Posts

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 #44: Mother’s Sharing – Breastfeeding Triplets

As told to Nabila Hanim, BMSG Staff

We have heard of mums breastfeeding twins, but rarely do we hear of breastfeeding triplets! We speak to Marie Lim*, who shares with us the highs and lows of breastfeeding her triplets, who turn 1 this year. 

*Name has been changed at mother’s request.


Breastfeeding multiple babies is not impossible but requires lots of support. [Photo for Illustration]

 

Q: Tell us more about yourself! What do you do, how many children/babies do you have, and how long have you been breastfeeding?

A: I’m a first-time mum of triplets. They’re about twelve months old now. My working hours are flexible and allows me to prioritise breastfeeding.

 

Q: How did you feel about breastfeeding when you discovered you were pregnant with three? Did you have any breastfeeding goals in mind then?

A: During my pregnancy I read up on breastfeeding from books, articles, and a couple of breastfeeding support groups like BMSG. I’ve always wanted to try breastfeeding despite having heard lots of horror stories from friends. I never had a specific goal in mind — I just wanted to be as prepared as I could and give it my best shot. As triplet babies are usually delivered prematurely, I hoped that giving them breastmilk would help them get stronger faster. That being said, all I had hoped for throughout pregnancy was an uneventful gestation and safe delivery.

 

Q: Tell us how you manage! What was it like at the start?

A: 
My first experience with breastfeeding took place at the recovery bay where I was being monitored post c-sect. I didn’t expect to tandem latch them at that point, so it was a pretty nice surprise.

In the hospital, the nurses would come by every 2 to 3 hours to ask if I wanted to latch the babies. It was always hard to answer because latching newborns took really long, and the third baby would get really hungry waiting. I was in a lot of discomfort and needed to rest myself. In the end, I settled with skipping the 3-4am feed and allowed myself to take breaks. The nurses would feed the babies with formula when I couldn’t latch them on myself. In hindsight, I realise they weren’t fed much because I only started collecting colostrum on Day 3 or 4.

I went home on Day 5 together with the babies and continued to struggle. Everything hurt – my abdominal muscles had separated, the wound area was sensitive, my breasts and nipples were sore and screamed all the time, etc. As I couldn’t walk properly, my husband or nanny would pass me a baby to nurse while I sat in a recliner.

Initially I’d latch one or two babies at a time and pumped after that. It was challenging as I was still tired and in pain all the time. My husband and family members were highly supportive and helped me throughout. We rotated the third baby, who would get the bottle, prioritising expressed breast milk over formula.

The key to breastfeeding triplets, just like breastfeeding 1 baby, is to get all of them latched on right from birth. [Photo for Illustration]

After 2 months, I tandem latched at almost every feed while my husband bottle fed the last baby. For the middle-of-the-night feed, all three babies would take the bottle as this allowed us to take turns to get some rest. I would pump and then sleep for 3 to 4 hours, which caused the occasional engorgement. However, I was just too tired and didn’t hear the alarms ring.

As they say, pumping is a skill. It is a skill which I honestly am still far from acquiring. I recalled doing power pumping daily for a week, trying to see if I could get enough milk to sustain a full breastmilk supply. While my supply did go up, I felt completely crushed and drained. Four months postpartum, I stopped pumping. It was killing my back. I somehow found it much harder to pump and way easier to latch. Yes, the initial 15 seconds of every latch was excruciatingly painful but once it was over, I found the actual latching experience very sweet and endearing.

I actually LOVED breastfeeding (for the most part). The initial latching pain went away eventually and latching was a lovely experience even though it still gave me backaches. When I pumped, I found it hard to get into a position that worked for the suction, my back and wound. For someone who couldn’t walk normally till 5 months postpartum, and had to rely extensively on others for the smallest of needs, I decided to accept that my babies will have a mixture of feeds.

On another level, breastfeeding also helped me understand and experience the beauty of creation. This whole world, the circle of life; we are one. It’s like the blue whale; it’s so large and majestic. It’s also a mammal and it also nurses its young! I could never be as cool as a whale, but I find it interesting that we share something in common, like breastfeeding!

 

Q: Has starting solids made it easier to nurse your children now? How is your breastfeeding routine currently?

A: We started them on solids at 7 months (actual) when they had good neck control. I was and still am worried about not having enough milk for them because they end up latching less, which makes me wonder if my supply will drop. It’s not easier per se because the logistics of solids for three is another challenge of its own. To accomplish solids prep+feed+clean, rest, diapering, latching, all within one waking period/cycle of about 2.5 hours means that everything needs to move like clockwork. If you factor in the occasional milk blister or clogged pores which requires frequent epsom salt soaks, hand expression, hot compress, etc, it can be overwhelming.

One thing to note is that our babies have been on a rough sleeping/eating schedule since they were newborns. I know that most breastfeeding mothers would suggest to fully go with the child’s cues, but for the sake of everything else, and to be able to do what we do daily, we would wake the other 1 or 2 babies at the same time for feeds.

Right now at around 12 months old, I latch in the morning around 8am, then about every 3 to 4 hours after. They go to bed at 630pm and we have a night feed at around 10pm.

Being flexible and sharing responsibilities can help mums and dads adapt to breastfeeding multiple babies. [Photo for Illustration]

Q: What are your observations about the benefits of breastfeeding on yourself and the children?

A: I found it most helpful when they were ill and managed to latch despite feeling poorly. I knew that the breastmilk would help them get better and it motivated me greatly. Personally, I also enjoyed the bonding  with the babies. My children are blessed with a father who does everything for them as a caregiver. As a mother, the only thing I could do for them that their father could not is to breastfeed them. On another level, breastfeeding also helped me understand and experience the beauty of creation. This whole world, the circle of life; we are one. It’s like the blue whale; it’s so large and majestic. It’s also a mammal and it also nurses its young! I could never be as cool as a whale, but I find it interesting that we share something in common, like breastfeeding!

I found it most helpful when they were ill and managed to latch despite feeling poorly. I knew that the breastmilk would help them get better and it motivated me greatly. Personally, I also enjoyed the bonding  with the babies.

Q: What advice would you give to mothers who are expecting twins or more, and worried about having enough to breastfeed their babies?

A: Please let others take over your responsibilities in other aspects of your life. In terms of caregiving, there’s only so much we can do. On the surface, it seems as if I’ve managed to do a lot. However, there are lots of other factors that have allowed me to breastfeed till now. I believe it truly takes a kampong (Malay for “village) to raise a child, especially for multiples. In my case, I had 2 confinement nannies in the first month after delivery. After which, we had the help of a couple of family members for another 1 to 2 months till I was able to physically handle a baby.

My husband and I are lucky enough to both have flexible working hours and have chosen to be the babies’ sole caregivers for now. We have no domestic helper and we share the majority of what needs to be done between us. Groceries are delivered by Fairprice, Amazon, or our loving parents. The floor gets a general cleaning session by the robot cleaner every other day. To keep things easy to clean and manage, we opt for a minimal interior living space and consciously declutter as we go along.

I mention the above because I feel we cannot just look at breastfeeding as the only aspect of caregiving a parent is involved in. Our habits and expectations need to be adjusted across the board. I noticed that when I started taking on work again at 5 months postpartum, the stress and further lack of sleep made my supply dip. It would be unrealistic to hope that I could still achieve the same productivity as before, with my new role as a mother considered. In the same vein, I knew that if I wanted to breastfeed, I had to prioritise my nutrition and value my rest.

According to Marie, mums need to adjust their roles with their responsibilities across the board. [Photo for Illustration]

Go with the flow, try your best, and stay flexible.

In terms of breastfeeding, I highly recommend reading up and talking to mummy friends during pregnancy. Even when armed with lots of book knowledge, the real experience still knocked the wind out of me. Thankfully, I had the support of fellow mummy friends who patiently answered my every query, listened to my virtual sobs, replied to my 2am WhatsApp spam messages while pumping. Also, I hope for every other mummy to have a partner who is equally invested in caregiving the way my husband is. It is the only way I could have survived for this long. Please try to communicate well with your family on your breastfeeding goals, ideally way in advance, such that they can have time to learn more and support you, too.

This journey is wonderful both for our babies and for us to learn so much more about our amazing bodies, not just in a physical way. It really takes a lot to sit at the dinner table with visitors, melting from a stiff c-sect binder, aching everywhere, having sharp sensations in your breasts, and trying to eat before rushing for the next feed again. I often think back to the trying initial days and smile at the bittersweet memories.

To my fellow mummies of multiples, big hugs and all the best!