about breastfeeding, it is more likely she will initiate and continue.
• If those conversations / classes / materials ALSO give concrete ideas to the partner or family member about how to help support the breastfeeding relationship, she will nurse and nurse for even longer.

To read a whole powerpoint on the evidence surrounding influences on breastfeeding (and how we can influence them), click here  Influence Of Family On BF Choices.

Teaching Partners and Family Members how to effectively support a nursing parent to increase duration of breastfeeding:

Here are five key areas we can focus on:

• Increase Knowledge: Offer relevant, targeted, accessible info about the process of breastfeeding, with an emphasis on how to help with BF and concrete information about how to prevent, recognize, and treat BF challenges.
• Enhance Positive Attitude: Teach them all the benefits of BF – for baby, mom, the family, and the world. The more excited they are about breastfeeding, the harder they’ll work to make it happen. Openly and honestly address worries. Encourage family commitment to BF.
• Involve Them in Decision Making: Welcome their questions and input. Encourage them to help the breastfeeding parent do research and strategize.
• Encourage Practical Support: Teach them all the skills to care for everything baby needs (other than feeding) and to take care of baby’s things (pack diaper bag, do laundry, etc.). Encourage them to take care of the breastfeeding parent (feeding the mom so she can feed the baby), maintain the house (groceries, cleaning, cooking), and manage outside duties (pay bills, plan, make appointments, etc.)
• Encourage Emotional Support: Acknowledge partner’s emotional challenges. Encourage them to offer the breastfeeding parent their presence, appreciation, encouragement, affection.

To read a full powerpoint fleshing out these 5 key areas of breastfeeding support, click here: Teaching Family Support for Breastfeeding

Handout You Can Use:

One of the key points in much of the research is that nobody talks to partners about breastfeeding, and that it helps a lot if they are given targeted information that focuses on what the partner needs to know about: benefits of breastfeeding, how it works, how they can help if there are breastfeeding problems and how they can help in general. So, I’ve designed a handout for partners. It is yours to use, free of charge. You can print it, copy and distribute to partners. You can give clients links to it. Anything to help get partners the information they need to be effective supporters of the breastfeeding relationship.

Here’s the PDF of the color version, and here’s the black and white version .

 

Seeding and Feeding a Baby’s Microbiome

What is the microbiome?

The collection of bacteria, viruses, fungi, and other organisms that live in and on the body. We have about 10 trillion human cells in our bodies, and about 100 trillion microbes. We have evolved in tandem with this microbiome for thousands of years. The balance of microbiomes varies throughout our body, and the bacteria found in our mouths is different than on our skin, which is different than in our intestines.

Why does the microbiome matter?

• A balance of microbes leads to optimal health. An imbalance can lead to disease. For example, a vaginal yeast infection may occur when the healthy bacteria are reduced by antibiotics, allowing yeast to overgrow.
• Good bacteria can aid digestion, provide vitamins (K and B12), regulate the bowels, stimulate the development of the immune system, and protect against infection.
• An overgrowth of harmful bacteria can lead to infectious disease.
• Disruption of the gut microbiota has been linked to inflammatory bowel disease, diabetes, obesity, allergies, asthma, and some cancers.
• Many studies have shown that the presence of absence of specific microbes can cause life-long changes in immunity.

How does a baby’s microbiome develop?

• During pregnancy
  • In the past, the womb was believed to be a sterile environment. However, microbes are found in the placenta, amniotic fluid, and in meconium. (The waste that accumulates in the fetal bowels.)
  • Maternal fecal microbes have been found in the uterine environment, leading to hypotheses that microbes from throughout the body are transferred through the bloodstream. And from there into the placenta, then the umbilical cord and the amniotic fluid.
  • Placental microbes are similar to the microbes in the mother’s mouth – especially types of bacteria that aid in the metabolism of food.
  • Healthy bacteria may benefit baby. For example, if the mother lived or worked on a farm, that might protect against allergies and asthma.
  • Others worry that unhealthy bacteria may affect baby. For example, obese women tend to have abnormal gut microbiota. This may be transferred to the baby.
  • Maternal diet affects the baby. E. coli bacteria (an unhealthy bacteria) was less common amongst babies whose mothers ate primarily organic foods.
• At birth
  • During a vaginal birth, a baby is exposed to the microbes in mother’s vagina. In the third trimester, these are especially high in lactobacilli, which help the baby to digest milk.
  • When a baby is placed skin-to-skin on a parent, they are exposed to the parent’s skin microbiome. The baby’s skin, mouth, and digestive tract are “seeded” by whatever and whomever they first have contact with.
• Through feeding
  • Breastmilk exposes the baby to more microbes. Several are gut microbes that influence digestion.
  • Breastmilk contains sugars (oligosaccharides) which are not digestible by babies, and whose role appears to be to nourish / feed a healthy microbiome in baby’s gut. These are also referred to as prebiotics. By helping healthy bacteria to grow, there is less room for unhealthy bacteria.
  • When solid food is introduced, the microbiome begins to evolve to a more adult-like combination of microbes.
• Through the environment
  • As baby is held by various people, their microbiomes influence it.
  • As the baby starts to explore his world, crawling on the floor, playing outdoors, petting animals, and putting everything in his mouth, his microbiome shifts and evolves, becoming quite diverse by age 3. The “hygiene hypothesis” states that babies who are exposed to more symbiotic organisms have lower risks of asthma and allergies, and stronger immune systems.

What can interfere with the establishment of a healthy microbiome?

• During pregnancy and labor
  • Antibiotics given to mom can affect the mix of microbes in the placenta, amniotic fluid and vagina. This disrupted microbiome is inherited by the baby.
• At birth
  • Babies born by cesarean, and thus not exposed to vaginal bacteria, are at increased risk of asthma, allergies, obesity, diabetes, and celiac disease. Studies comparing the microbiomes of vaginally born babies with those born via cesarean have shown differences in their gut bacteria as much as seven years after delivery. (Salminen)
  • After cesarean birth, instead of skin-to-skin contact with the parents, the baby’s first exposures are to hospital bacteria and the bacteria of hospital staff. (Babies in NICU were found to be colonized by bacteria from the health care staff, from medical equipment, and from the counter-tops in the NICU. – Brooks)
• Newborn care
  • After any birth, if baby is wrapped in a blanket, and placed on a clothed parent, rather than skin-to-skin, the transfer of skin microbes is not complete.
  • Early baths remove / reduce protective vernix, vaginal microbiome, and baby’s own newly seeded skin microbiome. Those are replaced by hospital microbes.
  • If baby is given antibiotics, it reduces microbial diversity, and the number of both harmful and helpful bacteria. The impact lasts over 8 weeks. The longer the duration of antibiotics, the harder it is for the microbiome to recover. Early use of antibiotics, or prolonged use, can have long-term side effects, increasing risk of obesity or inflammatory bowel disease in later life.
• Feeding
  • Formula-fed babies (even those who just had short-term formula feeding in the first few days) had increased harmful bacteria and decreased helpful bacteria.

What can parents and health care providers do to foster a healthy microbiome?

• During pregnancy:
  • A mother can increase exposure to diverse healthy bacteria. Taking probiotic supplements may improve gut diversity (for mom and baby), may reduce gestational diabetes, and may reduce risk of allergy and eczema for the baby. (Research cited in Collado) You can eat probiotic foods which introduce healthy bacteria, such as fermented foods and foods with live cultures. And you can eat prebiotics – foods with oligosaccharides which feed healthy bacteria – see the list at the end of this article. (Reed)
  • Minimize exposure to unhealthy bacteria, such as food-borne illnesses.
• During pregnancy and labor: Minimize exposure to antibiotics. If they are needed, consider consuming probiotics or prebiotics after the course of antibiotics is complete.
• If baby will be delivered by cesarean, a baby’s initial seeding is from hospital bacteria and skin microbes rather than vaginal microbes. You can expose the baby to vaginal bacteria by swabbing. Although swabbing does not colonize the baby as well as vaginal birth, it helps. (Swabbed babies had twice as much maternal bacteria as babies who were born by cesarean but not swabbed. Babies who were born vaginally had six times as much maternal bacteria.) Here’s the process:
  • Sample mom’s vagina: make sure the mother is HIV-negative, strep-B negative, and has an acid, lactobacillus-dominated vagina.
  • Place sterile gauze in the mother’s vagina. Incubate gauze for one hour. Remove prior to surgery.
  • After birth, wipe baby’s mouth, face and hands with the gauze.
  • Note: If the caregiver will not do this procedure, the mother and partner can do it themselves.
• After birth, baby should go straight onto the mother’s body, skin-to-skin. (Consider bringing a blanket from home to cover baby, rather than using a hospital blanket.)
• In the first hours, encourage people other than the parents to look but not touch.
• Wait 24 hours after birth to bathe the baby.
• Feed baby only breastmilk for as long as possible.
• If a breastfeeding mother develops mastitis or a yeast infection, ask a lactation consultant about treatment with lactobacillus probiotics.
• Giving probiotics to a baby can treat antibiotic-induced diarrhea, prevent eczema, reduce colic symptoms, and possibly reduce obesity in later life. (Studies cited in Arrieta and Collado.)
• Let your child explore their world, with plenty of time outdoors, digging in gardens, and exposure to animals, both pets and animals at petting zoos.
• Offer your child diverse foods, including: fermented foods and foods with live cultures (Yogurt, buttermilk, sour cream, kefir, sauerkraut and other fermented vegetables, tempeh, miso, soy sauce, kimchi, dosas and sourdough breads, kombucha, etc.) and prebiotic foods that are high in oligosaccharides (onions, garlic, legumes,  asparagus, starchy vegetables like sweet potatoes, squash, turnips, parsnips, beets, and plantains)

Note: While many of those recommendations are supported by scientific research, not all have been adequately researched.

Here is a 2 page handout of this information to share with clients.

Sources:

• Aagard, et al (2014). The placenta harbors a unique microbiome. Science Translational Medicine. http://www.ncbi.nlm.nih.gov/pubmed/24848255
• Arrieta, MC, et al. 2014. The intestinal microbiome in early life: health and disease. Front Immunol. Sep
• 5; 5:427. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155789/
• Azad MB, et al. 2013. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. CMAJ. Mar 19;185(5):385‐94. http://www.cmaj.ca/content/185/5/385.long
• Brooks B, et al. 2014. Microbes in the neonatal intensive care unit resemble those found in the gut of premature infants. Microbiome. Jan 28;2(1):1. http://www.ncbi.nlm.nih.gov/pubmed/?term=Microbes+in+the+neonatal+intensive+care+unit+resemble+those+found+in+the+gut+of+premature+infants
• Canadian Medical Association Journal. (2013, February 11). Infant gut microbiota influenced by cesarean section and breastfeeding practices; may impact long‐term health. ScienceDaily. sciencedaily.com/releases/2013/02/130211134842.htm
• Collado, et al. (2012) Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes. 3(4): 352-365. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463493/
• Dominguez‐Bello MG. 2014. Restoring the Newborn Microbiota. Poster presentation American Society for Microbiology, Boston. (http://commonhealth.wbur.org/2014/06/birth‐canal‐bacteria‐c‐section)
• Grens, K. (2014). The maternal microbiome. The Scientist Magazine. 28(8), 46‐46.
  http://www.the‐scientist.com/?articles.view/articleNo/40038/title/The‐Maternal‐Microbiome/
• Kesser, C. L.Ac. (2014) What to do if you need to take antibiotics. (blog post) http://chriskresser.com/what-to-do-if-you-need-to-take-antibiotics/
• Salminen, et al. (2004) Influence of mode of delivery on gut microbiota composition in seven year old children. Gut. 53: 1388 – 1389. http://gut.bmj.com/content/53/9/1388.2.long
• Reed, Rachel, and Johnson-Cash, Jessie. (2015) The Human Microbiome: considerations for pregnancy, birth and early mothering (blog post) http://midwifethinking.com/2014/01/15/the-human-microbiome-considerations-for-pregnancy-birth-and-early-mothering/
• Silgalliss, Mara. (2015) Type of Birth Alters Baby’s Bacteria. (blog post) http://lactobacto.com/2015/01/09/type-of-birth-alters-babys-bacteria/
• Simkin, P. (2015) Maternity Care And The Microbiome: How Birth Practices Dictate Future Health. Conference presentation. http://www.goldmidwifery.com/pdf/handouts/2015/PennySimkin.pdf

To learn more about practically any topic related to the perinatal period, check out Pregnancy, Childbirth, and the Newborn: The Complete Guide.