The Ordinary Doula Podcast

E81: Is My Baby Getting Enough? A Lactation Expert Explains

• Angie Rosier • Episode 81

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Lactation Consultant Angie Rosier shares insights about baby weight gain and how to know if your baby is getting enough milk. Many parents prepare extensively for labor but overlook preparing for breastfeeding, which generally lasts much longer than the birth experience.

• Newborn stomachs are tiny—marble-sized on day one, growing to walnut-sized by day three
• Weight loss up to 10% is normal for newborns in the first days
• Babies consume approximately 24 ounces daily for the first 16 weeks
• Healthy weight gain is typically one ounce per day during the first four months
• At 16 weeks, babies' metabolism changes and weight gain slows to about half an ounce daily
• Three ways to know baby is getting enough: weight gain, diaper output, and arm relaxation
• Feeding patterns evolve from many small feedings to fewer larger feedings
• Seek support and education to prepare for your breastfeeding journey

Thank you for listening to The Ordinary Doula Podcast. Make a human connection today—digitally or in person—through a touch, eye contact, a smile, or a message, and make a difference in someone else's life.


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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Speaker 1:

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2:

Hello and welcome to the Ordinary Doula Podcast. My name is Angie Rozier, I'm your host and I am so glad to be with you here today. So I want to take I know this is called the Ordinary Doula Podcast, but I'm also a lactation consultant. I'm an IBCLC. I work in a couple of local hospitals. I live in the Salt Lake City, utah area and do private lactation as well. So I'm seeing people right after their babies are born in the coming days, like day one, day two, day three, in hospital, and then I'm seeing people privately in their homes anywhere from I don't know the first day home from the hospital to months afterwards.

Speaker 2:

So the breastfeeding journey, as I've been reminded by clients even this very day, is much longer than labor is right. So a lot of times people, well, as a culture, we're really kind of programmed to do some pretty decent preparation for labor, birth delivery and that's a. You know it's a very pivotal experience, but it's also relatively short, like that will be over within one calendar day, maybe two, maybe three. But then we have all these days, weeks, months of breastfeeding or infant feeding. You know for bottle feeding afterwards that we do not usually give as much preparation to. So I had a few lactation visits today in people's homes and a couple of the people I'd had three visits and two out of three said you know what. I did not prepare for this, like I just thought this would be great, I thought it would be fine, I thought it would go well. I prepared really well for birth. That's done over and gone and now I'm doing all this work day after day on lactation. So I want to just talk about that a little bit and it definitely deserves some attention and preparation.

Speaker 2:

So I want to talk specifically in this episode about baby weight gain. So a big pressure that parents feel after that baby's born and we come home is like is this baby getting enough right? Are they eating enough? Are they going to be able to gain weight? And we watch that really closely in the beginning and as time goes by we can be a little more lenient on things, of course. But I want to talk about those first days and weeks and how we can know babies are getting enough.

Speaker 2:

So there are growth charts, right, there's some growth charts put out by the world health organization, the cdc. They each have a slightly different one for different ages of babies. If we were to really get into the details of things, we would have one chart for breastfed babies exclusively breastfed babies and a different chart for formula fed babies, because they are a little bit different. The, the gains are a little bit different, the trajectory that we see is a little bit different. We don't differentiate that necessarily when you go to your pediatrician. They don't look at it by the chart. We have one general chart, so keep that in mind as well.

Speaker 2:

Depending on how you're feeding, your baby might be not totally, totally accurate to these growth charts. And these growth charts are averages. If you've ever seen one they have like average. They have some outliers. You know, babies who are born very small are going to be on the low end. Of course. Babies who are born large are going to be on the higher end. They may start in a different place. Then they kind of get to the baby born big we call LGA large for gestational age might end up on a regular curve in time. A baby that's SGA small for gestational age might end up on a regular curve at some point or they might just kind of stay on that SGA curve. So there's a lot of things to look at, to consider with that. That's something you generally will do with your pediatrician or a lactation consultant, if you're checking weight gains with a lactation consultant. So let's say, a baby's born, hopefully we know that their intake levels are very small in the beginning.

Speaker 2:

Their stomachs are the size of a marble on day one and they work up to be the size of about a walnut or a ping pong ball by about day three. That third day is when we generally expect the milk to come in. Sometimes it's day four or day five, but generally it's day three is what we can look for, and their stomach has done a lot of growing and changing in that amount of time. So as I work in the hospital, so so so many times as I'm going into rooms on day one, two, three people say my baby's not getting enough, there's not enough, I'm not making enough milk and it's true Like there's not very much because their meals are so tiny. At that point, with that tiny tummy, there's not a lot of colostrum. The babies don't need a lot of colostrum, so it all works out. But we need to understand that and trust that and we watch the weight gains is one of the things. I'll talk about. A couple other key indicators that can help us to know if babies are getting enough. But meals on that first day are two to 10 milliliters. That is tiny, tiny. Second day we've got five to 20 milliliters, you know, we're like half an ounce. Maybe by the third day, when your milk comes in, we're 10 to 30 milliliters. That's one third to one whole ounce per feed. Right, this is per feed. So it takes a while for babies to kind of ramp up and get their volumes higher.

Speaker 2:

So most babies, almost all babies, are going to have some kind of weight loss in the beginning. And it's small, right. These babies come pretty small as far as human beings go, and they it's very normal to have some weight loss. I'd say it's incredibly rare, for baby has no weight loss. But babies are born with what we call brown fat. They put that brown fat on in the last three to four weeks of pregnancy. They're gaining about a half a pound a week in utero. So that's like eight ounces a week sorry, eight ounces a week, about an ounce a day in average that they're going to be gaining in those last three to four weeks. And that's brown fat, not the color brown, but it's a fat that has some high energy stores for them that they're going to need in those coming days before the milk comes in. So babies are going to kind of lean on that, those fat stores, and as those get depleted and used up by their body as they should, they might have a weight loss.

Speaker 2:

So a hospital generally will weigh the baby, usually once a day, right, and if different hospitals they might like we weigh all our babies at midnight or whatever the case may be. So you're going to have some weight checks in the hospital and a discharge weight. So mom's going home, she's been discharged from the hospital, they'll get a weight check there and then you see a pediatrician within a few days, right, hopefully within a few days of going home, you're going to see a pediatrician. We'll also do a weight check there and that's how we kind of check those weight gains. Now, up to 10% loss is normal, right. So if we have a 10 pound baby, that's a one pound loss. So that's normal.

Speaker 2:

If it's creeping up to be seven, eight, 9%, those who are interested, that would be your nurses in, you know, the postpartum or mother baby unit. That would be your pediatrician, your lactation consultant. They're going to take notice of that and they're going to want to be very cautious about that, that the weight gain doesn't creep up. 10 is normal, but we're watching it. We're watching it pretty closely at that point and after that milk comes in, that baby's tummy is can hold more volume. There is more volume coming from the breast. So all of that works out. It's a nice system. So once mom gets, the mom gets to full milk production, which you know it takes a few days for the milk to totally transition to what we call mature milk Babies are going to work up to.

Speaker 2:

It's not immediate but it takes, you know, a good week, week and a half. They're going to work up to their daily intake, which is going to be about 24 ounces a day, about 24 ounces a day. Now if we're just breastfeeding or we're combo feeding or we're pumping and doing some bottle feeding, we might not have a super accurate assessment of the baby's actual intake by the day. If we're bottle feeding or pumping and bottle feeding, we are going to be able to get that accurate. We can easily track how much is going in from a bottle, from the breast. Not as easy to track we're more tracking time than we are amount not as easy to track. We're more tracking time than we are amount, but if we were to be tracking it we would know that babies are taking in on average about 24 ounces a day once they get up to full milk supply and that rate sticks around for 16 weeks. So babies are going to intake 24 ounces a day, some up to 30 if we have our big eaters. Some might be a little bit less, but we're looking at about an average of 24 ounces a day.

Speaker 2:

And then their weight gains. What babies are going to be gaining by weight is also going to be pretty predictable for 16 weeks. So four months, 16 weeks, is a pretty good marker for some of these things. So we expect babies to be gaining one ounce a day for those first 16 weeks. So that's about, you know, half a pound a week. Basically is what they're going to be gaining kind of what they were doing in utero before they were born.

Speaker 2:

So as you work with, if you work with a lactation consultant, that's kind of what they'll be watching for. If you know, if you're working closely with a pediatrician and you don't see your pediatrician crazy often, usually it's like what? Day three or four and then maybe week two and then one month. So we've seen three times in that first month and then two months, four months. So we're not doing regular weight checks. However, if you work with a lactation consultant, we do home visits. Of course we can do those weighted feeds, check on baby's weight gains over time. And the older a baby gets, the better data we have right, because we're always dealing with a loss well, almost always dealing with a weight small weight loss in the beginning. Over time we get more data that gets more accurate so we can kind of assess oh yeah, this baby's gaining one and a half ounces a day or this baby's 0.75 ounces a day.

Speaker 2:

There is a range of normal that we look for. Some babies will be on the low side of gains, where they're gaining like half an ounce a day. I watch those babies very closely. Other babies are going to be on the high gainers. I've seen over two ounces a day, for some of our chunky monkeys are gaining quite quickly. But again, the standard on the average is one ounce a day. I have noticed in my life maybe you have two, maybe this happens to you.

Speaker 2:

In my practice, both as a doula and as a lactation consultant, the things often happen in threes, like we're working in. I don't know why this law of threes all the time, but I have had this week I had three visits on one day and all those babies were slow gainers. So they were like, I think, 0.47, 0.52 and 0.49 ounces a day and they were, you know, their ages ranged from like a couple of weeks to almost a month old. So I worry about those babies a little bit. That is in a range of normal, but it's a range of normal that I'm going to watch pretty closely, so doing some pretty close follow-up with those moms. So again, the numbers are gaining one ounce a day, intaking 24 ounces a day, keeping one, and that lasts for 16 weeks. Now, a cool thing about that 24 ounces a day, while that remains for four months.

Speaker 2:

The math around the 24 ounces a day changes quite a bit. In the beginning babies are having very small meals many times a day. So we might have up to 12 feedings a day, maybe they're two ounces each. Those are lots of little meals when their tummy is small and they're burning through that food pretty quickly. Breast milk is like high octane fuel for babies and they're going to burn through those little meals pretty quickly. So to get to our 24 ounces, we might have about two ounces a time, 12 times.

Speaker 2:

Right Now, when we're bottle feeding a baby, we can give pretty measured amounts that are consistent with every feed, and when a baby's breastfeeding the amounts are going to fluctuate. We don't always know that, nor do we care, we just kind of trust it. But their amounts are not going to be the same all the time. But we can say an average of two ounces a time, 12 times a day. That would get us to 24 ounces and then in time the babies are going to take more food and they actually take it more quickly, which is great. They get more efficient. So maybe they're getting two and a half ounces a day, 10 times a day. Sorry, two and a half ounces per feed, 10 times a day, and that gets them to the 24 about 24 ounces a day. Then maybe they work up to three ounces.

Speaker 2:

A lot of babies plateau at three ounces for a while. So maybe they drop a couple of feeds and they're taking three ounces a time, but we're only feeding them like nine times a day and then we're going to take a little bit more. They're going to work up to three and a half four ounces at a time, but maybe we're doing that seven times a day. So the math around the 24 ounces changes over time, but they're always taking about that until 16 weeks, and at 16 weeks they some things change in their metabolism. Babies will drop their gains. Instead of gaining an ounce a day, they drop. That about in half is what we can expect. So they're getting more mobile. At this time they're working up to you know, preparing for solid foods in the next couple of months probably, and their weight gains drop from seven, eight ounces a week to three to four ounces a week. They get a little bit more mobile and so their food changes and of course the breast milk is always changing at that time as well, right, which is pretty fascinating.

Speaker 2:

So ways to know that babies are getting enough is weight gains. That's what we've been talking about in this episode. We can also know by output. That would be peas and poops. If they've got stuff coming out, they've got stuff going in, and then also their little upper arm. I call this a fullness lever. Babies will usually start out their feeds pretty tight, like tight fist, tight elbow, and as our little belly fills up that wrist and that hand loosens up, the fingers open up, the hand becomes soft. That whole arm will become much softer. So, parents, you can test that as a little fullness lever on top, so when that's a wet noodle you can just pick it up and drop it. There's no tone left in it. The baby's pretty satiated. We can anticipate that their belly is kind of full. So that's a quick little ditty on baby weight gains.

Speaker 2:

A lot of parents, we feel a lot of pressure about this, right Like we have this massive responsibility to take care of this baby and keep them alive, right, and we're like it feels like a lot of pressure, especially at three in the morning, and we might be recovering from labor, from delivery maybe it was a surgical delivery. There's a lot going on as we move into that breastfeeding timeframe. So please do a little preparation for yourself. Understand what's normal as you work into the much longer phase of breastfeeding your baby after you've given birth to your baby. It's a pretty incredible journey. We hope it's positive for people I've seen, you know, as I work with different people with a variety of challenges, and it's interesting how challenges are totally opposite sometimes. Right Like we can have folks with you know, fussy babies or super chill babies, and both of those are challenges. We can't get them to eat, we can't get them to stop. We have an oversupply, we have an undersupply, like there's challenges that people face and there's combinations of challenges. So seek support, gain education and preparation so that you can feel that you have the tools that you need as you move into this journey. That is as long as you want it to be right, whether it's a few weeks you're working on this, or a few months or years. Hopefully your breastfeeding journey can be supported along the way.

Speaker 2:

Thank you so much for being with me here today on the Ordinary Bedula podcast. This is Angie Roser, your host, signing off, and, as always, I encourage you to reach out Someone you know or someone you don't. Make a human connection today. Make it digitally, make it in person, make it a touch, make it eye contact, a smile, a message, whatever that might be. Reach out and make a difference in someone else's life. Hope you have a good one and we'll see you next time.

Speaker 1:

Thank you for listening to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.