Unnecessary supplementation with formula

Why is there so little understanding amongst many HCPs in the U.K. of what’s normal for a breastfed baby in the early days? And why is there so little faith in a mother’s ability to feed her baby with her own body? ⁣It’s really common, in fact I would say it’s the norm, for parents of breastfed newborns to be told to top up with formula when it’s not necessary. 

Of course there are times when a newborn might need supplementation. This could be because they aren’t able to latch, (for example due to being born early or due to a tongue-tie), or are sleepy and hard to rouse. 

If a baby does need supplementation, UNICEF suggests the following in order of desirability: 

1) Mother’s own milk, hand expressed or pumped
2) Donor milk
3) Formula 

The majority of newborns will be able to latch and feed effectively if allowed to spend time in skin to skin with their mother and the majority of mothers are able to produce all the milk their baby or babies need, as long as the baby is feeding frequently (10-14 times, or more, in 24 hours) and removing milk effectively. 

Unnecessary supplementation with formula undermines a mother’s confidence and also undermines breastfeeding by reducing a baby’s appetite and therefore interest in the breast, so the baby breastfeeds less often, which leads to reduced milk supply which means a baby will have even less motivation to breastfeed. This is known as the top-up trap.

And of course it’s very common for babies to develop a flow and hard teat preference once they’ve been given a few bottles. UNICEF states: ‘Evidence suggests that early supplementation is associated with an increased risk of stopping breastfeeding.’

So we really don’t want to be telling breastfeeding mothers that they need to give formula top-ups unless there are very clear signs that it’s necessary.

Here’s what happened recently to a client of mine whom I visited when her baby boy was 3 days old. He was a little bit jaundiced so needed to be woken for feeds, but overall he was doing really well as evidenced by the fact he was producing the right number of wet & dirty nappies, latching well & doing good active swallowing.⁣

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I was therefore surprised when his mother contacted me in distress on day 5 to say she was being put under pressure to top her baby up with formula, despite the fact he was continuing to feed well & peeing & pooing as expected. ⁣He had lost 9.8% of his birth weight, but we know that when a mother has been given IV fluids during labour, as this mum had, babies can take onboard some of that fluid, which inflates their birth weight. 

The best way of telling whether a baby is getting enough milk in the very early days is by keeping track of their wet and dirty nappies. See my article https://www.cordeliauys.co.uk/howtotellyourbreastfedbabyisgettingenoughmilk This baby’s nappy output was fine.

Here’s my client’s story in her own words:⁣
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‘During my pregnancy, I spent a lot of time researching & reading about breastfeeding to feel as prepared as possible for when my baby arrived. After giving birth, I received support from midwives & breastfeeding specialists at the hospital who helped me with my baby’s latch, ensuring he was feeding properly & getting enough milk. I had also harvested colostrum from 37 weeks, which gave me an extra boost of confidence.⁣
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Once I was discharged from the hospital, I wanted to be absolutely sure I was doing everything correctly, so I contacted Cordelia. She came to my house, checked my baby’s latch, introduced me to different breastfeeding positions & provided me with a wealth of resources. Thanks to her guidance, I felt happy, confident & reassured that my baby was feeding well & that I was on the right track.⁣
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However, when the midwife weighed my baby on Day 5, I was told he had lost 9.8% of his birth weight. The midwife wasn’t overly concerned but referred me to a maternity support worker at the midwifery center. That appointment was devastating. The support worker was extremely harsh, telling me my latch was terrible, that my baby wasn’t getting enough milk & that a 9.8% weight loss was too much. She insisted I start supplementing with formula immediately. Her words crushed me—I left the appointment in tears, feeling like a failure, like I was doing everything wrong & that I wasn’t a good mother.⁣
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I reached out to Cordelia & explained the situation. She reassured me & encouraged me to try breast compressions during feeds while making sure I nursed my baby every 2 hours. I followed her advice & in just two days, my baby gained over 200g —without any formula top-ups.⁣
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Having Cordelia’s support was a lifeline. Two days ago, on Day 11, my baby was weighed again, and he was 160g above his birth weight. (N.B. It is considered normal for babies to take 2-3 weeks to regain their birth weight).⁣
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Looking back, I’m so grateful I had the right support and trusted my instincts. This experience taught me how important it is to surround yourself with people who uplift and empower you, especially in the early days of motherhood.’⁣

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⁣I am very glad this mother felt comfortable contacting me, trusted me and even more importantly had confidence in her own judgment of how breastfeeding was going. All her efforts to establish breastfeeding could so easily have been undone by the thoughtless words of one individual who didn’t take the time to look at the overall picture and possibly didn’t have the knowledge and expertise to assess the situation. It breaks my heart to think how often this is happening to mothers in the U.K.