OK guys, buckle up, this is a big one.
(Click the anchor links below to skip to a specific section! ♡)
1/ What are my feeding options?
a/ Exclusive breastfeeding
b/ Exclusive expressing
c/ Exclusive formula feeding
d/ Combi feeding
2/ How do I safely prepare (and store) formula?
3/ What is nipple confusion?
What are my feeding options?
If you are a UK based mother and had your antenatal appointments via the NHS, it’s likely you’ve been sung the many songs of breastfeeding. It’s likely, too, that any other feeding option raised has been quickly brushed under the carpet – not treated as shameful, as such, but not exactly explained in detail either. Breastfeeding has many proven benefits, which is why there is such a huge push for it by our healthcare system, and although it can be frustrating when your midwife steers a question about formula back to lactation, they genuinely mean no harm. Outside of your medical consultant’s office, however, it’s important to know that breastfeeding is not your only option, and may not even be your best option, for personal or medical reasons.
Without further ado, in the UK currently, the following feeding options are available for infants:
1/ Exclusive breastfeeding
Breastfeeding is, and will probably always be, considered the gold star standard of infant feeding. And for good reasons, too. If breastfeeding goes well, it can be fantastic for both mother and child, with a whole host of benefits that are said to be unrivalled by other forms of feeding. And because your body creates milk individual to your child’s specific needs, you know they’re getting the best start they can when consuming it. So far, so good.
According to the NHS, the reported benefits of breastfeeding include:
- milk that is perfectly designed for your baby
- increased protection against illness and disease
- milk that is available on demand, once supply is established
- a strong bond between mother and baby
- a reduced risk of SIDS
- a reduced risk of certain cancers for mum
- and a reduced risk of osteoporosis, obesity and cardiovascular disease (also for mum)
Breastfeeding is also reported to act as a contraception for some women, and to stop periods. Although many of the benefits have a good body of research behind them, however, it’s important to remember that all bodies are different, and not everything purported to be beneficial will be applicable to everyone. There are women that get pregnant when breastfeeding, for example. Some women start menstruating almost immediately after baby is born. Some women simply don’t lose the weight. So take everything with a pinch of salt, and know that while your risk of everything noted is reduced, you are not infallible, and should still be sensible with your choices.
Unfortunately, the story doesn’t end there. Because breastfeeding, although entirely natural and nothing to be ashamed of – despite what some fools will have you think if you whip out a boob in public – is not as easy as it may be made out to be when first planning your feeding options. As a first time mother, it’s very easy to buy into the propaganda surrounding this noble pursuit, and to listen intently when told that ‘breastfeeding is easy,’ ‘breastfeeding doesn’t hurt’ and ‘breast is best.’ After all, when classes run by the people in the know only ever tell you the benefits of breastfeeding, with a few demonstrations on positions using a one eyed doll and a knitted boob, what reason would you ever have to believe otherwise?
In the interest of honesty, it’s time someone burst that bubble. But not entirely, so don’t fret. I am not a devil woman, and I have no interest in swaying anyone one way or the other. (Honest!)
The good news is that, for some women, breastfeeding does come easily, it absolutely does, and although those women are somewhat like unicorns, there is no reason that woman wouldn’t be you. However, for the vast majority, breastfeeding is hard before it is easy. Those first few weeks tend to be the most difficult, as mum learns what to do to make things work from her end, and baby works out what to do from theirs. There is often soreness, cracked nipples and general discomfort, although most report that this goes away after 2-3 weeks (or so) and that feeding from then on out is a breeze… At least until the teeth start to come in 😉
But what are 2-3 weeks in the grand scheme of things, really? If you are able to power through, and really want to breastfeed (and I do mean WANT it, not feel like you SHOULD want it, whilst secretly longing for a reason to pack it in and reach for the bottle – both wine and formula) then those few weeks of discomfort are worthwhile, to reap the benefits of what comes next.
For some women, unfortunately, it’s not quite that simple, as there are other issues that can arise, that aren’t often mentioned (at least by medical professionals) prior to beginning your journey, for fear of scaring you off. Some of these are as follows:
- Some babies are allergic to their mother’s milk, and discovering exactly why that is isn’t always a short process
- Some women have supply issues. Undersupply can cause problems for baby, as they don’t get enough milk. Oversupply can cause issues for mum, as she can’t get the milk out of her fast enough (backed up milk can lead to infection)
- Some women simply don’t produce milk, due to past trauma to the ducts, or previous surgeries
- And some women, with certain medical conditions, can’t breastfeed, due to it being deemed unsafe
- Some women have painful ‘let down,’ experiencing pain each time they are preparing to feed
- Some women have problems with blocked ducts, which causes localised soreness, and feelings of being generally unwell
- And some have problems with mastitis, which is much the same as a blocked duct, but with a a high fever and flu like symptoms
- Some babies are born with tongue or lip tie, which impacts how they latch, and can lead to trauma to mum’s nipples
- Some women get thrush on their nipples, which can be passed back and forth between mum and baby (seemingly indefinitely) if left untreated
- Some women are victims of abuse, and find breastfeeding difficult as a result
This is not by any means an extensive list, but should give you an idea of why some women simply can’t/don’t breastfeed. And put your mind at rest if you have landed here in the midst of a meltdown caused by one of the above. You are not alone.
Again, these issues don’t arise for every woman. But, it’s good to have this information in your back pocket. To understand the full scope of what breastfeeding can entail. And to make an informed choice about whether or not it is the right decision for you, both before you begin, and after, if struggling.*
Breastfeeding is brilliant, is the long and short of it, as long as it works for both you and your baby. There are reasons it is so widely applauded, and reasons why it is pushed on us in the delivery room, sometimes earlier. But sometimes it can go wrong, and when it does, it’s horrible (you can read my own story, here, if interested). It is important to know in those instances that you do have other options, and there is no shame in taking them.
(Side note: If you’re thinking ‘what if I don’t want to breastfeed because I just don’t want to breastfeed?’ then don’t bloody breastfeed. Your body, your choice.)
*If you are struggling but wish to continue, do some research into lactation consultants/breastfeeding groups in your local area. In some places, they are paid for by the NHS, and they really can make the world of difference. Also consider that nipple shields are an option, if you are leaning toward quitting due to nipple pain, but don’t truly want to have to stop
2/ Exclusive expressing
For mums that want to give their child breast milk but, for whatever reason, can’t have them feed directly from the boob (a problem common in premature babies, and in women with nipple trauma, among others. As well as a common concern for women returning to work!) expressing milk and feeding to baby via a bottle is the next best thing.
Expressing milk is great, as it saves money you’d spend on formula – if your choice is purely down to wanting to feed from a bottle – and baby gets the health benefits of breastfeeding, without always needing you there at feeding time.
Note: There are some that say expressing shouldn’t be encouraged, as the bonding benefits between mum and baby are absent, due to less skin to skin time, that would have been there with direct breastfeeding. However, there are other ways to bond with your child. They don’t need to have your nipple in their mouth to know that you love them.
If you decide to express exclusively, know that it is a labour intensive task. You are essentially doubling your feeding workload, as every session becomes a two step process. Equipment needs to be sterilised between each express, and it is recommended that you pump 8-12 times a day, including during the night, in order to keep up your supply. As with breastfeeding directly, some women absolutely thrive on expressing, which makes it all worthwhile. Some women don’t, which doesn’t. It’s all down to personal preference.
When choosing this route, it is paramount that time is taken to research both ways to best establish your supply – over expressing early on can lead to oversupply, which in turn can lead to infection! – and the various options for pumps. An electric pump is fantastic if you want all of the work (once in position) done for you, but some women do prefer a hand pump, and that’s perfectly fine too. Either way, if expressing exclusively, a double breast pump – even a medical grade one, if accessible – should be strongly considered, as they cut expressing time in half, giving you more time with your baby (/more time asleep in bed, which can feel just as precious!)
Current break milk storage guidelines can be found via the NHS, here.
3/ Exclusive formula feeding
Despite huge advancements in recent years, choosing to exclusively formula feed still comes with a stigma. The very fact that you have to accept a disclaimer to confirm you understand that ‘breast is best’ before being allowed entry to the website of your chosen formula says it all, really. You may as well have formula mums walk through the streets naked as someone with a bell shouts SHAME and spits at them. Unfortunately, such unsupportive sentiments have a way of burrowing into a mums mind, and causing all sorts of issues, psychologically. Terrible, really, especially knowing that only 24% of UK mothers are actually breastfeeding by 6 weeks (source: UNICEF.) That’s a whole lot of women walking around thinking “I have failed my child.”
Despite this, formula is in fact a valid feeding choice. And there are plenty of reasons why:
- How you choose to feed your baby is exactly that, a choice. You should not feel obligated to use your body to feed, if it is not what you want to do
- Some women, for a variety of reasons, can’t breastfeed, even if they want to. Formula is a lifeline for those women and their babies, and that is nothing to be ashamed of. What happened to children whose mothers couldn’t provide milk before formula? They didn’t survive. As such, formula should be celebrated, not looked down upon
- Formula milk, and the water used to prepare it, is perfectly safe in the UK. Formula companies have to meet certain requirements in order to sell their product, and are strictly regulated, ensuring the milk you feed your child contains the nutrients needed for healthy growth, with no hidden nasties
- A number of the studies (not all, but enough to drown the seed of guilt, if you have one!) that once claimed to prove the saying ‘breast is best’ have since been discredited (claims that breastfed babies are of higher intelligence, for example) meaning we are not doing our children the huge disservice we were once lead to believe when choosing formula
- Formula feeding allows you to share the task of feeding your baby, which can help baby to form secure attachments with both parents…
- … And also allows both parents to get a good night sleep, if the person completing the task is alternated. This can lead to better relations between parents, and a more positive parenting experience overall
- Formula milk offers a complete nutritional meal, while breastfed babies are required to take some supplements (vitamin D, for example, is hard to obtain enough of via breast milk)
- Some (not all) babies sleep better if formula fed, as it takes longer to digest formula than it does to digest breast milk
Formula feeding does have disadvantages, however, as does any form of feeding. Whilst able to replicate the nutrients required for little ones to thrive, formula companies are simply unable to replicate the unique antibodies provided via mother’s milk, meaning formula fed babies are more likely to fall ill than those fed breast milk. There is the issue of judgement from certain other mothers, also (and, in some cases I’ve been told about, from some – usually older, and largely male – medical professionals), which can be hard to handle as a new mum, when emotions are running high. And, of course, there is the cleaning of bottles between each feed which is, to be blunt, a pain in the bum.
Despite this, formula feeding is a legitimate way to feed your child, that will see them grow healthy and strong, at the same rate as their breastfed peers. And while there may be some benefits to breastfeeding that simply can’t be replicated by a pharmaceutical company (at least, not yet, scientists are working on it) there is no shame in choosing to formula feed, or in having to take that route due to personal or medical reasons.
As for the mums that shame other mums for their feeding choices? There is no room for them here. Let’s give them the courtesy they deserve, and completely ignore them. They do not exist.
Repeat after me: My body, my choice. My health matters too. Happy mum, happy baby. Fed is best.
4/ Combi feeding
Combi feeding, short for combination feeding, simply means feeding your child using a combination of the above methods. Some purists will claim that this can do more harm than good, if chosen due to breastfeeding struggles. However, there is evidence to suggest that any amount of breast milk is beneficial, with some even claiming that antibodies simply become more concentrated in mother’s milk when fewer feeds are given this way, delivering just as much goodness as to children that are exclusively breastfed. The best of both worlds!
A couple of things worth noting when combi feeding:
- It is important to do your research if intending to combine breastfeeding with another form of feeding, due to lack of demand leading to a reduction in supply (in short: if you don’t use your milk, you may lose it entirely if not approached correctly.) Talk to a lactation consultant or other medical professional if this is your choice, to ensure you can feed effectively
- If choosing to partially express, be sure to do your research into how to do so effectively, so as not to overstimulate supply
- Keep in mind that milk from a bottle tends to flow quicker than milk from contact breastfeeding. This can lead to baby becoming lazy, and fussy on the boob. To combat this, do some research into the best bottles for combi fed babies, and choose a slow flowing teat. There’s a certain method of bottle feeding that really makes them work for the milk, too, which reduces the risk of this becoming an issue. This is known as ‘paced feeding,’ and can also reduce the rise of overfeeding, which reduces the amount of spit up (hurrah!)
- Some experts believe combi feeding can lead to nipple confusion (see below)
- Haakaa pumps are wonderful, gathering the milk from one breast as you feed from the other, that would otherwise be wasted. Pop it in a bottle, and you’re away
The most important thing to remember when combi feeding is that it is not a case of all or nothing, and choosing to mix up how you feed your baby is nothing to feel bad about. Fed is best, after all.
Whew! On to the next topic…
How do I safely prepare (and store) formula?
One of the things about new motherhood that really bothered me – both following a ‘feeding class’ that focussed exclusively on why I should breastfeed, and after a series of issues meant I had to switch to formula feeding – was the lack of readily available information in regard to safely formula feeding my baby, should that be my choice. And while I understand that the onus being on breastfeeding being the healthiest option meant such things were not likely to be discussed in the doctor’s office, I couldn’t help but think it slightly backward that, if this were a health push, I was not being told how not to accidentally poison my baby should an alternative to my breasts become necessary.
It can’t just be me?
Luckily, as I discovered once formula feeding became a necessary choice for me, all formulas have to meet a strict set of regulatory guidelines before being sold to feed your baby, so are all safe and, also, preparing a bottle of milk is not rocket science. Even better, it actually tells you exactly how to do it on the side of the tin. Hurrah!
Aptamil, for example, is prepared as follows:
There may be variants to safe preparation based on the formula you choose, so please refer to the box before making up a bottle. Alternatively, invest in a Perfect Prep machine, which does the majority of the work for you, with two pushes of a button, and in two minutes. Perfect for the baby whose bad mood goes from 0-60 in less than a second when hunger strikes:
Admission: my son was formula fed for the majority of his first year. Not once did I make a bottle of formula using the traditional method. I love my Perfect Prep almost as much as I love my husband.
In terms of storing formula milk, the current guidelines state that formula milk should be discarded after 2 hours if kept at room temperature, within 24 hours if stored in the fridge, and within 4 hours if kept in a cool bag with an ice pack. (Source: NHS.) Half-finished formula should be discarded immediately, to reduce the risk of bacteria forming.
What is nipple confusion?
Last but not least is a question that relates to all of the above (and to dummies, which are a topic for another day): What is nipple confusion? Will my baby suffer from nipple confusion? Why is everything in life suddenly about my nipples?
In short, nipple confusion is said to occur when babies are given more than one ‘nipple’ to suck. Some experts believe that going from breast, to bottle teat, to dummy can cause little ones to lose their inbuilt feeding instincts, and cause trouble when they try to latch to the breast (which, in turn, can cause problems for mum’s own nipples. Hello trauma.)
On the other side of the coin, there are experts that don’t believe nipple confusion to be real. And, as my very dear midwife once said to me, “your baby isn’t an idiot, he knows your boob isn’t a bottle.”
Whether it’s real or it isn’t, those in the know suggest holding off until feeding is fully established on the breast, if planning to combi feed. This allows baby to adjust to feeding this way, establishes supply, and ensures you’re both comfortable latching. (And dummies, said to also cause confusion, are best introduced after 6 weeks!)
As for why everything in life is suddenly about nipples… welcome to infant feeding. It sucks. You’re gonna love it* 😉
*Sneaky FRIENDS reference. It’s actually going to be fine.
All information correct – to the best of my knowledge – at time of publishing. Information gathered through a combination of personal experience, discussions with other mothers, internet research, reading parenting books, and speaking to medical professionals during my own feeding journey. Please speak to a medical professional if uncertain on any decisions you plan to make for yourself and your baby. And please remember that I am not a medical expert myself, I am just a mum trying to help other mums get a grasp on their new role