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Breast-Feeding or Bottle-Feeding

Barbara Struempler, Extension Nutritionist, Professor, Nutrition and Food Science, Auburn University. 

Originally prepared by Anna Resurreccion, former Nutrition Specialist.

Infant formula can be used in two ways. It can be a supplement to breast milk or can be used instead of breast milk.

The decision to breast-feed or bottle-feed is not an easy one. If at all possible, breast milk is the best choice. Breast milk is better than even the best infant formulas. However, an infant will be fine on formula. Bottle-fed infants can be held, cuddled, and bonded just as well as breast-fed infants.

How you feed your baby is your decision, or maybe a joint decision with you and the father or other family members. Family support is important to make breast-feeding successful. There is no right or wrong decision. Only you will know what is the best choice for you.

The Benefits Of Breast-Feeding For The Baby

Nutritional Benefits
Human milk is the ideal food for human babies. Its protein is best suited to a baby's needs. The fat is used more easily than the fats in cow's milk. Formula makers remove the fat from cow's milk and replace it with fats more like those in mother's milk. Still, human milk is better.

For one thing, colostrum (the first breast milk after birth) and regular breast milk contain elements that seem to help the baby in ways we do not fully understand.

Also your breast milk is always changing, depending on the age of your baby. For example, the milk the mother produces in the first 3 months of the baby's life has more protein. As the baby gets older, less protein is produced. The protein content in breast milk is lower than the protein content of infant formulas. Formulas must have more protein because this protein is not used as well by the baby.

Protection Against Illness
Breast milk has even more benefits. Studies have shown that in the first year of life breast-fed babies have fewer and milder illnesses and go to the hospital less often. In one study in New York, bottle-fed infants were sick three times more often than breast-fed infants. Babies who were nursed for more than 4-1/2, months had about half as many illnesses as babies who were bottle-fed. The longer a baby was breast-fed, the more protection against illness the baby seemed to have.

While you are pregnant, antibodies that you have developed against certain diseases cross the placenta to your baby. These antibodies give the baby protection after birth. But a newborn baby also gets helpful substances from the colostrum, your first milk. This is a thin yellowish fluid very rich in antibodies, nutrients, and other substances your newborn needs.

By the time your infant is 6 months old, his or her immune system will begin making more antibodies to fight disease.

Reduced Risk Of Allergies
If you have a family history of allergies, you have a special reason to nurse your baby. A baby is rarely, if ever, allergic to the mother's milk. Many babies are allergic to cow's milk, which is in infant formulas. The protein in cow's milk is not like that in the baby's system, and about 7 percent of babies react to these proteins. They may have diarrhea, vomiting, stomach pain, or skin rashes. Breast-fed babies also have fewer allergies in later childhood and adulthood.

You may hear about a baby that is allergic to his or her mother's milk. However, this is a not a true allergy to the breast milk. Usually there is a problem with a food the mother has eaten. This food has affected her milk supply. In this case the mother needs to change her diet and avoid that food for a while. As babies grow they will be able to tolerate foods which upset them earlier. Sometimes a nursing mother should even avoid drinking cow's milk if her baby reacts strongly.

Good Eating Patterns
Breast-fed babies are seldom overfed. You may not like not knowing how much your baby has eaten and wonder if the baby is eating enough. This is actually an advantage. The baby is the one who decides when to quit eating. The American Academy of Pediatrics says that bottle-fed babies may have more problems with weight later in life. Parents may push babies to finish all the formula, even though they may not need or want it all.

Your baby's appetite will change from day to day and meal to meal. Whether feeding formula or breast milk, let your baby's appetite be your guide as to when enough is enough.

Proper Tooth And Jaw Development
Babies who nurse from the breast use their mouths differently in sucking than babies who are bottle-fed. Your breast nipple shapes itself to the baby's mouth as the baby nurses. A mother's nipple is soft and flexible. It moves back into the baby's mouth and up against the roof of the mouth. The baby's cheek muscles and jaws work for the breast milk. The formula flows much more easily from the bottle. Many doctors feel that breast feeding leads to good development of the baby's jaw and facial muscles. In addition, the extra exercise required by the lips and tongue may help your child to speak more clearly and at a younger age.

Breast-fed babies have fewer dental problems. Formula-fed babies are sometimes put to bed with their bottles. As they sleep, the liquid pools around the gums and teeth and begins to cause tooth decay. Children as young as 18 months have had to have teeth removed. Do not put your baby to bed with a bottle if you choose to bottle-feed. Use a pacifier or plain water.

Benefits For You

Health Benefits
Some of the weight you gained during pregnancy was a special type of high-energy fat. This extra fat is used when you breast-feed. Milk production requires an extra 500 to 1000 calories per day. Breast-feeding, plus a good diet and proper exercise, will help you to return to your normal size. Mothers who nurse take in more calories than those who do not, but nursing usually helps you lose the weight and body fat you gained during pregnancy.

Breast-feeding soon after your baby is born reduces blood loss by causing your body to produce oxytocin. This is the hormone that causes the uterus to shrink and return to its normal size. This hormone also causes a mother to feel relaxed.

Closeness
Mothers who have bottle-fed one child and then nurse another baby say they feel especially dose to babies they have nursed. Nursing provides skin-to-skin contact, and mothers and infants tend to touch more and to have more eye contact during feeding. If you bottle-feed, try to give your baby just as much close contact as you would if you were nursing. Warm milk and close body contact should come with either type of feeding. Nursing also triggers release of hormones which increase feelings of closeness to the baby.

Milk Safety
Human milk has no disease-causing germs and requires no sterilization. In bottle-feeding, special care must be taken in preparing the formula. The utensils, bottles, and nipples must be very clean or sterile. After the formula is mixed, it must be kept refrigerated. Any unused formula should be thrown away, not saved for another day.

However, there can be dangers in breast-feeding also. If a breast-feeding mother takes medications, they may pass through the breast milk and have harmful side-effects for her baby. Talk to your doctor if you are on medication. There is usually more than one drug you can use to treat an illness or a medical condition.

Some drugs are not essential. If you are a nursing mother, you should avoid exposing your baby to them:

• Alcohol -- large amounts consumed over a short time can make a baby drunk and sick.
• Nicotine -- may cause vomiting, diarrhea, rapid heart rate, and restlessness.
• Caffeine -- may make the baby irritable and wakeful (more than 4 cups of coffee or 3 quarts of cola a day).
• Marijuana, cocaine, and other illegal drugs -- will produce various problems, including addiction or in some cases death.

Other Factors To Consider

Economic Factors And Convenience
Breast-feeding is easier and less expensive than formula-feeding. You have fewer bottles to sterilize or clean, no formula to prepare, no midnight trips to the kitchen to prepare or warm formula. Baby's food is always warm, fresh, and ready to serve. You don't have to worry about getting the right amount of water in the formula mix. And you won't have a hungry baby crying while you prepare the meal. You will spend less time nursing a baby than in formula preparation, feeding, and clean-up.

Traveling with a nursing baby is easy. You can take off on short notice and don't have to worry about bottles, formula, or a strange water supply.

On the other hand, while your baby is on breast milk only, you are the only one who can feed your baby unless you pump your breasts. So you may be able to leave the baby for only 3 to 4 hours at a time. Once your milk is established and you are comfortable with nursing, you can pump your breasts and store your milk. Then a sifter or the father can feed the baby. You can also use a combination of breast milk and formula. Your body will produce as little or as much milk as the baby demands. If you start supplementing your milk with formula, your body will think the baby needs less and will produce less. Try to avoid giving the baby a bottle for the first month. This gives your body time to establish your milk supply.

Working Mothers
You may wonder if you can breast-feed once you return to work. Or you may wonder whether you should even begin to breast-feed if you plan to return to work soon. By all means, if you can breast-feed even for a short time, do so. Breast milk for a few weeks or months is better than no breast milk at all. When you do return to work, you don't have to completely wean your baby to a bottle.

Nursing is not "all or nothing." Besides, this is one part of your baby's life that is unique to you: no sifter can substitute. Nursing while working does take some planning. Your body makes milk on a supply-and-demand basis. The more milk the baby drinks, the more you make. You can nurse in the morning before work, in the afternoon, during the evening, and for the night feeding (if the baby still wakes up for a night feeding).

The missed feedings during the day can be formula or breast milk. Breast milk can be stored in the refrigerator for 48 hours and in the freezer for 2 weeks. Some women pump while at work for the next day's feeding. Other women find it is easy to pump their breasts in the morning when they are full. Your body will provide enough for the stored feeding and for the baby's breakfast. The milk production is very adaptable. Soon your body will be used to the missed feedings, and your breasts will not be full during the day.

You can combine work and breast-feeding. Just be willing to experiment to find out what works best for you.

Diapers And Bowel Movements
For the first few days after birth, the baby's stool (bowel movement) will be dark, almost black, and sticky. This is called meconium, and is soon replaced by stools that are dark but more fluid. Once this is cleared out, the stool of the baby who is only breast-fed is very different from that of a bottle-fed baby.

Breast-fed babies have bowel movements more frequently, sometimes after every feeding. The stools are also yellow to yellow-green in color and quite loose. The odor, unlike that of the bottle-fed baby, is mild, almost sweet, not unpleasant. As your baby gets older, bowel movements will become less frequent, anywhere from once a day to once a week. The stools of formula-fed babies are less predictable in color and consistency.

Preparation Before Baby Is Born
How you will feed your baby is a decision you should make before the baby is born. This gives you time to learn about and weigh your options. You can also purchase bottles, stedizer (9 needed), nipples, and formula or nursing bras. And you can talk the decision over with your doctor and the baby's doctor. If you are thinking of breast-feeding, try to find a doctor who promotes this (most do today). The doctor may suggest ways to prepare your breasts for breast-feeding.

However, you may still be undecided when you go to the hospital. Perhaps you did not prepare your breasts. Many mothers decide to breast-feed only after they see their baby, and they still have success with breast-feeding.

One of the most important things you can do before your baby is born to prepare for breast-feeding is to learn all you can about it. Your Extension home economist can tell you about excellent books. Many are available from the public library or the hospital. You should also discuss your decision to breast-feed with those important to you. The father and other children should be told, especially if you are the first person close to them who has nursed her baby. Try not to let family or friends discourage you. On the other hand, 9 you decide not to breast-feed, don't let anyone make you feel guilty. Breast-feeding may not be for you at this time.

Getting Started
You may have friends tell you they tried to breast-feed but didn't have milk or it was very painful. If this was a first child or the first time the mother had nursed her child, both mother and baby were new at this. Don't let someone else's experience discourage you. Remember that many millions of women have successfully breast-fed their babies.

When getting started, be realistic. Don't expect everything to be perfect. During the first few days your baby will be getting colostrum, early milk. It is extra rich. It will be a day or a few days before your milk comes in. When it does, your breasts will be painful. This will end very quickly and soon you will be comfortable nursing. At first your breasts are not accustomed to this type of work. The nipples need some time to toughen up. If a new mother tries to nurse for a few days and gives up, these experiences may be the only ones she has.

If you decide to nurse, give it at least a week before you decide to quit. Many mothers keep nursing in spite of the pain the first few days or weeks and are glad they did.

Breast-Feeding And Diet
You may hear, "I'm not going to breast-feed because I don't want to continue watching my diet '" Your body needs extra nutrients and calories to maintain your health and still produce milk. You will probably be advised to continue your 'prenatal vitamins, drink more milk, and eat a varied, balanced diet. A nursing mother needs about 500 extra calories but is still advised to avoid empty calories-that is, foods high in calories with few nutrients. Ask your Extension home economist for Circular HE-433, "Nutrition For The Nursing Mother."

Staying on a healthy diet will help you feel better and have more energy for taking care of your baby. If you decide not to breast-feed because of the dietary requirements, think about it further. You will be healthier yourself if you maintain good eating habits.

When You Should Not Breast-Feed
If you must take a drug that crosses into breast milk and has the potential for harming your baby, you should not breast-feed. In addition there are some diseases that may force you to avoid breast-feeding. Your health and your baby's are major considerations in decisions about feeding your baby. Your doctor can best advise you.

Size of the breasts does not have any bearing on a woman's ability to produce milk for a baby. If you have twins, your body will produce more milk. Remember, the production is based on the demand. If your baby or babies nurse more often, you will produce more milk. Your body prepares to nurse your child while you are pregnant. The actual nursing does not cause any further changes in your figure.

Father's Role
If a baby is formula-fed, the father can take part easily. You can take turns feeding the baby, or the father may care for the baby when you go out or during the day. Breast-feeding is different, but the father can give a bottle of expressed milk or bring the baby to you for the night feeding. Your baby will want to be held and rocked at other times besides feedings. Perhaps the most important role fathers and families can play in a household with a nursing mother is to provide moral support and companionship for the mother.

One of the advantages of formula-feeding is that the father may also enjoy feeding the baby.

As Your Baby Grows
Feeding should be a happy experience for both the parent and the baby. It should be done at the right time and in a comfortable place. Feeding does more than provide nutrition. It also satisfies the baby's needs for love and care and the parents' need to nurture.

Your decision of whether to breast- or bottle-feed must involve several factors. Mother's milk is healthy and safe for the baby. It is also convenient and economical. It protects the baby against infection and is less likely to cause allergic reactions than baby formulas. For all these reasons experts recommend breast-feeding. However, baby formulas can meet the infant's nutritional needs. Baby formulas are much like human milk nutritionally, but they do not provide a the other benefits of human milk.

Consider both methods of feeding your baby and think how breast-feeding will affect your life. If you think you want to try to nurse, go ahead. The bottle will always be there. If you choose to bottle-feed, don't let anyone make you feel guilty about this decision. Whether you feed by breast or bottle, be sure the baby gets plenty of affection.- Cradle, nuzzle, and talk to the baby, and allow the baby to cling to you for support. Love and parenting are as important as the nutrients contained in the milk.

References

Brewer, M.M., M.R. Bates, and L.P. Vannoy. Postpartum changes in maternal weight and body fat deposits in lactating vs. non lactating women. American Journal of Clinical Nutrition 49(2):89.

East Cobb Pediatrics and Adolescent Medicine. Tuning in to Parenting, by E. Montana. Atlanta, GA, 1989.

Institute of Human Nutrition. Columbia University College of Physicians and Surgeons. The Columbia Encyclopedia of Nutrition. M. Winick, B. Morgan, J. Rozovski and R. Marks-Daufman, eds. New York: G.P. Putnam's Sons, 1988.

La Leche League International. The Womanly Art of Breastfeeding. New York: New American Library, 1987.

Satter, E. Child of Mine: Feeding with Love and Good Sense. Palo Alto, CA: Bull Publishing Co., 1986.

Trien, S. F., Parents' Book of Breast Feeding. New York: Ballantine Books, 1983.

U.S. Department of Health and Human Services. Keeping Breast Milk Safe for Baby, by D. Stehlin. FDA Consumer. Rockville, MD, Dec. 1986/Jan. 1987.

Worthington-Roberts, B.S., K. Vermeersch, and S.R. Williams. Nutrition in Pregnancy and Lactation. St. Louis: Times Mirror/Mosby, 1985.

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