Should I breast or bottle feed my baby?

August 07, 2015
This is a common question asked during pregnancy but one that it is easy to answer. I often advise to breast feed. There are very few contraindications to breastfeeding such as women that have HIV, herpetic breast lesions, active tuberculosis, or active drug abuse.

Why is breastfeeding better?
Breastfeeding is best for both moms and babies.

Benefits for mom include:
• Release of oxytocin which helps the uterus to shrink back down to pre-pregnancy size
• Increased maternal-infant bonding
• Helps with pregnancy weight loss
• Long term benefits including decreased risk of breast and ovarian cancer, osteoporosis, and cardiovascular disease
• Economically advantageous given formula costs about $1000 per year

Benefits for babies include:
• Improved function of the baby’s gastrointestinal system
• Protection against infection
• Long term benefits including decreased risk of obesity, childhood cancers such as lymphoma and leukemia, diabetes, and allergic conditions as well as possible improvement in neurodevelopment

When should I start breastfeeding, when does my milk come in, and how often should the baby feed?
You should start breastfeeding as soon as possible after the baby is born when the baby starts showing cues that he/she is hungry. Feeding cues include:

• Movement of the baby’s hands towards it’s mouth as well as sucking on their fists and fingers
• Smacking lips
• Fussiness and agitation
• Flailing of the extremities
• Loud, persistent crying

Breast milk takes several days after delivery to come in, usually day 2 to 4 after delivery. Prior to this, the baby gets something called colostrum which is very good for the baby. It is high in fat so although the quantity may not be large, it packs a lot of bang for the buck. Additionally, the baby’s stomach is small in these early days of life so it cannot accommodate large amounts.

The frequency of feeding depends on maternal milk supply, efficiency of milk transfer, and the ability of the infant to modulate his/her behavior. In the first 1-2 weeks postpartum, most babies feed 8 to 12 times a day. Sometimes babies are sleepy during the first week of life so if it has been 4 hours since their last feed, you should wake them and try to feed. After the first 1-2 weeks, the frequency of nursing decreases to 7 to 9 times a day. Duration of feeds ranges from 10 to 15 minutes right after birth to 8 to 10 minutes at one month of age.

How do I know if my baby is getting enough to eat?
A lot of women perceive that they have low milk production but they don’t. There are several ways to tell if you are producing enough milk and if the baby is getting enough to eat.

• Weight: It is normal for babies to lose weight after birth; it is expected that they lose 5 to 7 % of their birth weight. Most babies stop losing weight by 5 days of life and get back to their birth weight by 1-2 weeks of age. If babies are not losing too much weight after birth, they are getting enough to eat.
• Wet diapers: Babies who are getting enough to eat will make wet diapers. Voids increase from 1 in the first 24 hours to 2-3 in the second 24 hours, to 4-6 in day 3 to 4 of life, to 6 to 8 wet diapers on day 5 of life and after.
• Dirty diapers: Babies who are getting enough to eat will make poopy diapers, too. Babies have meconium and transitional stools during the first 3 days of life. After day 4 of life, most babies will have 3 or more small stools a day. By the 5th day of life, stools should be yellow and seedy.
• Satiety clues: Babies who are full will release the nipple, relax the face and hands, and often will fall asleep especially in the first 2 to 3 months of life. 

Should I supplement with formula?
Formula supplementation should be avoided when possible. Even one bottle feeding can alter the bacteria in the baby’s gut and can discourage initiation of breastfeeding and decrease the duration of breastfeeding. Supplementation is recommended only when the baby has lost > 7% of their birth weight between 5 to 10 days of age, if the baby shows signs of dehydration (such as decrease in wet diapers), or when stool output is < 3 small stools a day.

What resources are there?
If you have any questions about breastfeeding, please schedule an appointment to see one of our lactation specialists at the Lytle Center by calling 206-21-LYTLE (206-215-9853).