Options for Feeding your Baby
[After reading this overview, visit Breastfeeding Basics and/or Formula Basics for more details]
How beneficial is breastfeeding, really?
Breastfeeding is a weirdly contentious issue: the brief history is that formula became wildly popular in the 60s and 70s, and then there was a swing back to promoting breastfeeding (“breast is best!”). Now some believe we’ve gone too far in the other direction, and there’s a counter-movement to destigmatize formula (“fed is best!”)
My take: definitely some real health benefits of breastfeeding for both babies and mothers, but many benefits cited by advocates are unsupported by data. Give breastfeeding a try for the first few months but if it doesn’t work out, your baby will be perfectly fine with formula.
Real benefits for babies are short-term (first 12 months):
Small reduction in gastro-intestinal issues, eczema and other rashes (randomized trial). Likely also reduces ear infections (meta-analysis)
Breastmilk contains antibodies and changes composition based on baby’s needs (their saliva sends signals when it comes in contact with the nipple). Truly magical “personalized medicine”, which there’s no way for formula to simulate.
Real benefits for mother:
20-30% reduction in long-term breast cancer risk if you breastfeed for at least 6 months (and protection may scale further with length of breastfeeding); this is due to changes in the cellular structure of breast and lowers levels of estrogen (since breastfeeding inhibits ovulation)
~24% reduction in ovarian cancer risk depending on length of breastfeeding; the mechanism isn’t fully understood but researchers think it’s also due to the suppression of ovulation and resulting lower levels of estrogen (paper)
Small benefit for postpartum weight loss - breastfeeding women had lost ~3 more pounds at 6 months postpartum compared to formula feeding (paper). Breastfeeding definitely burns lots of calories, but most moms end up eating an extra 300-500 calories to keep up milk production which counteracts some of the weight loss (but is important for milk supply!)
Unproven benefits for babies:
Claims to raise IQ, lower risk of SIDs, lower long-term risk of obesity, etc.
However, the type of women who breastfeed tend to be better educated, wealthier, non-smokers- once you control for these factors with a randomized trial (or compare breastfed vs. formula-fed siblings), the effect basically disappears (paper, paper, and another paper)
For what it’s worth, the American Academy of Pediatrics (AAP) recommends breastfeeding as sole nutrition source for first 6 months, and then continued along with solid food through 1 year
So, should I breastfeed?
People will ask you, “Are you planning to breastfeed? For how long?” - I find this very strange because it’s impossible to predict how things will go or feel, especially since it’s a two-person system between you and the baby!
Some babies immediately figure out how to latch while others really struggle
Similarly, breastfeeding comes easily to some moms and they love it, while others have lots of pain and frustration. For most women, it’s a mix of both at different times.
Much of this is out of your control - it could be the shape of your nipples, how quickly your milk comes in, whether you have a low supply. Or factors related to your baby - their latch, their patience, their preferences. No matter what your hopes, it’s hard to know in advance so I’d recommend having formula at home just in case.
My own case is a perfect example of this: with my first baby, I exclusively breastfed until 15 months. With my second baby, exclusively breastfed for only 3 months, then introduced formula, and switched to exclusively formula at 6 months. And both kids are thriving beautifully!
You don’t need to decide now! Your options will be breastfeeding, pumping and giving breastmilk in a bottle, and formula; while some women choose one of these options exclusively, most end up doing some combination, especially if returning to work.
A less common option is to use donor milk. This is often used during a NICU stay, but some moms who can’t or choose not to breastfeed/pump may opt for donor milk instead of formula. This is mostly obtained through milk banks or informal milk sharing networks such as Human Milk 4 Human Babies. Make sure the org screens donors and takes safety precautions.
Experiences vary widely, but here are common features of each to consider:
Breastfeeding:
Always available and warm with no special equipment, convenient
Builds a distinct bond with baby - you are their source of nourishment (and comfort); downside is it’s harder for other caretakers to give you a break; truly a blessing & a curse
Note that if breastfeeding is a constant struggle, it can actually detract from your bond and might be worth considering alternatives
Breastmilk can provide antibodies and the composition changes throughout the day, with melatonin at night to make baby sleepy and cortisol in the morning to help baby stay alert
Harder to know how much milk baby is consuming - can only measure amount of time at the breast. If concerned about weight gain, you can do a “weighted feed” where you weigh baby on a special scale before and after nursing session.
Breastmilk is free (but much of the related gear is not!)
Pumping & Bottle-feeding:
In some ways, best of both worlds: all the benefits of breastmilk, but others can take turns bottlefeeding (which is nice baby bonding time for your partner)
Even if exclusively pumping, try to put baby directly on breast once a day so your milk can still adapt to baby’s needs in terms of antibody production
In other ways, worst of both worlds: still have to keep up tiring pumping schedule (including at night in the beginning), but now also separately need time to feed baby
Some women find pumping unpleasant, no baby cuddles
Conversely, much more predictable since no squirming baby to contend with while pumping
Bottlefeeding allows you to better measure milk consumption
Requires large amount of cleaning of pump and bottle parts
Formula:
Allows for more equal sharing of responsibility (and baby bonding time) between partners, plus help of other caretakers, including at night
You have your body “back” to yourself
Formula is not digested as quickly as breastmilk, which may allow baby to have fewer wakeups during the night during infancy and longer total sleep after 6 months (evidence)
Can take time and experimentation to find a formula baby likes
Risks of shortages and recalls
Composition doesn’t adapt based on baby’s needs or time of day
Bottlefeeding allows you to better measure milk consumption
Requires some amount of cleaning bottle parts
Picking a Bottle Brand:
If you’re planning on bottle-feeding, either with breastmilk or formula, you’ll want to pick a bottle brand, the most popular of which are Dr. Browns and Avent. We used Lansinoh, which is especially good for babies who will also be breastfed.
I’ve linked to the smaller size (4 or 5 oz) - when your baby is older, you can purchase the larger 8 oz bottles
Dr. Brown’s is specifically “anti-colic”, and other brands make anti-colic versions (Avent, Nuk) that can help reduce air bubbles and thus gas. But be warned that it means additional parts to wash, so I would only switch to these if your baby is super gassy.
Some babies are particular about bottles/nipples, so I’d start with only a handful of one brand and make sure it works before buying a ton. You can also consider the Babylist sampler box to try a few before committing.
There’s increasing concern around microplastic content in baby bottles, especially since heating the bottles during washing/sterilizing can release more chemicals (paper). If you’d like to avoid plastic bottles, here are some good alternatives:
Glass: this is the safest option in terms of microplastics, but if you’re clumsy like me (or have older children around) it can be stressful. You can buy silicone sleeves to put on bottles, but that adds a step to your process (Dr Brown’s, Avent, Nuk).
Hybrid: Brilliant concept where it’s glass on the inside (which touches milk) but plastic on the outside to prevent breaking - we switched to this as soon as we learned about it. Chicco is the only one who makes this and it’s currently out of stock but should be back in March.
Silicone: has much lower microplastic risk and doesn’t have the breaking issue of glass; the only downside is it can retain odor more, so you’d want to rinse out pretty immediately (Comotomo)
A Note on Menstruation:
If you aren’t breastfeeding, your period typically returns 6-8 weeks postpartum
If you are breastfeeding (or, to a lesser extent, pumping), it can be much longer, which could be a pro or con depending on if you want to get pregnant again soon. There is wide variation in how long it takes to return:
For some, returns after a few more months even if still breastfeeding
For others, not until fully stopped breastfeeding (could be years!)
For most, somewhere in between - often returns once baby is sleeping through the night or going long stretches at night without nursing
Technically still possible to get pregnant even if your period hasn’t returned (since you could get pregnant after the very first ovulation, before your first period) so consider birth control if you want to avoid that small chance
If breastfeeding, opt for progestin-only birth control pills (sometimes called the “mini-pill”) since they won’t affect your milk supply, unlike the typical combination pill that includes estrogen. IUIs are also safe.
When your period returns, it is often heavier than pre-pregnancy and may be irregular for a few cycles
