The New Leaf Nutshell: Breasts and Bottles

Each month, New Leaf Podcast Host Laetitia writes on the most controversial of motherhood topics. Doing all the Googling and researching, so you don't have to. #mymotherhoodmychoice.

In a Nutshell

There’s a lot of history, emotion, developing science, and opinion behind this debate, which is all detailed below.

It’s a long one, so grab a coffee and settle in, and you can always come back to it whenever you like.

There are pros and cons to whichever way parents feed their babies. Your choice comes first.

Before we begin

The New Leaf Nutshell is building a place where mothers, and mother-supporters, can access well-researched, good quality and non-judgmental information on tricky motherhood topics, to save you many (many) thousands of hours on Google.

Naturally, distilling the Breasts and Bottles debate down is no easy feat… so this is a long article that I’m not expecting you to read all at once.

As long as you’re subscribed, you can come back any time.

The internet loves a wild and unsubstantiated article. So, I will do my absolute best to not provide that.

This is a piece of widely-researched writing. I’ve linked as much as I can to academic repositories such as JSTOR and reputable scientific knowledge bases and thought leaders such as National Health Service UK, World Health Organisation, American Academy of Paediatrics, and equally official websites of well reputed maternal sources (Positive Birth Company, La Leche League, National Childbirth Trust, etc.). Click the lilac hyperlinks to see the original source, if you want to know more of the research background.

This is not a replacement for your own medical care, or the advice given to you by licensed professionals, or otherwise.

Disagree with something? Love something? Have your own experience you want to share? Let me know in the comments.

Ok - let’s do this.

Who’s this article for?

Anyone who’s curious!

Whether you’re pregnant now, a new parent, a dad wanting to support your partner, someone who’s already very happily breastfed their baby, or a mum who is struggling with breastfeeding and wants support - this article is for anyone who is curious about the breast and bottle debate. Share, share and share if you think this could be valuable to someone you know.

“Google, search for…

…Breastfeeding / bottle feeding / mixed feeding / pros cons”

Why are we googling this

Because breastfeeding is not the universal mechanism for infant feeding, for many reasons

If breastfeeding was immediately easy, universal and commonplace across all societies, if it suited all parents, all mums, all circumstances, each unique health need of a mum and baby, and all family setups - then there wouldn’t be a need to google this.

In a perfect world, we would all breastfeed with no difficulty or exhaustion. We would have unlimited and free support from our communities, with no external pressures or expectations. It would always be an instinctive, instant, easy-to-establish and pain-free activity, with perfectly designed temperaments and physiologies for breastfeeding (both mum and baby), and formula wouldn’t need to be used - because it would be accessible and possible for all.

Turns out: breastfeeding isn’t always straightforward, for a number of biological, social, cultural and societal reasons.

Why is this such a tricky topic?

How long is a piece of string…
  • It is an emotional topic that has a long and complex history, with no one-size-fits-all answer for each mother

  • Women are often judged in both directions. People may judge breastfeeding because they believe breasts are exclusively sexual, or that it’s somehow ‘disgusting’, or should be in private only (sadly, babies need to eat quite often, and without becoming a recluse for 6m+ it sort of requires the occasional feed in front of in-laws and in cafes *gasp*).

  • Others may judge bottle-feeding as not putting their child first, ignoring science, being the lazy approach, or not doing what’s best for baby. This can put women in a strange position on both sides, and at the mercy of out-dated attitudes / damned-if-you-do-damned-if-you-don’t…

  • People care about little babies, of course. They may feel that if breastfeeding is recommended by healthcare professionals, scientifically proven to be ‘best’ for baby, and ‘free**’, then it’s a no-brainer, and they struggle to understand why people wouldn’t.

  • Note: **Breastfeeding is only free financially, and if we don’t value a woman’s time and energy. It is also worth mentioning the significant industry around lactation: in terms of pumps, shields, lactation consultants and expensive supplements that some women use to facilitate breastfeeding.

  • Some women feel that those who have bottle-fed diminish the effort they put into breastfeeding their child. They may feel bottle feeding is giving up too easily, particularly if they themselves persisted through a hard time and were successful in breastfeeding e.g. “I found it so hard but I kept going. Why can’t they?,” etc.

  • For some, encouragement received from healthcare professionals can feel like pressure. Women have a great deal of interaction with these groups when pregnant and in early motherhood. If they are typically healthy, this may be the most attention they’ve ever received from their healthcare providers. This encouragement manifests itself in posters in hospitals, leaflets in doctors’ offices and in antenatal notes, well-meant community targets, and more. This compounds the social expectation that breastfeeding is the only ‘right’ option, and that ‘breast is best’ (read on for where this slogan comes from). This can be difficult to contend with or battle with if breastfeeding is a struggle, for whatever reason, and feel like… pressure.

  • The low breastfeeding rates in many first world countries means that we often have limited support to establish breastfeeding (…want to know why the rates are low? Read on.)

  • This encouragement combined with low breastfeeding rates causes a tension: where a very well-meaning set of healthcare professionals who are strongly encouraging breastfeeding, meet a wave of new mothers who are finding it understandably difficult in an environment of limited peer support, lack of shared knowledge in their community, or perhaps lack of support from the previous generation. We are not yet in an environment perfectly set up to breastfeed. But… even if we were, sometimes it simply doesn’t happen

  • ….There are approx 10,000 more bullets to this question. Basically, it’s a really hard question to answer. But hey, I love a challenge.

Feeding your child is pretty much the fundamental mum thing, right? You’re trying to keep them alive, deal with those first few months of madness, and do ‘what’s best’ so I guess food is the first place to start.

But… what is best?

Pumping can be hard work. The lactation process is complex and depends on a sensitive balance of hormones. Adrenaline directly inhibits your let down, your milk flow, and milk supply. Stressed? Skip the pump.

There are four ways to feed a baby aged six months and under

All have pros and cons. Scroll right down to the bottom of this article to see the pros and cons of each approach.
  1. Breastfeeding

  2. Feeding with formula milk developed for infants via a bottle (‘bottle-feeding’)

  3. Combining breast with formula, known as 'mixed feeding'

  4. Expressing breastmilk by using a breast pump, and feeding the milk to babies through a bottle. (NB: still breastfeeding!)

Isn’t Breast Best though?

‘Breast is best’ is a slogan that’s now regarded by some as controversial. To understand this, we need a tiny bit of history

‘Breast is Best’, a commonplace slogan or tagline for breastfeeding, comes from a book written in 1978 of the same name, in a context of low breastfeeding rates. The same title also spearheaded a government campaign in the 1990s in the UK, to encourage more women to breastfeed. A lot of women born in that era are now having first babies themselves, so this has resurfaced as they ask their own mums for advice in those hazy newborn days. But why is this such a controversial slogan?

Surely everyone breastfed before formula came along?

There have been alternatives to mothers breastfeeding for thousands of years

History has long shown a need for an alternative to breastfeeding in unusual circumstances, from as simple a reason as lactation failure in the mother, to dying in childbirth where the baby survives.

In the days before formula, we had animal milk and wet nurses as far back as 2000 BC. There is archeological evidence of this going even further back, with clay baby bottles have been found from 4000 years ago. The US National Library of Medicine have a great deal of papers on this topic here if you want to do some more reading (it’s pretty cool).

So when did we come up with formula?

Formula is a relatively recent invention, with a tricky history

In the late 1800s, formula milk was a useful way to use surplus milk from the dairy industry and could be used to feed babies who had no other form of nutrition. This coincided with wet nursing declining, as it had been realised that various blood-borne diseases could be passed from wet nurse to baby.

Lawmakers had little to no power to protect low-middle income mothers against outlandish health claims made by formula manufacturers by the mid-20th century, where there are swathes of examples of formula being sold to mothers as an improvement or supplement on breastmilk and the ‘best way’ a ‘modern’ mother could feed her baby. They capitalised on this, particularly in middle-low income countries, who were dealing with other major health epidemics such as HIV, when it was still poorly understood how disease transfer worked between mother and baby, in the absence of retroviral drugs. This ignorance was sadly exploited in the absence of international legislation in this area.

Other pretty major formula scandals in the 1970s also helped spur on the breastfeeding revival, in the resulting public disgust. The New Internationalist published a now famously scandalous pamphlet in 1974 entitled the ‘Baby Killer’, revealing how Nestle had mis-sold formula as an “improvement” on breastmilk, giving it out for free until the mothers’ supply ran out, and then charging them for it. Ouch.

However, over the course of the 20th century, formula got safer, advertising was not yet reigned in, and social attitudes around breasts being predominantly sexual crept in. A huge combination of factors meant that breastfeeding became less common, less observed in daily life, and a lot of confidence and vital tacit knowledge was lost.

I hope the above demonstrates why people feel so strongly about formula, despite us now being extremely lucky that safe substitutes exist in circumstances where we don’t, or can’t, breastfeed.

Where are we now with Breast is Best then?

International organisations are still firmly one-sided, but there are some ripples of change

The World Health Organisation are pretty clear in their advice. You’ll have heard it quoted many times if you’re a new mum: exclusive breastfeeding for the first six months of your child’s life is recommended, and that from the age of 6 months, children should begin eating complementary foods while continuing to breastfeed for up to 2 years and beyond (yes, 2!). In the developing world where women may not have access to clean water or sterilisation equipment and may be living in poverty, breastfeeding is considered the safest and most appropriate option.

Healthcare providers generally follow suit. Midwives, Paediatricians and OBGYNs encourage breastfeeding first and foremost.

However. The British Royal College of Midwives changed their position statement in 2018, to say that “the decision of whether or not to breastfeed is a woman’s choice and must be respected”, and that “breastfeeding mothers and their partners should be given information and support to help manage the physical, mental, emotional and societal challenges of breastfeeding”.

Equally, they stress the need for maternity units to be appropriately staffed, as well as sufficient investment in postnatal care being required, to enable each woman to get the support and advice she needs to make informed choices about feeding her baby.

Ok, so the tone is pretty damn different from Breast is Best. Why the change of heart?

Well, it follows on from my introduction: that breastfeeding suits some ladies and babies brilliantly. Others, not so much. That’s why we are having this discussion, and why I’m writing this article.

‘Latching’ baby to boob can be tricky to master and depend on a variety of factors. Midwives should be specially trained to assist new mums in getting it right. Your baby’s mouth, your nipple and your flow all make a difference to the efficacy of the latch!

Aren't there a tonne of benefits to breastfeeding?

Yes. But there’s a but. Some of the significant health benefits repeated by society are more correlative than causative, which can be misleading

Lots of economists and data nerds know that it is important to remember that correlation of data is not the same as causation. Too technical? Ok so an example: just because more people buy ice creams on sunny days, and more people drown on sunny days (these two things are linked, or correlated), does not mean that buying ice cream causes drowning (one causes the other, which is what economists call causation).

This is super important when we look at the shouty news headlines saying, ‘study shows incredible link between x and y!’. Yep, it may show a link. But, it doesn’t mean one causes the other - i.e., buying ice cream doesn’t cause drowning. It’s a correlative link, not a causative link. (If this still doesn’t make sense have a read here, or check out the book Freakonomics that has a tonne of examples).

Widely repeated benefits of breastfeeding for babies are that they:

  • Have higher IQs

  • Are less likely to be obese

  • Are less likely to have diabetes

  • Less likely to get leukaemia

  • Less likely to die of SIDS (Cot Death)

  • Less likely to get ear infections

  • Less likely to get gastro-enteritis and long term health digestive complaints

  • Less likely to get allergies

Some of these are absolutely correct, and backed up in several causative studies. Some are… not quite so clear cut.

IQ, obesity, leukaemia, SIDS and diabetes

I’d love to dive deeply into each of these claims, but sadly, this isn’t a book. So, let’s just take higher IQ in breastfed babies as a first example .

There are several studies that show a link between breastfeeding and IQ. A paper published in 2006 in the British Medical Journal used a sample of more than 5,000 children, where the authors compared IQ scores for breastfed vs bottle-fed children. They found that breastfed children had IQ scores of about 4 points higher than bottle fed. This correlation has been shown across other papers, too.

However, the authors also found that women who breastfed were better educated and richer than those who did not. They felt like this unfairly impacted the result, and needed to narrow it down better.

The authors wanted to find out whether IQ scores for breastfed babies were still higher among mothers with the same levels of education and income. I.e., if woman A and woman B have exactly the same education and the same income, but one breastfeeds and the other doesn’t, what happens to their babies’ IQs…?

They found that IQ scores were still higher with the breastfed babies - yet, 1.6 times, rather than 4 times. Hmm. Ok. But 1.6 times is still a lot, right?

So they dug into this some more.

They observed that even ladies who had the same level of education and same income had different IQs between them as mothers (obviously, because they are different people…!). So then they looked at women with exactly the same education, income and IQ, compared their breast and non-breast fed babies, and then looked again at baby IQ. The effect of breastfeeding was even smaller, at 0.5 points (…still higher, I hear you say).

But, because they’re scientists, they wondered how they could narrow this down even further. People are different after all, irrespective of their IQs (not to mention that IQ is only one form of intelligence), right? The study agreed, and felt it would be useful to compare children with the same mother, with and without breastfeeding - e.g., the first child being breastfed, but the second child not. This meant that the scientists could fully control for all characteristics of the mother, and could isolate the impacts of breastfeeding in a super targeted way. When the authors did this, they found that the effect of breastfeeding on IQ was just 0.02 points.

There are multiple similarly correlative results in some of the other claims of the benefits of breastmilk - most notably obesity, diabetes, SIDS and leukaemia. Emily Oster, world-renowned economist and author of the data-based parenting book Cribsheet, refers frequently to the numerous studies not controlling for other variables, and to the damage that some of these claims can have to the public rhetoric around breastfeeding.

SIDS (cot death) is another great example of a correlative result really affecting people’s emotions about breast or bottle feeding. SIDS is widely reported as being a reduced likelihood, if you breastfeed. A pretty convincing reason to breastfeed.

However, less educated women are more likely to have lower incomes, and are more likely to have jobs with worse benefits and terms and conditions to their jobs - e.g., shorter maternity leave, or longer / irregular hours, and employers who are less likely to provide the time or space to pump breastmilk. Poverty and low income not only make it it more likely that they’ll bottle feed, but also more likely for them to suffer economically and mentally, or be unfairly impacted by recessions. It has been shown that mothers who smoke, take drugs, or have a history with the social services are more likely to have an infant die from SIDS. SIDS and bottle-feeding may be correlated. But bottle feeding has not been shown to cause SIDS.

Ear infections, gastro-enteritis, allergies, and long term health digestive complaints

Just because there are a lot of correlative benefits, it does not by any means mean that they all are. There are definitely very causal links to breastfeeding and better outcomes for babies.

The same economist from above (Emily Oster) equally refers to the clearly causal links between breastfeeding and better outcomes for babies

Breastfeeding seems to improve digestion in the first year, lowers the risk of eczema for infants and is especially important for premature babies in managing their likelihood of contracting serious infections.

Reducing ear infections in young children and lowering the risk of multiple types of cancer for the mother are also backed up in multiple causal studies.

Let me know in the comments if you want to hear more about these.

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What’s the conclusion about science and breastfeeding?

Data is important, but approach sweeping health claims with caution

As we can see above - there are many correlative studies on the benefits of breastmilk, which are often mixed with the genuinely causative ones.

It tells us that sometimes it is worth digging a little further into the data before making a judgement call in either direction.

It’s important to mention that none of this is denying that breastmilk is a better alternative to formula in terms of infant health. Breastmilk has additional physical health benefits when formula does not. But — motherhood is a two-way relationship. And if you’re miserable breastfeeding, and it’s not working for you, then it’s time to reconsider your options, or get help with the option that you are wanting to persist with.

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Why doesn’t breastfeeding work out for some women and babies?

There are physical, mental and economic reasons as to why women can’t, or choose not to breastfeed

PHYSICAL REASONS

  • The woman has not received enough support from the community - whether it’s help with cooking meals, support from her partner, or proper advice from healthcare professionals - adequate and continued support is absolutely essential if women choose to breastfeed due to the physical, emotional and practical considerations that must be taken into account with breastfeeding

  • Tongue ties making it hard or impossible for babies to have a deep latch

  • Other latching difficulties, due to either mother’s anatomy (e.g. flat or inverted nipples, and yes this is a thing!) or to baby’s anatomy (cleft palate, difficulty extending their jaw)

  • Mastitis (inflammation of the breast) which can be incredibly painful and result in a fever. If left untreated it can lead to severe infection or breast abscess that requires surgical draining

  • Breast thrush where needle-like pain in the breast is not improved by latch. This affects both mum and baby and requires medication

  • Exhaustion of the mother due to baby sensitivities: such as reflux, allergies/intolerances from mother’s diet, colic, growth spurts that require ‘cluster feeding’ or very frequent feeds, or simply high-needs babies that are sensitive

  • Baby is losing significant amounts of weight and not producing wet nappies, and therefore may medically require supplementing with formula to prevent dehydration and hypoglycaemia. Hypoglycaemia can be extremely dangerous if untreated. If you feel your newborn isn’t getting enough milk, make sure you seek medical help.

  • Baby with special health needs requiring exact quantities of fluid means that the mother cannot put the baby to the breast, and may be required to pump (if she wants to continue giving the baby breastmilk). Pumping presents other practical and physical challenges. An exclusive dependency on pumping can lead to a greater likelihood of mastitis if not sensitively managed

  • Pumping and breastfeeding depends on a sensitive balance of hormones. Adrenaline, our stress hormone, inhibits oxytocin - the cuddle hormone that is released when a baby feeds or we have a hug, which directly supports the letdown reflex. If we are using a mechanical pump in a loo cubicle at work, or are away from our baby if the baby is in hospital, or feel pressured to ‘get the pump over with’ in an allotted period of time, this can cause less milk to be produced due to an excess of adrenaline.

  • Pumping also means you have all the sterilising and washing still to be done with bottles, as well as carefully labelling and storing milk safely, as well as the physical process of having to do the pumping. This can be an exhausting combination!

MENTAL REASONS

  • Post natal depression, caused by a variety of factors, coupled with sleepless nights from a hungry baby can be a significant factor for women wishing to discontinue breastfeeding

  • It can be a major adjustment if you are used to a very equal household to have the sole burden of feeding the baby on the mother. Some women choose to stop breastfeeding to share this load emotionally, mentally and physically

ECONOMIC REASONS

  • Some women may be returning to work, and require someone else to administer a bottle and cannot make a pumping schedule work with their employer

  • If women have really struggled breastfeeding, they may have spent considerable sums of money on lactation consultants, shields, creams, supplements and pumps that they no longer wish to spend. There is a major industry behind this, particularly in the USA. These products and services can all be extremely expensive (Lanisoh nipple cream is £10 ($14) per tube. Lactation consultants in the UK make an average of £48k ($67k) per annum, and can charge up to £100/h ($140/h). Breast pumps can be between £100-£200 ($140-$280). Combine all these, and it can really add up.

Ok so I’ve given you a lot of information. How do I make a decision as to what the ‘right thing’ to do or think, or suggest to my friend, is?

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The Pros and Cons

Each way of feeding has Pros and Cons that can be either emotional, mental, physical or financial. You need to look at each approach in a way that works for the individual.

Author’s note:

It is really important to mention that there are counter-arguments to every ‘con’ listed here, which is a good thing. Every mum that has successfully made it through a particular option will be able to give you a solution to a con, that may work for you depending on your own circumstances, temperament and temperament of your baby, too.

So if one of the methods below has a list of pros that looks instinctively good to you, speak to someone who’s done that method (or contact me, and I’ll put you in touch with a mum who’s been there and done that), and ask them about the Cons. If they seem manageable to you, then you’ve got your answer.

A quick reminder of the methods of feeding your baby before 6 months old:

  1. Exclusive breastfeeding

  2. Formula Feeding using milk developed for infants via a bottle (‘bottle-feeding’)

  3. Combining breast with formula, known as 'mixed feeding'

  4. Expressing breastmilk by using a breast pump, and feeding the milk to babies through a bottle. (NB: still breastfeeding!)

EXCLUSIVE BREAST FEEDING: THE PROS

  1. Considerable health benefits to your infant, as spelled out earlier, particularly in terms of ear infections, gastro-enteritis, allergies, and long term health digestive complaints. Too many sources to mention just one!

  2. It is (typically) financially no, low or minimal cost

  3. It is about as eco-friendly as you can get…!!

  4. It is a very intimate, close and bonding experience with your baby that releases oxytocin and has been proven to reduce pain in mothers

  5. Reduces your risk of breast, ovarian and endometrial cancer, as well as osteoporosis

  6. Breastmilk works with your circadian rhythms, containing different hormones at different times of day that help your baby go back to sleep quicker at night time and stay up during the day

  7. Breastmilk is pretty convenient. It’s ready at the right temperature, at any time or wherever you are, without needing to sterilise, make up bottles, wash up etc. Bottle washing gets extremely tedious!

  8. Lack of kit required! Formula machines, sterilisers, bottle washers, as well as space in your dishwasher and cupboards are genuine challenges, and make going out and about feel like an expedition. Breasts being physically attached to you certainly helps.

  9. Keeping your baby close at night makes night-feeding easier too, without needing to leave them to have a scream while you make up a bottle

  10. Delays the return of your periods, helping to space out future kiddies (note, this isn’t 100% failsafe... I have a couple of friends that this did not work for!)

EXCLUSIVE BREAST FEEDING: THE CONS

  1. Unfortunately, your partner cannot really share the feeding load without breasts, even if they can (and should!!) be helping in other ways. This can be pretty tiring on the mum.

  2. Establishing breastfeeding can be emotionally and physically hard, and take about 6 weeks

  3. Dealing with relatives, or members of the public, who don’t like public feeding can be a challenge. Negotiating feeding covers can be stressful if your baby doesn’t want to be under a blanket to have their breakfast!

  4. It can delay your sense of freedom, in terms of the need to return to work, or going out for an evening or a weekend. This because it can be challenging to get beloved baby off the boob! In other words, sometimes not introducing your baby to a bottle earlier on can mean the baby may refuse a bottle.

  5. Leaky boobs aren’t much fun, and bras and sheets can require a lot of washing to prevent everything smelling of cheese! This can also affect intimacy with your partner, as touching your boobs can result in the letdown reflex… hmm

  6. Although you burn a lot more calories breastfeeding, studies have shown there is no known link to breastfeeding and actually losing the baby weight, even if there IS a link to burning more energy. This may be because of the volume of food and energy your body requires to breastfeed (I.e., you may burn more, but you also eat more, and may be more sedentary). This can sometimes make it harder to lose baby weight

  7. There’s no way to measure how much your baby is getting, which can be stressful if you are unsure of your supply

  8. Mastitis and thrush are very common, and can be very painful

  9. Additional fatigue can be tough with breastfeeding. You’re burning more calories and you’re unable to split the night feeds. In the early days, you can be doing up to 12 feeds in a 24 hour period. And if feeds take an hour, it’s not an awful lot of time to rest.

  10. What you eat, drink and take (medication wise) is important, as some of this can be passed to your baby

FORMULA/BOTTLE FEEDING: THE PROS

  1. Anyone can take over, if you need a pee, need a drink, need a break, etc.etc.!

  2. Is a way to get more milk into baby if you are struggling with infant weight gain, supply issues, illness etc.

  3. Provides more opportunities for sleep, as you can alternate nights with your partner / another caregiver if they’re available

  4. Provides an emotional and mental break, as it takes the sole burden of baby feeding away from the mama

  5. If you have found breastfeeding difficult, or if you are self-conscious about breastfeeding in public, obviously bottles remove this issue

  6. It allows your partner to be more involved with feeding and provides an additional way for them to bond with baby (NB: feeding of course is not the only way to bond! It’s just another way).

  7. If you have to physically go into an office/your workplace, or if you have limited maternity leave, formula feeding can allow you to get back to work more quickly rather than taking unpaid leave, if you choose not to pump

  8. It gives you freedom, and can help you to feel a lot more independent more quickly, depending on when you are formula feeding from. If you are used to being very independent, formula feeding can give you a mental and emotional break from your baby

  9. Lactation Failure, or when mothers simply are unable to breastfeed, can be as high as 5%. We are incredibly fortunate to have adequate and safe substitutes for breastmilk that keep our babies alive!

  10. If you’ve suffered with breast thrush, recurrent mastitis etc., formula feeding completely removes this possibility when you stop lactating. For anyone who has suffered with these, they can be incredibly debilitating.

FORMULA/BOTTLE FEEDING: THE CONS

  1. … Ahem, anyone can take over! Yes you read this correctly - it’s the same as one of the pros of formula feeding. Anyone can take over. If you’ve struggled to bond with your baby, or have struggled with PND/PPD, everyone feeling they can ‘have a go’, or wanting to be involved, may reduce the opportunities for you to bond with your baby and can make you feel worse

  2. Bottles can be fiddly to put together (not fun at 2am), and sterilisation and clean water supply is essential to prevent serious illnesses

  3. If you don’t have a formula preparation machine**, the 30 min wait for your boiled bottle to cool as your infant screams isn’t much fun. (**If you’d like the name of a prep machine, write in the comments)

  4. Washing bottles is tedious, takes a long time, and they take up valuable space in the nappy bag! Formula equipment in general can take up an awful lot of space.

  5. It doesn’t release the same bliss-like hormones as breastfeeding, which can help if you are suffering with PND/PPD. (Note: some of the highest rates of PPD are in women who intended to breastfeed and couldn’t. If this is you, make sure you are receiving enough support)

  6. Formula shame and #mumguilt can be really upsetting if you’re prone to it, when you are most likely already frazzled, hormonal and sleep deprived. Bottle feeding in a predominantly breast is best culture can be tough, no matter what your reasons are, and even if they are medical reasons. You may find yourself repeating reasons constantly to Health Visitors, GPs, friends and family as to why you are not breastfeeding, as well as of course the abundance of pamphlets and posters at your checkups. You need a thick skin, and the self confidence to own the way you feed your baby. Need help with this? Let me know in the comments.

  7. Bottle feeding is expensive. Not including all of the kit you need (even finding the right bottle for your baby can take you buying a few different ones!), formula machines, new teats, sterilisers are all expensive - and formula is too. In the UK a tin of formula can cost between £8-£13 for a 800g (28oz) box, or in the USA between $9-$12 (weights variable).

  8. Formula milk and bottle feeding can make your baby ingesting air more likely, resulting in an uncomfortable baby from wind / gas

  9. Baby poo is smellier with formula fed babies. Seriously!

  10. When considering trips away etc., every feed require sterile bottles, sterile formula, and extra checks at customs (not to mention luggage space) if you’re going away with your infant. Equally, other countries with high rates of breastfeeding aren’t so hot on formula - so you may struggle to find formula for your baby abroad

MIXED FEEDING: THE PROS

  1. See above in both breast and formula feeding sections :)!

  2. If your supply is struggling to establish, or has a tongue tie that hasn’t yet been fixed, or your baby is in hospital, or struggling to gain weight etc - mixed feeding can be very helpful if you are still trying to ‘crack’ breastfeeding in those early days. (Note: you will need to keep expressing to keep your supply up! )

  3. You can get the best of both worlds - baby and you get the benefits of breastmilk, with the convenience of bottle feeding.

MIXED FEEDING: THE CONS

  1. See above in both breast and formula feeding sections..!

  2. You’ve got to be pretty diligent about pumping / regular feeding, to ensure your supply doesn’t dry up. This can mean 8-12 sessions per day.

  3. Baby can prefer one or the other... Babies can love boob because it’s soft, warm and close to mummy… but babies can love bottle because it is in their tummies faster, and typically are a little fuller for longer. This can take the decision to mixed feed out of your hands!

PUMPING: THE PROS

  1. Pumping allows Dad / other caregivers to get really involved, and provide additional bonding opportunities for them with your baby

  2. Your baby still gets the benefits of breastmilk!

  3. Pumping can give you (relatively) more freedom than exclusive breastfeeding. You can easily freeze and defrost breastmilk, which is already considered ‘sterile’, making it straightforward for others to feed your baby while you work / take time for yourself

  4. For very tiny or premature babies whose mouths may not be big enough for nipples or bottles, they are fed with a Nasal-Gastric Tube (NG Tube). Breastmilk benefits are unbelievably important for premature or unwell babies to protect their vulnerable immune systems from infections, and so pumping allows them to benefit from this

  5. If you have a handsfree/remote pump, you can get on with other activities without needing to be sitting down or feeling like you’re in a dairy

PUMPING: THE CONS

  1. Mastitis and thrush can be more common in pumping - as babies are known for their abilities to drain the boob in a way that machines may struggle

  2. Pumping can be painful, depending on your emotional circumstance, as hormone balance is extremely important in lactation. Stress and adrenaline can inhibit your letdown reflex and reduce your supply, and being cuddly with baby produces oxytocin that helps to dispel your adrenaline - so being away from baby (e.g. at work if you are pumping) can be tough.

  3. Pumping is time consuming, and this can be tricky to negotiate with work if you have poor maternity leave (NB: Be aware that most workplaces are legally obliged to provide a place to pump that isn’t a toilet, if it is requested. Have a tricky boss? Just ask them if they’d make their own lunch sitting on a toilet. No. So why should you prepare your baby’s meal there *mic drop*)

  4. Unfortunately you can’t fully escape sterilising! Pumps, bottles themselves and storage sachets/containers all still need sterilising, and careful labelling, which can be a total pain in the middle of the night. Sad face.

  5. Pumps are very different from each other, and it can be expensive and time consuming finding the right one that works for your anatomy and flow.

We’re reaching the end (you made it!) Wow that took a long time. I so, so hope this has been useful for you.

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Conclusion

It is your motherhood, so it is your choice. One size does not fit all when it comes to baby-feeding.

Someone once told me that “we Google what we want to find” and goodness me there is no space more like this than infant feeding. This amount of information can be super overhwhelming and tough if you are trying to figure feeding out, or get any sort of ‘answer’ that works for you. Infant feeding can be unbelievably raw and emotional, with people feeling so bullied and pressured - in both directions.

This is wrong.

We are in a very vulnerable space as new mothers, and it’s time to change the tide, and help feel mothers supported in their choices. Whether it’s the paediatrician bullying you into using formula if you don’t want to, or the woman shaming you for getting your formula bottle out, neither is right.

There are pros and cons to all approaches.

It is your motherhood. It is your choice.

If you’ve found this article informative, or useful, or unique in any way - please, please share share and share! I really want this information to get out there, and be helpful to people. It is truly a labour of love.

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Your motherhood journey is unique. <3

#mymotherhoodmychoice

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