What's Best for You?Even when the baby's weight is not a problem, maternal complications like physical illness, mastitis, nipple pain, clogged ducts, fatigue, anxiety, or postpartum depression can interfere with a woman's enjoyment of breastfeeding and her commitment to continue. In such cases, says Dr. Neifert, "if a mom's emotional well-being is at risk because she keeps trying and trying and it's still not a rewarding experience, we have to assess whether it's realistic for her to exclusively breastfeed. Many moms who are having a great deal of trouble and are ready to quit will breastfeed longer if they see it as doable for them" -- doable, in other words, by combining breast- and bottlefeeding.
Consider 41-year-old magazine editor Jane Peterson's experience. "When I had Ben six years ago, there was less awareness than there is today about what to do when you had breastfeeding problems," she says. Jane had planned to breastfeed exclusively for several months, but within the first week, she experienced a number of problems. "Ben wanted to nurse every hour," says the Cleveland, OH, mom. "He was a big baby, and he was hungry! He was gaining weight and my milk supply was fine, but I wasn't sleeping. Into the second week, my nipples were sore, cracked, and bleeding, Ben was still feeding once an hour, and in the evenings he would have a colicky period and cry for hours. My life was a blur of exhaustion and pain."
Jane knew pumping was out of the question because her breasts were far too sore and raw, and she knew that when she went back to work she wouldn't be in an environment where pumping was appropriate. At that point, Jane called her sister, who had nursed two babies, and told her she couldn't go on. "I sobbed and sobbed," she says. "My sister said, 'Jane, give him a bottle of formula, now.'"
The next evening she had her husband give Ben a bottle in the next room. A little while later her husband came in carrying a sleeping Ben and gave her the thumbs up. That night, Ben slept for several hours straight -- and so did his exhausted mom. The difference was in the formula: It remains in Baby's stomach longer than breast milk (which is more rapidly digested by Baby's immature system), and that extra hour or two break from feeding can make all the difference.
Making It WorkWhen Jane decided to combine breast and bottle, she had no idea how to do so. With her sister's help, she developed her own plan, introducing the first bottle at night, an hour or two after her evening breastfeed. "That way my husband could give Ben the bottle and I could sleep through that feeding," she explains. Then, as Jane neared the end of her maternity leave, she started to introduce another bottlefeed every four or five days, until she was offering a bottle at every other feeding. (According to Dr. Neifert, waiting four to seven days before eliminating another breastfeed will help a nursing mother avoid clogged ducts and even mastitis caused by insufficiently emptied breasts.) "That worked out well," Jane explains. "It gave my milk supply time to adjust, and it gave Ben time to adjust as well. Since I worked from nine to five, I was eventually able to breastfeed first thing in the morning and last thing at night for a long time."
According to Dr. Sargent, Jane introduced the bottle at the perfect point. If an infant is not losing weight, and if you can make it through the first ten days to two weeks breastfeeding exclusively, it may be best to delay supplementation in order to build up your milk supply and let you and your baby get used to breastfeeding. "At this point, substituting a supplemental feeding should make no difference at all in terms of whether or not you're able to keep up breastfeeding," says Dr. Sargent. Waiting a few months to introduce the combo is also okay, says Dr. Neifert: "Every baby adapts differently to new experiences. It may take a little longer for an older breastfed baby to accept a bottle, but it can work."
For many women, combining breast with bottle is simply the best choice for them and their baby. "Doing the combo allowed me to have the best of both worlds," says Jane. "Only then did I experience the bliss of breastfeeding -- after I was able to heal my sore breasts and finally get some sleep."
Donna Jackson writes for many national magazines and has two children.