To or Not to Breastfeed / Nurse?

To breastfeed or not to breastfeed is definitely a personal question you have to answer yourself. There are many different studies out there and a lot of the research does tend to promote breastfeeding; but ultimately you have to do what works best for you and your family. This article discusses the following topics:
Breastfeeding Is Best? How to Combine with Bottle Feeding Immune Support Health Benefits for Mom Save Time & Money Relax & Bond with Baby Formula? Decide What Works Best for You Works Cited

Breastfeeding Is Best?
Most professionals suggest breastfeeding is best. According to the U.S. Surgeon General’s public health report, “health professional organizations… officially recommend that most infants breastfeed for at least 12 months. These organizations also recommend that for the first six months infants be exclusively breastfed, meaning that they not be given foods or liquids other than breast milk” (Galson 356).

If you decide to supplement with formula or do all formula, most types of formula have additional nutrients to try to get the formula as close to breast milk as possible, please refer to the “Formula” article for more information. Remember, you have to do what works best for your family and bottle feeding may be what works best for you.
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How to Combine with Bottle Feeding
A lot of research discusses the issue of “nipple confusion,” when the baby either rejects breast for bottle or vice versa. Both of my babies had a form of nipple confusion, my first baby rejected breast for bottle and my second baby rejected bottle for breast. Fortunately I was able to breastfeed along with supplementing with formula my first baby for 6 months and I'm able to primarily breastfeed and occasionally supplement a bottle with breast milk for my second baby.

According to Hogg, “[i]f an infant is under three weeks old, it’s relatively easy to get him to take a bottle if he’s been on the breast, or vice versa, and for him to continue to do both” (120). Dr. Greene also suggests families to occasionally bottle feed once breastfeeding is established, “usually by 2 or 3 weeks.”  With both babies my plan was to introduce the bottle early on. With my first baby, we introduced the bottle too early (I believe the 2nd or 3rd day in the hospital), before breastfeeding was well established and my son learned to prefer bottle to breast. I did manage to still breastfeed him for six months along with supplementing with formula.

With my second baby, I wanted to more exclusively breastfeed and this time I was able to successfully establish breastfeeding. We waited until my daughter was around 2 weeks old to introduce a bottle since I wanted to make sure breastfeeding was well established before introducing the bottle. My daughter would gag at first when you first put the bottle in her mouth but once she realized it isn't Mommy and remembered how to suck on a bottle nipple, she would easily drink 2- 4 ounces. At the next feeding she would go back to breastfeeding without any problems. We only gave my daughter a few bottles each week unlike with my son where he had a few bottles every day. As discussed in the Save Time section below it was too time consuming to do a lot of bottles along with breastfeeding since you need to pump for every time you don't breastfeed and preferably you need to pump close to the time your baby took a bottle. Since this time I wanted to avoid supplementing with formula until closer to the 6 month mark, I primarily breastfed my daughter and we simply gave her a few bottles to make sure she was able to take a bottle in case I was unable to feed her due to an unexpected situation and also to allow me some freedom in case I needed a break.

The most important thing is to consistently introduce the bottle if you are primarily breastfeeding or to consistently continue breastfeeding (and pumping) if you are bottlefeeding. We got lazy when my daughter was 2 months old and didn't give her a bottle for a few weeks and then she rejected the bottle. Thus, to try to help her more easily accept the bottle again, we decided to find a bottle that had a more realistic nipple (for us this was the Tommee Tippee bottles. Soon as we tried these bottles she didn't gag as much and Erik was able to give her a bottle again. So when transitioning from breastfeeding it definitely helps to use a nipple that more closely resembles mom’s and also have someone other than mom give your baby the bottle. Also, with my daughter we had to make sure the milk was fairly warm, she was use to Mommy's milk being warm and did not want to drink breast milk out of a bottle unless it was just as warm.

On nights where I could use some extra sleep, if we thought our daughter was going to wake within an hour of us going to bed then I could pump before we went to bed and then Erik would pick up the next feeding in the middle of the night by giving her a bottle so I could get some extra sleep. But generally, with our daughter since I wanted to primarily breastfeed, it was easiest for me to simply breastfeed her most of the time. With our first baby, Erik did a lot of the feedings with a bottle which probably contributed to why I didn't produce enough breast milk to fully sustain our baby. It is a cyclical effect, the more you bottle feed, the more you have to pump, and possibly the more you have to supplement, and the more you supplement the less breast milk you produce since your body doesn't realize you need to produce more. So you have to decide what is your ultimate goal, do you want to primarily breastfeed, do you want to breastfeed and supplement with formula, or do you want to primarily bottle feed with formula? With my first, I wanted to breastfeed and supplement with formula and with my second I wanted to primarily breastfeed. Both ways worked well for me and I was thankful to have the option to both breastfeed and bottle feed with both of my babies.
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Immune Support
Most research suggests that breastfeeding helps boost the immune system since it “contains antibodies that can protect infants from bacterial and viral infections” (CDC). I believe the boost of the immune system is primarily only for the first six months; which is still essential in that you want your baby to be protected when she is so vulnerable to viruses and diseases. There are formulas that do have the immune support as well, please refer to the "Formula" article for more information.

According to the Office on Women’s Health, breastfeeding “is linked to a lower risk of these health problems: 

• Ear infections
• Stomach viruses
• Diarrhea
• Respiratory infections
• Atopic dermatitis
• Asthma
• Obesity
• Type 1 and type 2 diabetes
• Childhood leukemia
• Sudden infant death syndrome or SIDS
• Necrotizing enterocolitis, a disease that affects the gastrointestinal tract in preterm infants”

In addition, “[t]he iron in breast milk comes in a form that is very easy for babies to absorb. Formula manufactures have to add much more iron for the same amount to get into the baby” (Spock 242).  The additional iron may contribute to constipation problems. The week my first baby had mostly formula (due to my eye infection) he was much more uncomfortable and constipated then his “normal” constipation weeks. Some research suggests that “chemicals in breast milk may be important for optimal brain development” (Spock 242)  I believe this is referring to the “DHA & ARA” which is now added to most formulas. Although, most research claims that “no formula manufacturer can completely reproduce it” (Spock 242).

The one thing breast milk does NOT supply is sufficient vitamin D. According to the American Academy of Pediatrics, “[a]ll breastfed infants should receive 200 IU of oral vitamin D drops daily beginning during the first 2 months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is 500mL [16.9 ounces].” My daughter's pediatrician recommended giving 400 IU of vitamin D daily. I plan to start giving my baby girl Enfamil Poly-Vi-Sol Without Iron drops when she is close to 1 month old. Since I breastfed and supplemented with formula for my son I did not have to give him vitamin drops although I did start giving them to him when he was close to 6 months old to help boost his immune system. As with any medical advice, please check with your healthcare professional as to what you should be giving your baby.
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Health Benefits for Mom
In addition to wanting to breastfeed in hopes that I am providing my babies better nutrition, I also wanted to do it for myself. Hogg discussed that breastfeeding may help with postpartum recovery. “The hormone that’s released – oxytocin speeds delivery of the placenta and constricts uterine blood vessels, which minimizes blood loss. As the mother continues to nurse, repeated release of this hormone causes the uterus to return more quickly to its preprenancy size” (94).

According to the Office on Women’s Health breastfeeding “is linked to a lower risk of these health problems:  Type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression (PPD).”  I also read that breastfeeding may help take off baby weight. As documented by Hogg and many other mediums, “the internal production of milk burns calories” (94).  Although, you will want to make sure you do NOT diet while breastfeeding, in fact Hogg states you should “keep on an extra five to ten pounds of weight to ensure the baby is getting proper nutrition” (94). Someone I met once said breastfeeding also probably helps you lose weight since you tend to eat better knowing your baby is getting the nutrition of what you eat, which probably has some validity to it.
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Save Time & Money
If you solely breastfeed, it should save time as you won't have to make bottles or wash them. Also, for the middle of the night feedings, you don’t have to worry about spending time making or warming a bottle while your baby is crying and ready to eat. I generally preferred breastfeeding rather than bottle feeding in the middle of the night for this reason.

With my first baby, overall breastfeeding didn’t save me time; it actually required more time, but I’m glad I did it. Since I was pumping in order to provide breast milk for bottles and then also supplementing with some formula breastfeeding did not help me save time as I now had the added time of pumping and then cleaning all of the pumping products in addition to the normal formula bottle preparation process. This contributed to why with my second baby, I wanted to try to breastfeed more exclusively and I am enjoying not cleaning bottles and only pumping occasionally.

Breastfeeding definitely can help save money as formula can be quite expensive with the cans generally ranging around $28/ can and I believe we generally went through  one 30 oz can a week once my baby was only drinking formula (around 6 months.) According to Office on Women’s Health, breastfeeding “can save you between $1,160 and $3,915 per year, depending on the brand of formula.”
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Relax & Bond with Baby
Breastfeeding may actually help mom and baby relax and fall asleep. Breast milk “contains a natural sleep-inducing protein that…puts baby into a restful slumber.”  In addition, the “hormones induced by sucking tranquilize mother” (Sears 123). This does help for the middle of the night feedings as I do find that I am able to usually easily fall back asleep after feeding my baby.

With my son since I was supplementing with formula I didn't produce a lot of breast milk so with him I would have Daddy give him a bottle of breast milk that was pumped from the morning since breast milk is riches in fat in the morning, after a good night’s sleep (Hogg 117) to make sure my son had a full bottle of breast milk before bed. With my baby girl, I simply breastfed her before bed and would try to "cluster" feed her towards bedtime. She naturally seemed to want to eat a lot before bed, at 3 weeks old sometimes she would eat at 8PM, 9PM and then 10PM before then sleeping for five to six hours before waking to eat again.

The process of having your baby successfully latch on may not be easy at first but if breastfeeding does work for you it is a completely natural process and an incredible opportunity to bond with your baby. On the other hand if breastfeeding doesn’t work for you, I think feeding your baby a bottle is just as wonderful. Since breastfeeding never was totally natural for me with my first baby, sometimes it was actually more relaxing to give my baby a bottle as I could simply focus on my baby and not worry about trying to get him to latch on or worry that he was going to get upset if he wasn’t getting enough milk fast enough. With my second baby when breastfeeding worked well for both me and my baby, I really enjoyed the special bonding time we had while breastfeeding.
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Formula?
Whether you decide to give your baby all formula, some formula, or no formula is your personal choice. With my first, I liked the flexibility of giving formula in addition to breast milk. With my second baby I preferred to solely breastfeed as long as possible. With formula you do know that your baby is getting lots of vitamins and minerals. Although, as research suggests breast milk provides all of these vitamins (a Vitamin D supplement may be required) and minerals (in addition to other benefits) in an easier form for the baby to digest; although mom will need to make sure she maintains a healthy diet and continues taking her prenatal vitamin.

When traveling, it was easy to store the powdered formula in a container and simply have water in the bottles and when it was time to feed my baby I just had to mix the two. I didn’t have to worry about keeping the bottles refrigerated. If you are solely breastfeeding, the breast milk should keep at room temperature for 4 (ideal) to 6 (acceptable) hours (LLLI). Please refer to the "Storing Breast Milk or Formula" article for more information.

I would recommend that if you do not plan on giving your baby formula that you have adequate backup of frozen breast milk for an unexpected situation. If you plan on transitioning to formula you will still want to have some backup of breast milk as usually a slow transition works best.
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Decide What Works Best for You
In the end, deciding to breastfeed or not to breastfeed is a very personal decision and a decision that may continue to change. Maybe you previously decided to solely breastfeed and then discover that due to issues that isn’t possible or later you decide you need a break occasionally and want someone else to give the baby a bottle of pumped breast milk or formula.  Or maybe the opposite occurs you think you only want to give formula and then you try breastfeeding and realize you enjoy the special bonding time with your baby. I tried it all, with my first baby I enjoyed breastfeeding along with bottle feeding of both formula and breast milk. With my second baby, I preferred to primarily breastfeed. Whatever you decide most of us are fortunate that the baby will receive the proper nutrition to continue to thrive and grow in the miracle of life.

For more information on breastfeeding, please refer to “About Breastfeeding,” “Accessories,” “Tips,” and “Pumping” related to breastfeeding. If you need more information on bottle feeding, please refer to “Bottles,” “Formula” "Formula Transition," and “Nipples.”  Also refer to "Feeding Tricks," "Storing," "Reflux" and "How Much?" for more articles related to breastfeeding and bottle feeding.
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Works Cited

Centers for Disease Control and Prevention (“CDC”). “Breastfeeding: Ideal for Infants.” 17 Nov. 2009. <http://www.cdc.gov/breastfeeding>.

Galson, Steven K. “Surgeon General’s Perspectives:  The Status of Breastfeeding Today.” Public Health
Reports 124 (May-June 2009). 8 Nov. 2009 <http://www.publichealthreports.org>.

Greene, Alan M.D., and Cheryl Greene. “Breast to Bottle – Nipple to Cup.” drgreene.com. 8 Nov. 2009.
<http://www.drgreene.org/body.cfm?id=21&action=detail&ref=1463>.

Hogg, Tracy and Melinda Blau. Secrets of the Baby Whisperer: How to Calm, Connect, and
Communicate with Your Baby. New York: Ballantine, 2001.

La Leche League International (LLLI). "What are the LLLI guidelines for storing my pumped milk?"
La Leche League International. 17 Nov 2010 <http://www.llli.org/FAQ/milkstorage.html>.

Office on Women’s Health in the U.S. Department of Health and Human Services. “Benefits of
Breastfeeding.” 17 Nov. 2009. <http://www.womenshealth.gov/breastfeeding/benefits>.

Sears, William M.D., Martha Sears, R.N., Robert Sears, M.D. and James Sears, M.D. The Baby Book:
Everything You Need to Know About Your Baby - From Birth to Age Two. New York: Little, 2003.

Spock, Benjamin M.D. and Robert Needleman, M.D.  Dr. Spock’s Baby and Child Care. New York:
Pocket, 2004.

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Last updated: March 2011; November 2010; November 2009