As discussed in Part 1, there is a difference between breast milk and formula. However, it is not only the type of milk, but also the delivery method and style of feeding that can greatly affect the behavior of a baby.

It is not a very accurate scientific analysis when any amount of breastfeeding is weighted equally across the board. There are definite differences between exclusive breastfeeding, breastfeeding with occasional supplements of expressed breast milk and breastfeeding with formula supplements.

The types of milk offered, the delivery methods and styles of feeding can significantly impact any evaluation of breastfeeding success.

Milk:

• Human milk, being lighter and easier to digest, does not make the baby go into a heavy sleep for the entire interval between feedings.
• Formula, being heavier and more difficult to digest, and usually given in larger amounts by the bottle, seems to make the baby sleep much of the time, especially in the beginning.

Delivery Method:

Breastfeeding with a decent latch eliminates intake of additional air.

• The flow rate of milk directly from the breast is slower being delivered in a fine spray that can be more easily handled by the baby. This reduces the need for much burping post feeds.

Bottles, no matter what the manufacturers may claim, always have additional air in the system which can add to the sense of fullness experienced by the baby.

•  They tend to deliver the milk much more quickly than does the breast; the baby may gag and pull away or develop techniques to pinch off the nipple with its tongue to stem the flow. Obviously this action would not be pleasant if it was then applied to the human nipple.

Feeding Styles:

Exclusive Breastfeeding can vary a great deal from one nursing couple to the next. Much depends upon who is running the show.

Baby-led, or what I call free-style breastfeeding, tends to be more frequent and assessment of intake or quality of each feeding can be somewhat unclear to the mother, especially in the beginning of the breastfeeding relationship.

Conscious Breastfeeding, the term I coined to describe the mother putting the baby on with intention to ensure a qualitative feed, will lead to more defined patterns of feeding that can be optimized over time. NB. This does not mean a schedule, but rather a definite feeding rhythm.

Breastfeeding with Expressed Milk Supplements:

• The lighter, species specific nature of human milk causes much less digestive upset in the baby.
• Expressed milk given by a bottle is a pooled sample of milk and the ratio of water, fats, proteins, etc. may vary from one serving to the next.
• Nonetheless, it will be clear that all growth is taking place solely due to the nutritional value and calorie content of human milk whether taken directly from the breast or via the bottle.
• Additional air in a bottle of expressed breast milk may make the baby feel more full than when it feeds directly at the breast. This is one possible reason that premature babies only given human milk in a bottle, for days or even weeks prior to discharge, seem unsatisfied initially when switched to exclusive breastfeeding.

Breastfeeding with Formula Supplements:

Several variables are in play with this approach. The breast milk and formula are inherently different as has already been discussed.

• Caregivers tend to be very generous with the readily available, heavier formula when feeding by bottle. There is a belief that the baby will sleep longer.
• When formula is given there is usually an unlimited supply compared to the output that results from the mother’s pumping.
• Since formula is harder to digest, breastfeeding more frequently will not be as productive. The baby needs to be alert and truly hungry to breastfeed well. Otherwise, it will snack on the breast and wait for the bottle.
• The mom will think she is breastfeeding, but she is quickly becoming the aperitif rather than the main course.

Babies who have been on expressed breast milk and/or formula via bottles for a period of time are often difficult to transition back to the breast:

• They have developed a taste for the method (firm bottle nipple) and speed of the delivery system (fast flow bottle).
• The more bottles, the greater will be their discontent while breastfeeding.
• Their mother who has become accustomed to measuring volumes of milk being given via the bottle will soon become insecure and worry that she doesn’t have enough milk in her breasts.

Babies react differently when breastfed only or breastfed and given bottles of breast milk and/or formula. For this reason it is essential that the utmost effort be made to optimize the baseline of direct breastfeeding.

Judicious use of supplements, preferably of human milk whenever possible, will foster a less complicated analysis and more enjoyable breastfeeding experience.

Breast milk is a bioactive fluid that contains so many amazing and dynamic constituents that it is impossible to memorize all of them; it packs food and fluids into small amounts and cannot be exactly duplicated in a lab or from one mother to the next. Formula, although the name sounds scientific, is just a processed food. It is always the same. Whether you give one ounce or 20, the only thing that changes is the calorie count.

Dr. Sears, a renowned Pediatrician and advocate of Breastfeeding, has a very helpful chart on his site comparing some of the key constituents of Breast milk and Formula.

Breastfeeding without any supplements is a very different experience for the baby and its parents than when formula supplements are added. Unfortunately, breastfeeding mothers are often encouraged to add supplements of formula by health care workers and family members. This suggestion is especially common during the early days of breastfeeding when the milk supply is being established.

Although no harm is intended, most parents do not realize that implementing this strategy, without any restrictions, can negatively impact the breastfeeding dynamic of supply and demand.  Supplementation changes the timing and frequency of feedings and can adversely affect the quality of direct breastfeedings.  To further complicate matters, giving different milks and using different delivery systems can skew the perception of what satiety looks like in a baby.

When assessing if a mother has enough breastmilk, these facts need to be considered.

• Human milk is an energy-rich, bioavailable milk which nourishes and hydrates the baby in smaller volumes.
• Attempts at pumping human milk, especially in the early days, will yield misleading results. What is pumped does not correlate directly with what the mother is making and what is available to the baby with direct breastfeeding.

Formula, on the other hand,  is a processed food. It is always the same except when the “additives” and “chemical formulations” are periodically changed to generate some kind of brand loyalty among members of the medical establishment and consumers.

• Breast milk and Formula are very different foods; they each impact digestion, gas formation, appetite and linear growth and weight gain in differing ways.
• When both milks are mixed together in the same stomach any negative reaction will generally be blamed on the mysterious Breast milk, rather than on the cow or soy based artificial baby milk.

Comparing the two milks is like trying to compare apples and oranges. They are both fruit, but the taste, texture and impact on digestion will vary. You could never tell if you were allergic to apples by eating oranges. However, an analysis of breastfeeding is often based upon how the baby takes formula when offered.

Formula is often added because it so readily available and convenient. Marketing 101.

• If the baby needs to have its appetite stimulated by giving it supplements, the first milk of choice should always be human milk.
• Even if only small amounts of extra breast milk are available at first, the biological impact is far more powerful than that of formula.

Technically, whenever formula is added to a breastfeeding relationship, it is the beginning of the weaning process. If more women were truly aware of this fact, I believe the use of formula by breastfeeding mothers would be far more judicious.

Mothers cannot help but question their own milk supply when the analysis is too often based upon adding in a different milk.

In Got Enough Milk? Part 2, we will examine how style of feeding and delivery method of the extra milk provided will further impact the mother’s confidence in her milk supply and breastfeeding success.

Single-use, high quality electric pumps have been available for consumer purchase since the early 90’s.  During these intervening years, the amount of pumping has increased exponentially in the United States and across the industrialized world.  Pumping is very much part of the popular culture, often being featured in sitcoms and instructional media geared to expectant parents.  There is a not too subtle imperative to own a deluxe pump before the baby is even born.  Doctors, Nurses and Lactation Consultants encourage pumping as a way to both evaluate and to increase a mother’s milk supply. 

Pumping for some women is their idea of Breastfeeding.  Are you all Pumped Up?

Symptoms include, but are not limited to the following: 

• You Breastfeed and pump after almost all feedings
• You wake up in the middle of the night to pump
• Your are pumping weeks worth of extra milk, just in case
• You “power pump” if you get less milk out than usual in order to increase your supply
• You pump whenever you feel something is wrong with your breasts
• You pump to “empty” your breasts

I field inquiries in all my venues about pump management.  Mothers have been sold on the idea that the pump tells the whole story about their Breastfeeding.  They worry when they can’t extract the same amounts as their friends or in volumes that compete with ready-made formula bottles. 

Those women who do obtain copious amounts of milk when they pump will often have issues in their breasts while breastfeeding.  They tend to be out of sync with the baby and often contend with excessive leaking and engorgement.  Some will report having had Mastitis which was the result of inadequate drainage from only pumping or mixing pumping with direct, but inconsistent patterns of Breastfeeding.

Pumping can actually compound any problem brewing in the breasts.  Women who have sore nipples and engorgement are often advised to pump, rather than to correct the latch.  Congestion can build up and if not relieved the mother will spike a temperature leading to a course of antibiotic therapy.  Whenever, the health of the breast has been compromised it is essential to use the baby and not the pump to solve the problem.

Of course there is a time and place for Pumping…

• Premature Delivery
• Illness of mother or issues with the baby or babies that require a delay or interruption of direct breastfeeding
• To obtain human milk if supplements are medically indicated
• Returning to Work outside the home

Other reasons cited, may include:

•  Mom needs a break from breastfeeding
• Dad/partner wants to participate in feedings
• To know how much the baby is getting at feedings

Since the mother is the only one pumping and Breastfeeding, it is not exactly a vacation.  Pumping will increase her workload and can create additional anxiety as her milk output can vary greatly depending upon when she pumps.  The mother who feels overwhelmed and worried about her milk supply may begin supplementing and make decisions that lead to early weaning. 

If you are pumping or have pumped what has been your experience?  Are you all pumped up?…or more aptly all pumped out?  I invite your comments and concerns related to pumping.