Breastfeeding vs. Formula Feeding - the Unnecessary Debate!

Earlier this month, 'Mind Your Body', a supplement of the Straits Times newspaper in Singapore turned its focus to the subject of Breastfeeding. In a nation that is currently obsessed with falling birth rates and on encouraging its youth to marry and procreate; breastfeeding (the inevitable milestone for every new mother) is a very relevant theme.

The supplement carried reports of how hospitals in Singapore are encouraging new mothers to breastfeed. It also featured stories of some mothers who have successfully breast fed their babies despite problems such as clogged ducts and sore nipples. But shockingly the same supplement carried an editorial which was titled "Breastfeeding is not for everyone", it stressed on how cumbersome breastfeeding could be and how many women would not want to breastfeed after nine months of pregnancy, an arduous labor and because they did not want to feel like a cow! Hardly an appropriate editorial if the intention of the paper was to motivate more mothers to breastfeed! Not only that, the editorial also denigrated breastfeeding and mothers who happily and willingly nurse their babies.

It also made me realise how polarised view points are on breastfeeding; how we have unnecessarily made into a debate of breastfeeding vs. formula feeding where some stand squarely in support of one or the other. As a mother of 2, I find this debate totally superfluous. Women are meant to nurse their newborn which is why we lactate in the first place. I don't think any mother to-be or mother has any doubts on that. All women who choose to formula feed their babies are also aware of the benefits of breastfeeding. It is a matter of choice, convenience or priorities.  (Of course, this excludes mothers who do not lactate or cannot nurse on account of some illness or special condition) 

And as for feeling like a cow- most women start lactating when they are nearing the end of their pregnancy  and till they wean off their babies. Nature does not differentiate between mothers who decide to go the formula feed way and mothers who choose to nurse their offspring; both women will lactate in the beginning and both might experience clogged ducts, leaking milk and engorged breasts. The difference is that when the mother decides to nurse the baby, the baby will benefit from the goodness of the breast milk but in the case of the formula fed baby, the mother will experience the pains of weaning off without the baby benefiting at all from this gift of nature.

But I do agree that new mothers who intend to nurse their babies need all the support and encouragement  they can get. Initiating breastfeeding can be very daunting for first time mothers and they can easily get discouraged. First there is the problem of HOW? Despite breastfeeding being something nature intended, the baby may not correctly latch on and incorrect latching on can lead to problems such as sore nipples for the mother. It can also be very frustrating for the new mother when she is unable to placate her hungry and crying baby.

Then there is the problem of HOW MUCH? For the first 3 days of the baby's life, he or she is carrying reserves and only needs the colostrum, the yellowish first milk produced by the mother. But it is very difficult for the mother to convince herself that this tiny amount of liquid is all that is needed to sustain the baby. Also, it is very difficult to gauge the exact amount the baby has taken because sometimes the baby can keep sucking just for comfort. So each time the baby cries, the mother and other caregivers start worrying that he is not getting enough and the pressure to give formula feed builds up.

Most mothers would, if asked, relate a similar story of when and how the baby was first given formula milk despite her best intentions to breast feed. "The nurses would have brought in the hungry and howling baby to the mother's room for a midnight feed. The mother would try all possible positions to help the baby latch on- the football hold, the cross-hold, the cradle position, finally after half an hour of struggle the baby would latch on but he would not suck or even after sucking he would still be crying. By the end of it, all the people in the room including the mother would be feeling very anxious. The nurse would then suggest giving the baby formula feed or maybe glucose water to calm him down and the mother too tired to counter the advice and  feeling  guilty about not being able to satiate her baby's hunger would relent." Does the story sound familiar??

Some mothers who manage to cross this hurdle fail to cross the next, " Your baby is jaundiced, breast milk tends to worsen the jaundice. You must give your baby formula to help clear the jaundice." OR " The baby is on the lower end of the weight chart, he needs formula to gain weight as breast milk is mostly water."  This despite the fact that in most cases mildly jaundiced babies become normal within the first week, type of feed notwithstanding. And babies (who are not underweight due to premature birth) gain healthily with breast milk just as well.

It is these prejudiced opinions and advice that should be done away with.  Rather than fuss over those mothers who choose to formula feed, let's try and support the new mother who has decided to breastfeed. She needs constant encouragement and a pat on the back for her perseverance. To give her credit, the woman is exhausted and edgy after a gruelling labor and childbirth. She might be groggy (after effects of the epidural or anaesthesia in a C-section delivery) and experiencing excruciating pain in the wound area.  She is still making a valiant effort to nurse her baby despite the fact that every time the baby nurses, her uterus contracts giving her horrible after-pains. And when all she wants to do is sleep, she has to muster enough energy to help nurture the child she has given birth to. Does she really need to feel inadequate?

So to every new mother who wants to breastfeed, my advice is to;

1. Ignore well-meaning but unsolicited advice from people (especially those who think you are not producing enough milk).

2. Only listen to your heart (In this case, mother does know best) and to your kid's regular pediatrician.

3. If the baby is gaining weight well and is pooing and peeing adequately as per his age, he is getting enough milk.

4. If the baby is having problems latching on, you can ask for help (from an experienced woman or nurses/ lactation experts in the hospital) and just be patient. (It will get better, fretting over it will just worsen the situation.)

5. If you have to get back to work in three months to four months time post delivery, it is at least better to breastfeed while you can than not at all.

6. If you are worried it will be difficult to wean off completely in a few months time or that your milk might just dry up without warning (some mothers do fear that) or you don't want to nurse in public, it is a good precaution to introduce just one bottle feed a day (that does not interfere with the nursing cycle) once the baby is three months or so.

7. The toughest period for breastfeeding is right at the beginning with difficulties in latching, sore nipples and engorged breasts. Remember that "this too shall pass" for as the baby learns to latch on better and the gap between feeds widens, breastfeeding becomes a more pleasurable experience. The key for successful breastfeeding is not to give up early. As in all good things, perseverance pays.

My Breastfeeding Story?

My first son was born 5 years ago in London, at 42 weeks gestation. After a harrowing labor, failed induction and a dangerous wait for a normal delivery (thanks to the cash starved and over-crowded NHS in UK- but that is another story), I had to go through an emergency C-section to deliver my baby. After a C-section delivery we were bundled -6 pairs of mothers and babies into a dormitory like facility  (not even in my wildest dreams had I ever imagined such post natal care, but that's another story too, sigh!). My baby was put in a cot at arms length from me and I still had the IV so I wasn't very mobile. The nurses told us that they would be at their station and if we needed them, we could call for help. Then we were pretty much on our own ( partners are not allowed to stay the night).

Since I could not pick up my baby, each time that he cried I had to press the button for help. Being in a shared accommodation meant that every time the nurses came bustling in to answer the call and flicked the lights on, it ended up disturbing the other new mothers in the room and it made me feel guilty as hell! Then the nurse would be all business, eager to get this over and done with and leave but my baby would have other ideas- he would not latch or latch but not suck. And the nurse would then turn to me and ask - " Would you rather we take the baby and calm him down with a formula feed?" but each time I insisted on nursing him. Finally, when I pressed the button for help the fourth time that night, the nurse came in looking quite exasperated and I could feel my neighbor glaring at me in the dark (I still remember wondering why her one day old was so quiet and mine was refusing to calm down), so this time when she asked the same question, I let her take the baby- I was just so frustrated and tired by then- I wanted to cry myself to sleep.

Back at home after 40 hours post delivery (yes, they send you back home barely 40 hours after a C-section), I really wanted to breastfeed my baby but it was really tough in the beginning. I had no choice but to keep formula milk on standby since I was petrified he would starve. On the 5th day however, my milk really started coming in and miraculously my son learned to latch on. It was so relieving and I was so glad I had not given up. I happily nursed my boy till he was one year old, only giving the occasional bottle when we were travelling. 

I delivered my second son in April this year, again by emergency C-section at 38 weeks of gestation,  this time in Singapore. Medical costs are very high in Singapore, especially for foreigners but the hospitals here deliver excellent after-care in return. 4 days in the hospital helped me recover quite a bit before I reached home. But 5 years on, the breastfeeding story remains the same, except that this time around my past experience made me a more confident mother.

Despite the fact that the hospitals in Singapore are encouraging rooming in and there are nurses on call to help the mother in nursing; the nurses especially those on night shift (which is when the mother is most vulnerable)are quick to suggest formula feed or glucose water as soon as they see you struggling with the breastfeeding. At home, concerned family members are also quick to conclude that the baby needs top-ups whenever he cries. But this time I knew better than to fall for unsolicited advice. I knew the going gets better as the baby learns to latch and as I regain my strength post- surgery. I knew that the breast milk was enough to help my baby thrive and now at 3 months, my baby is a healthy and happy boy who is making both his parents and his pediatrician proud.

Of course, breastfeeding is not without its tribulations; sometimes you worry that you are not producing enough, sometimes you get so much milk you need to express. When the baby is still very young he needs feeds every 2 hours (sometimes keeping latched on for over half an hour at a stretch) - and at the end of the day, you feel you have done nothing else except sit on that nursing couch! Night time feeds are particularly tough especially in the first few weeks post delivery and exclusive breastfeeding means you cannot take help from anyone. You are tired and sleepy 24/7. When the gap between feeds increases, your breasts get engorged as supply exceeds demand and it can be quite painful and sometimes downright embarrassing.  You have to schedule your entire day according to the baby's feed time and when outside with the baby, you have to be on the lookout for nursing rooms. (which sadly even in a modern city like Singapore are few and far)

But the tribulations of breastfeeding fade in the light of  the benefits of breast milk to the baby and the sweet, exclusive bond that develops between the mother and child.

Do write in with your breastfeeding stories. Till then, Happy and Successful Nursing Mothers! 

The International Breastfeeding Symbol- source Wikimedia Commons