Mythbusting - "I can't satisfy my baby, I need to give a bottle"

Did you know - most breastfed babies don't take more than 5oz of milk during one feed.

The Disclaimer

This piece isn't intended to replace medical advice. If you're concerned about your baby's growth or development, please contact the appropriate health-care professional.

It's also not telling you how to feed your baby. Reams of discussion have occurred on this subject. Suffice to say: this is for each woman to decide.

The goal here is to impart to you some information how breastfeeding works. That's it.

Why don't breastfed babies need more milk?

You might be thinking, "Wait a minute, that can't be right. I know babies who take 7 or 8oz at each feed!"

Dollars to doughnuts, those babies were fed formula. Now, formula is good for several reasons. It affords mothers a choice. It allows for a reliable way to feed babies if a mother is unable to breastfeed, or chooses not to. But it has some limitations. It cannot adapt to the needs of the baby.

Babies who are bottle-fed formula will gradually take more ounces as they get bigger, to keep taking in the nutrients they need to grow.

This is because the formula given to a brand new baby who was born yesterday is the same as the formula given to a baby born several weeks ago. The baby's needs have increased, but the formula has not changed. The amount of milk given has to increase.

Breastmilk is completely different

It's very important, if you're breastfeeding, to soak this in. Breastfeeding doesn't work anything like bottle feeding. This alone can make feeding your baby quite challenging, because we live in a bottle feeding culture.

I believe it is also important to fully acknowledge it even if you are not breastfeeding. That way, you can offer the proper support and encouragement to women who are. Perhaps you are a partner or parent of a breastfeeding mother. Or a doctor, or a nursery worker, or a friend.

Vive la difference!

• For formula fed babies, the milk they are given increases in quantity to match their need.
• For breastfed babies the milk itself changes to adapt to the babies' needs.

The amount of breastmilk they need does increase up to a point, but it can't keep doing that - otherwise poor mum would be extremely uncomfortable. Instead, the milk contains more nutrients.

Keep in mind, as well, that breastmilk is an excellent food for babies. It's easy for them to digest.

Epidermal Growth Factor

Human breastmilk contains EGF, and babies who have consumed it are better able to extract nutrients from what they're fed. This is another reason why breastmilk feeds can be smaller than formula feeds.

So, to recap:

• The breastmilk is more nutrient dense
• The nutrients are easier for the baby to absorb
• The baby is better able to extract those nutrients, thanks to EGF

But my baby guzzles down a bottle after a breastfeed! Why?

Some babies develop a preference for the bottle because it's easier to get the milk out. This could be one reason.

Please do keep in mind how easy it is to overfeed when using a bottle! The swallowing action triggers the suck reflex. With a mouthful of milk, what's a baby to do but swallow again? A baby who's actually had enough milk could appear to be hungrily gulping down a bottle. This can cause parents stress and doubt.

Babies often seem wiped out afterwards, which some parents interpret as "being contented", and further proof that breastfeeding isn't enough. The reality is, they are more likely sleeping off an uncomfortably large meal.

If you do need (or want) to give your breastfeed baby a bottle:

• Use paced feeding (I'll go into this in another post) to reduce the chance baby will develop a bottle preference. It will also make it easier to avoid overfeeding.
• Use a slow flow teat
• Remember they are unlikely to need as many ounces of breastmilk as your friends formula baby takes

My baby is unsettled after feeds - why is that?

There are many reasons why this could be happening. Here are a few examples:

• Baby is having (or about to have) a growth spurt
• Milk transfer is poor
• Wind
• Reflux
• Allergies or intolerances
• Low milk supply

It is possible low supply is a factor, but in my opinion it's probably an outside chance. That's why it's last on the list. Please don't leap to that conclusion straight away!

Why do I think low supply is unlikely to be the issue?

First, let's recap some basics about infant feeding:

For the first three months, hormones play a huge part in milk production. In simple terms - you produce milk largely because your body just birthed a baby and assumes that baby needs to be fed. At this stage, most women can assume they are producing more than enough milk. (Your body does this on the off-chance you have had twins.)

After this time, your milk production is driven almost solely by supply and demand. Essentailly, if your baby keeps feeding, you keep making milk.

If your baby regularly and effectively strips milk from your breasts, you produce the right amount of milk. If baby's feeds are restricted or substituted, or if milk transfer is poor, you produce less. If you are feeding often, for as long as baby wants and if you know milk transfer is effective then you are most likely producing everything your baby needs.

Low milk supply

Low supply can happen. A significant minority of women are simply unable to produce enough milk. Either because they never developed enough glandular tissue, or because of surgery (cancer, masectomy, augmentation, etc).

Bottom line: If you have never had surgery, and not been diagnosed with insufficient glandular tissue, the odds are better than 98% that you are perfectly capable of satisfying your baby.

What are the causes of low supply?

• Insufficient glandular tissue (a diagnosed health condition)
• Breast surgery
• Restricted time at the breast (feeds being timed or strictly scheduled)
• Substitutes offered, or offered too soon/too often (eg. bottles or dummies prior to the recommended 6 weeks)
• Poor transfer not being detected
• Nipple shields, especially longer time use
• Long term exclusive pumping (expressing not as efficient as a baby, so it is typical to see a drop when supply stops being hormone-driven - ie. around 3 months)

Milk transfer

What can happen is baby not getting enough because she's struggling to remove it from your breast. There's loads of it; the trick is getting it in there.

You're doing great, and producing enough to feed a small village and start a niche cafe in a swanky part of London. But your baby might need a little bit of help. You can satisfy your baby. With the right support!

How do I know if my baby is getting enough milk?

First and foremost, if you have any concerns at all - please get eyes-on support from someone who is properly qualified. That means someone who has specialised in lactation. Don't wait!

If feeding is painful, or you are concerned about your baby's growth go and get seen. Even if someone has told you that your position is great, the latch is perfect and there is no tongue-tie... GET HELP. Many mothers are told this, and struggle on in pain, only to find out later there was a problem after all.

Some clues that your baby is feeding well:

• Baby is producing the expected amount of wet and dirty nappies. This is the big one! If it's coming out it must be going in
• Baby has a good latch (deep, with a mouthful of breast - not just sucking on the end of the nipple)
• You can see and hear swallowing (periodic pauses every few sucks)
• Baby appears healthy and well, growing at the expected rate (NB this might not be the same as a formula fed baby)
• Feeding is fairly comfortable - likely some discomfort early on, but it is manageable and temporary

Some signs your baby is not transferring milk well:

• You are not seeing the above reassurance that your baby is feeding effectively
• Feeding is painful. The pain is significant and lasts throughout the feed, or persists between feeds
• You dread feeding your baby, feeding makes you cry, or you think, "I can't do this"
• Your nipples are extremely sore or even damaged
• Your nipples are mis-shapen after feeding (they might look a bit lipstick-shaped)

Sometimes it is as simple as adjusting your feeding position.

Other times, baby's tongue might be tethered too tightly to her mouth, and she can't move it well enough to suckle. (Yes, babies use their tongue to suckle - the breast is "milked" between the tongue and palette.) If baby's tongue movement is restricted, this is called a tongue-tie, and it can make breastfeeding extremely painful.

Pain (not mild to moderate temporary soreness, but actual pain) is a sign something is wrong. The good news is, the wrong thing can usually be fixed and you can go on to feed your baby comfortably.

Things which do not indicate you don't have enough milk:

• Baby is very big
• Baby wants to feed often
• Night-waking (even if baby has previously been sleeping longer stretches)
• Not being able to express much milk (your body responds differently to a baby, so pumping or even hand expressing is no indicator).

These are all normal. Difficult, absolutely. But normal. You may have a friend or an aunty or a random on Facebook telling you otherwise. Please be reassured: Yes - you CAN satisfy your baby.

Remember how amazing your body is - try to trust it!

You made an eyeball, a liver, two kidneys, a complex skeleton with all the accompanying muscles and blood vessels, and an honest to goodness actual brain! Odds on, 4-5oz of milk is child's play.

Conclusion

Feeding problems are common, but a genuine inability to satisfy your baby is unlikely.

It is far more likely to be a transfer issue than a supply one.

Low supply can happen, but in many cases it is a created problem, and one that can be avoided with the right knowledge beforehand.

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For more information and support through pregnancy and beyond:

Antenatal Classes in Shrewsbury