Supplementing Breastfeeding With a Bottle
How to Introduce Bottles Without Jeopardizing Nursing
Sep 15, 2008
Giving bottles to a breastfed baby can damage the nursing relationship, especially if the mother has a low milk supply. Still, there are many reasons why a mother may want to introduce bottles, especially if she does not make enough milk to meet her baby’s needs. The following tips will help a mother to successfully continue breastfeeding her baby even after introducing supplemental bottles.
At-Breast Supplementer Versus Bottle
For mothers with a low milk supply, an at-breast supplementer like the Lact-aid Nursing Trainer or Medela SNS is often recommended. These devices allow women to breastfeed their babies while supplement is being administered to the baby via a small tube that lies beside the nipple.
While these devices work wonderfully for many women, even long term, there is a learning curve to them. Some mothers may find them too overwhelming or difficult to use, and for those women, a bottle can be a viable option.
“Bottles are not the most undermining factor for breastfeeding,” says Diana West, IBCLC in a 2008 interview. “There are ways to use bottles that are very supportive of breastfeeding. In many ways, the freedom to be able to use a bottle helps keep mothers going.”
Keep the Flow From the Bottle Slow
According to West, the most important thing you can do to keep babies from developing flow preference (sometimes called “nipple confusion”) is to slow the flow rate down. A woman with a low milk supply will have a slower flow because she has less milk. “Feed baby upright,” says West. “If the bottle is horizontal, the flow is slower. This also helps babies regulate their own intake. They can stop and start as they please.”
For mothers who may wonder if their babies will get too much air in their bellies as a result of a horizontal bottle, West reassures them that they won’t. “The air that gets in comes out as a burp. It doesn’t cause gassiness.”
Another recommendation is to tip the baby forward every once in awhile so he can take a break. This applies to older babies as well as to newborns. “It’s a good tip for daycares,” says West. “When the baby is held lying down, she is swallowing defensively.” This may explain why a breastfeeding mom who goes back to work finds out from her daycare provider that the baby drank 16 ounces from the bottle in the eight hours she was gone. It can be disheartening to a breastfeeding mom, and if the baby is full of formula, she may nurse less in the evening and compromise mom’s supply.
When To Give the Bottle
The standard advice for offering supplemental bottles to babies when their mothers have a low milk supply is to offer the breast first and the bottle next. West admits that this information is outdated. “Babies learn that there is faster milk coming out of the bottle. They pay their dues at the breast, then relax and get a full feeding from the bottle. Moms watch this and think, ‘look how satisfied he is with the bottle, and he isn’t happy with me’. And the slippery slope (to exclusive bottle feeding) begins.”
A newer and better approach is one that many lactation consultants and nurses discovered intuitively: give the bottle of supplement first. That way, the baby’s hunger and thirst is satisfied and she isn’t as panicked when she gets to the breast. According to West, babies take more from the breast with this "finish at the breast" technique.
There is a positive psychological result to this tactic as well. The mother has the satisfaction of seeing her baby fall asleep milk-drunk at the breast. Instead of feeling rejected, she feels encouraged. She thinks, “He’s happy nursing with me. I want to do this more.”
How Much Supplement to Offer
With some of the at-breast supplementers which work on a vacuum, the baby only takes the amount of supplement he needs as dictated by the flow from the breast. With bottles, however, the mother needs to use trial and error to determine how much supplement to offer the baby so that his hunger and thirst is satisfied, but he still empties the breast and stimulates the mother’s supply to its fullest.
“Initially, you give them a half ounce or a quarter ounce less than they would normally take,” says West. “It can take two or three days to find out how much they really need.”
For mothers with low milk supplies who choose to supplement with bottles, the tips outlined above can help tremendously in preserving the breastfeeding relationship while still ensuring that the baby gets the nutrition he needs. More information on increasing milk supply, supplementing babies, and coping with a low milk supply is available in Diana West and Lisa Marasco’s book The Breastfeeding Mother's Guide to Making More Milk, available in November 2008 from McGraw-Hill. Additional information can also be found on Diana West’s Low Milk Supply website and in her other interviews with Suite.
