There’s a lot of pressure to breastfeed but not nearly enough conversation about what to do when it doesn’t go as planned.

In this honest and compassionate episode, Dr. Mona sits down with lactation counselor and mom of two Kaia Lacey to talk about low milk supply, combo feeding, and the emotional weight of unrealistic feeding expectations. Whether you’ve struggled with supply, felt shamed for using formula, or wondered if you’re the only one doing “a little of both,” this one’s for you.

They cover:

• The difference between primary and secondary low milk supply

• What IGT (insufficient glandular tissue) is and how it’s often missed

• Why combo feeding isn’t a failure—it’s a valid, supported choice

• How internalized “breast is best” messages can lead to shame and burnout

• What parents really need: support, diagnosis, and honest information

Our podcasts are also now on YouTube. If you prefer a video podcast with closed captioning, check us out there and⁠ ⁠subscribe to PedsDocTalk⁠⁠.

Get trusted pediatric advice, relatable parenting insights, and evidence-based tips delivered straight to your inbox—join thousands of parents who rely on the PDT newsletter to stay informed, supported, and confident.⁠ ⁠⁠⁠⁠Join the newsletter⁠⁠⁠⁠⁠!

And don’t forget to follow⁠ ⁠⁠⁠⁠@pedsdoctalkpodcast⁠⁠⁠⁠⁠ on Instagram—our new space just for parents looking for real talk and real support.

We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on the⁠ ⁠PedsDocTalk Podcast Sponsorships⁠⁠ page of the website. 

00;00;00;02 – 00;00;29;10

Dr. Mona

I’m Doctor Mona and this is the follow up. Where we revisit past episodes in less time than it takes to explain to your judgmental mother in law or friend that your milk supply isn’t low because you’re not trying hard enough, but because, well, physiology exists. I’m rereleasing this episode in honor of National Breastfeeding Month and especially World Breastfeeding Week, which runs August 1st to the seventh to remind all of us that no feeding journey looks the same.

 

00;00;29;12 – 00;00;58;23

Dr. Mona

Even within breastfeeding, comparison can quietly chip away at confidence, especially when we’re not talking about realities like true low milk supply. In this episode, I’m joined by Kaia Lacy, a certified lactation counselor partner of the Low Milk Supply Foundation and mom of two. We break down the difference between primary and secondary low milk supply, how misconceptions around breastfeeding can harm parents, and why combo feeding can be a valid, supported choice and not a fallback.

 

00;00;58;25 – 00;01;19;11

Dr. Mona

If this episode resonates, hit subscribe and download and download all of your favorite episodes, because that is one small way we can push back against shame and help. Real stories from this podcast reach more parents who need them the most. Let’s get into it.

 

00;01;19;13 – 00;01;47;22

Kai Lacey

I hear so many times I wish that I had learned about this before the baby, or someone had told me so much earlier I didn’t even know that combo feeding existed. And in reality, it is actually more common for families to be combo feeding in those 6 to 12 months. Then to not be combo feeding. So this is kind of I like to say it’s like the breast feeder skeleton in the closet, like a lot of people are doing it, but we’re pretending that it doesn’t happen.

 

00;01;47;25 – 00;02;18;19

Kai Lacey

And when we don’t have those conversations like, yes, as you well know, as I know, a lot of the brunt of that then falls on parents to try and DIY their experience to kind of figure it out, because instead of, you know, engaging in productive conversations and education, it’s kind of like an abstinence only approach where really a lot of different providers are really promoting exclusive breastfeeding as the goal without educating on other options.

 

00;02;18;19 – 00;02;26;27

Kai Lacey

And so when we can’t, you know, rise to the occasion and accomplish that goal, it leaves us feeling kind of like failures.

 

00;02;26;29 – 00;02;44;29

Dr. Mona

Oh, and you said it perfectly like that impacted obviously. Or you said it’s a perfect recipe for postpartum depression. I mean, I see this commonly like the first thing that we’re supposed to quote unquote, do as a mother, which is feed your baby. And when you’re not able to do it in the way that you’re being told to do it, correct, like, oh, you need to breastfeed.

 

00;02;44;29 – 00;02;55;24

Dr. Mona

Okay, well, it’s not working. It’s not I’m not producing whatever it is. It makes you feel like you said, like this is the first thing that you’re supposed to do as a parent. And when you’re it’s not happening and it’s it is a recipe for feeling like a failure when you’re not a failure.

 

00;02;55;29 – 00;03;21;27

Kai Lacey

Yeah. And you know that anti formula rhetoric or the attitudes that really do vilify formula, they do truly exist. And it’s more prevalent in some communities and others. But for me that was a huge factor in, you know, my breastfeeding grief was that I had really been inundated to believe that formula was poison. You know, good mothers breastfeed, good mothers don’t give their children formula.

 

00;03;21;27 – 00;03;48;26

Kai Lacey

It was all these internalized stigmas that I really, really struggled to navigate after I was faced with the fact that I had to give my baby formula and yeah, it’s something that I wish we were able to have these conversations where there wasn’t such a polarity between the formula. You know, we know that breast milk is wonderful, and in a perfect world, every child would have breast milk.

 

00;03;48;28 – 00;04;18;12

Kai Lacey

Unfortunately, we do not live in some sort of utopia where biological diversity and access to support or mental health is just like beaming with rainbows. Like this is just not reality, right? So because we don’t live in that, you know, perfect utopia, we have to talk about what makes the most sense. You know, a lot of people approach this conversation from a nutrition perspective and leave out the fact that we’re human beings.

 

00;04;18;12 – 00;04;35;02

Kai Lacey

We are not robots. We’re not just mechanical beings that are able to accomplish these things just because, you know, they might be ideal in certain parameters, right? But there’s a whole puzzle here that I feel like oftentimes we just leave the nuance out of this conversation.

 

00;04;35;04 – 00;04;52;12

Dr. Mona

I think there’s a lot of stigma. There’s a lot of just confusion. And that confusion does not help anybody, especially the baby and the person who’s feeding them or the people who are feeding them. So I think it’s an important conversation. Like, is there anything else that, you know, any other misconceptions about breastfeeding that you feel impacted your journey early on?

 

00;04;52;15 – 00;05;15;01

Kai Lacey

Well, you know, I think the majority of the misconceptions really associated feeding with morality for me. You know good mothers breastfeed. It’s you know if you want it it will work. And a lot of that aside from those kind of emotional manipulative like not a great approach. You know we want to inspire parents but that’s just not the way to do it.

 

00;05;15;07 – 00;05;33;27

Kai Lacey

And those things just aren’t entirely true. You know, there’s this misnomer that formula will ruin breast feeding. And that was a huge one for me. You know, I felt pressure any time I was giving Carl formula, I thought, well, this is just I’m ruining breastfeeding. Every bottle I give him, my supply will go down. And that’s not necessarily true.

 

00;05;33;28 – 00;06;08;08

Kai Lacey

You know, it’s more so. It’s not the formula that complicates a nursing relationship or a breastfeeding relationship. Whether you’re pumping or nursing. It’s really that there is such a lack of access and education on how to incorporate formula or donor milk into feeding while sustaining lactation. And so instead of just giving parents the tools to learn about, you know, certain techniques or practices or even giving them info about lactation physiology, that could really come in handy while you’re doing these things.

 

00;06;08;08 – 00;06;28;07

Kai Lacey

We just say formula is going to ruin breastfeeding. You know, if you supplement, it’s going to ruin breastfeeding. And that’s just not true at all. You know, I’ve seen that in my own life. You know, I have insufficient glandular tissue. After my second childbirth I produced around, I don’t know, 10 to 12oz a day. And I combo fed her from birth through the first year.

 

00;06;28;09 – 00;06;46;28

Kai Lacey

And she is three years old and she is still breastfeeding. And so, you know, when people say formula One’s breastfeeding, I’m like, Here’s exhibit A, you’re not. That’s just incorrect. It’s not true. It’s not the formula. It’s the absolute lack of information. Yeah. It’s just it’s not true. It’s a big misconception.

 

00;06;47;01 – 00;07;07;05

Dr. Mona

Yeah. And it’s again, it’s lack of maybe the people who are giving the advice don’t have the education or have bias behind it. So they don’t know that it actually is a possibility. I do a lot of combo feeding education in my practice. It’s just I’ve realized how beneficial it can be for many women who maybe whether they have IGT or whether they just have unnaturally low breast milk suppliers.

 

00;07;07;10 – 00;07;25;03

Dr. Mona

It is something that I’ve seen as a vehicle, like you said, of helping them get to breastfeeding. And like I said, some of them, they do not want to continue breastfeeding. And I’m happy to support them on that too. Right. But it is an awesome option. Now with your IGT, you got diagnosed with that or you found out you had that with your older son.

 

00;07;25;05 – 00;07;45;18

Kai Lacey

Yeah. With Carl. So intuition glandular tissue is, you know, when you think all the milk that we can make, we all have our individual milk storage capacity. Right. So the breasts have these cells inside of them. And that’s kind of what dictates how much milk you can make. So milk storage capacity is going to be the largest yield of make a person can ever have at one time.

 

00;07;45;18 – 00;08;08;19

Kai Lacey

It’s the largest amount of milk that you can hold inside the breast. So for older suppliers their milk storage capacity may be eight ounces nine ounces. It can be as big as like 16 17oz per breast, which blows my mind. Yeah. And an exclusively breastfeeding dyads. That milk storage capacity may be as small as 2.5 to 5oz per breast.

 

00;08;08;19 – 00;08;31;04

Kai Lacey

So with insufficient glandular tissue you have a milk storage capacity that is below that threshold. It’s really hard to even identify what your milk storage capacity is. But a lot of times, you know, we can find it by accident if we’re frequently nursing or pumping and maybe baby has missed a feed overnight and we wake up in the morning and pump.

 

00;08;31;06 – 00;08;57;15

Kai Lacey

Sometimes that can give us an idea that our milk storage capacity is there or larger than that. So with IGT you may have a milk storage capacity of one ounce per breast. And so you have a smaller volume of lobular tissue or the cells inside your breast that make breast milk. Right. So the issue with IGT is that it is not well understood.

 

00;08;57;15 – 00;09;29;18

Kai Lacey

The majority of research that has been conducted on IGT and even low milk supply causes, a lot of it has happened within the last 10 to 12 years. And as you all know, there’s a huge gap in when research is implemented into curriculum, whether provider curriculum or elsewhere. And so when I presented with symptoms of IGT that were very apparent to someone who knows about IGT, that was overlooked because the providers I worked with just weren’t aware of it.

 

00;09;29;20 – 00;09;56;19

Kai Lacey

So it took until my six week postpartum appointment where I had a midwife, actually a nurse practitioner, who was able to identify that I had IgG through blood test to rule out any other conditions, but also through some physical features. You know, hyperplastic breasts is one physical feature that’s more prominent with IgG. And I also had no breast changes in pregnancy or postpartum.

 

00;09;56;19 – 00;10;18;28

Kai Lacey

And those are kind of red flags for IGT that were very much so overlooked. Had I known about that, you know, 2 or 3 weeks postpartum, it may have changed the trajectory of feeding, but because I was just told, you know, keep pumping, take some moringa and you’ll be able to make enough milk. Yeah, it really damaged my view of breastfeeding.

 

00;10;18;28 – 00;10;44;11

Kai Lacey

It damaged my ability to bond with my child. And it was really a negative experience. So getting parents these diagnoses is important. Helping them to understand why they may be struggling is important because at the end of the day, so many of us are going to blame ourselves when truly it is a biological physiological condition.

 

00;10;44;14 – 00;11;05;24

Dr. Mona

And that’s your follow up. Just a small dose of the real, relatable and eye opening conversations we love to have here. If you smiled, nodded, or had an moment, go ahead and download, follow and share this episode with a friend. Let’s grow this village together for more everyday parenting wins and real talk. Hang out with us on Instagram at the PedsDocTalk podcast.

 

00;11;06;01 – 00;11;21;13

Dr. Mona

Want more? Dive into the full episode and more at PedsDocTalk.com. Because parenting is better with support. And remember, consistency is key. Humor is medicine and follow ups are everything. I’m Doctor Mona. See you next time for your next dose.