First, I want to start this post with affirming this is in no way formula-bashing. I know lots of mamas who tried everything and were still unable to have a breastfeeding relationship with their baby. Some women can’t nurse their babies, some can only nurse them for a short period of time, some have to (or choose to) exclusively pump. I believe the most important thing is that each mama is provided with all the information necessary to make an informed decision on what is best for her, her baby and her individual situation. These are things I discovered while dealing with my personal breastfeeding struggles, things that I credit as being the reason I have been able to nurse my daughter into toddlerhood.
So your baby loses 5oz after birth. By the time you go in for your 1 week well baby appointment, he has only gained back 2, but your pediatrician is supportive of your breastfeeding, maybe she even offers you some tips. You go back home and things take a turn for the worse. Your nipples are cracked and start to bleed. Tears prickle your eyes every time your little one latches on. Your nipples throb as the blood rushes back to them when your baby is done nursing. You begin to dread each nursing session (which you currently only get 30 minutes reprieve from). You are exhausted, frustrated, in pain and maybe even beginning to feel that you can’t do this for the next year of your life. As if things weren’t bad enough on the breastfeeding front, you arrive at your 1 month appointment to find out not only are your nipples in rough shape, your baby is still at or under birth weight. Your pediatrician begins pushing supplementation. She says just top your baby off after every nursing session with a few ounces of formula. Your supply just isn’t substantial enough. You are a small woman. You are a large woman. Your baby is a lazy nurser or a distracted nurser. The list of reasons may go on and on. Maybe your doctor isn’t so supportive and begins to accuse you of starving your child to live up to an ideal.
That may seem extreme, but I’ve heard that story more than once, including from my own pediatrician.
Mama, I want you to stop, breathe and relax. Before you start comparing formula brands, here are 4 things to consider.
1. Get a second opinion – see a lactation consultant (or two)
Unfortunately, pediatricians aren’t taught much about breastfeeding. That’s not to discourage you from talking to your pediatrician, but if he/she suggests you start supplementing with formula or insinuates your baby isn’t gaining weight fast enough, don’t panic. You have lots of options before resulting to formula. Make sure your doctor is using the WHO growth charts for breastfed babies, as the patterns are different from formula fed babies. If growth is still low, keep a close eye on diaper output. If your LO is still having plenty of wet and dirty diapers, I would highly suggest getting a second opinion – specifically that of a lactation consultant.
2. Could your baby have a tongue or lip tie?
If your nipples are cracked and bleeding, if they feel pinched while nursing, if they appear flat or pinched after your baby unlatches, you could be dealing with a tongue and/or lip tie. Most pediatricians aren’t trained to be able to identify them. Get an appointment to see a lactation consultant ASAP. Even if it isn’t a tie, a LC can help rule out other problems like positioning or incorrect latch issues. If it is a tie, your LC can help you get a referral to an ENT.
3. Breast size, breast hardness, stomach size, height, etc. – none of these are accurate indications of your supply. See a lactation consultant and do naked weigh-ins.
Not even your output via a breast pump paints an accurate picture of your breastmilk supply. Your baby was designed to withdraw nourishment from your breast. Your nipples were designed for the unique shape and function of an infant’s mouth. Even the best pump on earth cannot replicate that. You may only be able to pump 2 oz (or even .5 oz) but your baby could easily be getting 3-5 oz at a time. Call your lactation consultant and ask to bring your baby in for naked weigh-ins. The single best bit of information I received was via naked weigh-ins. Get in when your baby will be hungry and have the LC weigh him with only a diaper on. Then nurse on one side for at least 15 minutes and weigh again. Switch to the other side and repeat. Then pump. This is a much better measure of how much your baby is getting.
4. Have you considered full-time pumping or donor milk?
It is indisputable that from a nutrition standpoint, mamas milk is superior. If your nursing relationship needs to end, that doesn’t mean you have to switch to formula. Most insurances will pay something toward a breast pump. Some will even entirely pay for an electric pump of your choosing. Call your insurance to find what they offer. If you have WIC, they will usually help you get a pump as well. There are tons of tips out there for maximizing your output while pumping, though I’ve found using your hand after you finish pumping can help you get every last drop. I highly recommend a hands-free bra or the Freemie pump/cup adapter. I’ll be writing a post about pumping later with lots of tips and tricks, but here are a few good ones in the meantime. It may sound odd but there are also lots of YouTube videos that can be helpful.
If your supply is tanking and you are consistently not pumping at least as much as your little one is consuming, I would highly recommend looking into donor milk. There are several milk banks throughout the country that collect milk donations from moms that have been screened for transmittable diseases. This milk is pasteurized. For some women that’s comforting, for some that’s a turnoff. If that’s not a feasible option, connect with your local breastfeeding groups and see if there are any donations. I personally have donated 30+ oz to a local mama but know of several moms who donate upwards of 100 oz to other moms in need. Obviously you will want to know them either personally or through a close friend as there are things that can be transmitted through milk you do not want, but this can be a great option. You could use donor milk to make up the difference of what your supply is vs. what your little one wants to eat (and you could do the same with formula if you don’t want to use donor milk. Any breastmilk is better than none).
If none of these things help and you do end up needing to supplement with formula, research your options and find one that is the lowest allergen possible. Several more natural brands are producing formula options now, and the Weston A. Price Foundation has a recipe for homemade formula that would be a great option. Obviously priority is a fed, content baby. How you get to that is up to you. Our culture has several traps that can discourage women from breastfeeding if they don’t fall into a perfect nursing experience from the very beginning. Hopefully these give you a few options to look into before using formula.