Is it okay to discuss supplementing if it's the only way to convince some moms to breastfeed at all?

[Chavelamomela]

I have previously written about my thesis paper for my master's degree. I am working on a project to create a cadre of volunteer breastfeeding "ambassadors" in an inner-city neighborhood.

The bulk of the paper discusses the steps we're taking to implement our program, who we're working with, how, the formal & informal process, allies, enemies, etc, and then the "hand-off" for after we're out of the picture. (40 pages)

The first section (10 pages) identifies the problem & our solution to that problem.

The professor has given us some feedback on the first section of the paper, and he asked me to include some more information for people who don't know the mechanics of breastfeeding. How does it work? Can a mom start & stop? Is it possible to feed sometimes by breast and sometimes by bottle?

Obviously, it is possible for moms to both breastfeed and formula feed together, as long as they ensure to continue nursing at regular intervals every day to maintain their supply. I am not advocating it, but I have to provide that info, and frankly, I think there are many moms who aren't interested in breastfeeding, but would consider it if they knew they could do a combination of formula and breastfeeding.

But I also recognize that it's a slippery slope, and once you introduce one bottle, it's very easy to replace one feeding w. a bottle, then another, and another, until you have a baby who is barely nursing or not nursing anymore at all, and the mother's body may stop producing enough milk to feed her baby even for those few nursing sessions

I am concerned that I don't want to come across too one-sided (on either side). Because I am totally gung-ho about breastfeeding, and frankly, if i can encourage moms to consider breastfeeding their babies, even part-time, that's still a "win" in my book - that's more breastfeeding than before.

Any recommendations for how I can address this issue in a fair manner?

[pumpkinhead]

I think talking about bottles and breastfeeding in the context of switching back and forth would be appropriate. As long as you explain the potential pitfalls involved with non-judicious bottle use,. Bottles and formula can be useful tools but it's important to point out that they should always be used mindfully if the desire to maintian a breastfeeding relationship exists.

[2lilsweetfoxes]

I believe it is okay to discuss supplementing. For some moms, strict breastfeeding is a seemingly unreachable ideal. They may have jobs which do not "allow" them to pump or are in school and cannot figure out how to pump. As in, no fairly private, set aside places that are clean, with an outlet and a place to set the pump and sit and to clean it or lack of enough or long-enough breaks. Some women cannot pump enough to keep up with demand. Sorry to say, but it seems a woman of lower socioeconomic status is less likely to want to "rock the boat" and demand her rights with regards to breastfeeding and her employment. I advocate the "at least breastfeed when together, even if you are out and about".

[APmomto3boys]

I would talk about the changes that formula makes to the baby's still developing digestive system.


here is more:
http://www.breastfeeding.org/bfacts/bottle.html
But studies show that "just one bottle" can be harmful to both the mother and baby by

1. Increasing the likelihood of serious allergy to cows' milk protein.
2. Increasing the chance of bowel infection and diarrhea by changing the pH of the bowel. It may take up to a month to return to normal, safer levels.
3. Causing nipple confusion--having difficulty latching to the breast.
4. Affecting the delicate supply and demand balance.
5. Increasing engorgement by not emptying the breasts.
6. Decreasing the mother's confidence in her ability to feed her baby.
7. Reducing the duration of breastfeeding.

[KristyDi]

I think I would talk about the realities and possible difficulties with combination feeding and how it can quickly become a slippery slope, but then point out that any breastmilk a baby gets is beneficial. Combination feeding, while far from ideal, is superior to straight formula feeding.

As a PP said, especially dealing with a lower socioeconomic group, pumping can be difficult. Working a minimum wage job at say a fast food place or in retail leaves very few times and places to pump. I know in both of those types of jobs I held literally the only place I could have pumped would have been the bathroom while trying to eat during my meal break. Add to that the fact that employers are not always supportive and the fact that in the current economy, jobs are becoming harder and harder to find, a mom who's got a job may not be willing or able to risk it for her pumping rights.

[BnInTheOvn]

You can bring up the option to pump -- but someone who isnt 100% GO on breastfeeding anyway probably isnt going to want to pump, or possibly cant (because of job place, etc).

Bring up the idea of supplementing, but maybe in a way that still encourages the breastfeeding first.

If a mom can't be with the baby each time it needs to eat, supplementing with formula is an option. Just list the ways that she can be sure that she wont create confusion or dependence on the bottle, and stress the importance of breastfeeding when mom is home, not making a bottle because she "doesnt feel like" nursing.. Most babies will be ok with it, and know the difference when Mommy is feeding me, I nurse. When Daddy/grandma/babysitter does it, I get the bottle.

[beru]

Yes! Yes! Discuss supplementing. I know quite a few women who weaned their children at about 3 months because they were overwhelmed. It didn't seem to occur to them that they could breastfeed part-time. They thought it was all or nothing. (I thought it was all or nothing too with my first baby and totally stressed myself out.) Also, I agree you have to present the information carefully. Say, the more bottles you give and the earlier you give them, you increase the chances of not meeting your breastfeeding goals. The compromise of combo feeding does not come without a price. You are risking failure. However, that risk may be worth it for many women who are too overwhelmed by the idea or the actual act of exclusive breastfeeding.

[Ruthla]

Originally Posted by Chavelamomela

Ifrankly, I think there are many moms who aren't interested in breastfeeding, but would consider it if they knew they could do a combination of formula and breastfeeding.

Absolutely! For many women, just knowing that they have an "out" makes them willing to try- knowing they can give formula while at work and BF at home makes them willing to BF at home- and in many cases makes them willing to even initiate BF if they're planning to go back to work within 2 months of birth.

How about presenting some case studies and some statistics? Show the number of women who "combo feed" who then go on to exclusively formula feed after X length of time and the patterns that lead to this. Be sure to include statistics about these babies' health compared to both exclusively BF and exclusively FF babies. Include case studies of women who supplement long-term and continue to BF- and show how they do it.

Be careful that your language is free of judgements on the women who choose to introduce formula, or who don't take steps to preserve the BF relationship after its introduction- you may need to do a lot of editing and rewrites to keep the language neutral!

You also might want to include information on bottle alternatives if a supplement is medically needed for a newborn (or a mom MUST return to work before 3 weeks- whether or not she's able to pump.)

[PatioGardener]

Originally Posted by Chavelamomela

Any recommendations for how I can address this issue in a fair manner?

As long as moms are informed of the risks of feeding some formula (both to breastfeeding and baby's health) and the risks of not breastfeeding at all, then they can make an informed decision. At least they can here in Canada, where mat. leave is 1 year. Exclusive breastfeeding is safest, but partial breastfeeding is so much better than no breastfeeding at all - and sometimes may be the only way to preserve breastfeeding at all (when mat leave is not paid.)

[pumpkinhead]

Originally Posted by APmomto3boys

I would talk about the changes that formula makes to the baby's still developing digestive system.


here is more:
http://www.breastfeeding.org/bfacts/bottle.html
But studies show that "just one bottle" can be harmful to both the mother and baby by

1. Increasing the likelihood of serious allergy to cows' milk protein.
2. Increasing the chance of bowel infection and diarrhea by changing the pH of the bowel. It may take up to a month to return to normal, safer levels.
3. Causing nipple confusion--having difficulty latching to the breast.
4. Affecting the delicate supply and demand balance.
5. Increasing engorgement by not emptying the breasts.
6. Decreasing the mother's confidence in her ability to feed her baby.
7. Reducing the duration of breastfeeding.

I think bringing that up is fine, but I think that if one is striving to be fair, you also need to balance this by saying that the reality of some breastfeeding relationships is that formula might be necessary. Some breastmilk is better than no breastmilk. Breastmilk and formula is better than 100% formula. In that vein, I think it's fine to illustrate how supplementing can become a slippery slope as long as one includes information on how to help it not become a slippery slope. If problems are presented, solutions should be as well and not every woman will desire to or be able to provide 100% breastmilk.

[readytobedone]

haven't read the responses but i think yes, absolutely, yes. there are women who fully anticipate needing/wanting to supplement for whatever reason (they work at jobs where it is too hard to pump), and sure, supplementing can undermine the nursing relationship. and that would be something to discuss also. but IMO it is definitely unwise to pursue an all or nothing approach to nursing. any breastfeeding is better than no breastfeeding. which is not incompatible with the fact that more breastfeeding is (virtually) always better!

[phreedom]

There is a difference between discussing it and encouraging it. For some moms exclusive BFing is not going to happen ever and no one is going to convince them otherwise. If may be for reasons that are beyond their control or not, but it just ain't going to happen. For these moms I try to discourage the all or nothing approach. Many are willing to do it then. Because while all BM is the ideal, some is still better then none at all. I NEVER discourage BFing when it is a possibility even if the only thing possible for the mama is BFing sometimes.

[Mama Poot]

Originally Posted by 2lilsweetfoxes

I believe it is okay to discuss supplementing. For some moms, strict breastfeeding is a seemingly unreachable ideal. They may have jobs which do not "allow" them to pump or are in school and cannot figure out how to pump. As in, no fairly private, set aside places that are clean, with an outlet and a place to set the pump and sit and to clean it or lack of enough or long-enough breaks. Some women cannot pump enough to keep up with demand. Sorry to say, but it seems a woman of lower socioeconomic status is less likely to want to "rock the boat" and demand her rights with regards to breastfeeding and her employment. I advocate the "at least breastfeed when together, even if you are out and about".

: I think this was a perfect response. So many mothers in this position think its "all or nothing", but that simply is not true. However, I do think that they should be well-educated in the physical realities of breastfeeding and the whole "supply and demand" process that keeps it going.

[Siera]

Don't know if its applicable, but you could also discuss how premature babies often have to have EBM fortified with formula and often, preemies go home being supplemented. Some moms can transition the baby to the breast, while others, too tired of pumping, problems with supply, etc, transition to formula, while others do a combination of both. From my experience in the NICU, there were plenty of moms who fit these categories.

[G8P4]

Well, supplementation is necessary for some women, largely from baby unfriendly practices occuring within a baby unfriendly culture. So, I think there is a preferred way to supplement, and that is to supplement at the breast.

[dollyanna]

I totally agree with PPers; so many women are unable to EBF for so many reasons, it makes sense to talk about supplementing as an option.

Pumping can be impractical for all the reasons listed above, PLUS let's not forget that a good quality pump is EXPENSIVE.

[KBecks]

I've supplemented all three children and I'll share my experience if that helps you. For me, I like being able to BF and FF. We did it mostly to allow my husband to feed the baby and for me to get some sleep (we split the overnight into 2 shifts). With my first two children I combo fed for the first 7 months or so, and then we used formula until 12 months. It's not the greatest outcome, but I think it's much better then only using formula.

I would say that the pros are flexiblity, ability for the parents or other caregivers to share feeding duties, and ability to BF or FF in different situations if the mom feels uncomfortable BF somewhere. It also means there is something available if the mom isn't pumping or finds pumping too tedious, especially if mom has a lot of other responsibilities besides caring for the baby. Another pro is that any breastmilk is positive, the more the better.

The cons are using formula, cost, concerns over formula ingredients and safety, and waning supply. And yes of course forumula can be a habit and replace breastfeeding.

I'm sure there are more pros and cons, etc. etc. Just wanted to share what I can. I frankly love having the option of formula available. As another mom said to me at school -- it keeps you sane, when she asked if I was breastfeeding an I said yes but we're doing a little formula too.

[KBecks]

Originally Posted by Ruthla

A
How about presenting some case studies and some statistics? Show the number of women who "combo feed" who then go on to exclusively formula feed after X length of time and the patterns that lead to this. Be sure to include statistics about these babies' health compared to both exclusively BF and exclusively FF babies. Include case studies of women who supplement long-term and continue to BF- and show how they do it.

B)

Is there any research on combo feeding? I'm curious, but I have never heard it mentioned. I think research would be very helpful on that topic.

[Flor]

I am torn. On the one hand, I sorta feel that formula should be prescription only, on the other hand, I know sooooo many working moms who stop bfing the moment they go back to work. They never even think its possible to do both and they are totally shocked to hear that at some points ds was getting a bottle of formula while I was at work, then was breastfed the rest of the day (and he weaned at 3.5 years), they've never heard of such a thing.