Formula – friend or foe?

Talk of formula in breastfeeding circles can seem shocking and be risky (like formula itself).
Let’s take that as a starting point: the risks of formula, the ‘foe’. The name sounds scientific and possibly trustworthy – yet it’s a non-sterile mixture,  its components can change according to what’s available and cost-effective at the time of manufacture,  it’s made up of the waste products of the dairy industry (unless it’s soya), it could be laced with the toxins of the environment it’s come from and it can programme a baby’s palate and pancreas in damaging ways. It also creates plastic waste and transport pollution – yet it’s been so successfully marketed that it now reaches all the corners of the globe.

So I bring up this subject with caution because I’m fearful of misinterpretation, but I also have hope that readers can explore the subject matter. For over time, my relationship with formula has lost just a few of its sharp corners, even though  I still get hugely saddened if I see a baby being routinely formula-fed.  Why has my feeling about formula changed over time? because I’ve seen it preserve many breastfeeding relationships that were in danger of collapsing altogether.

When I’m asked to help a mum and baby who are struggling, it’s not often in the very early days of life – it’s  some weeks on when time has passed and hormones are settling.  The mothers are often extremely committed to breastfeeding and when I meet them, they express  disbelief at finding themselves in a difficult breastfeeding place they never imagined they’d be in when they were pregnant. Many of these mothers are worried and fearful about giving formula to their babies. They believe it’s the start of a downward spiral which will inevitably end the breastfeeding relationship.

But the situation has become complicated: mother’s milk production may have dwindled because of poor milk transfer over a period of time, and baby may have slow or no weight gain and either is flagging at the breast or becoming panicky and refusing to ever leave the breast. In fact, baby is not getting enough food for its needs and as this happens, the cycle is set up for less and less co-ordination of the infant at the breast, less milk intake and, over time, less milk production.

What that baby needs is calories! It needs the energy to be co-ordinated so that it can feed more  rhythmically at the breast, it needs the vigour to attach well and milk the breast effectively, it needs mum’s milk production to be boosted in order to meet its growing needs. What that fatigued baby also needs is an intervention that maintains milk production whilst keeping her well fed. The Womanly Art of Breastfeeding describes this as The Three Keeps: keep the baby fed, keep the baby close, keep the milk flowing. These are wise words and memorable ones too – they’re words that mums can act upon in a dazed and despondent state.

In earlier times, a wet-nurse would have stepped in or a relative would have raised a robe to put the baby to breast. (The new informal milk-sharing groups are trying to replicate this womanly service – see EatsonFeets and Human Milk for Human Babies ). The mother may be able to do lots of expressing herself, feed her infant this EBM and turn the situation around very quickly. But our living circumstances are different from the past and expressing may not be enough.  The fact is that we don’t have lots of breastmilk easily available if mum and baby hit a big challenge, but we need to remember that the baby needs its energy in order to do well at the breast. So, in these circumstances, with a plan of action to increase milk production alongside baby doing what it can at the breast, formula is most likely to be that source of calories. My encouragement to mums is that the other milk is helping to preserve and protect their breastfeeding relationship, especially if a mother chooses to use an at-breast supplementer. It’s what is described in hospital settings as ‘formula from the medicine cabinet’, only to be prescribed when breastfeeding isn’t straightforward.

Of course, no giving of formula is risk-free and I wouldn’t pretend otherwise to a mother – but if you can accept that it’s a food which can temporarily step in with usually much-needed calories in challenging situations, you might find yourself coming to peace with these ideas. It’s certainly the language that those mothers – faced with a bewildering feeding situation – say they eventually use when reflecting on their experience with formula. Just for a little while, whilst they rebuilt and reclaimed their breastfeeding relationship with their babies, the formula was a necessary ‘friend’ in their lives.   Nevertheless, they’re overjoyed when their babies are once more ingesting adequate breastmilk, the food which is in fact nutrition, protection and information rolled into one, the birthright of all human babies.