Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.
Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.
Excuses, excuses. That’s all I’m good for lately. All I can say is that I have the utmost respect for all you full-time working moms out there. Keeping it all together with freelance/part time work was no biggie, but I’m full time temporarily and it is absolutely kicking my ass and taking names. Well, one name. Mine. I’m waving the white flag, and really, really want to return to only answering to bosses who I love and whose crap I don’t mind cleaning up.
Anyway – to get us back on track, here’s an incredible FFF Friday submission from Miriam, who blogs over at mommd.com‘s “Maternity Scrubs”. What makes me smile about this story is that the author found a way of feeding her baby which worked for her family, even though it took some creativity and open-mindedness to do so. Things do not need to be black and white, and it makes me sad to think that so many more women could find a more satisfactory and rewarding feeding experience if the experts didn’t insist on seeing the world like a giant checkerboard.
I mean, come on. If you’re gonna play a giant parlour game, play Giant Connect Four. Geesh.
Happy Friday, fearless ones…
My FFF saga, begins, like so many others, with a non-latching baby in the hospital and a milk supply that just never came in. There were many of the vaunted “booby traps” along the way- a pediatric nurse practitioner who told me I should only pump 4 times per day (with a non-latching baby?), woefully inadequate LC support in the hospital, a postpartum nurse who warned me that if I tried too hard to breastfeed, I’d just wind up with post-partum depression. The first week was serious hell. I kept waiting and waiting for my milk to come in, and pumping the tiniest drops of colostrum, which changed to milk with no appreciable increase in volume over a few days. I had the worst hospital pump in the world, the Ameda Lact-E, which looked like a refugee from 1970. The night we came home from the hospital, my mom was pushing the baby on me to latch every 3 hours while I desperately pumped and syringe-fed drops of colostrum. It wasn’t enough (is it ever?) and my son was seriously dehydrated and lethargic by the time we got him to the pediatrician the next morning. We were told to supplement, and my poor little dude could barely stay awake to finish a whole ounce from an Enfamil nursette. We had to keep waking him up during the feed by taking off his clothes and blowing on him. I felt, like so many other moms, like a complete failure, like my attempts to breastfeed were selfish.
Still, I was determined to make it work. My family was in town and everyone except me kept feeding the baby, totally ignoring my “breastfeeding friendly” bottle-feeding techniques I found on the internet and was trying to enforce. One family member even showed me how “if you poke the nipple in again, you can get him to finish the bottle!” Bottle-feeding FAIL!
Somewhere around day 11, with the help of a saintly local IBCLC, I got a nipple shield and a decent latch going on a consistent basis and thought, ok, great! I’m nursing now! No more supplementing, no more pumping, let’s just do this! And I settled in to nurse. I thought things were going great! The little dude seemed happy and satisfied, there were drops of milk in the nipple shield whenever he came off the breast, and he didn’t look dehydrated or lethargic like he was the first few days before we started supplementing. I happily and proudly bundled him up to go to lactation group on Thursday and measure his intake on the scale. I forgot the pre-feed weight that day, so I never knew what he got. Something, however, struck my IBCLC as not quite right, and she told me that she’d like me to come see her on Sunday, after a weekend of nursing on demand.
She weighed the little dude, then sat me down in her office with a feeding pillow and a comfy chair. I got out my shield and began to nurse my son. She came back 30 minutes later to re-weigh him and check his intake- the scale reading hadn’t changed. At all. He’d gotten absolutely nothing in 30 minutes of nursing. So here we were, two weeks postpartum, with no detectable milk transfer from nursing and no pumping at all for the last 6 days, during which I’d felt no engorgement or buildup of milk. I started to cry. I’d been starving my son! My feelings of guilt and remorse and shame at failing to lactate and failing to see my son’s distress overwhelmed me. I’d stopped supplementing (which, come to think of it, was pretty stupid to do without consulting a health professional), and the little dude hadn’t lost weight, but hadn’t gained anything either. My nipple shield turned out to have been too big as well, so he couldn’t pull milk out effectively. I didn’t know that there weren’t just supposed to be drops in the shield, it was supposed to be FULL of milk.
My IBCLC brought out a Symphony pump, which managed to extract 10 ml of milk total. I cried again. I knew I had to keep feeding my little dude by any means necessary, but I was also determined to keep nursing going as long as possibly could. I bought fancy bottles that were supposed to eliminate nipple confusion. I changed my status with WIC to “partially breastfed” and stocked up the kitchen with formula. (The breastfeeding advocates at WIC, for what its worth, were incredibly supportive of my mixed feeding and continued, throughout the year, to supply lavish support and praise and help along with cans of formula and breastfeeding advice.) I rented a Symphony and pumped 8 times per day. That next week was my last week of maternity leave before I had to return to medical school with a 3-week old baby, but I devoted the whole week to getting my milk supply off the ground in any way I could. I ordered domperidone and fenugreek and blessed thistle and goats rue and did breast compressions during pumping and nursing. And it even worked a little! I was up to 15 ml, then 20 ml, then a full ounce, once I increased my pumping sessions from 15 to 20 minutes. My son was getting plenty of formula but still seemed interested in nursing whenever we had time, and I tried to nurse as often as I’d pump.
I LOVED nursing my son. His latch issues were resolved and I even stopped having to use a nipple shield. I’d come home from school and we’d cuddle up and nurse for a good hour or more and I felt like I finally got what all the cozy bonding stuff people talk about nursing was all about.
Formula gave me a very special gift- being able to nurse my son without worrying about being his only source of food. And every day, I got to feed him a bottle of breast milk that I’d made! Still, I think about those early days and I just feel exhausted. I blogged elsewhere about the craziness of taking an eating-every-two-hours infant to a medical school library. I’d nurse him, then pump while I mixed up and fed him a bottle of formula, then change him and put him to sleep, then study for an hour while he slept, then he’d wake up and we’d do it all over again. I couldn’t go anywhere without my Symphony pump, lanolin, breastmilk bags, cleaning wipes, and a cooler. I had a special rabbinical dispensation to turn my pump on on Shabbat. I pumped everywhere and all the time- in class, in lab, while studying at Starbucks, (always under a flowered nursing cover). I was bound and determined to keep it going, because I loved nursing, and whatever benefits there were to breastmilk and to nursing, I wanted my son to have them as long as I could do it, even though I never made more than ⅓ of his caloric needs per day.
Around 6 months, when the little dude started solids, I gradually cut back on pumping. I wanted to be able to go out for an afternoon without strapping a 7-pound pump to my back. I had a new goal now- I wasn’t even trying to produce any significant proportion of my son’s nutrition, I just wanted to keep nursing, at some level. And I knew, because my son was mostly bottle-fed, that I had to keep pumping to do it. I cut back to 3 or 4 pumping sessions per day, so I was making a 6 oz bottle every other day, which still felt significant to me. Meanwhile my son was thriving. He was growing into a curious, active, crawly, reachy, grabby litte guy who only had the patience to nurse in the early morning and at night, when he was sure not to miss anything exciting. We did baby-led solids and he fed himself every variety of yummy healthy food like a champ. At 9 months, when I dropped to two pumpings per day, the pumped milk collected to about two bottles per week. At 11 months, I gradually stopped pumping altogether. We still nurse early morning and at night, but not every day, and I’ll keep it up as long as he’s still interested.
As we transition from bottles of formula to cow’s milk in a sippy cup, I guess I will no longer qualify as an FFF, but my experiences with being a fearless formula feeding mom, exclusive pumping mom, and nursing mom, all at once, have given me insight into the worlds of all three modalities of babyfeeding. Formula made my baby grow healthy and strong and always have enough to eat. Formula also made it possible to continue breastfeeding, with the help of a pump and meds.
Ready to take the leap and share your story? Email me at firstname.lastname@example.org. I’ll be your best friend. For realz.
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 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)