Dr. Nina Olsen discusses medical and mental health reasons for choosing the formula route with personal insights from a patient
According to the American College of Obstetricians and Gynecologists, “each woman is uniquely qualified to make an informed decision surrounding infant feeding.” There are so many factors that go into the decision of whether to breast feed or formula feed – not to mention, sometimes babies have their own plans! During National Breastfeeding Month (August), we’ve shared the benefits of breastfeeding. Now, let’s talk through some physical and mental health reasons why formula feeding might work best for your family. We will discuss what to expect if you go this route, including how to stop your milk supply or choose the best formula. We’ll also take a look at one couple’s decision to formula feed – and how things didn’t quite go to plan.
Medical Reasons to Formula Feed
In most cases, the method of feeding your baby is a personal choice, and we’ll cover a lot of factors to consider. Yet there are some medical situations when physicians may recommend formula feeding.
Some babies have milk-soy-protein intolerance (MSPI), which makes it hard for them to digest breast milk if mom is not following a very strict diet free of cow’s milk and soy. For moms who are not able to follow this diet, formula might be the best option.
Additionally, breastfeeding has certain contraindications (specific situations when it could be harmful). The American College of Obstetricians and Gynecologists recommends formula feeding in these cases:
- Infant is diagnosed with galactosemia (a group of inherited disorders that impairs the body’s ability to process and produce energy from a sugar called galactose.)
- Mother is infected with the human immunodeficiency virus (HIV). (Please note: recommendations about breastfeeding and HIV may differ in other countries.)
- Mother is infected with human T-cell lymphotropic virus, type I or type II.
- Mother has active untreated tuberculosis or varicella (the virus that causes Chickenpox.)
- Mother has active herpes simplex virus lesions on the nipple.
Emotional and Mental Health Reasons to Formula Feed: Stephanie’s Story
“From the beginning, I had never had any intentions of breastfeeding.” For patient Stephanie and her husband, the mental health benefits of not breastfeeding outweighed any physical health advantages that breastfeeding would offer her baby. “My mother didn’t breastfeed me or my siblings, and we never experienced any health complications. So I had no concerns over the health of my child.”
Feel Supported Even If You’re Outnumbered
“I was the only person in our prenatal classes that was not breastfeeding, and that made me feel isolated at times.” But she and her husband were comfortable with their choice and knew they had support from the medical community. “All of the doctors and nurses we encountered were supportive of the decision – no one tried to talk us out of it,” said Stephanie. “You might be the only person in the room and that’s okay. Your physician and nurses know that it’s your choice, and they aren’t going to put any pressure on you or judge you because of that choice. Know that you have their full support.”
Stay Flexible – Babies Have Their Own Plans
Remember that when it comes to how you bring new life into the world –and sustain it—you and your baby may have different plans. “As soon as they laid her on my chest, she crawled straight to my breast and immediately latched, as instinctively as an animal in the wilderness.” When Stephanie and her husband realized that their baby wanted to breastfeed despite their choice to formula feed, they pivoted to accommodate that. “Because it was what the baby clearly wanted, we thought we would give it a try; and the doctors and nurses were extremely supportive.”
But after that first day, their baby stopped latching. They decided to try a supplement, as well as using a breast pump. “The minute I was hooked up to the pump, the feelings I had feared came rushing over me.” Stephanie was mentally and emotionally exhausted, and her hormones were all over the place. The pumping experience brought her back to the clarity she had when they decided to formula feed in the first place, before the baby was born. “We gave it a good try, and my husband wanted so badly to help. But mentally, I knew that I needed to be my best self in order to be the best mother to my baby, and I wasn’t going to get there by struggling to breastfeed.” So they decided together that they would go back to their original formula feeding plan where her husband could participate and give Stephanie more support.
Some moms may have the opposite experience. They might plan all along to breastfeed, and then due to difficulty latching or an intolerance to breast milk, their babies may need them to switch to formula feeding. Having to change plans, especially due to struggles with breastfeeding, can be very stressful. The best way to prepare when there is this kind of uncertainty is to be aware ahead of time and accept that things may not go as planned. Think of the method you choose to feed your child as a means to what is best for your family as a whole, knowing that can change with little notice.
How To Stop Your Milk Supply
While you may make a conscious decision to formula feed, your body will not automatically know that! It may come as a surprise, but lactation consultants are wonderful resources for helping you stop your milk supply. Talk to them in the hospital or after you leave for advice on making the transition. “The lactation consultant at my pediatrician’s office was a huge help,” said Stephanie. “Some home remedies she shared that worked for me were eating peppermint and menthol (things they say to avoid if you want to breastfeed), and putting cabbage leaves in my sports bra to help dry up the supply.” The consultant also recommended having someone else hold your baby for a couple days. “She told me that as long as your body can sense your child’s pheromones, you will continue to produce milk. I held her a little bit, but I had my husband and mom hold her most of the time, and it only took a day or two, maybe three.”
Which Type of Formula is Best?
Once you have decided to go the formula route, the choices don’t end there. In fact, that’s where many choices begin. From the different base ingredients to different levels of preparation, there are several considerations that should go into what type of formula is best for your family. We encourage you to discuss with your partner as well as your pediatrician and, as usual, stay flexible! It may take a few tries to find the best fit.
Three main types
There are three main types of formula. Cow’s milk/protein-based formulas are most common. They are altered to resemble breast milk so that they provide the right balance of nutrients for your baby. Soy-based formulas are great for people who want to exclude animal products from their child’s diet or for babies who are not able to tolerate cow’s milk. However, babies that have a milk-soy-protein intolerance would not be able to tolerate cow’s milk or soy-based formulas. A great option for these babies is protein hydrolysate formulas. They contain proteins that have been hydrolyzed, or broken down into small enough pieces that babies with a milk or soy intolerance are able to digest.
It’s also important to buy formula that is iron-fortified. Otherwise, you will need to provide an iron supplement to make sure your baby is getting the iron he or she needs. Neither regular formula nor breast milk provide enough iron on their own.
Different preparation levels
There are also formula options that require different levels of preparation: powdered, concentrated liquid or ready-to-use formula. They come with different requirements of your time and different price tags, so consider these factors when making your decision. One thing that doesn’t matter much is brand name. All formula, whether generic or brand-name, needs to be approved by the FDA before it can be sold.
It is very important to follow instructions closely when mixing the formula: if the mixture is too diluted or too concentrated, it can be harmful to your baby. Always make sure you wash your hands thoroughly and follow instructions for proper storage.
Have an ongoing conversation with your pediatrician about what type of formula is best for your baby. They can help you navigate the choices and make recommendations based on your baby’s dietary needs. They may even provide free samples to try before you purchase! Continue that conversation at each appointment since the baby’s needs may change. Your pediatrician can show you the best way to transition to a new formula if you need to.
The Bottom Line: Fed is Best
For Stephanie, going the formula route meant a great deal when it came to her mental health. She was able to share the experience with her spouse, have a more consistent schedule, and adjust feedings according to her baby’s needs. “I knew she needed a certain amount before bedtime to sleep through the night – which she started doing regularly at 6 months due to our consistent feeding schedule. Formula feeding worked great for us and for our baby.”
All our physicians agree that “fed is best.” Women owe it to each other not to stigmatize based on the method they choose to feed their child. What’s important is that it’s a personal choice based on your family’s needs, including medical and mental health factors for both baby and mom. You can always count on your physicians for support, no matter which method you choose!