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The Supplementation Game

By Doula Jen

Thought I’d kick off World Breastfeeding Week with an issue that seems to be plaguing many of the nursing mothers we work with.

Supplementation, or the addition of formula—any amount—to the nursing family’s feeding routine, has become more common over the last year. Somewhere along the line, moms are getting the message that their bodies are just not enough—that they need to offer a syringe or a bottle of formula. They are home in those first few days, already coping with HUGE postpartum changes, and now also riddled with self-doubt and over-concern about the breastfed baby’s natural and expected post-birth weight loss.

We have said it before and we’ll say it again: we are not anti-formula lunatics who will ever shame a mother for her feeding choices. We know that by the time we meet you, in the home, you have heard “Breast is best” so often that you probably hear it in your sleep. We choose not to add to the finger-wagging, guilt-inducing language often fired at our new and expectant mothers.

We provide non-judgmental care. Period.

That said, I am getting a little ticked off about this supplementation trend! Not because I am disgusted by formula or am so earth mama-hippy dippy-doula that I am militant about breastfeeding. No. It’s not that. It’s that I am meeting women who want to nurse. Truly, madly, deeply, passionately—they do. And they’ve come to think they can’t.

They come home with the recommendation to give ONE OR TWO ounces of formula to their child after EACH AND EVERY feeding.

Here’s the thing:  1)That’s a lot for a newborn! 2)When the ounces come from another source, Mama’s body gets the message: stop making that amount of milk. 3)Now the supply issues that may not have been there in the first place…are there! 4)Pumping is recommended to stimulate production. 5)Pumping sucks, literally. 6)Mom sees that she only pumps half an ounce and her fear that she is “not enough” is confirmed. Did I mention that moms NEVER make for the pump what they actually make for their actual baby? It’s noisy plastic… 7)Now her routine consists of feeding (perhaps a baby with a lazier latch because he has become accustomed to the ease of the bottle), pumping, and supplementing.

The pumping routine alone is exhausting. Add actual at-breast time and bottle feeding? To a newborn’s schedule? When does Mama rest?

At this point, she feels caught in the middle. How do I get to exclusive breastfeeding now that we are giving at least 14 oz. of formula per day? I’m scared. He’ll starve. Should I just move to all formula? How do I stop pumping? Should I stop pumping? What the heck will happen if I stop pumping? I hate pumping!!

What a mess. What a total and complete mess! As if the transition from pregnancy to motherhood isn’t difficult enough.

The definition of weaning is the introduction of sustenance other than that which comes from the mother’s breast.  So, when someone gives Mom instructions to, “Just give a little of this until you get the weight up,” they are really giving her—likely before her milk has even come in—instructions to wean. And then, if she wants to breastfeed, she has to claw her way back from a supply issue that has been inflicted upon her as a result of a (possibly passing) trend and over-conservative ideas about breastfeeding, birth weight, and subsequent loss and regain of that weight.

Do some baby’s need supplementation? Sure. Maybe. I guess. But not as many babies as I am seeing. And I am seeing a very small percentage of one city’s babies. And I have to wonder…just how many families are receiving—from either a pediatrician, a friend, a nurse, or a website—a strong, insisting recommendation to supplement?

Like I said, if a family whole-heartedly wants to move to formula or dabble in formula or mix formula with breast milk, we will not get in the way. We will honor all choices once they have been made.

But if they want to breastfeed and have been told they can’t, we are going to tell them that they have to move away from supplementation in order to try to reach that goal of successful breastfeeding.

As for the message—supplement, or your baby won’t thrive. It comes from different sources and it comes—I do understand—with the best of intentions. However, delivering this message without real, emergent medical reason messes with one of the most amazing, life-affirming experiences available to mother and child. Asking a mother to supplement might be necessary, sometimes. Nonetheless, we should all understand that asking a women to do so is asking her to walk down a path that she might not be able to come back from, while both freaking her out and making her job way more difficult than it should be. Being a mom is hard enough.

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