Breastfeeding

Variations of the breastfeeding experience

A variety of health organisations (such as the World Health Organisation (WHO)*1, the UK Department of Health, NICE (National Institute for Health and Clinical Excellence) and the UNICEF Baby Friendly Initiative) recommend that a baby should be exclusively breastfed for the first six months of their life. This means that babies need only breast milk and not other liquids or solids of any sort. The WHO definition of exclusive breastfeeding includes giving babies expressed breast milk, although some authorities make a distinction between exclusive breastfeeding (feeding only at the breast) and exclusive breast milk feeding (feeding expressed breast milk via a syringe, cup or bottle).

There were several variations of the breastfeeding experience that the women talked about, including expressing breast milk and feeding expressed breast milk to their baby; donating expressed breast milk to a milk bank; mixed feeding; supplementing breastfeeding and using a dummy or pacifier with a breastfed baby.

Expressing breast milk
Most women we spoke to had expressed breast milk for one reason or another, some regularly and some occasionally, and found it useful and relatively straightforward. However, others said that they had never expressed, could not do it, did not enjoy it, found it painful or uncomfortable, or found it a real 'faff' and just another job to do. Some women expressed breast milk for their sick baby. One woman expressed for ten months to feed her baby with a cleft palate and another expressed for ten weeks until her baby learned to breastfeed. For these women, expressing was important as it enabled them to give their baby all the benefits of breast milk and avoid using infant formula.

Other women expressed as a way of dealing with engorgement, slow let-down or low milk supply in the evening or to build up or maintain their milk supply or to stockpile expressed milk in case of later need (such as returning to work - see 'Breastfeeding and working'). Although in some cases, such as engorgement, expressing helped women with their milk supply, several women felt that continued expressing had the opposite effect of unbalancing their supply. One woman called it “madness” when she realised that her husband was giving their son a bottle of expressed breast milk while she was actually expressing. “Why am I doing this … when I could be breastfeeding him”, she said.

Sometimes the women's reasons for expressing were more social, including enabling their partner to take part in feeding, or enabling them to go out for an evening and leave a bottle of expressed breast milk for a babysitter.

Some women used hand expression or preferred a manual pump. A few said that they were put off by the noise of an electric pump or that it made them feel a bit 'like a cow'. Others recommended electric breast pumps as faster and more efficient. Some women preferred to express from one breast at a time, some expressed from both at once and others expressed from one breast while the baby fed at the other. A few women said that they had adapted a nursing bra to enable them to express from both breasts at once and keep their hands free for doing other jobs. A few women said that understanding how their let-down reflex worked helped them to mimic it with their breast pump and be more successful with expressing (see 'The sensation of breastfeeding'). The women fed the expressed breast milk to their baby using a variety of techniques, including nasogastric tube, syringe, cup, bottle or Lact Aid® (a breastfeeding supplementing system). 

Donating expressed breast milk
Several women talked about voluntarily donating breast milk. Some did it to help newborn babies who, for some reason, were not able to have their mother's milk and others did it because their own baby had been the recipient of donated breast milk from a milk bank and they wanted to 'repay the debt' (see 'Breastfeeding in special circumstances'). One woman said that a friend had offered her frozen expressed breast milk when her son was refusing to breastfeed. She didn't use it but would have if she had needed to.

Mixed feeding
One woman talked about what she called “combination feeding”, which was a mixture of breastfeeding and bottle feeding, that she did on a regular basis right from the start. It worked for her because she had been so ill at the time of birth that she was unable to produce enough milk for her baby (see 'Feeding patterns in the early days').

Supplementing breastfeeding
Although current guidance is that babies should be exclusively breastfed for the first six months, some women we spoke to had introduced occasional bottles of infant formula. Both medical and social reasons were given for supplementing breastfeeding. Many babies were introduced to formula in hospital because of low blood sugars, jaundice or delay in beginning to breastfeed. Others were given infant formula later because of weight loss or slow weight gain (see 'Monitoring baby's growth'). The social reasons for introducing supplemental feeds of expressed breast milk or infant formula included allowing the father or other close relatives to experience feeding the baby (see 'Changing family relationships with a breastfed baby'); returning to work (see 'Breastfeeding and working'); attempting to get the baby to sleep longer, especially at night*2; giving the mother a break; “socialising” a clingy baby; feeding the baby in public or because it was seen as a “natural progression” from breast to bottle feeding. Other supplements given to breastfed babies included honey on the tongue at birth, cooled boiled water, dioralyte for diarrhoea and a cinnamon, aniseed and rice water mixture for colic and, for a child over one year, a mixture of breast milk, infant formula and cow's milk to tempt him to take cow's milk. While some babies took a bottle without fuss several women said that their baby did not want to feed from a bottle (see 'Breastfeeding and working').

A few women worried about nipple confusion and the baby refusing to breastfeed once they had tried a bottle*3. Others said that giving a bottle had been detrimental to their breastfeeding and resulted in early weaning which they regretted. Some women agonised over introducing infant formula.

What most of the women who supplemented their babies and then continued to use infant formula seemed to have in common were unresolved breastfeeding problems, particularly pain and underweight babies.

Using a dummy or pacifier

The use of dummies (pacifiers) was a controversial issue, sometimes with the same reasons being given for and against their use. Some women said that they never used a dummy because they were concerned about the effect it might have on breastfeeding and on the shape of the baby's mouth and later speech development. Some women encouraged their baby to suck his/her thumb or finger in order to comfort themselves. Others introduced a dummy for a variety of reasons that included allowing the baby to soothe, comfort and settle itself; providing an alternative to comfort feeding especially when the mother felt drained and needed a break from having the baby at her breast; and instead of thumb-sucking that may have affected the baby's jaw development and proven difficult to discourage later on. Several women spoke of their baby having sucked their thumb or fingers while still in the womb. One woman said that her friend called her a “human dummy” because she fed her baby for comfort as well as hunger and another said that giving a dummy would have been for selfish reasons so she couldn't do it.

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* Footnote 1: In 2001, the World Health Organisation issued a global public health recommendation which said that babies should be exclusively breastfed from birth to six months, and then breastfed together with age-appropriate, solid foods for two years and beyond.

*Footnote 2: Supplementing a baby with infant formula (whether standard formula, 'follow-on formula' or 'hungrier baby formula') at bedtime to make them sleep longer is not recommended. In the early weeks, the introduction of infant formula will decrease the likelihood of the confident establishment of breastfeeding. The production of the non-standard infant formulas is simply a marketing gimmick. 

* Footnote 3: Artificial nipples, such as bottle teats and dummies (pacifiers), have been associated with incorrect sucking technique and refusal to breastfeed in some babies but there is very little evidence for this belief. The concept of 'nipple confusion' is widespread but largely anecdotal at this time.
Last reviewed September 2015.

Last updated September 2015.
 

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