New Parents : I Do Not Want to Breast-feed Bottle-feeding your baby (part 1)

I don’t want to breast-feed—can you tell me what to do?

If you do not want to breast-feed, you can either bottle-feed
your baby expressed breast milk or formula. There are many women who do
not breast-feed because they receive a lack of support and find that the
advice available is insufficient. However, making an attempt at
breast-feeding, even if it’s just for one week, will benefit your baby.
If you have chosen to bottle-feed you will need to decide on a few
things. First, you need to work out which type of formula you want to
use. Take some time to look at the many brands on the market and opt for
one that you feel will be right for your baby. Ask your midwife or
postpartum nurse for advice if you are not sure. You will also need to
purchase bottles, nipples, and a sterilizing unit. This can be confusing
since there are lots to choose from, so you will need to take some time
to find out about the available options and decide which unit will work
best for you (see Sterilizing equipment).

Bottle-feeding sounds so complicated. Are there “dos” and “don’ts” to remember?

Yes, it is important to bottle-feed safely. Guidelines for safe bottle-feeding include:

Always make sure you use a sterilized bottle, cap, and nipple for each feeding.
Ideally, make up one feeding at a time and discard any leftover milk at the end of a feeding.
Use boiled tepid tap water that has been left to cool for half an hour before making up a feeding.
Put the water into the bottle before the formula.
Don’t pack the formula into the scoop

Warm the bottle of formula —not in a microwave, but in a bowl of hot water—and test the temperature before giving it to your baby.

Avoid swapping scoops from different makes of infant formula because different scoops may be different measurements.

I feel guilty for not breast-feeding—should I?

No! The main thing is to ensure that your baby receives the best
possible care in life that you are able to provide. If it is not
possible for you to breast-feed, then formula feeding is a safe option.
However, you need to feel comfortable with your decision and not be
swayed by others. You may want to look at the advantages and
disadvantages of both breast- and bottle-feeding. That way you’ll be
sure you’ve made the right decision for you and your baby without
feeling guilty. Once you have made an informed decision, communicate
this confidently to family, friends, and your health-care provider.

Is formula as good as breast milk?

Breast milk is universally considered the ideal nutrition for
your baby, and the American Academy of Pediatrics recommends
breast-feeding for the first year of life since it provides all the
nutrients a baby needs for the first six months. However, there are a
variety of high-quality, nutritional baby formulas available that
scientists and medical experts have spent years developing. Most infant
formula milks are derived from cow’s milk, but are modified to resemble
breast milk as closely as possible. If you feel confused, discuss the
different brands with your midwife or postpartum nurse.

What exactly is in formula and how similar is this to breast milk?

If you read the labels on different brands of formula, there are
not many differences. The Food and Drug Administration provides
information on the contents and labeling of infant formulas available in
the US. Baby milk must provide energy, fat, protein, carbohydrate,
vitamins, minerals, and trace elements, and the quantity of each
nutrient is specified by law. The proportions of energy supplied by
protein, fat, and carbohydrate in infant formulas are similar to those
in mature breast milk.

The fat content.
In infant formulas this is based on blends of dairy or vegetable fats
that are chosen partly depending on their levels of unsaturated fat.
Omega 3 fats may be added since these are vital nutrients for growing
brains and bodies. Formula does not have the fat-digesting enzyme,
lipase, which accounts for the unpleasant-smelling stools of formula-fed
babies.
The protein source. In formula, this is either cow’s milk, in the form of casein or whey, or soy (see soy-based formula milk ). The amino acid content of formula is equivalent to that of breast milk to meet the needs of the rapidly growing baby.
Lactose.
This may be included in formula; mature breast milk contains about 7
percent carbohydrate in the form of lactose, which is thought to be
important for brain development.
Vitamins, minerals, and trace elements. These are added to formulas to meet the nutritional needs of the baby and to comply with legal requirements.
Iron.
This is vital to your baby’s well-being, being essential for healthy
blood, growth, and development, and this is added to formula brands.
Other components.
Infant formula may contain other components that are found naturally in
breast milk, such as long-chain polyunsaturated fatty acids (for brain
and membrane development), oligosaccharides (to aid digestion and
immunity), or nucleotides (to promote healthy growth and development and
to help the immune system).

There are some
components of breast milk that cannot be replicated in formulas. For
example, breast milk contains important antibodies that help protect
babies against infection and illness and these are not present in
formula. However, probiotics, which are nutrients found in breast milk
that strengthen a baby’s natural immune system, may be added to some
brands of formula.

Is it OK to combine breast-and bottle-feeding?

Yes, it is possible to combine breast-feeding with bottles of
expressed breast milk or formula, and many women choose to do this
rather than stop breast-feeding entirely. You may also decide to do this
if you are returning to work.

Feeding from a
bottle uses a different technique than feeding from the breast, and your
baby may take a little time to get used to it, which can make it quite a
struggle to introduce bottles. It may help to warm the nipple and to
get someone else to offer the bottle the first time, since your baby may
be able to smell your milk if you hold him and will be likely to want
to be breast-fed instead. Holding him in a different position, such as
propped up against your front and facing away from you, may also help.

Before deciding to
introduce the bottle, it’s worth considering that breast-feeding does
get easier and that there is a lot of extra work involved with
bottle-feeding in terms of preparing feedings. Also, as your breast milk
is produced on a supply and demand basis, introducing bottles for some
feedings will affect your milk production. If you do want to combine the
two, talk to your doctor or a lactation consultant about how to manage
this so that you can maintain breast-feeding.

Will people treat me like a failure if I can’t breast-feed and have to use formula?

Many mothers do feel pressure from friends and family to
breast-feed their newborns. It is unlikely that you will be treated as a
failure, since Western society is very accepting of bottle-feeding and,
on the contrary, it is a continual effort to try to promote
breast-feeding in our society. Unlike the UK, the US hasn’t been
successful in banning advertising infant formula for children under six
months old on television and in parenting magazines.

Breast-feeding is a
worthwhile endeavor for mother and baby but can sometimes be work to
establish. If you find that you are struggling to establish
breast-feeding, seek help before giving up. However, if you find you
simply cannot breast-feed, or you choose not to, you should try not to
feel guilty since formula-fed babies grow and develop well. This is your
baby and you have your baby’s best interests foremost whatever you
decide to do.

Which formula should I buy?

There are a number of brands that have a very similar nutritional
content and you may need to discuss this with your postpartum nurse or
pediatrician, when trying to decide which one to use. Sometimes, babies
are born prematurely and may need a special formula, or occasionally may
react to a particular brand. If your baby was born full-term and is
healthy, it usually comes down to personal preference.

Manufacturers
modify cow’s milk to make formula for human babies by adjusting
carbohydrate, protein, and fat levels, and adding vitamins and minerals.
There are two main types of formula, which have different ratios of the
two proteins in milk: whey and casein. Those that are suitable for
babies from birth contain more whey than casein. The ratio of whey to
casein in these formulas is similar to that of breast milk, so it is
thought to be easier for new babies to digest. Formulas that are
marketed for the older baby (known as “follow-up” milk) are
casein-dominant and take longer to digest.

Why do some people use soy-based formula and is it safe?

Soy-based formula is made from soy beans, which are modified for
use in formula with vitamins, minerals, and nutrients. Some parents
consider giving a soy-based formula if their baby has an intolerance or
sensitivity to cow’s milk formula. Soy infant formulas are nutritionally
similar to cow’s milk-based formulas. The protein used in soy formulas
is an extract of the soy bean, which has a high protein content. However
you should always seek the advice of a health professional before
giving soy-based formula to your baby. The current advice is that soy
formulas should not be given automatically to babies with a sensitivity
to cow’s milk, since there are other types of formula that are suitable
for most babies with an allergy or intolerance that may be more
favorable than soy. So if you are considering soy milk, make sure you
seek pediatric advice first.

The carbohydrates used in
soy milk contain glucose syrup, which may damage your baby’s teeth over
a period of time, so if you are using soy formula, make sure you take
your baby to the dentist once his teeth come through and tell the
dentist that your baby has a soy formula. There is concern that
soy-based formula could affect reproductive health because soy contains
phytoestrogens, substances found naturally in some plants, which may
mimic or block the action of the hormone estrogen. The US has yet to
issue a conclusive recommendation on this and since this is a sensitive
time in a baby’s development, it is not clear whether soy-based formula
could affect reproductive development.

How should I hold my baby when I’m giving him a bottle?

Bottle-feeding can be a wonderful time for bonding with your baby
by holding him close. Find a position that both you and your baby
like—think about whether you are right- or left-handed and the age and
size of your baby. You can cradle your baby, or simply sit your baby on
your lap. You will help reduce gas by giving your baby his bottle in as
upright a position as possible. Also take care to tilt the bottle so
that the nipple and neck are always filled with formula and never leave
your baby to feed unattended by propping the bottle up. Ask your
pediatrician for further advice.

How long do you need to sterilize bottles for?

The recommendation is that you sterilize bottles and nipples for
at least the first year of your baby’s life. It is during this time that
they are most vulnerable to germs and viruses, which if contracted
could cause illness and possibly dehydration. Boiling bottles in water
for 15 minutes will sterilize bottles after purchase. Thereafter, a
dishwasher, set to 165° F (74° C) will sterilize bottles and
accessories.

Can I make up feedings in advance?

Ideally, you should make up each feeding as you need it. The
risks associated with using powdered infant formula are reduced if each
feeding is made up fresh, since the longer the formula is stored, the
greater the risk of bacterial growth. However there are times when this
is not practical, for example if you are going to leave the house for an
extended period, or if you are leaving a baby at a day-care center. In
this case, you should prepare the feedings in separate bottles as
instructed and store them in the fridge (see Pre-made feeds ). Throw away formula left out of refrigeration for over two hours and throw away the formula left in a bottle after a feeding.

Q:	How long can pre-made feeds stay in the fridge?
A:	Although it is not recommended that you make up bottles of infant formula in advance to store in the fridge because of the risk of bacteria developing, if you need to do this, store them in the back of the fridge, not the door, to ensure they are below 41° F (5° C) and never store feedings for longer than 48 hours. Formula is not suitable for freezing.

Is it safe to warm a bottle and take it out to use later on?

Carrying warm formula in an insulated carrier is not safe, since
warm milk is a good breeding ground for bacteria. The safer option is to
make a bottle up fresh for your baby just before it is required. If you
are out, you can carry boiled water in an insulated container ready to
mix with formula powder when you need it. Ready prepared formula that
comes in little cartons is a more expensive option, but handy for
instantly decanting into a sterilized feeding bottle. If your baby is
reluctant to take milk at room temperature, you could use a travel
bottle-warmer, which can also be used to heat up containers and jars of
baby food.

What precautions should I take making feedings with bottled water when I’m traveling?

When using bottled water to make up a feeding, make sure the seal
is still intact. Unless labeled as “sterile,” bottled water should be
considered “clean” only. This means that for an infant less than 3
months of age, the water should be boiled for at least one minute before
using it to prepare formula, after opening. For convenience, you may
prefer to use smaller bottles of mineral water if you are traveling from
place to place. For extra convenience, ready-to-feed formulas are
available in cartons so you do not have to carry bulky cans of powdered
milk with you. Although more expensive, these cut down on the amount of
work you have to do while traveling and they give you the peace of mind
that you can be sure of good hygiene for your baby in the absence of
adequate facilities.

I’ve heard that bottle-fed babies have smellier poop—is this true?

This does seem to be the case. Bottle-fed babies may have one
bowel movement a day or only have a bowel movement once every three or
four days. Both are normal. A bottle-fed baby’s stools are pale brown,
smelly, and more formed than those of a breast-fed baby. Some baby
formulas give a greenish tinge to the stool. It is thought that
unabsorbed fat causes the unpleasant-smelling stools in formula-fed
babies. Breast milk is better absorbed, which means the stools usually
have less odor.

Will my baby get more gas if he is bottle-fed?

Gas refers to the air in your baby’s tummy. It is swallowed along
with milk during your baby’s feedings, but also when he cries. It will
fill his tummy before he has had enough milk and be uncomfortable. Also,
the faster flow of milk from a bottle can make babies take in more
gulps of air. Some babies suffer with gas and need burping after every
feeding. Breast-fed babies tend to have fewer problems with gas than
bottle-fed ones because they control the flow of milk at the breast and
so suck at a slower pace, thereby swallowing less air with the milk.
Breast-fed babies also have smaller and more frequent feedings than
bottle-fed babies and they may be fed in an upright position, both of
which can reduce gas.

Some babies have
trouble bringing up gas and their discomfort is quite obvious. You can
reduce gas by feeding your baby in an upright position and tilting your
baby’s bottle so that the nipple is full of milk—and not air. If your
baby doesn’t burp after a couple of minutes, he probably doesn’t need
to. You can burp your baby by gently rubbing his back or placing him
over your shoulder. Some babies only seem to be able to get rid of gas
through hiccuping. If the gas is severe, see your pediatrician who may
suggest medication that will provide your baby relief.

Is it OK to give my baby water as well as milk?

Formula, in general, does tend to be less thirst-quenching than
breast milk because the strength of formula doesn’t vary, whereas breast
milk varies in consistency. For example, the beginning of a feeding
with breast milk tends to be more watery than the end of a feeding of
breast milk. If your bottle-fed baby still seems hungry after a feeding,
it could therefore be that he is just thirsty and some cooled boiled
water may be the answer in helping to placate him. In hotter weather he
may need regular extra doses of cooled boiled water to quench his
thirst.