When FC was a wee little sprout, he looked a bit like my grandma did when she had hepatitis. (An image that haunts me to this day – her eyes turned yellow. Yellow. Can you imagine what that did to my 5-year-old brain?) Yep, little FC was jaundiced, and since he wouldn’t latch after the first day in the hospital, we were given “permission” to supplement with a bit of formula.
Needless to say, this caused a lot of consternation for pro-breastfeeding Fearless Husband and me, but the prospect of not being released from the hospital was an incredibly persuasive argument in favor of formula. My PPD had already kicked in, and the cold, stale smell, white walls, and constant buzzing of machinery seemed unbearably eerie to me; I honestly believed that if I stayed there a moment longer, I would start screaming and never stop. (I’m thinking I may sign out against medical orders this time after 24 hours, as long as FC#2 gets the okay from our fabulous pediatrician. The idea of spending 48 hours in that hospital again is far scarier to me than the birth itself. I’d almost barter a med-free birth for the ability to be knocked out for the “recovery” period. And I’m a big fan of the epidural.)
So, we ended up letting the nurse feed FC a tiny bottle of formula. As I watched him guzzle the liquid down as if it were manna from heaven, my heart started thumping around my chest. The latching had been hard enough; what if he got nipple confusion now? I vowed that this would be the last bottle he’d take, at least until we had breastfeeding down, my supply leveled off, and he conquered the whole latch thing.
Cut to a week later, when one of our many lactation consultants encouraged me to exclusively pump as a solution to our problem (i.e., a child who couldn’t latch well, and who was incredibly hungry at this point). This was a life-saving suggestion, for both mother and baby – I finally felt that my breasts could do something productive, and my son started gaining weight like a champ. On MY MILK, no less!
But as the days went on, I started having trouble keeping up with FC. He was a voracious eater (I still think it’s because he was growth-restricted, and making up for lost calories on the outside, even though I have no medical evidence to back me up), and barely slept – my pumping schedule was every 2 hours, and took 40 minutes (20 minutes per breast) to get enough milk, which meant the most I could sleep was 90 minutes at any given time (and that was if my husband got up to give FC a bottle while I pumped – and I say if, because my husband, while lovely and amazing in so many ways, is a horse’s ass about waking up in the wee hours of the night - otherwise, I had to factor in a 30 minute feeding/burping in that time slot, as well). Between my postpartum issues and sleep deprivation, I was drowning. I convinced myself that one small bottle of formula a night wouldn’t hurt my baby, and we started supplementing. I could barely admit it to myself – when asked, I’d say we “occasionally” supplemented with formula, but very rarely, when in reality it was a nightly ritual. A ritual that ended up allowing me to give him breastmilk for the rest of the day, however, and even get “ahead” of him every now and then – that was the best feeling ever, seeing a nice, full bottle of expressed breastmilk in the fridge, knowing that it could hold my child over until I pumped again….I started fearing the formula a bit less every day, especially as nipple confusion was no longer an issue. FC was clearly confused from day one. Somehow, the instinctual knowledge all babies are supposed to have about suckling human breasts never made it to my son’s developing brain. Maybe he was out of the house when the intra-utero UPS tried to deliver that essential piece. Or perhaps our bottle-feeding culture has seeped into the collective consciousness?
I digress. The point is, while FC was still getting breastmilk, I supplemented with one bottle of formula a night. And I strongly believe that supplementing can be a girl’s best friend, especially if she has supply issues, needs to pump exclusively, or has to work full time where pumping is simply not convenient (like, say, in service industries like restaurants or Starbucks, where facilities other than a restroom are not physically available, and taking an additional 40 minutes of break time per shift can result in lost tips). Supplementing, or “combo feeding”, can allow you to keep breastfeeding while taking some of the pressure off. There’s a ton of conflicting advice out there on supplementation, though, so for those who are considering going in this direction, confusion probably abounds.
I’ve scoured the internet for the past few days, and everything I read seems to contradict the thing I read before it. Parenting Magazine’s August issue had a big feature on combo-feeding; it was pretty solid advice, so if you can get your hot little hands on a copy, I’d highly suggest it. It quotes Dr. Marianne Neifert, who is a great example of a strong breastfeeding advocate who still acknowledges that supply issues and breastfeeding setbacks are real, and not something mythical, like unicorns or the Tooth Fairy.
One of the more interesting things Dr. Neifert says in her book, Great Expectations: The Essential Guide to Breastfeeding, is that while many lactation professionals prefer alternate suppplemental feeding methods, like feeding baby with a cup, spoon, finger or supplemental nursing system (SNS), rather than a bottle), especially if breastfeeding hasn’t been successfully established, “cup feeding is the only alternative method that has been studied, and research shows no significant benefit of cup feeding over bottle-feeding in maintaing breastfeeding beyond hospital discharge”. She also explains that the babies who most often get nipple confusion are the ones who are not latching correctly or have mothers with compromised milk supplies. The logic here is clear – these babies aren’t getting what they need easily, and then a bottle comes along, and gives it to them with far less work involved on their parts. This information can be taken two ways: first, it kind of sucks, as the kids who could benefit the most from supplementing are the same ones with whom doing so could complicate the breastfeeding relationship in the future. On the other hand, it’s encouraging for moms who want to supplement just for their own sanity, or because work makes exclusive breastfeeding difficult.
Let’s clarify this a bit. If you are having breastfeeding problems like I was, then yes – nipple confusion is more of a concern. I don’t regret my decision to allow supplementation in the hospital, though, because ultimately, I believe the end results would have been the same. Dr. Neifert suggests that even babies who do develop nipple confusion can bounce back with a little effort of the mother’s part; I just heard from a chat room friend that her baby, who hadn’t latched for nearly 6 weeks, suddenly just started breastfeeding like a champ. We tried and tried, but it just never happened for us; I don’t think FC would have latched better if he hadn’t had that one measly bottle in the hospital. And according to this 1985 study from the official journal of the AAP, I’m probably right – the researchers found that “It thus appears that formula supplementation in the hospital is a marker, rather than a cause, of breast-feeding difficulty.” Kids are resilient, you know? But I am not a lactation consultant, so if you are truly concerned about causing further problems for yourself, I would call a reputable LC, pronto – don’t wait, because the earlier you get help, the better – and hold off on the supplementing until you feel secure about it. You don’t want to be blaming formula for your breastfeeding failure somewhere down the line. Trust me.
Lecture over… let’s move on to those without problems. Say your kiddo is latching like a champ – when can you start introducing formula? The issue here is establishing your supply. The more your baby nurses, the more milk your body (ideally) will produce, so if she is sucking on a bottle instead of your breasts, your supply might not meet her growing needs.
It comes down to your reasons for supplementing – is it because you need to go back to work? If this is the case, you might want to wait a month (see reference to BabyCenter’s advice below) before introducing formula; when you do start, just do one small – and I mean SMALL, like 2oz – bottle a day. This will get him used to the bottle and the taste of the formula. Now, I know some people might disagree with me on this one, and say to wait until the last possible moment to start supplementing, but I see a few inherent problems in this. Some babies get nipple confusion in the other direction – breastfed babies won’t take a bottle (I think FFF Megan has some firsthand experience with this, no?) If you’re going back to work after 12 weeks of maternity leave, things are gonna be relatively stressful as is; the last thing you want to be worrying about is if your baby will starve at daycare because he won’t take a bottle. If you’re concerned about supply, you could pump during that one formula-feeding session and store the milk you express; not only will you be giving your body the message that it needs to maintain its supply, but you’ll be getting a headstart on your milk stash for when you go back to work.
What if you just want to give one bottle of formula a night, so you can get a little sleep? Well, if you’re doing this because you think formula fed babies sleep better, think again. I wish that old wives’ tale was true, but, sadly, no. Also, if you’re pumping, be aware that some studies show that morning milk may keep babies up at night – so if you’re EPing, use freshly expressed evening milk before bed; or the evening bottle would be a good one to supplement with formula, if you’re heading in that direction. However, if you’re not co-sleeping (which usually makes for a situation where breastfeeding is easier than formula feeding, since all you have to do is roll over and let your baby latch on), and your husband can get up, go down the hall, and feed your little one once a night with a bottle of formula, then I do think it can allot you a little more sleep. If you’re going this route, according to BabyCenter’s medical advisory board, the best time to start is when your baby is around a month old.
(One small tip here – if you do want to use a bottle of formula at night, keep your supplies in your master or closest upstairs bathroom. We used to keep a jug of distilled water (recommended for the early months by our pediatrician), a can of formula, and a bottle, on our master bathroom vanity. That way, all we had to do is mix the stuff up and give it to FC, who was asleep in his cocoon sleeper next to our bed. As we got better at everything, we would pre-measure the water in the bottles, so all we had to do was add the appropriate scoops of formula. Done and done.)
I know many of you have asked for specific information on supplementing, but I can’t really give much, as most of the information I’ve found is incredibly biased (it all starts with the caveats about breastfeeding being best, and how you should avoid formula at all costs, etc, etc). Plus, I am not a physician, and I don’t think it’s appropriate for me to be doling out information that could potentially affect someone’s health. I will post some links at the end of this which offer advice without being too judgmental (those are hard to find, unfortunately), and hopefully these can answer more specific questions.
I think the important thing to remember is this: some breastmilk is better than none. If you are committed to exclusive breastfeeding, well, then you may not want to supplement – that’s kind of a no brainer, if you ask me. But if you are struggling, or just feel like combo-feeding might be a better option for you, I have to wonder if it’s really necessary to wait the requisite month before starting formula. Because if you only need your supply to be sufficient enough to feed your child for a few meals a day, what’s the problem with establishing that kind of supply right off the bat? I’d imagine that if you establish the supply of an exclusive breastfeeder, but are planning to supplement heavily with formula for whatever reason, you’d be setting yourself up for some pretty intense engorgement. (I suppose the argument could be that perhaps you wouldn’t have made up your mind about these things in the early days; maybe you’ll find that breastfeeding is easier than you expected, and decide to punt the supplementation altogether. I’m talking about the women who KNOW they are going to supplement, for their own personal reasons – why not help them do so? Otherwise, they might be less likely to breastfeed at all, which I assume is counterproductive to breastfeeding advocacy efforts.) I’m genuinely curious about this – if there are any lactation consultants, scientists or pediatricians out there who have an answer for me, please post it – I’d love to know the answer. I feel like there has to be a rational explanation, otherwise, why are we freaking women out about supplementing if supplementing is going to allow them to breastfeed, with the alternative being no breastfeeding at all?
Any answers? First one to give me one gets a big gold star.
Some good resources for supplementing info:
Supplementing With Formula (BabyCenter.com)
Formula Feeding FAQs: Supplementing (KidsHealth.org)
Yes, You Can Supplement: Breastfeeding with Bottles (Parenting.com)