Newsletter #48:Why Formula is not the Answer for Struggling Breastfeeding Mothers

By BMSG Editorial Team

If you have been on the BMSG’s private Facebook support group, you might have seen our advisory to members not to recommend formula feeding in their comments and replies to mothers who post on the group. Perhaps you’re wondering – what’s up with that stand, and why? 

Typically, recommendations to give formula are quite common in threads which talk about a drop in milk supply or when mums are unable to match the amounts that their babies drink in a bottle. 

The BMSG’s stand is that formula feeding should only be an option where medically indicated. This may mean that a mother has a medical condition that renders her too unwell to feed her baby, or that human milk donations are not readily available. There can also be situations where both the mother and baby are warded in the Intensive Care Unit (ICU) and are unable to establish a breastfeeding relationship.

Echoing the Stand of the WHO

The stand that we follow is in line with the World Health Organization’s hierarchy of infant feeding. A mother’s own milk is naturally the top priority, but it may surprise you that donor milk from another mother is the second best option, whether it has been expressed or if baby is nursed directly from another lactating woman. This may seem foreign to us urban dwellers in (almost) squeaky clean Singapore, but if we think about the lack of clean water and sanitation in some environments and situations, it is clear what is the obvious and, often, the life-saving choice.

(For those who seek donor milk or who wants to donate excess milk, you can do a shout-out at our Facebook private group, or at the Human Milk 4 Human Babies Singapore public Facebook page.)

The truth of the matter is that although we do have access to clean water, breastfeeding is something that we need to preserve especially when a breastfeeding mother seeks support. In our comfortable lives, it  can be convenient for us to reach out for infant formula when breastfeeding challenges arise. However, there are a few reasons why providing formula may not be the best way to get over a breastfeeding challenge.

Feeding a breastfed baby with formula milk in a bottle can make a baby too full to latch from mum. [Stock Photo]
  1. Giving formula can make baby too full to latch on mummy’s breasts

    When a new mother is just starting out with breastfeeding, the apparent low milk volume is often easily mistaken for milk insufficiency or “low milk supply”. Formula is often quickly given as a stop-gap measure, as parents are afraid of dehydration. 

    However, it is important for parents to be aware of how much (or how little!) milk is actually needed by babies at this stage. Newborn tummies are tiny and need very little milk – at best, the size of a newborn’s tummy at birth is about the size of a shooter marble (3-5ml). Furthermore, newborns drink colostrum, which appears in low volume but is incredibly rich in nutrients. We are so used to the media portrayal of a full bottle of formula that it makes us uneasy to think that an infant may only need a few millilitres of breast milk! It‘s time to recalibrate and understand that in nature, newborns drink less than what we might expect.

    As a result, when a baby receives formula, often more is given than what the baby actually needs. Baby’s tummy can become distended, leading to baby feeling too full to nurse. We also know that newborns are sleepy beings so an uncomfortably full tummy may mean longer sleep before the next feed as baby’s body works to assimilate the harder-to-digest formula. This contributes to the cycle of the formula top-up trap where the mother constantly feels resigned that she just does not have enough milk.

    This can also happen when water or even too much top-up of mother’s milk is bottle fed to baby. Excessive water can cause toxicity in baby.
The estimated sizes of a newborn's tummy during the first month. [Credits: www.letmommysleep.com]
  1. Mother’s Supply will be Affected

    Naturally, when a mother chooses to supplement with formula, she needs to ensure that she is also removing milk from her breasts. Just like in economics, the demand (or milk drank) by the baby is the amount that is signalled to the body to produce – thus, the more baby drinks, the more the body produces.

    However, when the breast is replaced by a bottle, mothers often miss out on pumping and may not remove the amount that baby would need. It becomes necessary for the mother to play catch up by taking more time to pump and remove the amount that has been drunk.

    In the event that the mother does not return to latching her baby or is not able to express the amount of milk equivalent to that which baby drinks in the bottle, the mother is at risk of facing a dip in her supply. This will then sabotage her efforts to continue latching at the breasts because a drop in supply will make it hard for her baby to be satisfied at the breast. Inevitably, this is highly likely to lead to a premature end to breastfeeding when the mother is unable to catch up with expressing the amount of breastmilk that is required.

  2. There are risk of allergies with formula

    It can be tempting to provide a baby with formula in times of desperation but it is a temporary solution to a problem that can be fixed. While it is natural, breastfeeding is a skill that takes time to learn. With the right support, most mothers should be able to breastfeed. In the event when a mother is unable to provide breastmilk for her baby for whatever reason, it has also become socially acceptable to provide an alternative in the form of human milk donations.

    We don’t talk enough about this but there are babies in the world who cannot take formula milk. For a mother of a newborn, introducing formula milk for the first time can be a make-or-break moment. If the child has an undiscovered allergy to dairy or cow’s milk, there is always a possibility of an allergic reaction to the said formula milk.

    A newborn baby has a stomach that is vulnerable to pathogens. It is a built-in mechanism that prevents a baby from having harmful germs enter its system. Breastmilk has the natural ability to protect the linings of baby’s intestines as it forms a layer that prevents the intestines from absorbing these harmful stuff. But when you introduce formula or other substitutes that are not appropriate for a baby, this protective layer is destroyed.

    Babies then are at risk of developing digestive issues as well such as lactose intolerance, reflux and constipation, which can lead to discomfort in the baby.
  3. Economic sustainability of formula milk

    It can be “helpful” for a stressed-out mother at first to use formula, but as the breastfeeding journey begins to end prematurely, the baby will then become dependent solely on formula milk.

    We don’t know what the situation of the mother’s family is like when we suggest formula. Formula milk can be economically unsustainable for a family in the long run, should the family income be decreased. With a dried-up milk supply and a limited amount of powder left in the can, a mother may be forced to stretch out her baby’s feeding, or dilute her baby’s milk. In fact, this has happened and is already happening in Singapore, and even in more dire situations where the baby is very, very young. The baby will not be receiving enough nutrients to grow and develop properly.
Breastfeeding has to contend with formula milk companies, who invest in heavy marketing to parents. [Stock Photo]

We hope the explanation above has provided a clearer picture on the reasons why formula feeding is not always the one-size-fits-all solution for mothers who are still trying to overcome breastfeeding challenges. We, all of us as women, help the mother to help the baby – it is a community effort.

Newsletter #42: Preparing to Breastfeed Before You Meet Your Baby

by BMSG Editorial Team

With greater awareness of the importance and benefits of breastfeeding, many expecting mothers want to prepare themselves for this momentous journey. But how can you actually get ready to breastfeed when you haven’t even met your infant yet?

 

Information is Power

Pregnancy often makes mamas attracted to peaceful, calm photographs of mothers breastfeeding their infants. It looks like the easiest, most wonderful thing in the world – and, of course, it can be.

However, the truth can be very different for many mothers after delivery, when your body feels as though it has been torn into two and you are battling with blood loss, pain, fatigue and hormones. Breastfeeding may look natural but it is in fact a learned skill that takes time and effort to figure out.

Yes, the truth is that many mothers may face difficulties breastfeeding in the beginning. These issues could range from flat nipples, sleepy jaundiced babies, tongue ties, extra-large breasts or nipples, or even just trying to figure out the best way to hold your floppy newborn.

Breastfeeding can be hard work but with some support and mental preparation, it can be a satisfying journey. [Credits: Lisa Matthews]

 

On the bright side, most of these problems are common ones with established solutions, and being empowered with information before you give birth can be the best way to prepare. If you know beforehand the kind of issues that many mums face, you will be less thrown off if it happens to you, and you and your partner will know that there are solutions you can employ to help make your journey a little easier.

Some ways which you can prepare yourself:

  1. Speak to mummy friends who have breastfed their children and ask them to share with you honestly what their pitfalls and problems were, and how they addressed them
  2. Join the Breastfeeding Mothers’ Support Group Facebook group and read posts as they pop up on your feed. This is an easy way for you to get a quick handle on the common issues that many mamas face
  3. Attend prenatal classes (including BMSG’s Breastfeeding 101 workshops) to find out more about the journey ahead of you and how you can make it easier for yourself and your baby

 

Knowing where to find support, including seeking comfort in other mothers, can be helpful if you are overwhelmed or just need reassurance. [Credits: Lisa Matthews]

Form Your Support Team

Although much is made about the breastfeeding mother, the reality is that we create breastfeeding families. A mother is never alone in her journey and the best way to make sure you can succeed is to ensure you have everyone on the same page.

First and foremost, it is crucial that you have your spouse on your side. It is a wonderful way to bond and prepare for baby’s arrival by attending prenatal breastfeeding classes together and understand how important the role of each parent is. 

Fathers must also buy in to breastfeeding, fully understand and support the decision to breastfeed. After giving birth, mothers are often disoriented, in pain, and may find it difficult to advocate for themselves. This is where Dad needs to step in and step up to support Mom. Be the guardian and a wall to block off unhelpful advice and unnecessary comments that may come from people who have good intentions but do not know better.

Daddies, don’t undermine your presence – mummies need you more than ever especially in the challenging early days of breastfeeding. [Stock Photo]

 

Choose Postnatal Support That Suits You

As mentioned before, being prepared is the best plan of attack. It would be useful to have the contacts of some good International Board Certified Lactation Consultants (IBCLC) whom you can speak to if you have any problems.

Many newly-delivered mothers in Singapore also hire confinement nannies to help out in the first month or more. Very often, mums hire these nannies based on word of mouth and friends’ recommendations.

However, it is really important to note that different mothers have different needs and requirements. A nanny who worked out well for your friend may not be as helpful for you if your needs are different. Therefore, if you intend to breastfeed your infant, look specifically for a confinement nanny who is fully supportive of breastfeeding and who can help you succeed. She should be up-to-date with breastfeeding knowledge and be willing to assist you as needed.

For example, while many confinement nannies try to make themselves useful by offering to take the baby at night so that you can “rest”, remember that night feeds are crucial to establish and maintain your milk supply and avoid engorgement, blocked ducts and mastitis. A breastfeeding-supportive confinement nanny can help by changing baby’s diaper at night and then passing baby to you for a feed. 

Confinement nannies and any other family member who is helping the breastfeeding mum should support the mother without imposing on her wishes. They can focus on helping mum on other mundane tasks such as changing baby’s diaper, cooking meals for her or doing other household chores to keep mum comfortable. [Stock photo]

Ditch the Pump

Many mothers are told to bring the pump to the hospital and to start pumping diligently from the beginning. Wanting to ensure they have sufficient milk supply, mums bring out their expensive dual electric pumps and go at it in the hospital room – only to be devastated and panic when they find they are getting nothing.

 In the first few days, your breasts make colostrum, a thick, rich, sticky liquid that is highly concentrated, full of protein and nutrient-dense. It’s the perfect food for your newborn and helps to fight infection, supports baby’s immune system and gut, and flushes out bilirubin through baby’s poop. Did you know that colostrum is similar to amniotic fluid? It’s the best bridge between the fluid baby has been swallowing in the womb, and the mature breast milk which he will eventually drink.

The keyword in all that information up there is “sticky”. Because colostrum is so thick and sticky, it is hard for a pump to extract it efficiently from your breast. Because your newborn baby has a tiny little belly, your breasts do not need to make a lot of it to fill baby’s tummy. Because of both these things, when a new mother tries to pump, most of the colostrum will stick to the flanges or on the sides of a bottle – wasting all that precious goodness.

Credits: Morgan Temple, IBCLC

 

 New mums expect to see a bottle full of milk when they express milk; it is what we are naturally conditioned to see. So when we look at a handful of viscous droplets sprayed all over the flange and barely covering the base of the bottle, we panic.

What is the solution? Ditch the pump and hand express instead. Massage your breasts gently in circular motions to loosen the sticky colostrum from your milk ducts. Learn how to hand express effectively and gather the droplets in a 3-5ml syringe rather than in a bottle. The colostrum can be chilled and fed to baby, which can be especially useful just in case baby has jaundice or other unexpected medical issues which may result in prolonged separation from mum. A very helpful resource to watch and learn hand expressing from is this video by the Stanford School of Medicine, which explains and demonstrates via real mothers how hand expression can be especially helpful for new mums and newborns. 

The pump is not a need as long as your baby is with you right from birth and breastfeeding well. When your milk supply is well-established, pumping may cause an oversupply. Use it wisely and only when necessary. [Stock Photo]

 

You Are Not Alone

Last but not least, remember that millions of women around the world have been where you are and come through on the other side. You are not alone, even though the nights can feel lonely. When your baby arrives earthside, cuddle that soft, sweet little infant (even when she’s bawling and angry and red in the face) and know that you have made a strong, wonderful choice to breastfeed. Hang in there Mama! We are rooting for you.

Credits: Illustration by Paula Kuka from Common Wild

 


Looking for resources for your partner? Read the following articles written by the BMSG to help dads learn how they can better support the breastfeeding mum: Role of Dads in Breastfeeding Families Part 1 and Part 2.

If you need help with breastfeeding, reach out to our BMSG volunteer counsellors by calling or sending a WhatsApp message to +65 339 3558 between 9am and 9pm daily.