Using Bottles for Breastfeeding

There are all sorts of reasons why babies may still be offered a bottle although their mothers intend to breastfeed, or are breastfeeding.

Babies Needs

• Babies who are premature, small for gestational age or unwell in the newborn period may be offered bottle feeds as a short term, temporary means of feeding until breastfeeds are established.
• Sleepy babies or those with low blood sugar levels may also be fed via bottles if there is concern about their intake of kilojoules.
• Occasionally, a mother’s lactation is slow to establish and as a means of satisfying her baby’s hunger, bottles are recommended.
• Similarly, if a baby has lost a significant amount of weight, bottles may become necessary.
• Babies with a cleft lip or palate, swallowing or breathing difficulties or issues with coordinating a suck/swallow reflex may also be offered bottle feeds.

For mothers who are keen to breastfeed this can be disappointing, but it does not signal the end of breastfeeding plans. Depending on the reasons why they were necessary in the first place, bottles are often timely solution to a problem which, when resolved, means that breastfeeding can resume. It is important to tell your midwife, doctor and health care professionals involved in your care, that you are keen to breastfeed. They can support and educate you on how to express and stimulate your breasts so that you can still lactate. It can take three days or more after birth for breast milk to “come in”. In this time, regular stimulation and emptying by either hand or pump expression will help initiate your lactation. Even if you are only obtaining a few drops of milk, this will still be incredibly beneficial to your baby.

Mothers? Needs

• Sometimes bottle feeding becomes necessary because of a mother’s return to work.
• If a mother is unwell and unable to breastfeed.
• If a mother needs to start medication which is contraindicated with breastfeeding bottles may become the only alternative feeding option.
• Some fathers and partners are keen to share the feeding responsibilities and couples negotiate how this may work for them. Mothers may choose to express and partners offer the breast milk to their baby. For mothers who are exhausted and need a few hours of continuous sleep, this can be an option which works for them.
• Mothers who want to go out but not breastfeed in public sometimes offer bottle feeds. Dependent on the baby, they may take some time to adjust to the different sucking action required when sucking on a bottle when compared to the breast.
• When the baby and the mother are separated, bottles of expressed breast milk (EBM) or formula become necessary. Make sure you give clear instructions on storage, warming and preparation of feeds to your baby’s caregiver.

Bottle Feeding Tips

• Breast milk can be offered alone in a feeding bottle or combined with formula.
• It is preferable to offer expressed breast milk to the baby first and on its own, followed by formula if necessary.
• Expressed breast milk (EBM) separates when left to sit for a period of time. The fat rises to the top and separates from the more watery components of the milk. After shaking, the fat content disperses through the rest of the milk so it appears more white/yellow than before. EBM is warmed in the same way as formula. Avoid using microwaves as they pose a risk of burning and heating the milk unevenly.
• Breast fed babies do not tend to have a consistent preference for teat shapes. Some like orthodontic shaped teats and others seem to prefer the longer teats which sit closer to the junction of their hard and soft palate. Experiment with a range of teats and flow rates until you find one your baby seems to enjoy sucking on.
• There is often a change of feeding frequency when babies change from breast to bottle feeding. Breast milk is lower in protein than formula milk so if you are combining EBM and formula, you may find your baby is not demanding their feeds so often.
• Breastfed baby’s poos are different to formula fed motions. Some babies can become constipated when formula is introduced. Speak with your health care professional if you are concerned.
• If your baby has not finished all of the milk in their bottle, it will need to be thrown away. Rewarming breast milk and formula is risky and can lead to a baby becoming sick. It is also important to store breast milk and formula correctly, in the body of a refrigerator and not the door.
• Breast milk can be stored for 3-5 days in a refrigerator within a closed sterilised container.
• EBM can be frozen in the freezer section of a refrigerator for 3 months.
• EBM can be stored in a deep freeze for 6-12 months.

Maintaining Breastfeeding When Offering Bottles

• Even though your baby is having bottles, this does not mean you cannot offer them the breast between, before and after bottle feeds.
• You may find your baby prefers sucking on one breast more than the other. However, it is important that you still offer both breasts.
• Hold your baby close to your chest with skin to skin contact when you are offering the bottle.
• Your baby may want to suck for comfort even though your supply is low. Sucking will help to build your supply and produce sufficient milk for your baby’s needs.
• If you are expressing your breasts, aim to pump on both sides simultaneously. This reduces the time involved and in some mothers it helps to boost their supply.
• Once mothers have “let down” and their milk is flowing, expressing is relatively straightforward. Thinking about your baby, having them close to you, focusing on relaxing and even smelling their skin just before you express can really help to initiate the milk ejection reflex.
• Breast pumps are available to buy, hire and borrow. Although the initial outlay can seem high, when compared to the cost of purchasing formula, offering breast milk is still a cheaper long term option.
• If your supply is low, you may want to breastfeed your baby first, then offer them EBM and/or formula. Be organized when you sit down to feed so that there is not a long delay between finishing the breastfeed and offering the supplement. Feeds which extend longer than 1 hour can impact on the subsequent feed and lead to infant tiredness.

There is some debate around how bottles and teats can impact on the success of breastfeeding. The general recommendation is to avoid bottles if at all possible and only offer the breast. Dummies can also impact on the success of breastfeeding and the general recommendation is to avoid offering one in the first six weeks of life or until breastfeeding is well established.

Nipple confusion can occur when babies need to swap their suck pattern from a nipple to a teat and vice versa. However, some babies have such a strong sucking action that nothing seems to interrupt this. Seek specific information regarding your individual circumstances from your health care professional. Although general information still applies, both you and your baby are unique.

Where to Get Help

• Your local Child Health Nurse or Community Health Centre. Check your local White Pages of Personal Health Record for local area contacts.
• A Lactation Consultant and/or Midwife. Check www.alca.asn.au
• Your General Practitioner.
• Australian Breastfeeding Association. Check www.breastfeeding.asn.au