By Shel Banks and Emma Ashworth
Doulas who are supporting families postnatally will frequently work with women and birthing people who have made the decision to feed their baby formula, or to mix feed (part formula, part breastmilk). The decision to formula feed or mix feed can be a very positive one for some families. For others it may not be what they wanted, and for some it can be devastating. You, the doula, can make a huge difference to each family by listening to them, hearing their feelings and reflecting them without judgement, and if they wish it, by signposting them to support and information.
Doulas are not expected to be infant feeding specialists. If you are a doula and you also have training in infant feeding, for instance as a peer supporter, breastfeeding counsellor or IBCLC, it’s always important to ensure that you are clear about which ‘hat’ you are wearing when you offer support to doula clients. This article offers doulas some key tips to help you to support families who are formula or mix feeding – things that doulas have told us they wish they’d known before they were supporting families in these situations. Remember that your super power as a doula is to signpost to excellent quality information, so keep this article and the links in it saved for when you might need it!
Expensive formula isn’t necessarily a better formula
By law in the UK, all infant formula needs to have the same core ingredients, which provide the vitamins and minerals, and the right mix of fats, proteins and carbohydrates for a baby’s health. All infant formulas sold in the UK from the most expensive to the least expensive will, therefore, provide babies with the calories and nutrients they need to thrive.
Some infant formulas have added ingredients, with a variety of claims attached to them, which may or may not have benefits to babies, but they can make the formula much more expensive. These ingredients may make medical claims (for instance, formula for babies with reflux), or developmental claims (for instance, ingredients which help to develop eyesight). Families may appreciate knowing that their baby’s nutritional needs will be fulfilled without having to buy the premium brands, but also that some of these claims of benefits may actually be at best misleading and in some cases harmful. (https://changingmarkets.org/wp-content/uploads/2018/02/BUSTING-THE-MYTH-OF-SCIENCE-BASED-FORMULA.pdf)
Breastfeeding babies generally follow a suckling pattern which can be seen as active suckling/mouth movements followed by a few moments of rest/not suckling. This allows the baby to control the flow of milk into their mouth, and to stop when they’re full; it’s what babies are expecting.
When feeding babies infant formula or breast milk from a bottle, they cannot control the flow of the milk in the same way as from the breast. If the bottle is held so that the milk continues to flow, they have no choice but to keep swallowing to avoid choking. This can lead to a few different problems:
- Some babies start to prefer this fast flow, which leads them to become fussy on the breast if they are also breastfed, as they’re expecting the milk to come without them having to do the work.
- If too much milk is swallowed, the baby can become over fed and more prone to vomiting, stomach pain or reflux pain.
By using the paced bottle feeding technique, the baby has more of a chance to feed at their own pace, and have the chance to stop and swallow, and not be overwhelmed by the milk flow.
This is a great video to show how to do paced bottle feeding: https://www.youtube.com/watch?v=TuZXD1hIW8Q
IBCLC Kelly Bonyata has a useful web page on paced bottle feeding: https://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/
Pre-made formula is safer and quicker than powdered formula
Infant formula power is not sterile, and it can grow bacteria, funguses and viruses. This is why it’s important to always use water that’s around 70 degrees centigrade on the powder. This is hot enough to kill any pathogens that are on it, but not so hot that it destroys the vitamins. Of course, the bottle then needs to be cooled to be safe to feed to your baby.
This doesn’t mean that if you make up bottles differently that every baby will become sick. It simply means that sometimes a dangerous pathogen may be able to grow in the formula, and that this will make some babies sick – sometimes very seriously.
This does make it challenging to make bottles quickly. Because of this, pre-made or ‘ready to feed’ formula, which is sterile until the bottle or carton is opened, is a safer and quicker way to feed formula. Unfortunately, it’s much more expensive than powdered formula, but it might be helpful to some parents to keep some stock of pre-made formula to use when a bottle is needed really quickly, or for night time or when out and about.
Pre-made formula may be less likely to clog up the tubes of a nursing supplementer. (link: https://www.laleche.org.uk/nursing-supplementers/)
Every Drop Counts
Human breastmilk contains all of the nutrition that a baby needs, but it also contains unique components which cannot be manufactured and put into infant formula. For this reason, if a mother or birth parent wants to, and is able to, provide any breastmilk, even if it’s only a small amount, it will be valuable to their baby’s health.
If parents are feeding both breastmilk and formula to their baby, feeding the breastmilk first means that the baby gets as much as possible, and as little as possible is wasted. This might look like feeding from the breast or chest before offering expressed milk, if available, in a bottle (or syringe, cup, nursing supplementer, etc), then any necessary formula. Or it may mean feeding expressed breastmilk in the bottle (cup, etc) first, then, once that’s all drunk, feeding the formula. Mixing breastmilk and formula risks milk being left over which includes those vital, precious mls of breastmilk.
Further Resources on formula feeding, mix feeding and bottle feeding:
Responsive Bottle Feeding – A Unicef Guide
First Steps Nutrition – a vast amount of information on infant formula and infant nutrition
A Guide to Safe Bottle Feeding – A Unicef Guide
What are the different types formula milks? – more from First Steps Nutrition
“Why Formula Feeding Matters” by Shel Banks, published by Pinter & Martin January 2022
Shel Banks is an experienced UK-based IBCLC, and works in the NHS as well as working and volunteering for various national and international organisations in the world of infant feeding and early parenting. In addition to a small private practice as an IBCLC, she is Clinical Director for LatchAid, an innovative app to support breastfeeding and lactation. Specialising in the unsettled baby with symptoms of colic, reflux, allergy and faltering weight, she has long been troubled by the impact this has on the family and has spent time as a committee member on 3 infant feeding-focussed NICE Guidelines – including NG75 on Faltering weight in Infants and Young Children, published first in 2017. Shel has seen a gap in the evidence base around how exactly to manage these unsettled babies and so improve family wellbeing, and so has begun PhD research focussing on a strategy to improve things for families, through their contacts with frontline health professionals. Shel has 4 adolescent children, and lives in Lancashire.
Emma Ashworth is a breastfeeding counsellor, and blog editor for Nurturing Birth.