What to Expect the First Year (24 page)

Maybe you'd like to try the “combo” of breast and bottle. Or maybe you'd just like to introduce a bottle so you have the option of falling back on one every now and then. But you've heard that bringing on the bottle too soon or in the wrong way can cause “nipple confusion,” and now you're confused about how to proceed. Though some lactation consultants warn that starting a bottle before breastfeeding has been mastered may sabotage nursing, others believe that there's no such risk—and no such thing as nipple confusion. And in fact, the majority of infants seem to agree, switching effortlessly between breast and bottle if the combo is started at the right time.

Timing is key in introducing the bottle. Bring it on too soon, and baby may get hooked on the bottle's easy-feed features and decide to reject the harder-to-work breast. Bring the bottle on too late in the game, and baby may already be too attached to mom's nipples to consider sampling the factory-made variety. Personality plays a part, too, in whether a baby will go for both breast and bottle—some babies are more flexible when it comes to feeding (as long as they get fed), others are intractable creatures of habit. Most important, however, is perseverance. While your breastfeeding baby may well be puzzled by this unfamiliar milk dispenser at first—and may even reject it repeatedly—chances are he or she will eventually take the bottle bait. For more on introducing a bottle,
click here
.

You're committed to exclusive breastfeeding but something's not working out as planned (your milk won't come in because of a hormonal imbalance, for instance, or baby's not able to suckle effectively) and now the doctor is telling you that formula is medically necessary to adequately nourish your little baby. But you're reluctant. After all, you've heard over and over that breast is best—and of course, you want to give your baby the best. That breastfeeding isn't always easy and takes time to work out all the kinks—so of course, you want to give it more time. And that supplementing with formula sabotages the chances of breastfeeding success—and of course, you want breastfeeding to succeed.

Completely understandable—you're feeling the way you feel for all the right reasons. And yet, there are sometimes reasons to rethink a breast-only approach (either temporarily or long term) or to rethink breastfeeding entirely. The truth is, breast-only is best only when breast alone can nourish your baby the optimum way (and in the way a newborn needs). When it isn't, supplemental or exclusive formula may be needed so your baby can thrive (and in some extreme cases, even survive).

If your baby's doctor (or the hospital staff) has told you that supplementation is necessary to protect your baby's well-being, ask why—and whether there are alternatives (such as pumping to pump up your supply or getting intensive help from a lactation consultant). In some cases, routine policy might be at the root of the recommendation. For instance, formula may be prescribed when a baby has hypoglycemia (low blood sugar), even though many experts agree that breastfeeding can help baby regulate blood sugar just as well (except when the condition is severe). If that seems to be the case with your baby, consider asking for a second opinion.

But if supplementing or switching to formula turns out to be necessary, don't hesitate—and definitely don't wait to follow the doctor's orders. Refusing formula that's needed for medical reasons can put your baby at risk.

Do keep in mind that just because you're giving your newborn formula that's medically necessary, it doesn't mean you'll have to give up completely on breastfeeding. It's very possible you'll still be able to make it work—with the combo (
click here
) or by relactating (
click here
). Also remember that there's nothing more important than your baby's health and well-being, no matter where his or her first nourishment comes from.

You're determined to give your new bundle nature's best—your own breast milk. But what happens if you can't, for whatever reason? Would someone else's breast milk be next best?

It might be. Research shows that donated breast milk can nourish babies just as well as mother's own milk can. Just as safely—well, that depends. Though you can obtain milk through private donations (from friends or family) or through online milk share collectives, studies show that it may be unsafe for your baby—in some cases carrying infectious disease or containing harmful bacteria due to unregulated collection, storage, and shipping practices. Accredited, nationally recognized milk banks screen all donors and pasteurize milk before freezing and sending on to hospitals and families, ensuring its safety.

There are a growing number of milk banks in the U.S. that operate under the strict guidelines set up by the Human Milk Banking Association of North America (HMBANA), an organization of pediatricians and other health care workers. You can search for one at
hmbana.org/milk-bank-locations
.

Once a baby's born, there's just about nothing that a biological mother can do that an adoptive mother can't. And that even goes, to some extent, for breastfeeding. Though most adoptive moms don't end up lactating enough to breastfeed their babies exclusively, a few moms do manage to breastfeed at least partially.

Breastfeeding will be possible only if the baby you are adopting is a newborn and not yet attached to bottle-feeding, and if you have no medical condition (such as a history of breast surgery) that might prevent you from producing milk. Even with all those boxes ticked, however, it's important to also consider this: Establishing lactation will be extremely challenging, and even if you're serious about facing those challenges—and giving your effort to breastfeed everything you've got and then some—you may not manage to reach your goal.

Keep reality in mind, but if you're determined to do whatever it takes to try breastfeeding your baby, you should definitely consider going for it. Following these steps will increase your chances of success:

• Read up. This chapter will tell you everything you need to know about breastfeeding.

• Visit the doctor. See your gynecologist to discuss your plan and to be sure that you don't have any condition (or take any medication) that will make breastfeeding especially difficult or even impossible. Ask for advice on logistics, too. If your doctor isn't familiar with lactation induction, ask for a referral to one who is. Also loop in the pediatrician you've chosen for your baby.

• Start popping. A prenatal vitamin or supplement designed for lactation can help boost your nutritional status and get your body geared up for baby feeding.

• Get help. Contact the La Leche League for advice and to recommend a local LC who can join your support team. You also may want to consider enlisting an acupuncturist or other CAM practitioner who has experience with breastfeeding issues.

• Get a head start. If you know approximately when your baby will be arriving, begin priming your breasts for that momentous day. About a month or so in advance, start stimulating lactation with a breast pump, preferably a powerful double electric one. Try to pump every 2 to 3 hours during the day and twice at night (if you don't mind interrupted sleep even before your baby arrives). If you successfully produce milk before your baby arrives, bag it and freeze it for future use.
Click here
for information about expressing milk.

• Feed frequently. Once baby arrives, you'll want to nurse often, depending on the age of baby (at least every 2½ hours during the day and every 3 to 4 hours at night for a newborn), being sure to supplement with formula so your new arrival gets the nutrition he or she needs.

• Stimulate while you feed. A supplemental nursing system (SNS,
click here
) will allow your baby to stimulate your supply by suckling, and at the same time, get the feed he or she needs from supplementary formula. Even if baby arrives unexpectedly—and you didn't have a chance to get a head start on milk production by pumping—an SNS may help you catch up, without shorting your little one on nutrients. And if you don't end up making enough milk to meet your baby's needs completely, you can keep supplementing with the SNS (if your baby cooperates with SNS feeding—not all will) as long as you breastfeed.

• Encourage let-down. If you're having trouble with milk let-down (that is, there's milk in your breasts, but it needs hormonal help making its way out), ask your doctor whether a prescription for oxytocin nasal spray might be useful. Just keep in mind that so far the use of oxytocin for boosting let-down is a little controversial—studies show that it isn't always effective, and some experts believe more research should be done before it can be safely recommended.

• Relax. Get plenty of rest, relaxation, and sleep. Even a woman who has just given birth can't produce enough milk if she's super stressed and super exhausted. Stress can also interfere with let-down, so try to do some serious relaxing before each nursing or breast stimulation session.

• Don't give up too soon. A pregnant woman's body usually has 9 months to prepare for lactation—give yours at least 2 or 3 months to get it going.

You'll know your body is making milk if you feel the sensation of letdown in your breasts. But the only way to know if you're making enough milk is if your baby shows signs of adequate intake (such as contentment after feeding, wet diapers, frequent bowel movements). If it doesn't seem like you're meeting all your little one's needs, continue to use the SNS.

If, in spite of all your hard work, you don't succeed at producing milk, or don't produce enough to make you the sole supplier of your baby's nourishment (some biological mothers don't, either), you can quit knowing you and your baby have already shared some of the important benefits of breastfeeding. Or you can continue nursing for all the nonnutritive perks and pleasures it offers. Just supplement your baby's intake of breast milk, if any, with formula, either through the SNS, with a bottle, or a combination.