Breast Still Best (Unless It's Not)

A little infant formula might help women breastfeed longer. A new study in Pediatrics showed newborns given small amounts of supplemental formula in the first days of life breastfed exclusively for longer than those given just breastmilk.


Formula helped breastfeeding?

No it's not a typo. Just a bit of nuance in the breastfeeding literature thanks to one ballsy researcher, Valerie "Formula" Flaherman, an assistant professor of pediatrics, epidemiology and biostatistics at UCSF who ventured into unchartered and hostile territory by trying to actually test whether a few ounces of formula in conjunction with breastfeeding would promote or sabotage exclusive breastfeeding in newborn babies who'd already lost at least 5% of their birthweight.

The small study in Pediatrics found when babies were 1 week old, 10% of moms assigned to the formula group (babies got formula and breast milk) still used formula in some amount and sit down, 47% of those in the breastfeeding group started using formula. When the babies were 3 months old, 79% of the original formula moms were still exclusively breast-feeding compared to 42% of moms in the breast-feeding group. 

In other words, supplementing with some formula appeared to help mothers breastfeed exclusively.

Now before all hell breaks loose, some important details. The study included a mere 40 babies.  It's really a pilot study.  The dose of formula ended after a few days. Nor did it involve any bottles:
For the trial, Flaherman and her colleagues assigned half the babies a couple days of birth to receive two teaspoons of formula after each breast-feeding, via a syringe so as not to encourage “nipple confusion,” a condition in which a baby has trouble transitioning between breast and bottle. Mothers were instructed to discontinue the formula supplementation once their milk supply appeared, which generally takes two to five days. The other half were exclusively breast-fed unless the doctor ordered formula.  How Formula Could Increase Breast-Feeding Rates, Time Healthland
So feel free to shoot up your newborns with some formula, orally or otherwise. 

Now let's listen in to our fearless maternal and child health advocates...

Cue the cries of disbelief (from professionals who never challenge studies finding benefits of breastfeeding):
Tanya Lieberman, a lactation consultant who writes about scientific research for breast-feeding advocacy organization Best for Babes, says she’s “a little confused” by the results. “We know what works to increase breast-feeding exclusivity and duration and we’ve known it for 20 years. That includes no supplementation unless medically necessary.” How Formula Could Increase Breast-Feeding Rates, Time Healthland

We know it. I know it. In my gut. 

Cue the outrage:
“This study goes against everything that’s been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula,” says Dr. Kathleen Marinelli, an associate professor of pediatrics at the University of Connecticut School of Medicine and the chair-elect of the U.S. Breastfeeding Committee. “They’re flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things.” How Formula Could Increase Breast-Feeding Rates, Time Healthland 
Reliable clinicians? Like her RN friend? The pediatrician down the street? The lactation support group? Goes against everything published!  Hhhmm, except the one randomized controlled study to directly test breastfeeding and small bits of formula. A researcher glibly glossing over empirical evidence (e.g., its limitations) to promote his or her own agenda. Now why does that sound so familiar? 

Cue the visions of nightmarish formula consumption by incompetent confused moms:
I worry that the headlines from this study will translate into 'A Six Pack of Formula Back In Every Bassinet!'" said Dr. Alison Stuebe*, an assistant professor in maternal fetal medicine at the University of North Carolina School of Medicine, who did not work on the research. Stuebe said the next step would be to replicate the findings, ideally using donor human milk, to see if they hold up. Could Formula Help Breastfeeding Moms? Huffington Post
Because donor human milk is so easy for most mothers to pick up at the CVS late night.

The study I'd like to see...whether supplemental formula beyond the first days of life helps women breastfeed for longer (not exclusively).  A bottle of formula a day helped me breastfeed longer. And did wonders for my mental health, you know, that little factor that eludes breastfeeding researchers except when they want to show lactating reduces the risk of postpartum depression.

*Breastfeeding researcher who routinely uncovers evidence of its health benefits (e.g., reduced risk of maternal diabetes) and who clearly states her mission to promote breastfeeding.


Awesome Mom said...

I love all the outrage on this one. My best attempt at nursing involved this very thing, giving a little formula so that my cranky fussy infant (who seemed to lack the foresight to know that if he saw the boob he would get food if he worked at it) to settle down a bit and start nursing. Sadly my body still did not fully cooperate by producing the amounts of milk he needed to you know live and grow but it helped him get what little there was.

Polly Palumbo, Ph.D. said...

And of course I didn't bother going to the less mainstream outlets on this one...but maybe I will for fun later.

So what, no human donor milk down at the local supermarket?

Awesome Mom said...

I am sorry but with formula being as safe as it is there is no dang way I would go to donor milk for a healthy full term infant. I am just too nervous about what can get passed on to the baby from some stranger's milk.

KiwiMama said...

I have to say, this makes a lot of sense to me. If/when I have another baby I will definitely consider supplementing until my milk comes in, or if the circumstances merit it. My 1 yo was born with a tongue tie that went undiagnosed for a week, resulting in a detached nipple and my milk supply coming and going for me and dehydration for him. I had been advised so vehemently against formula that it wasn't until the damage was well and truly done that I fed my son via bottle. It seems very sensible to use formula as a bit of a stop gap so before things get to that point so baby can be partially breastfed.

Karleen said...

Polly I was wondering whether you've read the paper or just the commentary on it?

Polly Palumbo, Ph.D. said...

KiwiMama, thanks for sharing your experience and bringing some "sense' to the discussion.

Polly Palumbo, Ph.D. said...

Karleen, yes and also many related media articles which I find more interesting than the study itself, which is why I focused on the response here.

Janet Dubac said...

With my first child, I also had problems with breastfeeding because I can only produce very little milk that my baby never stops crying (I believe it's because of hunger or frustration that he's not able to drink as much as he needs). I was advised by my doctor to use formula milk until I can produce enough milk.

Anonymous said...

Great. I'd be interested in your thoughts on the actual study.

Jen said...

I breastfed for 21 months before needing to wean very quickly due to needing long-term steroids. My child had reflux, was hospitalised and I had a dropping supply with PCOS. What got me to 21 months? Supplementing with formula twice a day. I wouldn't have lasted nearly as long without it. And it saddens me there an A vs B ideology when A with B works so, so well. Why can't we encourage women to supplement to allow themselves a very needed break if necessary and allow mums to do what they need? Formula isn't poison and the sooner people accept that, the better.

Polly Palumbo, Ph.D. said...

Anonymous, small pilot but published bc it's randomized and controlled w sig results. Jen, thank you for sharing your experience and thoughts. If we're truly interested in the health and over-all well-being of both child and mother, then you'd think the professional community would endorse a more reasonable approach.

Karleen said...

I finally got a hold of the paper.
I'm wondering why you thought the comments by Alison Steube were so outrageous? (it was your response to that that led me to believe that perhaps you had not read the paper). The women supplemented with Nutramigen provided by the study, it could just as easily be banked donor milk could it not?