Sunday, January 17, 2010

Breastmilk vs. Formula: the epic battle

Breastmilk vs. formula is one of those topics that is highly controversial on the internet. When my daughter was of breastfeeding age, I was scared to even broach the topic on this blog. However, she's almost three now, which is an age where I would probably be given a lot of funny looks for breastfeeding, so I feel safe talking about it without being accused of child abuse.

I think most women would agree that breastfeeding is better than formula. However, there's a culture of women (very vocal on the internet) that will yell at any mother who does not breastfeed. You must at least try to breastfeed. Any woman who doesn't breastfeed is selfish. Formula is full of chemicals and is harmful to your baby.

But for a physician mother, especially one still in training, it can be hard to provide exclusive breastmilk for a baby. I know women who are great mothers who just couldn't swing it with their schedule. Giving your baby formula is not child abuse. Saying that is an insult to babies who actually ARE neglected or abused, of which there sadly are many.

My story:

I struggled with breastfeeding initially. I wanted to do it very much, but it was not one of those things that came instantly and easily to me. I had a very hungry, jaundiced baby who wanted to suckle nonstop, which was becoming more and more painful. With a rising bilirubin level, I consented for my daughter to have a couple of ounces formula in the hospital, which she sucked down in about five seconds. I felt guilty about this, because people told me that if she was given formula, she'd get nipple confusion and it would hurt my supply.

When I brought her home, I was determined to feed her only breastmilk straight from the source. She had a voracious appetite (she was at the 50th percentile for height/weight at birth, but was at 95th percentile by two months and stayed there) and I didn't get much pumping done, so we had no supply tucked away early on, which meant that I had to be up for every single feeding. I was stubborn and wanted to do it all myself. But when I was hospitalized with 103F fever at two weeks postpartum, my husband and I decided that he would give her one bottle of formula per night so that I could have the luxury of four straight hours of uninterrupted sleep.

I told this to a friend of mine who had been giving me advice about breastfeeding, and she belittled me for allowing my daughter to have a bottle of formula per night for the sake of my sleep. I was being selfish. Once again, I felt guilty.

When I went back to work, I was attached at the hip to my pump. I would hook it up while I returned pages on my cell phone, praying nothing would come up that couldn't be put off for fifteen minutes. When I came home from work and saw a bottle of breastmilk on the counter that was half empty, I'd be furious about the wasted two ounces of milk. We did have a can of formula in the cupboard, but I was proud of the fact that we rarely used it.

At six months, I moved on to a much more demanding rotation where I was the only resident looking after twenty patients. I put away my pump and just nursed in the morning and at night (until one year, when my daughter self-weaned).

When I look back on all the stress I had worrying about my daughter getting a few ounces of formula, I feel angry at myself. I was a loving mother. I cared about my baby and took very good care of her. It was stressful enough to manage residency and a baby without feeling like an ogre because my daughter was getting a few ounces of formula. Whenever a working mother tells me she gave up nursing because it was too hard, I immediately give her my sympathy. I would never say anything judgmental, because I'm sure she gets enough of that, most of all from herself.

If I have another baby, I don't know if I will do anything differently. I loved nursing and I think I stopped at the right time. But I definitely will keep a can of formula in the cupboard and not allow myself to feel guilty if I need to use it.


  1. My daughter is now nearly 18 months old. I breastfed her exclusively for the first month. At that point I realized that I would be unable to keep up with feeding her when I went back to work. Pumping was a nightmare and it took me almost two days to store enough to cover one call day. Then I realized that I would have my only break time spent attached to the pump - two 15 min and one 30 min breaks which never came at regular times.

    At 4 weeks we started transitioning her to formula. I felt so guilty I cried for days. I felt like a total failure. Especially with all the crazy breastfeeders out there encouraging my guilt. And I knew better.

  2. I breastfed both of my sons, the elder for 13 months and the younger for 18-19 months. It wasn't easy for me, and that was with a mother who'd breastfed, and with me being a stay-at-home mother. I can easily see breastfeeding ending up being too difficult for women, especially if support is inadequate or their schedule is beyond inflexible.

    The mommy wars give me a headache. Love your children, care for them, and it's all good. Supporting breastfeeding is important, in large part because breastmilk is free and heck, why not utilize a free resource? But when the cost is in the mother's time, that can offset the financial burden of formula.

    I've babbled. I'm shutting up now :)

  3. I just wish the crazy breastfeeding mothers would spend as much time attacking women who actually DO abuse or neglect their babies.

  4. I know EXACTLY how you feel. I have four children and made four decisions and am pretty much immune to the judgements of other mommy's at this point. The first was the hardest - same thing as far as breastfeeding a jaundiced baby, except I wasn't as smart as you - I was too scared of the breastfeeding only mommys and REFUSED to give my baby formula - he ended up hospitalized at 3 days old because his bilirubin as 22.5, and dehydrated. I relented and let him have a bottle in the hospital. When we got home i refused to give him formula again and he was re-hospitalized at 3 weeks with a fever - needed the spinal tap and all because of his age. I still refused to give him a bottle - stupid me - because I was afraid of letting down the other mommys, so I kept nursing him with my almost nothing supply - used the tinctures, herbs, reglan, etc - nothing worked. At three months I finally gave up. I couldn't do both supplement and breastfeed because I never wanted to give a bottle so for the sake of my child i just stopped breastfeeding. He is almost 8 now, and healthy, and T-G smart -I am glad my stubbornness didn't ruin his brain development.

    quick story - right after I stopped breastfeeding we went to a wedding. I was sitting at a table with a bunch of other young mothers and some were breastfeeding. When it was time to feed my baby, I was embarrassed to take out my bottle, but I did and I fed him. One of girls looked at me and said "did you ever consider breastfeeding?" Her question and judgmental tone made me break out in tears right there at the table full of strangers. I learned a lesson there about NEVER judging other mothers based on a quick observation and I hope my crying taught her the same lesson.

    Next two babies I struggled with - still not enough milk (hypoprolactinemia? - maybe) but i had access to domperidone which seemed to give me "just enough" to squeeze out and was able to breastfeed them both for over a year. Not enough to pump - so no extra supply. I was still a pre-med then, so I took a lighter schedule when both children were born and hired babysitters at school so I could nurse before, go to class, and then nurse right after. Pain, but worth it. I also nursed all night long. I felt thankful that, with the help of the medicaton, I was able to produce enough milk.

    So the fourth one, I had 3 months before starting MS1. Before I got pregnant with her, I knew that I wasn't going to breastfeed. I knew the struggle it took and that I would not be able to do MS1 part time like I had done some of my pre-med stuff. I decided that if I was choosing between having another child and not breastfeeding versus not having another child, I was going to pick the first choice and not feel guilty. I still breastfed her for those three months until school started, but I was supplementing so that she would be used to taking bottles before medical school started.

    I am glad you posted this. I think it is an important thing to point out so that other mothers do not feel guilty when the choice to breastfeed is not really in their hands.

  5. I have a psychotic SAHM neighbor who still breastfeeds her son at age 18 months. That is not why she is psychotic. She is psychotic because she has allowed her image of perfect motherhood to ruin her life. This includes never letting her husband help with anything because he might screw it up, never giving her child formula, never letting him cry. She hasn't slept more than 2 consecutive hours in the past year and a half.

    Sometimes you have to do what is best for your family, even though that may mean it is not the 100% perfect way of doing things according to medical texts. Being a good mother is not a contest.

  6. As a psychiatrist, I have actually looked into this a little from a professional point of view, since some of the women I treat need to take medication either during pregnancy or right after. The literature on the advantages of breastfeeding is solid ONLY on the issue of immunity. At least for women who are not impoverished, it is irrelevant to bonding, nutrition or any other important aspect of child development or maternal well being. Trading a slightly increased risk of ear infections for peace of mind and an involved father is a no brainer. And if you can switch hit--breast feed and bottle feed-- you get the best of both worlds, clean ears and a chance to go out on an occasional date.

  7. I'm a doc. I was induced when I had my first child, and my breastmilk didn't come in for four days. I remember those first frenzied days in the hospital--I was exhausted and struggling with getting my baby to latch--she was starving. When we were feeling totally frazzled and at our wits' end, our pediatrician (who has children of her own) gave us a rather stern lecture about not giving the baby anything other than the breast, telling us about the whole 'nipple confusion' thing, and all three of us (me, my husband, my daughter) wept.

    Fortunately, my OB came in next and very kindly relayed her own frustration with breastfeeding and decision to use formula. She and our nurse encouraged us to give the baby some formula, which we did, and it allowed us all a few hours' rest.

    Ultimately, I went home, where my milk came in and my mother helped me get the baby to latch. I struggled to breastfeed but nursed (and used formula for occasional breaks) x 8 months. Just had my second child a year ago. He nursed well and often--he was exclusively breastfed during my maternity leave but I had no qualms about giving some formula at night when I went back to work. He had a mixture of breastmilk and formula until 11 months, when I weaned him from breastmilk entirely.

    And you know, I've never taken my kids to that pediatrician. I was really shocked by her condescending tone as we were clearly struggling.

  8. Following up on my previous "anonymous" post, that pediatrician came highly recommended but after that interaction with her, we started seeing a male physician in her group who is much less blaming in his demeanor. Another woman MD from that group rounded on our son after his birth, and she tried to actively dissuade us from having our son circumcised, even though we were very clear about that being our decision.

    These interactions have been interesting, as there are doctor-mommy, mommy-mommy, doctor-doctor politics involved. It has certainly affected the way I interact with my own patients. I try to offer options and support parents in their decisions a little more than I may have in the past, recognizing how hard it is to be a parent and that there are often many good ways to approach a given situation (vs. my one perceived 'right' way and their 'wrong' way).

    And with regard to breastfeeding, our pediatrician told us how awful it would be to give formula but never offered any substantive info on how to nurse or get the baby to latch effectively. There was a real paucity of breastfeeding support in the hospital. I was fortunate that my non-medical mom had breastfed. Yes, I believe breastfeeding supports immunity--and if we want to encourage people to do it, we need to give them useful tools.

  9. I think there is a fine line that clinicians need to walk. What one woman considers condescending may be just what another woman interprets as support.

    With my first, who is nearly 5, I struggled a lot with milk supply. It took me two months to get her latched and I pumped every 2 hours and syringe fed her during that time. I went back to work, kept up the pumping, and took medication to increase supply. By 6 mos, we were finally settled into a normal pumping/breastfeeding relationship. My OB was my cheerleader and never ONCE suggested formula or weaning. I'm happy to say that most days I wasn't sure if I would have enough milk for the next day, I am extremely happy I didn't give up. Yes, those early months were incredibly trying, but the rewards have been worth it many times over. I also saw a therapist during this time for other issues and she gave me the whole "formula is just as good as breastmilk, just wean her" speech. How completely flippant. She clearly did not "get" me at all and I felt she was completely dismissive of my desire to continue breastfeeding. When my daughter weaned at 2.5 due to my pregnancy with her brother, she transitioned well and I was fine with it.

    With my son, I fortunately did not have any latch or supply issues. It's been a perfect breastfeeding relationship from the beginning. He is 21 months how but I had to wean him 3 months ago due to staring a medication not compatible with breastfeeding. It has been incredibly trying for all of us. He clearly was not ready to wean and still tries to nurse every time I hold him. I know it's what's best because I need the medication, but it's hard knowing that it's not what's best for my son.

    If I choose to have another child, he/she will likely be formula fed at some point. After being off the medication for all of pregnancy, I'm not sure how much longer I can stay off of it to breastfeed. I've come to accept that formula is in my future and that's fine. So I'm not some hard-ass militant breastfeeder who will breastfeed at any cost. I get that formula has a place and hardly feel it's child abuse to use it. In the end, though, we can only do as good as we can do. After all, life is full of trade-offs. If formula is as good as we can do, given our unique struggles and situations, then I'm fine with that.

  10. To the last Anonymous: I agree that pushing formula on a woman who badly wants to breastfeed is just as bad as judging a woman for using formula. I guess I feel like nursing is a personal choice, but some women act like it's a matter of public importance. As long as a woman loves her child, I don't think these choices (nursing, co-sleeping) are anyone else's business.

  11. Speaking from the perspective of an old mom (kids are 27 and 29) I think the mommy wars need to get a grip. Back in the day, the breastfeeding instruction consisted of bringing baby into room in the little plastic bed and the nurse said, "here you go. Good luck." With the help of a sweet mother andmother-in-law who had breast fed and a supportive husband, plus the occassional call to La Leche (I know, but that was the only resource there was where we lived back then) it worked. Second baby was much easier, I just nursed her when whe cried. When I went back to work (part-time for 6 months both times but well before 6 weeks) we just did formula during the day (pretty much whatever the rep brought, they did well on all the brands)because I couldn't pump worth a flip and the pumps back then were all terrible and then we nursed at night and on weekends. Yes, I know you're not supposed to be able to do that, but the kids didn't know. They did fine and are both honors college graduates and seem to be well adjusted. I think this mommy war stuff is just dumb. Mothers need to support each other regardless of their choice. Do what works for you and your baby, and tell them to go pound sand.

  12. I love this post. I breast fed my daughter for 11 months, and my son for 7.5. Both were supplemented with formula around 6-7 months, and then switched when I let go. The letting go was hard, and painful, but I think I let my own exclusivity and fairness hang-ups torture me to the point of horrible sleep deprivation and mental health issues. In retrospect, I am proud of all I did, and do not punish myself for any supplements. I also had the werewithal, throughout my nursing, to be extremely supportive of other moms, no matter what choice they made. Yes, we all love our kids.

    My dad is a neonatologist, and he is supportive of all moms, no matter what choice they make. He said something once to me, that I think he says to a lot of fearful moms, especially ones with neonates. "You've seen the pictures on TV, of what children survive, with a lot less." Images this week of the earthquakes in Haiti come to mind. "You can't hurt this baby. No matter what you do, as long as you love him or her, and provide good care."

    We often let too many other people's ideas of "good care" being nursing, sleeping habits, or one of my favorites - "You're spoiling that baby by holding it too much," dictate our opinion of ourselves as mothers. You can't spoil a baby - that's ridiculous. You can spoil a toddler or child, by being overly permissive and not drawing boundaries, but you cannot spoil a baby. Giving a child formula, a luxury to have on our grocery shelves, is not a problem.

  13. Just to followup, you have to understand that when my kids were born breast feeding was considered vaguely wierd, especially if you did it very long. Both of my daughters have successfully breastfed their babies. They've had a lot of support with lactation consultants, etc. although I find the consultants vary--daughter #1, with first baby, didn't get much useful advice. When she had her second baby (different hospital), the consultant she sounded a little goofy, she gave some pretty good advice. Both of my daughters say they got their best advice from the L & D nurses. Things really have changed.

  14. Thank you for having the courage to say what so many do not. While there is no denying breast is best, it doesn't work for every family, and it certainly doesn't make the mother. I didn't even try to breastfeed my son, I was young, and it made me so uncomfortable, and you know what, I might feel guiltier for it if he weren't such a healthy, kind, intelligent, THRIVING 4 year old now. I tried REALLY hard with my daughter, having learned more about it, even visiting with a lactation consultant, but with a receding chin, and high palate, along with a difficult eater (even from a bottle) it just wasn't working. My son was miserable, because I was always either feeding, or pumping, andI was resenting everything about it, including HER. When I made the decision to stop at 3 weeks, I was finally able to truly bond with my baby, and actually ENJOY my daughter.

    I think, in general, people need to stop worrying so much about each other's choices. As long as everyone's getting fed, I don't care how it happens.

  15. Not to be overly cynical here, but is it really interesting to me that a lot of the people who commented said, "We should not be critical of other moms," and then immediately after, "I just want you to know that I breast fed MY child until it was a year old -- just like I'm supposed to -- even though I had to deprive myself to do it."

    Sounds like you'll be supportive of the other moms as long as they know you did a better job.

  16. To the last anon: I think it's OK to be proud of an accomplishment that wasn't easy, without necessarily being judgemental of those who didn't take the same path. I am really proud of having breastfed the amount of time I did, just like I would be proud of running a marathon (I haven't!), but that doesn't mean I think women who make a different choice are any lesser parents.

  17. In the end (and I speak as a pediatrician), the most important thing any baby needs is a loving, caring mother. Everything else is extra.

  18. I second mommy doc above.

    Also, ability to BF may be hormonal per recent study:

    Their quote:
    "A mother should do what makes her happy."

    We mothers all want what's best for our children. And we do the best we can.

  19. and if mom is super busy - a loving caring father works too! better yet - both of them can love, care and be super busy - ha!

  20. Ditto what mommy doc said!

    My mom had 12 kids, breastfed us all like champs, never had any anesthesia at delivery, blah blah blah. She has such strong opinions about breastfeeding and natural childbirth that when my younger sister took the plunge as the first daughter to give birth, she told me that she literally felt like it was morally wrong to have an epidural or use formula! The worst part about that is that her baby had a cleft lip and palate. So my poor sister pumped and pumped and pumped until her little boobies could handle it no more after about 7 months, and spent her entire day either pumping or feeding it very slowly to her difficult to feed baby.

    I felt a lot of that same pressure with my first, and felt like a failure when my milk supply began to dry up around 9 months despite my best efforts to pump like a madwoman while I was at work.

    With my second, she cold turkey quit breastfeeding on me at 3 months, despite my best efforts to convince her otherwise. I had to come to grips with the fact that formula wasn't a bad thing. Interestingly, she's been healthier than my oldest. Way fewer ear infections and sinus issues. For whatever that's worth.

    My "baby", now 2 1/2, was a really hard kid to breastfeed. Honestly, I would have quit sooner if I'd have found a formula that didn't make her scream. But we toughed it out to 6 months, gosh dang it.

    Every woman should do what's best for their family. The only time I feel compelled to intervene is when I see soda in a bottle (which I have!) Millions of babies bright, well adjusted and happy formula fed babies are running around at this moment.

  21. Kellie (general surgeon)January 19, 2010 at 4:50 PM

    Love this post and the comments. I tried exclusively breastfeeding until about 3 weeks. I wasn't sleeping, baby nursing all the time. Husband said that we should try a little formula. We did mostly breastfeeding for 11 months, but did feed formula also. never any "nipple confusion". I had some problems with it at first because I felt I was "failing" my child, but did get over it. It was hard pumping at work. I did set aside time in the morning and afternoon to pump, but always seemed to not have as much as I wanted.

    If I would ever have another child, I would certainly try exclusive breastfeeding again. However, I don't think I would feel as "bad" about giving a bottle of formula as I did the last time.

    I try to support women in both endeavors. Being a mother is hard enough without being judgemental about someone elses decisions. Especially as the original post stated, there is no true child abuse there.

  22. Like other things in life, breastfeeding should be a woman's individual choice. She should not be judged by anyone for the choice she makes, and she should not feel guilty about her choices.

    Women have fought long and hard in order to have options in our lives. It outrages me that we so often turn on each other for exercising our right to choose between our options. We should be supportive of one another's choices.

    As for my two cents on this subject, I was adopted as an infant. Therefore, of course, I was bottle-fed. I chose to breast-feed my son for the first 6 weeks postpartum, then electively switched to bottle-feeding when I went back to full time residency training. This worked very well for our family, and I felt no guilt whatsoever. I still feel no guilt, and I would probably choose to bottle-feed from the very beginning if I decided to have another child.

    It matters not to me who would criticize me for this decision. It was right for us, and that's what matters. My son is healthy and has followed the curves nicely on the growth chart.

    Breast feeders, bottle feeders, working moms, SAHM's, whatever your description, more power to you, and good luck finding your own happy medium!

  23. Thanks for addressing how hard pumping can be.

    I am a (hopeful) pre-med with a beautiful 6 month old daughter. I wanted to breastfeed her for all the healthy benefits and I wanted that bond that breastfeeding mothers seem to have with their babies. In the hospital I tried so hard to get her to latch, but I couldn't seem to get it. I asked to nurse for advice and she tried to help me. I learned that even though she thought she knew what she was doing, never ask advice from someone who doesn't have kids and therefore has never breastfed. She would come in every 3 hours, pinch my nipple and shove it in my daughters mouth. It hurt bad (the nurse told me to deal with it), and my daughter protested the fingers holding the nipple in her mouth.

    Just barely before we left we were finally able to get a lactation consultant up to our room. That was the one and only time I was able to get my baby to latch on and successfully nurse.

    When I went home I was unable to replicate the results I'd had with the lactation consultant. And my own mother was far away, and while she sent many emails, I couldn't ever manage to feed my daughter, and without support I got very depressed. Feeding sessions wound up being just her and I crying and screaming for hours on end. I was so frustrated and depressed I didn't want to even hold my baby, and I did only when it was time to feed her.

    This went on for the first 4 weeks. And then one day I saw my pump sitting there (we'd bought it since I'd be going back to school 6 weeks after her birth) and decided to give it a go. It felt so amazing in 20 minutes I had emptied myself, and my baby girl took to the bottle instantly. She was done eating in 10 minutes and was content. I was ecstatic. I started pumping and then feeding her breast milk from the bottle. I loved it and I started to actually pick her up just to hold her and enjoy her. I regret that I didn't start pumping sooner, and I feel like I missed out on that first month.

    However, when she was 3 months she went away for a weekend to visit her grandma and my mother-in-law. I sent a hearty amount with her and continued to pump in her absence. But when she came back she refused to be set down, even for the briefest of moments and it became hard to fit in a pumping session while still pacifying her. And it only got worse as finals came, and then I got swine flu. The result is now that I manage to pump out a measly 6-8 oz. a day. Despite all my struggles I can't seem to regain my supply. So she gets one bottle a day of breast milk and the rest is formula. Sometimes it's very discouraging for me after I pump and see the pathetic little drops I manage to squeeze out and I feel like a failure. I try to tell myself that she is healthy, very chubby, happy and that she still gets some breast milk and I should be proud of that.

    But what appalls me is the judgement I've received. People, especially other mothers (who I thought would appreciate the struggle) are quick to condemn me when they see me feeding her with a bottle, even when I inform that that is is breast milk in the bottle. I've been told that I'm "corrupting" the breast milk, and that when they say Breast is Best, they mean still in the breast. People have argued with me that I am depriving her of the benefits of breastfeeding and that since it comes from a bottle she'll have weaker jaw and eye muscles, and that her fine motor skills will develop slower. I think my baby is doing fine, she is right on track of every growth and milestone chart there is, and if she does have weak jaw muscles, well then I don't think that's something incredibly important in life.

    I wish people would be less quick to judge, and that they would not stick their nose in what is a very personal decision and none of their business. And I also wish that us mothers would stop feeling so darn guilty.

  24. You just have to not listen to them. They're full of baloney. Most of the boomers were bottle fed, and whatever our other failings, I think our jaw and eye muscles, as well as our motor skills, did just fine. Don't let those people mess with you.

  25. Fizzy, I am so with you- I "exclusively breastfed" my daughter for the first six months, because that's what the guidelines said. I want to whack myself in retrospect for not being a little easier on myself and everyone else involved. All the tears, the stress, the intense anger about wasted milk- it was so hard! Although I was proud at the time for exclusively breastfeeding, I felt so stupid about it in retrospect, once I supplemented. Because I'm sure that it would have been better for my daughter to have me be less stressed with a few extra bottles of formula. Not to mention myself, and my husband!


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