One of the crazy things about motherhood is that we often feel we have to choose a side. Natural birth or medicated? Helicopter parent or free ranger? Spoon-fed or baby-led? And let’s not forget: breast or bottle? When I had my first child, I fell squarely in the breast-only camp. If I wasn’t in the glider nursing him, I was on the sofa. In between feedings, I pumped and stored my milk so that he’d have enough when I returned to the world of business casual. Except he didn’t have enough. During my second week back at work (with my pump and cooler in tow), my son’s caregiver called, asking, “Do you have any formula? There doesn’t seem to be enough breast milk.” My stomach dropped. Tears fell. How could this be?
Looking back, I realize I wasn’t being “hormonal” or hard on myself. “Many women plan to exclusively breastfeed, but if they find themselves needing to supplement or add in formula, they are not really sure how to do both,” says Stephanie Nguyen, R.N., founder of Modern Milk, a breastfeeding clinic in Scottsdale, Arizona. And the health halo surrounding exclusive nursing can make women feel they shouldn’t consider other options. Well, I’m here to tell you there’s another way: Fifty-nine percent of new mothers opt for combination feeding—when Baby gets both breast milk and formula—reports the Centers for Disease Control and Prevention. Find out how using bottles can help you be the nursing mom you want to be.
Nurse at birth
Put your baby to your breast immediately after birth, and nurse her as much as you can. This will help her learn to feed properly while giving her colostrum, the immune-boosting, disease-fighting liquid that your breasts first release. This nursing practice during these first few days primes your breasts to produce milk. Every time you do it, the nerves in your breasts send a signal to your brain to release prolactin, the hormone that’s behind milk production. If you’re having a hard time at the hospital, speak up. Ask the nurses who come into your room to examine your latch. Don’t be shy! And get contact info for a lactation consultant to call, in case you have trouble later at home.
Before your milk comes in
Supplementing with formula during the first few days after delivery might help give you the confidence to nurse longer, according to a study in Pediatrics. Researchers had moms whose babies had lost about 5 to 10 percent of their birthweight (a typical amount to lose after delivery) either exclusively breastfeed their infant or top off Baby with 2 teaspoons of formula after every nursing session. Both groups did this until their milk came in.
Three months later, 79 percent of moms who had topped off their babies with formula after nursing were exclusively breastfeeding, compared with 42 percent of moms who only had nursed at the start. But sticking to just 2 teaspoons of formula appears to be the key: Another study found that the more formula given to a baby in the hospital, the less likely the mother would continue to breastfeed. “Less is always more when it comes to any early formula supplementation,” says Diane L. Spatz, Ph.D., R.N., a professor of perinatal nursing at the University of Pennsylvania School of Nursing, in Philadelphia. “If a newborn gets filled up on formula, he won’t wake and feed well at the next meal.” Since your milk production increases only in response to your baby’s demand, a negative cycle can begin. To stay on track, give just a bit of formula in those first few days after nursing.
Day 5 through 30
This is go time! It’s when you want to try really hard not to give your baby a bottle, so that the nerves in your body that promote breast-milk production get stimulated as much as possible. You can do it! How will you know you’ve made it? When your baby’s latch is comfortable for you, your nipples are no longer sore, your baby is gaining weight, and he’s producing five or six wet diapers a day. Basically, you’ll start to feel like you know what you’re doing. “If you begin trading a breastfeeding session for a bottle of formula before this point, your body may recalibrate its milk production and not make enough,” says Nguyen. The less milk your body makes, the slower the flow for your baby when nursing. If your supply continues to decrease, your baby may start refusing to nurse because he has to work hard for a small amount of milk.
Figure out pumping
Once your baby is about 4 weeks old you can start pumping, as your body is better at regulating your milk supply. Or, if breastfeeding is going well, you can put it off with no repercussions. There are no strict rules about pumping, but if you want your baby to have expressed breast milk when you’re back at work, start pumping about two to four weeks before your start date. Returning to work, though, is only one reason to pump. A survey conducted by Lansinoh, a company that sells nursing products, found that many women pump to have an in-case-of-emergency stash and to involve their partner in feedings.
Pump for five minutes after a good nursing session, or for about ten minutes if your baby didn’t nurse well or took only one breast. “Completely emptying the breast is important for getting out all the high-calorie milk that comes at the end of a feeding or pumping session,” explains Dr. Spatz. While pumping after any feed can help build your refrigerator supply, the most productive one is after your first a.m. nursing session, says pediatrician Tanya Altmann, M.D., author of What to Feed Your Baby. “Overnight, your levels of prolactin and oxytocin—the hormone that’s responsible for your letdown—are high, so you’ll generally have a lot more breast milk in the morning than in the afternoon.”
To maintain enough milk for your baby, you should pump whenever you miss a feeding session. Otherwise, your supply can decrease. However, as your baby gets older, a decreased supply may work in your favor. For instance, once an infant starts eating solids, some moms nix the pump and choose to nurse only in the morning and evening, while the baby gets bottles of formula and food the rest of the day.
Time the first bottle
Whether you plan to use breast milk or formula, introduce the bottle when your baby is between 4 and 6 weeks old. You have given your body time to build a strong supply, and your baby has become an expert nurser. “The physical action of breastfeeding is very different from the physical action of drinking from a bottle,” notes Dr. Spatz. “It’s not nipple confusion—I don’t like that term.” From the breast, Baby needs a deep latch to drink up the milk that flows from a nipple’s many showerhead-like ducts. Your baby first suckles quickly, to get the milk flowing, and then he slows into a rhythmic suckling pattern to empty your breast. With a bottle, he doesn’t need a deep latch, and the milk comes out at steady flow from start to finish. Essentially, drinking from a bottle takes a lot less effort. “Asking a baby to jump back and forth between two different suckling techniques can be tough for a newborn,” says Dr. Spatz. Waiting to introduce a bottle will reduce the risk of your baby getting frustrated with the breast.
The flip side is that if you wait too long to introduce a bottle, your baby might reject it, preferring the comfort and familiarity of nursing. “I see a lot of moms who don’t offer their baby a bottle until between 2 and 4 months old, says Dr. Altmann. “Then, when the mom goes back to work, the baby goes on a bottle strike.” (This happened to me. It wasn’t pretty.) Instead, give your baby a bottle once a day, starting by 6 weeks. “Even if you’re not going back to a job, I still recommend it,” Dr. Altmann says. “Families often need that flexibility.”
Compared to breastfeeding, bottle-feeding sessions are lightning fast. It takes most babies about five minutes to down a bottle, compared to 10 to 40 minutes to finish nursing. “To slow down bottle feedings so your baby doesn’t start to prefer them, hold him upright instead of cradling him, and keep the bottle almost horizontal to the floor to reduce the fast flow. Look for bottles with a soft, wide-based nipple (to resemble the breast), which promotes an extra-slow flow. If you can, have another caregiver or loved one do the deed, for the obvious reasons that you’ll get a break while allowing someone else to experience the pleasure of feeding a baby. Plus, your baby won’t be expecting to be nursed if he’s not in your arms.
At first, offer a bottle when your baby isn’t super hungry, about an hour or two after a regular feeding. “If your baby is starving, she’s going to be in no mood to try something new,” says Nguyen. And only give about half an ounce to start. After the first few successful bottle feeds, offer the bottle at the same time of day, specifically when you expect to be gone—you know, doing that work thing you do to pay the bills. Finally, you may have heard not to mix breast milk and formula in the same bottle. But there’s no medical or health reason why you can’t, says Dr. Altmann. Expressed breast milk is so precious—you worked so hard to pump it and store it—that it’s unfortunate to waste if your baby doesn’t finish a mixed bottle and you have to throw it out. “If you’re confident Baby will drink it all up, go ahead and mix them,” she says.
In the end, being flexible with whatever feeding challenges come your way will help you the most, whether you combo-feed or nurse exclusively. And it’s okay if what you were planning to do turns out not to be what you want after your little bundle arrives.
Me? After I got over the shock and disappointment of my own foray into exclusive breastfeeding, I bought formula. I continued to listen to the hum and suck of my breast pump until my baby’s first birthday. I nursed him every morning, every evening, and every weekend for a year. And when my second son was born, I did the same thing. Except I had a larger supply of breast milk in my freezer when I returned to work. And the formula was there, ready to go. What wasn’t there? My guilt.