Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!

Through the hard work and dedication of many hospital employees throughout the state, and the gentle insistence of our Health Department, Rhode Island became the first “Bag Free” state in the nation. I realize it is old news by now, but for those who don’t know, this means “women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital.”(www.banthebags.org) In an event held at the State House on November 28, 2012 Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign all celebrated this achievement and “spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding.”(www.banthebags.org)

I think that most everyone who heard about this knew that it was a good thing for the health of babies in our state. Some weren’t happy about it, but I really don’t think they understood what it means. And let me be clear: it does not mean that mothers will not be able to receive formula in the hospital if they choose not to breastfeed. The hospitals will still have formula, and will still provide it for your child if you want it. What they will no longer do, is routinely give out discharge packs with free formula to mothers as they leave the hospital. Dr. Melissa Bartick, a Boston MD, wrote in a very public debate with MA Governor Mitt Romney that giving formula samples to new mothers was akin to giving Big Macs to patients on a cardiac floor. As Marsha Walker has said many times, “Hospitals should market health, and nothing else.” When nurses send new mothers home with a bag of free formula, it is an implied endorsement of that product. “State health officials noted that studies link these giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.”(www.banthebags.org)

We all know the benefits of breastfeeding. This information has been well promoted among the public health community for years. But “because breastfeeding is the gold standard infant nutrition that provides optimal healt
h for both mothers and infants, lactation experts have recently shifted to describing the risks of formula feeding rather than the benefits of breastfeeding. For mothers, not breastfeeding is associated with an increased risk of post-partum blood loss, post-partum depression, and ovarian and breast cancer when compared with women who do breastfeed. For children, risks of formula feeding include an increased incidence and severity of a wide range of infectious diseases as well as chronic diseases such as diabetes mellitus and obesity.” (MacNamara et al, 2012) When framed that way, doesn’t it make sense not to promote an unhealthy behavior? Especially in a hospital, where we really have the opportunity to help mothers get off to a great start establishing healthy habits with their baby!

So our tiny little state has really done a big thing for families who deliver their babies here. Next on our agenda: having Rhode Island become the first state in the nation with all birthing hospitals designated as Baby Friendly. “The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.”(www.babyfriendlyusa.org) Currently in Rhode Island, Newport, South County and Westerly hospitals have all achieved this status. Throughout the world, the majority of hospitals are Baby Friendly. It is only here in the USA, which is so heavily influenced by the business of formula marketing, that Baby Friendly hospitals are in the minority. Interested in helping to make this happen? Contact your local hospital and ask that they do everything they can to achieve this designation and deliver only at a hospital that has it. Consider joining the Rhode Island Breastfeeding Coalition (RIBC) and joining our advocacy efforts. You can read more about this wonderful organization and ways to get involved at the following link: www.health.ri.gov/partners/coalitions/breastfeeding. We hope that you will join us!