I still remember those tiny, impossibly strong hands pushing back against my chest. It was 2 in the morning, just a few hours after what seemed like an endless 21-hour labor, and my newborn didn’t seem the least bit interested in feeding at my breast — in fact, he was actively fighting me, like a mini-Muhammad Ali. Fly like a butterfly, sting like a stubborn baby.
Though I had initially planned on exclusive nursing, at that point, in my exhausted, postpartum haze, if someone had offered to take my firstborn away and feed him formula, I wouldn’t have said no. Heck, if someone had offered to feed him mushed bread and beer, I wouldn’t have said no.
Now, the results of a new study suggest that temporarily including just a little formula in a breastfed newborn’s diet (known as early limited formula, or ELF) in those early days won’t hurt a mother and baby’s prospects for exclusive breastfeeding down the line but could actually help some nurse longer.
The study, by researchers at the University of California – San Francisco, focused on more than three dozen full-term newborns who had lost weight — more than 5 percent of their birth weight — in the first 24 to 48 hours of life.
Half of the full-term newborns were given small amounts of formula — one-third of an ounce — after each nursing session. To avoid nipple confusion, the formula was administered through a syringe. The other half in the study — the control group — were exclusively breastfed.
The formula supplementation for the first group stopped after the nursing moms started producing mature milk (as opposed to the colostrum moms produce early on, which is high in nutrients but tends to be secreted in smaller amounts than mature milk.)
Three months later, when researchers followed up with the two groups, they found that 79 percent of the babies who had received formula in those early days were now exclusively breastfed, compared to just 47 percent of those in the other group.
How to explain these surprising results?
Lead author Valerie Flaherman, a pediatrician and an assistant professor of pediatrics and epidemiology and biostatistics at UCSF, chalks it up, in part, to the stress moms feel when they worry that their babies are hungry.
“Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months,” Flaherman said in a statement released by UCSF. “But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breastfeed.”
But Flaherman emphasized difference between ELF and giving newborns full bottles of formula.
“Rather than giving full bottles of formula that make it hard for the baby to return to the breast, ELF is a small amount of supplementation with a clear end point,” she said.
The study’s results, to be published in the journal Pediatrics, fly in the face of earlier findings that mothers who combine breast and formula-feeding stop nursing earlier than those who do exclusive breastfeeding right from the start. The USCF’s study’s authors, however, noted in their report that those earlier studies were “observational” — researchers were drawing conclusions from existing data instead of designing their own trials — and that the women included may have had weak intentions to breastfeed to begin with.
While USCF researchers urge that additional controlled studies be conducted to confirm their findings, Flaherman said that given this study’s results, doctors may consider recommending small amounts of formula for newborns experiencing significant weight loss.
Before the USCF results were made public, I checked in with several moms who successfully started exclusive breastfeeding after early formula supplementation.
Melissa Lawrence, the mother of five breastfed babies and the CEO of the parenting how-to video site CloudMom.com, said her third child received formula to treat low blood sugar and jaundice.
She said it never affected his ability to nurse nor her ability to produce milk. (To keep her supply up, Lawrence pumped her milk when she wasn’t breastfeeding.)
“Despite my fears, it was fine,” the New York mom said. After they left the hospital, “he nursed for 18 months!”
For some, the transition was more challenging, especially in cases where serious health problems didn’t help.
“It took me three months of practice nursing and pumping to get it right with my preemie,” said Oregon mom Ilana Elms. “I think determination makes a huge difference.”
As for me, I stuck to exclusive breastfeeding at the hospital but three months later, after I went back to work, I did supplement with formula.
Luckily, by then my son had become far less combative at meal times, happy to be sucking on real nipples or plastic ones…and I was happy to be feeding a lover, not a fighter.
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