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Breast, Bottle, or Both?

Breast Benefits: You've heard it before -- breast is best. "Breastfeeding protects your baby from illness and infection, enhances brain development, and lowers the risk of developing asthma and diabetes," says Marianne Neifert, M.D., a Denver pediatrician and the author of Dr. Mom's Guide to Breastfeeding. Moms benefit too: Nursing lowers your risk of breast cancer, rheumatoid arthritis, and possibly osteoporosis. It also burns calories (about 500 a day), can be convenient (no bottles to wash or formula to mix), and is cheap (you only need a few nursing bras and, usually, a breast pump). If you pump breast milk, someone else can feed it to your baby by bottle. Drawbacks: It's all you, all the time: Nursing is time-consuming (a newborn can feed every two or three hours all day and night), and you need to pump even if Dad gives the baby a bottle of breast milk. "Nursing can cause great fatigue," says Will Wilkoff, M.D., a pediatrician in Brunswick, Maine, and author of The Maternity Leave Breastfeeding Plan. "In fact, it's a bigger energy drain on your body than pregnancy." Nursing can make some women self-conscious, and the learning curve can be steep. Sore nipples, plugged milk ducts, mastitis (a breast inflammation), and engorgement can be painful side effects. Scheduling can be a challenge, especially for working moms -- some jobs may not allow for multiple pumping breaks. How I decided: "I breastfed my baby because it was the easiest method for me. When my son woke up at night, the milk was set to go -- it was already mixed and warmed." -- Misty Zerkel, Lyons, OR "I worried that breastfeeding would be embarrassing and that my husband might get grossed out. But even after soreness and mastitis, it still was the best choice -- and my husband is more amazed by my body than ever!" -- Zoe Albright, Lee's Summit, MO

Bottle Benefits: Feeding with a bottle can be very comforting: You see just how much is going into your baby and can be satisfied knowing the feedings have been complete. Bottle-feeding can provide an emotional closeness and nurturing similar to breastfeeding. "There's a quicker start to bottle-feeding -- you just pop it in the baby's mouth and you're off," says Dr. Wilkoff. You can also share the feedings with Dad or a sitter while you're freed up to work, care for other kids, or rest. Drawbacks: "In a word -- constipation. You just don't see this in breastfed babies, but it's pretty common in formula-fed ones," says Dr. Wilkoff. Babies can also develop an intolerance to formula, so several switches may have to be made to find the most suitable version for them to drink. Overfeeding is a possibility, especially if moms encourage their tot to finish the prepared bottle even when the baby is satisfied. Formula is costly, though it varies by brand and preparation (ready-to-go liquid or powdered, individual servings or bulk packages). Bottles and nipples need to be purchased, initially sterilized, and washed after that. Feedings have to be prepared, stored, and then packed for most outings with your baby. How I decided: "Bottle-feeding allowed my three step-kids to help feed their new baby sister, which they were so excited to do." -- Kimberly Carney, Drexel Hill, PA "I was getting terrible migraine headaches, so in order to take prescription medications, I put my daughter on formula. I think that the bottle-feeding has helped her and my husband develop a strong bond." -- Kara Tobaben, Fairfax, VA Both Benefits: Supplementing breastfeeding with bottles can be the best of both worlds: You're giving your baby the nutritional benefits of breast milk while giving yourself some flexibility and a chance to rest. Adding formula bottles to a nursing routine can be ideal for working moms -- no pump or on-the-job breaks needed. It's also a relief for those with low milk supply or latch-on difficulties, or who are exhausted or frustrated by nursing. Giving your baby expressed breast milk is even better. If pumping works well for you, your supply can usually be maintained while you're at work and nursing can continue when you're at home. Drawbacks: Fully breastfed babies are the most protected from illness. "The immune benefits from breast milk work best if it's the only food being given," says Dr. Neifert. And while most babies can easily switch between breast and bottle, some may refuse. Or your baby may prefer the faster flow of a bottle and nurse less frequently, which means your milk production will decrease. "Cutting back on nursing is not always a linear process, so that breastfeeding only half the time may produce less than half the milk," explains Dr. Wilkoff. If you decide to do the combo with formula, wait until after the first few weeks so you can build up your milk supply. To avoid clogged ducts as you add bottles, wait four to seven days before dropping a nursing session. How I decided: "I like to breastfeed at home, but when I go out I either pump milk for her or have a bottle of formula ready. It's been very convenient." -- Eliana Munoz, Astoria, NY "My son was in the NICU for a week, so I wasn't able to be there all the time or pump enough milk. At home I nursed most of the time, but since my production was still low, I supplemented with bottles of formula." -- Jamie Wanis, Gaithersburg, MD The Breastfeeding Mom's Bill of Rights As if engorged breasts weren't enough of a pain, breastfeeders have to face bossy strangers and cruel coworkers. Here, a review of your rights. 1. If you have a right to be somewhere with your baby, you have a right to breastfeed there. It's the law, says La Leche League International. While there are a few places, such as courtrooms, where babies aren't permitted, women can legally breastfeed in most public places -- stores, restaurants, parks, and malls. This holds true even if your state doesn't have legislation protecting a woman's right to breastfeed in public. (Almost half of all states do; visit LaLeche League to see if yours does.) 2. You have a right to ask for pumping accommodations at work. American employers aren't required to provide moms with a place to pump, but several states mandate that employers enable women to breastfeed. And most require that workers be given break time and a space to pump that isn't a bathroom stall. The Breastfeeding Promotion Act includes a provision to offer tax incentives for businesses that provide private lactation areas. The key to successful pumping at work is clear communication with supervisors, say experts. Ask for a room with a lockable door, a place to sit, and an electrical outlet for the pump. 3. You have a right to breastfeed for as long as you see fit. While nursing into toddlerhood is common elsewhere, Americans often view it as odd or even perverse. Critics may be surprised to learn that the American Academy of Pediatrics (AAP) recommends nursing "for as long as mutually desired." That can mean up to age 3 or 4, says Lawrence Gartner, M.D., executive committee chair of the AAP's Section on Breastfeeding. In addition to health benefits, he says, nursing provides a strong bond between mother and child. -- Katherine Kam The Bottle-feeding Mom's Bill of Rights Only a mom can know what's best for her baby -- and for herself. So, instead of letting someone else guilt-trip you, know your rights. 1. You have a right to bottle-feed without guilt or lengthy excuses. Sure, some moms aren't able to breastfeed for health reasons. "There are women determined to breastfeed who just aren't able to produce enough milk," explains Phillip Stubblefield, M.D., a professor of ob-gyn at the Boston University School of Medicine. But whether it's health-related, because of painful side effects, or for another reason entirely, don't feel that you have to explain yourself to avoid being publicly ostracized. "Women have the right to decide what's best for themselves and for their baby," says Diane Sanford, Ph.D., who specializes in women's health. If you feel good about yourself and your choices, those positive feelings will get passed on to your infant. 2. You have a right to supplement nursing with formula or breast milk. Don't feel like you have to choose one method or the other. Many women prefer a combination of breast and bottle. (Be aware that if you choose to supplement with formula, you'll have a decreased milk supply if you don't pump regularly.) 3. You have a right to bottle-feed without trying to breastfeed first. "Trust your instincts," says Sanford. "There's not a lot of encouraging literature out there about bottle-feeding. The worst situation is if a mom wants to bottle-feed but is persuaded by others to breastfeed." While breastfeeding may be ideal, there's nothing wrong with using formula, says Mel Heyman, M.D., a member of the American Academy of Pediatrics committee on nutrition and a professor of pediatrics at the University of California, San Francisco. What's most important to your baby's development is love, affection, and a close emotional bond. Says Sanford: "Whether it's breast or bottle, you can still provide these things to a baby." -- Emily Hebert

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