Booby Trap Series: If you need to supplement with formula, avoid these Booby Traps

This post is the 58th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Sometimes supplementing a breastfed baby is necessary in the early days and weeks after birth.*

When it is, it’s also necessary to protect breastfeeding.  So, how do you do that, and what are the Booby Traps to avoid along the way?

The Academy of Breastfeeding Medicine (ABM) lays out how to supplement while protecting and supporting breastfeeding in their supplementation protocol.  And some great advice is also contained in The Breastfeeding Mother’s Guide to Making More Milk and at Low Milk Supply.

Unfortunately, not all care moms get is consistent with their guidelines.  So, below are some Booby Traps to avoid if you need to supplement.  Do any of them sound familiar to you?

Booby Trap #1:  Not having an evaluation and plan to “fix” breastfeeding before starting supplementation.  The ABM recommends that supplementation begin in cases of dehydration when the condition “is not improved after skilled assessment and proper management of breastfeeding.” Being instructed to supplement when no one has helped you try to figure out and fix any breastfeeding problems is a Booby Trap.

Booby Trap #2:  Not being allowed to use your own milk as a supplement.  The ABM states, “expressed human milk is the first choice for supplemental feeding” when available.  But many mothers aren’t given the option of using their own milk.  Using pasteurized donor milk is not common practice for healthy, full term babies, but it remains “preferable to other supplements,” according to the ABM.

Booby Trap #3:  Being told to use a breastfeeding unfriendly feeding device.  Your providers can’t really be blamed for this one.  The Booby Trap here is that there is no consensus on which method is best.  The ABM states, “There is little evidence about the safety or efficacy of most alternative feeding methods and their effect on breastfeeding.  An optimal supplemental feeding device has not yet been identified, and may vary from one infant to another. No method is without potential risk or benefit.” A detailed discussion of the strengths and weaknesses of each is at Low Milk Supply.

Booby Trap #4:  Being instructed to use more formula than is necessary.  The ABM states, “As there is no definitive research available, the amount of supplement given should reflect the normal amounts of colostrum available, the size of the infant’s stomach (which changes over time), and the age and size of the infant.”  So being told to give your newborn baby “as much as she will take,” is probably not the right approach and will just result in some dirty laundry.  For older babies, a the ABM provides guidelines based on the available research.

Booby Trap #5:  Not getting support for maintaining and increasing milk supply (if necessary).  The ABM states, “If mother–baby separation is unavoidable, established milk supply is poor or questionable, or milk transfer is inadequate, the mother needs instruction and encouragement to pump or manually express her milk to stimulate production and provide expressed breastmilk as necessary for the infant.”  For older babies who are not gaining weight normally, mothers should receive breastfeeding support and a plan for increasing milk supply, if appropriate, and other recommendations for optimal feeding.

Booby Trap #6:  Not receiving a plan for weaning from formula supplements.  This issue is not addressed by the ABM protocol, but it’s a significant issue in the management of breastfeeding when supplementation is necessary.  Sometimes women are told to go “cold turkey” on formula supplements once a baby is gaining well, only to return to the office with an angry, hungry baby.  Sometimes they’re instructed to continue supplementing longer than is necessary.  A good resource for reducing formula supplements while ensuring normal growth is at kellymom.com.

There are other Booby Traps specific to preterm babies.  One of the most obvious is not using donor breastmilk as the supplement.  More Booby Traps in the NICU are here.

Did you have to supplement?  Did you encounter any of these – or other – Booby Traps?  Did your providers help you do it in a way that protected breastfeeding? 

*Of course, the biggest Booby Trap is being given formula when it’s not necessary – a practice of 4 out of 5 hospitals.  See the ABM protocol on supplementation for guidelines indicating when it’s truly necessary.

Image credit:  Wikimedia Commons

 



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7 Responses to Booby Trap Series: If you need to supplement with formula, avoid these Booby Traps

  1. Leslie says:

    When my daughter was born she swallowed a lot of amniotic fluid and blood… it made her tummy upset and it made her a very fussy, unhappy baby. We were bullied by our first nurse to give her a bottle (because she didn’t want to take the time to help me latch her on). Being exhausted and having passed out when I tried getting out of bed it was really easy for her to bully us. She gave my daughter a FULL BOTTLE (we asked for her to use a syringe but she refused)!!! Well this was both a good and bad thing, it made my daughter spit up (obviously since her stomach couldn’t hold that much) which is how we found out she had blood in her stomach (brown spit up is not normal). The end result of this was she needed her stomach suctioned several times and she became dehydrated. Although it was a HUGE challenge I continued to breastfeed her and ended up supplementing with formula until my milk came in. I would nurse my daughter first and then she was given a few cc’s of formula by my husband (we never used a bottle after that first one). Once we had our wits about us we realized that we could exercise a lot more control over the situation and still appease the doctors and make sure our daughter was healthy. Once my milk came in we slowly cut back the amount and number of times we gave her formula; my milk came in over the course of several days so it was easy to wean her off the formula over a few days. I was completely distraught over supplementing but because I had such a great support system (outside the hospital; doula, lactation consultant, husband, family)I was able to succeed at breastfeeding (which for other reasons was so hard at first). I should also say that getting out of the hospital and away from the not so helpful and often times pushy nurses was a huge help. (and just because I’m thinking of it I ran into a “booby trap” nearly immediately after my daughter was born when the nurse gave me a nipple shield(my doula was too busy worrying about me and the fact I wasn’t doing that great to say anything). I threw it away that next morning much to the annoyance of my bossy nurse).

  2. Brandi says:

    I had to supplement both my kids, due to IGT, but it wasn’t diagnosed until my second. With my first, we ended up in a children’s hospital due to dehydration. After being there for several hours, and after they had pumped in fluids via an iv, a lactation specialist came to see me. She weighed my little man, had me feed him (with her standing over me constantly asking if he was done), then weighed him again. He only had gained a quarter of an ounce. She then told me I don’t make enough milk, and what I needed to do was nurse for 15 min, give him a bottle of formula (as much as he wanted), and pump for 15 min. As she was heading out the door, she handed me her card and said if I wanted to do some testing to find out why I didn’t make enough, give her a call in a week or two. Thanks to her caring, “I want to help you” attitude (note the sarcasm), I never called. Thankfully I did get involved in my local La Leche League, and I ended up weaning him off formula at a year old, and continued bf until he was 2 1/2. With my second, I hired an IBCLC I came to know through LLL, got a diagnosis, used a baby scale to daily weigh and adjust formula amounts (going for 1/2-1 oz weight gain daily), tried different herbal and prescription aids to increase supply, and used a supplemental nursing system until she was about 6 mos old, then a bottle till she weaned off formula at 9 mos old.
    So, I would add a booby trap of “experts” (ie, hospital lactation specialist) who don’t want to take the time to help you.

  3. Ash says:

    I think doctors are so used to telling women to supplement now they say it whether there is medical reason or not. My daughter was perfectly healthy, active, not dehydrated in the least and I was still ordered to supplement because she wasn’t gaining as much weight as the chart said she should, even though if you looked at the girl you could tell she was fine. I ignored the doctor and continued to breastfeed on demand (the doc had ordered me to only bf every 3 hours and to use formula between) and my daughter is a normal, healthy little girl 9 months later and still bfing. Had I listened to the doctor, she would’ve been a formula baby eventually.

  4. Julie says:

    I have PCOS and small nipples. When my dd was born, it seemed that all things were against us for breastfeeding. It also just so happened that my daughter was born on a Friday of a weekend that all the lactation support team at my hospital was off on. The nurses did their best to help us. One gave us a nipple shield. We started using that and went all weekend in the hospital with just me. Come Monday, they decided that she was loosing too much weight and I wasn’t producing enough so we started supplementing with formula. I went to LLL and WIC’s consultation. I refused to give bottles because I didn’t want my daughter to associate me with bottle feeding. I was momma – momma breastfeeds! Then, one lactation consultant finally told me that I could either enjoy my baby and just accept that she needs formula or we could keep struggling and I can keep refusing to cuddle my little girl while she takes a bottle.. the choice is mine. I took the first. At 4 months, she decided that it was just easier to take a bottle than to nurse and weened herself.. basically overnight.
    My child has been healthy, is ahead in many developmental milestones, attached to her momma, still prefers me over anyone else, and is a beautiful little girl.
    I plan on trying to nurse our next one (when the time comes for another one), but if not, my world won’t crash like it did with my dd. For those of you that have to use formula, please do not feel bullied by militant breastfeeding mothers (I’m NOT saying this is what this site is in the least!! But, they’re on here and everywhere you turn!). Remember, most of them get their information from websites and posts and blogs and call themselves experts. I’m not saying doctors are perfect, but I have personally chosen to trust a doctor’s educated opinion about my daughter’s health than another mother’s harsh bullying.
    I’m not saying these things aren’t good things, they are, but if you try and it still ends up that you must use formula, it’s okay. You’re a good momma, and your baby won’t grow up to hate you and resent you for not breastfeeding.

    • Julie says:

      I also want to add, I know that there are things that people say you can to increase supply and while these work for some women, most didn’t work for me. I would definitely try other things, if your doctor is okay with it. But, a lot of them are old wives tales passed down through the generations and don’t necessarily work (or worked for someone’s best friend’s great aunt’s husband’s sister’s grandmother’s nextdoor neighbor back in Italy..).

      • Ash says:

        I understand that with PCOS, it’s common not to make enough milk. It just makes me sad that women like you WITH legitimate medical reasons get judged because there are so many women WITHOUT medical reasons who just don’t try. I’m sorry for your experience, but I’m glad your baby is healthy and happy.

  5. Lindy says:

    I supplemented with my own pumped breastmilk for a month after my daughter was born. I was determined to breastfeed but the baby kept losing weight and my pediatrician said I needed to pump and supplement with my own breastmilk for every feeding for awhile. As the baby got older, stronger and more alert I was able to wean her from the bottle back to the breast and the pumping protected my supply. It took a month of tears to get it to work but now she’s a pro.

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