Mixing bottle and breast – it doesn’t have to be all or nothing.

Several mums I’ve spoken to recently have mentioned it’s hard to find good information about mix-feeding.  Often breastfeeding websites don’t discuss it as they promote exclusive breastfeeding and the reasons for doing so.  Similarly some mums are nervous about asking too many breastmilk questions on bottle-feeding forums, for fear it may upset those not breastfeeding at all.  Mix feeding, combination feeding – whatever you prefer to call it, almost seems to fall into a no mans land.

What concerns me about this is hearing from a number of mums that they thought it had to be all or nothing; some have said that once they had given a bottle and destroyed the “virgin gut” (the special environment created by baby having solely breastmilk) they believed there was no longer any point continuing.

I hope this entry helps….

Why isn’t mix-feeding promoted more by breastfeeding supporters?

There is no doubt that exclusively breastfeeding is the safest way to nourish an infant.  As mentioned above, certain antibodies work to help prevent harmful pathogens or allergens being absorbed into baby’s bloodstream (often called “virgin gut”).   Small amounts of formula remove the protective coating,  although evidence also suggests several weeks of exclusive feeding can help it revert back to one dominant in good bacteria again.  Read more about exclusive breastfeeding v mixed feeding here.

The other big issue is supply – in simple terms your body knows what to produce based on how much your baby consumes and how frequently.  Logically if you replace one breastfeed with a bottle feed, your body will produce this much less milk and everything else will be the same.  In the early days however this logic often doesn’t work; a baby drinks more from a bottle because it’s a more passive method of feeding, which combined with the fact formula is harder to digest leads them to go longer before the next feed.  Because they’ve drunk slightly beyond satiation, next time they may need a slightly bigger bottle or a bigger top up, to create the same “full” feeling.  Some babies then become frustrated at having to wait for the breast to “let down” and having to work for milk, rather than it just being poured out – so may fuss at the breast.  Mum can easily then think baby prefers the bottle and seems happier – baby may even refuse the breast entirely, particularly if breastfeeding wasn’t going that great when the bottle was introduced.  It can be a slippery path from giving one bottle to the supplement amount increasing, time at the breast reducing and mum suddenly finding herself almost entirely bottle feeding, when in fact she wanted to breastfeed.

What if mum can’t get help to resolve the problem or feels she has to or really wants to give a supplement/bottle.  What if the choice isn’t exclusive or mix feeding – but mix-feeding or nothing, is there any point continuing breastfeeding?

Yes, yes, yes, yes, yes!

There are two different issues at play here; the first is the protection from breastmilk coating the gut.  The second is all the other many many constituents in breastmilk that work in a different way; those that enter babies blood stream and target pathogens, or help sweep them from the body.  Cancer fighting agents, stem cells, hormones and a lot more besides! We often hear it said that even one breastfeed per day is valuable, and this is absolutely true.

If breastfeeding were only of worth when exclusive, there would be no reason to continue once solids were introduced.

I find it helps to look at things on a big scale in terms of risks/benefits – right at one end you have the exclusively breastfed infants who have never been supplemented, feed on demand and likely co-sleep with lots of nightfeeds.  At the other an infant who is exclusively formula fed with no breastmilk.  All other infants sit somewhere on this scale and the more breastfeeding/breastmilk is involved, the further down the “risks” scale they sit.

But is there any point if I have to return to work?  I will have to stop then anyway?

Returning to work doesn’t have to spell the end of breastfeeding.  There are many different options to explore.  Some build a “freezer stash” of expressed milk in the early months and give this when they return to work – perhaps continuing to express, or deciding to just use the stash before supplementing with another milk.  Others might choose to express whilst at work and give that, whilst some might fit say one expressing session in and give the rest as a different milk.  If baby is well established on solids, mum may choose not to leave another milk and instead feed lots when at home (perhaps offering more cheese/dairy products).  If mum works near home or near her childcare, sometimes she can even arrange to visit baby during breaks to feed or have baby brought to her.  There are no hard and fast rules as it’s about finding something that works for you and your circumstances.

But what is key is in any of the above scenarios – you can still choose to breastfeed when you are with your baby.  This means your baby still gets passive immunity which when starting daycare or a childminders (positively a germ party!)  can be invaluable, not only for baby’s health but also as a way of reconnecting after a day at work.  It also means mums don’t have to bother with the hassle of making up bottles/cleaning them etc taking further time out of what can be a busy day!  In the UK mums may often have 6-12 months maternity leave, meaning supply is much more established by the time and can quickly adapt to new and changing patterns.  Even at a few months old supply has more chance of keeping up than in the early weeks – allowing you to continue as long as you want.

There are so many reasons to breastfeed – it really doesn’t have to be all or nothing…