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.

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.

2. 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.

3. 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.

4. 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.

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.

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