Let’s talk formula

Because someone needs to.  So here it is from me- someone who wanted to breastfeed and supports breastfeeding where reasonable, yet used and uses formula for medical reasons. Maybe that makes me a mostly neutral party. Maybe not.

First off- everything I learned about formula is self-taught or I learned from a Lactation Consultant. A good LC, on seeing that you want or need to use formula should be able to give you some pointers. Theoretically all formulas should be pretty much the same, brand name or budget. The WHO is supposed to regulate the ingredients and basic proportions. However-sometimes things are not so straightforward.

What you want out of a formula is to have it be whey based. Not casein based. You want the from birth formula. The follow-ons  marketed from age 6 months + are not as well regulated and unnecessary (though they are often cheaper…). If your child requires supplementation beyond 1 year, full fat cow milk can be given (or mixed with formula if you are concerned about diet or intake).

Cow milk is recommended because growing brains need fat. If your child does not like cow milk to drink (mine didn’t), just be sure to supplement with other high fat foods alone or in cooking. Food such as- avocado, cheese, coconut oil or cream, peanut or seed butters, butter, cream, lamb, olive oils, and so on. For extra calcium try various vegetables like kale, alfalfa, etc and fish like sardines, salmon etc.

Back to formulas. Whey or milk solids should be the first ingredient. Maltodextrin is a common additive and should be around the 3rd-5th ingredient. It is sometimes seen as the first ingredient- this is not necessary and may make your baby eat more- its a carbohydrate that is digested quickly.

If you are combination feeding you do not need any special formula. Any birth to 12 month one that suits you is fine.

This sort of thing

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Image credit

Is straight up predatory marketing. I was always ambivalent about formula companies being big and bad and preying on the breastfeeding mother, but yeah. Not after seeing that. I’m pretty sure people are eating it up too. I’d hate to be more cynical but I’d imagine that if the one on the left cost more people would be paying for that too.

Let me reiterate: You do not need anything special to combination feed. No formula is better than any other. In fact less is often more.

Some reading on safe formula use can be found here http://info.babymilkaction.org/infant_feeding/formulafeeding

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Deficient.

I do often wonder if there is something mentally wrong with me for doing this mixed feeding malarkey. In my cynical moments I see myself as a mother willing to risk starving her child out of stubbornness. At this point I know my breasts do not lactate appropriately. There is no tricking, hoping or stimulation that is going to make that not be the case. I don’t think formula is that bad or I’d maybe motivate myself to get some donor milk. Despite that I am now citrus, tomato, brassica, onion, garlic, pulse, and gluten free to keep my baby reasonably happy. Yeah if you’d told me ever that I would be on a restricted diet feeding a baby through a tube I would have thought you were crazy. But here I am. Anyhow. But at some level I can not let go of breast feeding and go completely over to the bottle and formula. Now that we are at the point where it isn’t complete hell to mix feed (seems to be 12 weeks is the magic hump) I seriously wonder what is wrong with me.

I see mothers blithely (so I imagine though I’m certain the reality included tears) say that they stopped breastfeeding due to low supply and I wonder why not me? Since this method is definitely not the standard way of dealing with low supply I do wonder of those that have low supply how many would like to be educated about management option and how many prefer to stop outright.

Last time I persevered because it was a giant fuck you, a because-I-can to everyone who told me I couldn’t. This time, in light of a tricky, overly sleepy baby who is not easy to feed and is orally particular, I wonder why I am so stubborn and dangerous.

I do know that once solids are established my feeding rig will be packed away and things will be…normal. Is that reason enough though? To deal with 6-7 months of difficulty for another year of unfettered breastfeeding before I have to encourage weaning and do it all again?

It’s certainly been harder with two. The mixed feeding takes more time than a healthy breastfeeding relationship so the older child misses out. We had planned three children when we were being logical (before kids) but the idea of doing this feeding regimen again is depressing at minimum. The only thing that makes me consider doing this mixed feeding thing again is that we can self wean. The perks of being the youngest.

Why a correct diagnosis is important.

Or how wait and see doesn’t cut it.

For the first 8 months of my first child’s life I thought I had low supply, probably from insufficient glandular tissue. I wanted a definitive diagnosis though and couldn’t find anyone to give me one. Then around 8 months, after we’d transitioned to just solids and breastfeeding and put the SNS away in the closet I noticed something that led me to believe that a posterior tongue tie might be the real problem. I couldn’t get a diagnosis for that either, but the more I read and researched a tongue tie did seem to be present. That discovery filled me with hope. Hope that next time would be different, that there was something I could do to make things better. So I planned my next breastfeeding experience around that. I lined up tongue tie release, made my midwife aware of my history and suspicions and mostly did as I was told- to wait and see because this time things might be different. I was told different child, different mouth shape, maybe no problems this time. I was dubious, and didn’t use as my midwife anyone who refused to take my concerns seriously, but I did get some variation of wait and see from everyone I talked to.

Just to hedge my bets I drank various teas throughout my pregnancy and made all my postpartum meals full of lactogenic ingredients.

And then I had my second baby, not how I planned, in fact things went in a way I hadn’t thought to plan for, but I had her and it was ok. Not great, not bad, but ok. And there was an obvious tongue tie, not a posterior one, and there was some waffling about whether it would cause problems from the hospital lactation consultants, and my midwife went to bat for me and we got it snipped anyhow. It made the latch a bit better and things were going normally. We were proceeding with caution, and I was getting some varying opinions on whether intake was good. Some people said looks good, some people were concerned about swallow frequency. I was a little stressed out, but I was assured that if I hadn’t had any history that no one would be worried. I was cautiously optimistic. Things were already different and better by leaps and bounds in terms of latching and output and weight loss.

After 5 days we went home. My milk came in, though there wasn’t engorgement as such, just a feeling of fullness and heaviness. I wasn’t too worried. After all some women don’t have much engorgement, right? Yes, but. Be concerned when you keep running into signs and symptoms that by themselves don’t mean much but when accumulated paint a more dire picture.

We’d had 8% weight loss by day 6. Well within normal ranges. Considering last time we’d had 11%+ by day 5 and more after that, 8% was fantastic. Output was good, my optimism was increasing. There was still concern about swallow frequency, but things seemed to be going well.

By day 11 only 60g (2oz) had been gained. Normal newborn weight gain should be at least 30g/day. I’d been expressing milk on top of feeding to boost my supply and to give as top ups to combat the cluster feeding. My midwife wanted me to get more than 2 hours sleep per day to help my milk, and also because having a toddler and a newborn isn’t sustainable on 2 hours of sleep out of 24.

The baby was sleeping more and more. We were feeding on demand, but where #1 had screamed and cried and never slept unless held, this one would sleep for 4+ hours, fall asleep at the breast and was generally very lethargic. I was pumping 4-6 times per day on top of feeds, and giving that milk via the SNS. Output was still good.

And day 15 came and the weight was the same as at day 11, 210g below birth weight. And the baby was so lethargic at that point that getting her to take a bottle was over a 1 hour affair of cold cloths, stripping, changes and so on for 60ml consumed.

So now we went into disaster management mode. I was to give 60-100ml via bottle every 3 hours day and night and pump afterward. We practically have to force feed the baby at this point.

It’s been a few days of that and hopefully birth weight will be regained in another day or two and we can revisit other feeding options, or even go back to feeding on demand.

And that’s where we are now. I wish we’d known before that IGT was the issue. I wish I’d been able to get that diagnosis. I could have been using the SNS from around day 10 or before and doing test weights to measure intake rather than disaster management of a lethargic and dehydrated baby.

Now I’ll likely have to contend with nipple confusion, breast refusal and possibly losing any kind of breastfeeding relationship. I might still be able to pull this situation out of the fire, but a diagnosis last time would have made this easier.

 

On congratulations, extended breastfeeding and weaning

I was asking around for weaning advice some time ago and someone said to me ‘you’ve done well to get so far, most women would have given up’. I was kind of flabbergasted. There are a few ridiculous things about that statement. This is an irritating topic for me because I’m reluctantly pushing weaning rather than allowing self weaning. But the idea that breastfeeding success is measured on length seems ridiculous to me. Ridiculous because after you work out the issues it is often far far easier to just let things happen than it is to actively wean. It’s laughable that after you get to 6,7,8 or more months that at some point you can still ‘give up’ breastfeeding. For one, it’s generally much easier by that point, and two, no, sorry, by that point you have a semi-autonomous person who has their own wills and desires to contend with. Also, that ‘most women’ phraseology drives me crazy.

To put this more in perspective: I’ve been breastfeeding for close to 16 months now. The first 8 were a struggle with me either trying to up my supply, or simply using the SNS multiple times a day. The past 8 have not been difficult at all. OK, not difficult in the same ways. Or rather, only difficult because I want different things than my baby at this stage. Like sleep. Yet there have been rather a lot more congratulations on getting ‘so far’ since I hit 12 months rather than dealing with the initial issues. I’ve noted before that serious issues seem to make people’s brains shut off. They either armchair quarterback it (you could have done better) or their eyes glaze over. I don’t really bring it up (except for here), because there’s no really good response I can think of. Basically anything anyone is likely to say is shooting themselves in the foot. I guess the point I’m making is I find these congratulations for extended breastfeeding so ridiculous because it’s not anything I did or didn’t do. It’s not some superstar parenting ability that kept us breastfeeding, it was me being lazy. As far as I’m concerned preferring the boob is mostly my child’s personality. I’d argue that while extended breastfeeding is an excellent parenting tool, parenting without the tools that breastfeeding affords one is more difficult. So here’s a tip of the hat from me to all those parenting without using breastfeeding or any simulacra thereof.

Honestly, stopping is proving to be more difficult than I bargained for. How hard? Put it this way, I wanted (well not wanted, but, well, planned…) to stop around 4 months ago. And I started gearing up to start 6 months ago. Well, I did, but my child really did not. I wasn’t willing to take it away from her at that point, so I let it go. Then two months ago I stepped it up a bit more and we’re still not there.

I tried asking around for weaning tips, but no luck. I have a difficult child in this respect as she will no longer take a bottle and dislikes all milk in any container but me. I mostly got the ‘not allowing your child to self wean is cruel’ type of responses, but I also got a fair amount of ‘I gave my kid a bottle/cup with cow milk and that was that’. Not really any help on either side. Then there were the people who told me to let my child cry it out for a few nights in regards to night weaning. Again, not helpful. My child does not respond well to being left like that. So here’s what I’ve learned about dealing with the difficult to wean child.

First, make sure your child is difficult. Try offering substitutions, cups of milk, bottles, etc. Maybe that will work for you and you won’t need the rest of this advice. Otherwise…

Start with don’t offer don’t refuse. This, depending on the child’s age will probably cut down on a few feeds right off the bat. Mine actually took a few months (I started don’t offer don’t refuse around 9-10 months) before she realized she could ask. Then she picked up again as she explored her new found skill. But it’s a good starting point. If you’ve already done that then…

Set associations. Baby sleep books talk about setting sleep associations, so I thought, why not set breastfeeding associations. We set associations that breastfeeding only happened on the couch and in preparation for bed (or in bed). We’d also had a breastfeeding to sleep association which was a nightmare for a few months until we broke it. It’s all well and good until your child gets too big to comfortably or easily put down when they fall asleep. Then it’s significantly less of an easy sleep aid. Read: feed to sleep for 10-20 minutes, hold for 15 minutes until you’re sure (haha) they are asleep, put down, baby wakes up, repeat for up to 3 hours. Yargh. If you’ve got one of those and you don’t want it, or you don’t want to develop one I can recommend Elizabeth Pantley’s book The No Cry Sleep Solution.

Consistency is key. This is where I’m really having a hard time because I’ll do things to make the  baby toddler sleep in my sleep. Which includes my best laid plans of wearing a shirt and a bra to sleep, I’ll wake up part way to find myself already feeding the baby. I’ve been really good about following our other rules for breastfeeding. Only after dinner, before bed, etc, but bets are off when I’m being a sleep deprived zombie.

Age: Weaning after 8-10 months for us has unfortunately been one of those things you have to want to make happen. Why 8-10 months? There are a few times in a child’s growth where weaning from the breast is thought to be easier. Around 9 months and around 18 months are two of those times. These are when babies are more likely to go on nursing strikes, have a lot of developmental things going on and cut down on breastfeeding naturally. At 12-13 months there is a growth spurt and in addition to eating like a horse, your breastfeeding child will give you a blast from the past, cluster feeding. So, what I’m saying is that if you miss that 9 month window, you may find yourself in a difficult situation from a weaning perspective after 12 months. Why? Because of the 12 month growth spurt and molars the child may have re-established breastfeeding as a source of comfort.

Distraction. Day weaning has been loads easier for us than night weaning. When she asked during the day I’d refuse, she’d cry for a bit, I’d give her a hug, a snack or drink, and within 5 minutes all forgotten.  It’s hard getting past those initial 5 minutes, but once you’re out the other side it’s easier to keep on doing it. After the first few times it’s like an ‘oh is that all?’ moment.  That has not worked for night times as the element of distraction is not there. If your child sleeps through the night or will take a bottle or cup at night this will be much easier for you. Mine does not and will not, alas. Pacifiers have also found some limited success here. My child has not been terribly interested in them (mainly as she can’t keep them in her mouth), but I’ve found them a nice oral distraction (though she mainly chews them-we have these wholly silicone ones) when she just wants a little comforting sucking.

Being firm, with limits: A lot of applying some of these things is knowing your own child’s limits. I found that mine might fuss for 5-10 minutes when not given the breast, but then would move on. I set a personal limit of 15-20 minutes. If after 15-20 minutes fussing and demanding of breast was still going on then I would accommodate her wishes.

Tough titty, the big guns: This is where you start the hardline tactics when the others have failed. When nothing else has worked. This is where I’d put allowing my child to cry it out, but then the goal is no boobies at night so that didn’t seem quite appropriate.  Things you can try include lemon juice or vinegar on your nipples. This totally didn’t work for us. I felt really mean, but then mine was all, yum, lemons (she will chow down on whole lemons including the peel if I let her). Doh.  So when I feel like I’ve exhausted my options and what I’m comfortable trying I revisited some things that I’d previously failed at.

What finally worked: So I revisited consistency. I made sure I had a bra on and a long shirt and tried that. As long as I was firm I could rub her back back to sleep and it worked fine. Also a water cup is key here. You may be able to bribe them with a drink of water if they are thirsty. Mine takes it some times, other times she just screams and hits me in the face.  Such is life. So once I got that working I had really bad insomnia for a few nights because I didn’t have those fancy breastfeeding sleepy hormones. But it got us through the no feeds between 8pm and 5am week. She still wakes up, but getting her back to sleep isn’t that bad. Reposition in her bed, tuck her back in, rub her back, maybe turn on a lullaby toy…

I met her halfway (really I wanted to sleep some more) and decide that she can have a feed any time after 5am that she wakes up. That one however will be the next to go. I thought, hey, the bed time feed is kind of nice us time, let’s keep that one and work on the middle of the night ones.  I also knew how to deal with the bedtime feed because I’d already dealt with it in a different form when I removed the nap time feeds, so I wanted to save that one for last. Now I know, sort of, how to deal with the sleep-time feeds.  Weaning is a fairly individual process, much like defining your breastfeeding relationship.

It’s sad. I’ll be able, most likely, to write down the day we stopped breastfeeding. After what we went through to get here I can’t help but feel awful. If it were not for my pesky lack of ovulation this post would not be. I’ve armed myself with some extra information for next time, but I do suspect that our feeding issues have something to do with it. Even at 16 months she is an inefficient feeder, sometimes staying on the breast for 30-40 minutes for her single feed of the day. Perhaps next time, with oral issues attended to early, this will not be a problem.

Before this post came out I got an 11th hour pardon. Literally one week remaining in the weaning plan and my cycles seem to be starting up again. It seems that our week or more of no feeds between 8pm and 5am was enough to get things started. We’re down to one feed before bed and I’m happy enough with that for now. Stopping is no longer in our immediate future. But, these are still good tips for weaning. Extended breast feeding doesn’t have to be about complete surrender of control.

How can you say no to this?