A recent study claims that 'topping up' with a small amount of formula can increase the length of time babies are breastfed. The US study found that when underweight newborns were given both formula milk and breast milk immediately after delivery, 79 per cent of their mums were still breastfeeding at three months.
Of those babies who were initially only having their mum's milk, just 42 per cent were still being nursed at the same age. The findings suggest that if mums are able to supplement their feeding routine with formula, they are more likely to persevere with breastfeeding.
So, to top up or not to top up?
"Although breastfeeding and the amount of milk a mum produces is usually based on a supply and demand basis, I've found this is not always the case and sometimes formula top-ups are needed.
"I've worked with some mums who can be sitting breastfeeding for an hour or more, and their baby is still crying with hunger afterwards. In these scenarios the mum is producing some milk but just not enough to satisfy the baby's hunger fully, so I encourage them to offer a formula top-up after a full breastfeed.
"It may be that a formula top-up is only needed after one or two feeds. In offering these top-ups, the baby will feel more satisfied and so will the mother. One of the biggest worries that a breastfeeding mum has is that their baby may not be getting enough. Most of the time these fears can be reassured by the fact that the baby is having lots of wet nappies, feeds well, seems satisfied after a breastfeed and is happy between feeds.
"This scenario is common for many mums I've worked with as their babies get older and their appetites increase. I get really frustrated when I read statements from anti-formula mums that every mum can breastfeed and that it works on a 'supply and demand' basis. They state that as long as you just feed and feed then your body will produce enough to satisfy your baby.
I don't agree that this is true in all cases. There are circumstances and contributing factors that can make it very difficult or even impossible for some mothers to breastfeed – and they should never be made to feel guilty for not breastfeeding or for supplementing with formula.
"I work with both breast and bottle fed babies, and there are of course times when babies need additional milk. Leaving a baby hungry, losing lots of weight and at risk of dehydration doesn't empower anyone.
"But I'm not sure why researchers of this very small study used 5 in the first few days (sometimes more if IV fluids or epidurals have been used: most hospitals consider up to 10% acceptable).
"The study highlights that concerns about milk supply are why some mums stop breastfeeding, and researchers theorise that perhaps 'giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breastfeed'.
"But what the research doesn't do is compare what else might help empower parents instead of formula, because these concerns may actually be unfounded. We know antenatal breastfeeding education, alongside good postnatal support from both health professionals and other mums who have breastfed, also increases breastfeeding duration.
Instead I find parents have often not been told what to expect from their breastfed newborn, or how to tell if they're getting enough. This means they may be comparing their baby's behaviour to that of a formula-fed infant.
"If there is a problem and health professionals cannot help baby obtain more when breastfeeding, showing mum how to hand express (not a pump before milk comes in) and giving that back to their baby is surely Plan A'?
"If more is needed, donated breastmilk should be on the table for discussion. I was thrilled to hear from a doctor I worked with that when she was readmitted to Chester hospital for medical reasons, donor milk was offered as standard for her newborn – this needs to be an option for all who need it, not just in isolated areas.
"Supplementing with human milk would also 'ease concerns' without risking potential sensitisation to cow's milk, as has been noted when formula is introduced in the first few days of life. Beyond this, mix-feeding can increase the risks of some medical conditions, which is why health authorities and professionals recommend exclusive breastfeeding where possible.
"We need to explore the long-term health implications of early formula use; longer duration is great, but surely we also need to know if this comes at a price?"
What do you think? What worked for you?