Part 2 – When Should I use it ?
Part 1 of this article covered the first few days in the hospital, and focused on what temporary supplementation was, and how to do it.
This second part focuses on when to use it, and how it might help you in the following weeks.
Temporary supplementation can mean just 1 bottle of formula in the whole of your bf journey, or the occasional bottle on the odd occasion, or once a week, once a day, or after each feed.
Reasons you might utilise temporary supplementation
• Building supply
• Birth recovery
• Nipple pain/cracks/bleeding
• Latching problems/tongue tie
• Sleep deprivation
• Illness (you, baby or anyone else in your family)
• Social occasions (weddings, christenings etc)
• Social life (avoiding isolation)
• Partner’s involvement.
• Parent’s mental health
Remember, all of these situations can be dealt with using expressed breastmilk but this article is dealing with those times when that isn’t an option for whatever reason.
In the first few weeks when your milk comes in, your breasts are trying to figure out what their job is and how to do it. Bearing in mind the differences in people’s own biology, birth experiences, baby, and lifestyle it is not surprising that there is a huge variation in how soon and how efficiently this all settles down.
If there is a delay in supply building to the point where you can exclusively bf your baby, you will probably consider taking measures to stimulate your breasts to produce more milk. This might mean feeding more frequently, or triple feeding where you breastfeed baby, pump, then feed baby the expressed milk.
Both of these regimes can be exhausting and upsetting and you need to know that the occasional bottle of formula every now and again to give mum a break is a perfectly valid reason and will not damage your supply.
You also need to know that topping baby up with formula after a feed until your supply increases will not damage your milk supply as long as you breastfeed first until baby has emptied the breasts.
Birth hurts like hell and even the easiest can be exhausting. The biggest mistake I see parents making is not making sure mum gets enough time, help and support to recover.
**Note – two of the biggest factors in low milk supply are pain and exhaustion…how can your body produce milk when it is trying to protect and repair itself ?**
Sometimes the best way to improve milk supply is to take care of the mum. If this means missing/delaying the occasional feed, and giving baby a snack or feed using formula then that is fine…just remember that over 24 hrs the breasts need to be stimulated 7 or 8 times.
There is always some degree of discomfort involved in breastfeeding. For some women this is mild and short lived, but for others it can become very painful, and go on for a long time.
She might experience cracked and bleeding nipples which can be so severe that the woman considers giving up breastfeeding altogether.
In this situation it is perfectly ok to supplement the breastfeed with a few formula bottles in order to give the mum a break, and to allow her nipples to heal.
If you choose to do this just replace the feed with a bottle when you feel you need to and pick up breastfeeding again when you feel ready.
Whilst your milk supply is still establishing you can keep it ticking over by pumping for 15 mins each side for your usual 7 or 8 times a day.
If you are still trying to build your supply, remember, it is not a race, it doesn’t matter if you take the scenic route and get there a few days or even weeks later.
Don’t push yourself until you are in so much pain that you dread feeding your baby !
If you get mastitis that needs treatment, there are antibiotics available that are fine for breastfeeding so you can feed directly, or pump and use the expressed milk.
Sometimes, however, often with serious or repeated infections, you might be medically advised to use stronger medication that is not safe for baby. In this case just continue to pump to relieve the breasts and keep your supply up, dump the breast milk, and use formula until it is safe to restart breastfeeding.
Latching problems and tongue tie.
Remember that both mum and baby are beginners at this breastfeeding game, and so it can take a while for you both to get the hang of it, especially if baby has complications like tongue tie, or jaundice that makes them sleepy and unable to put much effort in to feeding.
You may also have a baby who gets so ‘hangry’, that they get frustrated if the feed doesn’t go smoothly. I have seen some epic tantrums in highly strung, impatient babies, and the feeds can be exhausting and seriously stressful for everyone involved !
This usually comes right with help and support but may take some time whilst you wait for a tongue snip, or for a lactation consultant appointment so in the meantime, as long as the breasts get decent stimulation 7 to 8 times a day, it is fine to use formula to either top up, or for a full feed.
This is the biggest and worst difficulty encountered by parents with a new baby…and it can be a total nightmare until things settle down.
Remember that exhaustion can contribute to low milk supply, quite dramatically, depending on the person, so a partner giving a bottle of formula in the middle of the night whilst the mum gets some much needed sleep should be seen as a very positive thing.
I know there is a lot of talk about how mum has to feed in the middle of the night because of hormones, but there is no reliable evidence that night feeds have any significant affect on long term milk supply.
In my own experience with hundreds of families over 25 years I have noticed no difference in the milk supply of the mums, or the health of the baby between those mums that fed in the night, and those that let me do the feed whilst they slept. The only difference was in the health and mental well being of the mum, which improved dramatically in those that got more sleep, so never feel guilty for skipping one of the night feeds if you feel you need it.
Sometimes life just gets in the way and illness of parents, baby, or someone close to the family means that mum might not be available to breastfeed baby either because she is too busy, or because she has to be elsewhere.
It might also be the case that baby is too ill or weak to breastfeed directly, and if there is no expressed milk available, formula will do just fine.
Focus on trying to keep up supply with pumping, even if this is less than you would like, then work on getting feeding back to normal once everyone is healthy again.
For some people breastfeeding in public is quick and easy, but for others it is more difficult.
If this is the case, and you have important social occasions to attend that clash with baby’s breastfeeds, then the odd bottle of formula will not make any difference. You are allowed to enjoy yourself every now and again !
Here, I am talking about every day socialising i.e. when mum gets to leave the house and meet up with friends or family for some adult company.
Again, if breastfeeding in public is a problem for whatever reason, and expressed milk is not an option, then using formula to cover a feed is not only ok, it can be extremely beneficial to the mums quality of life.
I have known mums with difficult feeders who end up staying home for every feed and missed out on any socialisation because they were afraid that using formula for outside feeds would ruin breastfeeding and also because they were afraid of shaming comments from other people.
They were unhappy, and lonely, and even resentful of the restrictions, which can lead to serious isolation and deterioration in her mental health and anxiety levels.
By partner I mean whoever is involved as a primary carer for baby, regardless of sex, sexual orientation or marital status.
A parent is a parent and they can all get great joy and satisfaction from feeding their baby. In this case, the use of formula plays a very valid and important role in allowing a parent to experience feeding their baby.
I’ve left this till last because parents mental health after a new baby is massively ignored, under-diagnosed and poorly treated.
Whilst both parents can suffer from Post Natal Depression and Anxiety, it is more often the stay at home parent who is most vulnerable its affects, and this is most commonly the mum.
Whilst PND can affect anyone, any time, there are certain (non hormonal) factors which contribute to its occurrence and these can include:
• Ill health
• Sleep deprivation
• Lack of support
If you compare that list with everything we have talked about so far I’m sure you will see a similarity between PND/Anxiety and some of the complications of breastfeeding.
Am I suggesting that breastfeeding causes PND ? No, of course I am not.
What I am suggesting is that the occasional and strategic use of formula can play an important role in lifting some of the pressure from a struggling parent, so it should be embraced as the useful tool that it is, instead of something to be avoided at all costs, which is how some people portray any use of formula.
In the end it is your choice and your decision to make, which is why I have tried to give you an unbiased and practical overview of temporary supplementation.
This is such a huge topic and in trying to keep things brief there is a lot I have had to leave out, or just touch on briefly.
If you have any questions about temporary supplementation, or need help, or just someone to talk to, then please don’t hesitate to get in touch and I will do my best to help.
For the company of open minded, friendly people and my ongoing support and advice please come along and join my free Baby Detective Support Group.
If you have used temporary supplementation for any reason at all, please can you take a moment to share in the comments below because it will help other parents to realise what a useful tool it can be.
Sarah Norris is one of the UK’s most accomplished maternity nurses, with over 25 years experience caring for hundreds of babies and families in the UK and internationally.
She treats all babies and families as individuals, and respects all forms of parenting and feeding, aiming to help and empower new parents with sensible, practical tips and advice that is always non judgemental and non biased.
She is the author of ‘The Baby Detective’ with Orion Books, out now.