by Jennie Bernstein
“I always feel bad sharing my story because I don’t want to make others feel bad, breastfeeding my baby was so easy for me, it was just perfect. I almost feel like my story doesn’t count.”
The woman standing in front of me had a sleeping little one strapped on her back and a worried expression pressed on her face. She shared briefly in this rushed moment with hundreds of people around us that she rarely talked about her breastfeeding experience when she knows so many women struggle in their own journeys. Concern that sharing her own story may cause them pain, she keeps it to herself.
Another woman before her told me she didn’t talk about her breastfeeding journey except around a few key friends because it was so discouraging and difficult she didn’t want anyone else to feel sorry for her or not try breastfeeding out of fear that they would have a similar experience.
And before that a mother told me that she never talked about her experience feeding her baby for fear of judgment because she switched to formula just a few weeks in due to difficulties and postpartum depression compounded by needing to return to work. She just couldn’t take hearing more of the inevitable questions that would follow if she shared, asking if she tried any number of herbs and medications for her supply, if she saw the right kind of breastfeeding support, or how she felt about poisoning her baby with formula, or that if she truly loved her son she would have tried harder to give him breastmilk.
Following all of them was the mother that loved breastfeeding, had overcome a few difficulties, and went one to breastfeed for 3 years before weaning and starting all over again with a new little one. But she was a quiet person and not comfortable with breastfeeding in public, it was even challenging for her to do so with a cover and she preferred a private location away from other people. Awkward and very self-aware, she hated breastfeeding in public and she never posted breastfeeding pictures online (does that mean she even really breastfed if she didn’t take and share a #brelfie? Would people think she was lying?). So she didn’t talk about breastfeeding much because she felt like a fraud. There were some points she would love to tell but not all of it and not to just anyone. Her past history of sexual abuse made it even more difficult for her and she didn’t want to share more about her infant feeding path than she was comfortable with but that seemed inadequate and wouldn’t really help anyone.
All of these women and thousands of others I have heard from felt that their story didn’t matter. They felt their stories weren’t happy enough, dramatic enough, perfect enough, difficult enough, strong enough, smart enough, right enough, important enough, painful enough, humble enough, promising enough, advocate enough, bold enough.
YOU ARE ENOUGH.
You aren’t perfect and you never will be, whatever perfect means.
YOU ARE ENOUGH.
Your highs, your lows.
YOU ARE ENOUGH.
The good, the bad, and the ugly.
YOU ARE ENOUGH.
The flab, the stretch marks, the skin and bones, or the extra padding.
YOU ARE ENOUGH.
The moments of pride, the moments of shame.
YOU ARE ENOUGH.
Your hurt and your joy.
YOU ARE ENOUGH.
Your vagina, your scars, your breasts, and your bottles.
YOU ARE ENOUGH.
Our children are watching, long before you will realize they are aware, they are watching. Every criticism you bestow upon yourself eats away at your confidence and how you view yourself. Which eats away at your child. How they will grow to see you, how they will grow to believe you see them, and how they will grow to see themselves. Are you treating yourself as well as you want your child to be treated by themselves and others some day? We are their models, is this what we want for them? And are we treating others, our friends and peers, how we want our children to treat others and how we want others to treat our children?
Will your child look at you and see that you are enough?
Will your child look at themselves and see that they are enough?
Perfection is far too high to aim for and since it is unattainable we are setting ourselves and our children up for failure if we tell them they are perfect and berate ourselves when we’re not. Someday they will know the truth that they aren’t perfect and we will have been the ones that lied to them.
But enough is enough. Within enough, there’s room for growth but still acceptance of where you are. When we are enough we can see how our stories matter. All of ours.
TLB is celebrating its 5th birthday this month. A month long celebration of our community and the thousands upon thousands of stories shared there. For 5 years families have been finding support in their journeys, receiving support and giving support. After finding the support they needed, many stay to pay it forward. Support forward. #TLBSupportForward. There is no better way to celebrate this milestone than going back to our roots, sharing our stories of feeding our children, our babies. To share your story with our community, email it to content @ theleakyboob.com (no spaces). All stories are welcome, we will have to be selective in what we publish to be sure it is a good fit and due to the volume of submissions it is possible we won’t be able to publish them all, but your story matters; so whether it is published on TLB or shared in the comments and interactions of our community, we hope you share your story. You can help encourage others with your story by making your own sign like above and taking a picture of you holding it to share on social media with these hashtags. Whatever it may be, from pure bliss of rainbows and sunshine to heartache and pain, your story matters. In sharing it you testify that you are enough and encourage others that they are enough too.
And together we all can say #IAmEnough #MyStoryMatters #TLBSupportForward.
You’ve seen it, the advertising of bottles and formula announcing how their product is somehow “like mom.” Or proclaiming that there are new developments that allows their product to be “more like the breast” while elsewhere on the packaging they say “breast is best.” It sounds amazing: new technology, new understanding, new science has unlocked some secret that makes this nipple shape and design more like a real breast than all previous nipple shapes or this specially formulated blend of ingredients more brain boosting like what is found in breastmilk than all previous specially formulated blends ever of all time in the history of feeding babies. Now it’s “more like mom” than ever before! Hey, this could be the answer to your breastfeeding troubles, this product will fix colic, sleep issues, calma your kid, teach them how to breastfeed, and probably even make your bed, because it’s MORE LIKE MOM!
Honestly though, I understand where it is coming from and it’s not the first time plastic and silicone has been confused as being “just like” the real thing, so really, it’s not that surprising. (Boobs, I’m referring to fake boobs. Which, really, when you think about it, bottles are just a different version of fake boobs. Portable, detached, feeding utensil fake boobs for feeding babies.)
But of course that’s what they’re trying to do, create, market, and sell something that is as close as possible to what human infants are born expecting. It’s probably not going to do so well with truly honest advertising that says “really nothing like mom but acceptable delivery system for infant nutrition.” Can’t imagine why brands would shy away from that approach. Besides, the basic shape is there and the design is sometimes there requiring the baby to suck to get anything from the teat (you may be surprised though, lots of bottles just run like a facet when you tilt them, some of the biggest culprits are those that claim to be for breastfed babies).
These claims, while highly contested, are on to something. It just makes sense to feed babies “like mom”. Their mouths are shaped for that, their brains are wired for sucking, and developmentally that’s really all babies can manage since forks and spoons are tricky at that stage and tubes are hopefully medically unnecessary. Having used a eye dropper to feed one of my infants, that’s also rather time consuming and messy. Having used bottles with all my babies (photographic evidence here because apparently if you’ve never posted a photo of it online, it never even happened and you’re a lying jerk), I can say a bottle tends to be a effective delivery system of infant nutrition. Very few people would argue against the basic design of bottles, it’s comparing it to mom that gets confusing and, well, kind of like lying. A predatory preying on someone who just wants to do what’s “best” for their child. These companies have financial motivation to convince someone that their product is like mom.
Because, let’s be honest here, how do they know it’s “like mom?” Aside from the obvious differences in materials (warm, living tissue vs plastic and/or silicone), each woman, shoot, for most of us, each breast is different. When they say more like the breast, I find myself asking “which one?” and when I read claims of a bottle design being closer to mom, I wonder “who?”
So, I did. I asked several of my friends to give me their interpretation of what a bottle that looked like them would look like. I asked them, if there was a bottle designed to be like their breast, what would be distinctive of their customized more like mom boob bottle, what we’re calling “Boobles™- MOST LIKE MOM”. For several of us, that would require two very different options since each of the breasts on our chest are unique in their own right. Can’t be more like this mom with just one bottle.
Here are the renderings of these moms and what their breasts would look like topping a bottle, if bottles were truly more like THAT mom. Introducing “Boobles™- MOST LIKE MOM” concept bottles that are truly, “more like mom”:
What would your Booble™ look like and what would be the unique features to make it “more like mom” for your baby?
With all the brands out there touting to be “more like mom” and promising silly things like teaching your baby how to breastfeed (biology taught your baby to breastfeed, the bottle is an attempt at copying your biology, plastic can’t teach a baby how to breastfeed!) and product names that make you think of breasts and breastfeeding, it can be confusing to find a bottle that works for your little one should they need it. How do you cut through all the gimmicks and marketing to truly find one that will meet your baby’s needs, particularly if you are breastfeeding? A popular suggestion is to find a nipple shape that looks like your breast, but aside from the potential awkward moment to check your boob selfie on your phone or to whip a boob out if you need to compare your own nipples to the bottle while you’re at the store (and then I bet you’ll wish you were shopping online), is that really helpful? I decided to ask my friend Amy Peterson, IBCLC and co-author of the book Balancing Breast and Bottle, Reaching Your Breastfeeding Goals for some guidance:
Don’t waste time looking for a bottle nipple that looks like your breast. The best way to choose a bottle nipple is to look at your baby’s latch on your breast, and then on the bottle nipple. The tip of the nipple needs to reach far back into your baby’s mouth, while the baby’s lips are slightly opened and rest on a portion of the nipple base. Surprisingly, many shapes marketed for breastfed babies are often the shapes that cause the worst bottle latch: a latch where the baby looks like he is sucking on a straw.
It’s probably a long way off for customized bottles made from silicon molds of each individual mother’s breasts, Boobles™ aren’t going to be happening any time soon. (Either a brilliant business idea or the worst idea ever.) Of course, the ridiculous claims and names of bottles aren’t about to go away any time soon either. Sifting through it all to find what works for you and your family, with the help of an IBCLC health care professional if necessary, skip the comparisons to your own breasts or those of a random woman in a stock photo used to make a sale and look for something that meets the needs of your baby. While the breast is certainly the best design for a human infant, though not always without problems that may make feeding difficult, there’s no bottle that’s going to really be anything like the breast. Unless of course plastic, silicon, glass, and/or rubber makes you think “more like mom.”
Here at TLB, how you feed your baby is secondary to that you feed your baby. Having a sense of humor, exploring some of the social and relational aspects of infant feeding and parenting, discussing information, and sharing our stories is really what we’re about. Phrases comparing infant feeding devices (doesn’t that sound so much cooler and refined than “bottle”?) to breasts are something we take issue with because ultimately we feel it’s confusing and it undermines the confidence families can have in feeding their babies well. Because, let’s get real, there can’t be many of us that look at a bottle nipple and say “hey, I resemble that teat!”
What would a Booble™ based on you look like and what kind of functional features would your customized Boobles™ have? Email your rendering of a custom designed Booble™ to [email protected] with the subject “My Booble™” in the subject and we’ll add it to our gallery of bottle designs that would actually be more like mom.
For me, aside from two different models, my Boobles™ would have one a bit more dense than the other and both would leak whenever a baby cried. I could never take them in public without some sort of cover.
Boobles™- MOST LIKE MOM!
*Please note, you don’t have to use bottles to feed your baby if you don’t want or need to.
** Please note, doesn’t have to be breasts either.
*** Also, this post is supposed to be humorous, not something to get worked up over.
****And Boobles™ aren’t really a thing.
This is my 5th version of this letter. I’m going to finish this one.
But first I’m going to do something I’ve never done here before:
That’s a picture of Sugarbaby receiving a bottle. A bottle of my milk. Taken 2 years ago by my wonderful husband, I love this photo. So much love and pride captured in this moment. A vital moment in me reaching and achieving my breastfeeding goals. And that bottle wasn’t even kind of a “booby trap” to my breastfeeding goals.
Still, I never shared it with any of you here, on Facebook, Twitter, or Instagram.
Why haven’t I shared this or images like it with The Leaky Boob community before now? Why is this my 5th attempt at this letter? It’s simple:
Yep. I have harbored shame. Not shame that my babies have received bottles, no, I have absolutely no shame that I’ve fed my children as I needed to. No, my shame came from using a bottle made by a WHO Code violating company. (To learn about what the International Code of marketing of Breastmilk Substitutes is, go here.) Only, that’s not really the shame I’m holding either, do you know how hard it is to find a bottle that’s not made by a WHO code violator? Nearly impossible.
No, my shame goes way beyond even the WHO Code, bottle feeding, or supporting a WHO Code violator.
My shame is that I haven’t cared about the WHO Code for 3 years, but felt I had to in order to be a “good” breastfeeding supporter.
My shame is that I played along, even became a part of the self-appointed WHO Code policing brigade for a time, even though I knew all along, deep down in my heart, that the almighty WHO Code was creating barriers.
My shame is that I felt righteous supporting the WHO Code. The original purpose of the WHO Code was so pure, so right, so good, how could I not support it?
My shame is that I upheld an artificial picture of what it looked like to successfully breastfeed and called it supporting the WHO Code.
My shame is that my actions supported the WHO Code more than they supported women, babies, and families.
But my shame is not that my babies were fed, not that they were loved, not that they sucked on an artificial teat.
Screw shame. I’m done. And I’m sorry. I’m deeply sorry that it has taken 3 years for me to find my courage to take the stand I live but never shared here. I’m sorry that I’ve not been honest.
Because this is what successful breastfeeding has looked like for me:
And so is this:
For every single one of my 6 beautiful children, bottles and breast have been a part of me reaching my goals. And not just because I had to go back to work. I choose to go back to work, I love working and am a better parent when I work, but even when I didn’t work outside the home, I elected to partially bottle feed my milk to my baby. This was a positive thing for me as I get physically stimulated very easily and as an introvert found the need to create some space for myself. I did better mentally and emotionally, which meant I was in a healthier place mentally and emotionally to parent my children. It was the best healthy choice for us. I have never, not once, regretted it. Today, with a breastfeeding 2.5 year old, I also don’t believe it ever interfered with our breastfeeding nor did bottles have a negative impact on me reaching my breastfeeding goals.
In fact, I firmly believe that without bottles, I would have quit breastfeeding early on.
And see the big child in this photo bottle-feeding her baby sister my milk?
She was mostly formula fed.
I don’t have any shame about that either. In fact, I’m damn proud that when the time came I could make the right decision for us to stop breastfeeding and switch to formula. The regret I have felt about that has been artificial and circumstantial, never true. It took a lot of courage for me to make that decision and it was the right one. I would make it again if I had to. I will support you if it’s the decision you need to make as well. We’ve been vocal here that breastfeeding doesn’t have to be all or nothing to be successful, I just haven’t been visible with that reality for myself.
Through The Leaky Boob I have contributed to a beautiful yet often unattainable depiction of what it looks like to breastfeed. In my attempt to normalize breastfeeding and provide support up what breastfeeding looks like, I have held up at the breast breastfeeding as being more beautiful, more important, more viable, more worthy of sharing and discussing and promoting than any other infant feeding methodology.
I support people before I support a feeding method.
I look at these photos of my baby receiving bottles and I see a beautiful, important, viable feeding worthy of sharing and discussing and promoting. Normalizing breastfeeding (bottle-feeders will tell me they feel that is normalized) and normalizing bottle-feeding(breastfeeders will tell me they fell that is normalized) shouldn’t be in competition with each other. What really seems to need to be normalized is caring for children. Parenting. Without it being a contest or a platform to boost how we feel about ourselves.
Feeding your child is real, no matter what they are fed or the mode of delivery. It’s real, it’s important, it’s complicated, and parents deserve support as they navigate this terrain. I am sorry that The Leaky Boob has, at times, failed to communicate that. I a sorry if instead of being a part of building your confidence, I’ve been a part of tearing it down. Deeply sorry.
I know there are those who will tell me I haven’t failed and I appreciate that.
I also know there will be those that will tell me that I haven’t failed until now. I appreciate that too.
But for the last 4 years as The Leaky Boob I have not been entirely honest with you. As a public voice in breastfeeding support, I have contributed to a mythical image of breastfeeding. I wish I could say it wasn’t intentional but it was and of the 4 years I’ve been doing The Leaky Boob, I have wrestled with this for three years. Motivated by fear, I allowed myself to present a picture of my breastfeeding journey and an idealized image of “successful” breastfeeding that simply wasn’t true. Well, not true for me anyway and likely not true for many of you. And I know holding that ideal up was damaging for some and a sort of betrayal for others. It wasn’t that I overtly lied, it was more of an omission of truth. I was wrong to do so and I am sorry.
A few weeks ago I was sitting with a friend of ours, a new dad who was bragging about how his wife and son had worked so hard at breastfeeding and just the day before, at close to 8 weeks old, had fed directly from the breast for all of the feeds. He said something that struck me: “you know, I think they’ve been breastfeeding, we’ve worked so hard but it’s not like you ever see pictures of breastfed babies getting bottles. Our lactation consultants were great but it’s a lot of work, a lot of time, a LOT of money, you know? The work you do is so important, we were on The Leaky Boob all the time and we have found a lot of help and support there but we still felt alone. I mean, it feels like it’s not as real if we’re giving a bottle, nobody ever talks about that. Does anyone else go through this?”
I was confronted with the reality of my failure on my couch.
Leakies I am sorry I never shared images of my babies and other babies receiving bottles. I was wrong to only ever present a side of my infant feeding journey that was safe for me as a public breastfeeding supporter. Anxious that I would be inviting drama and attacks from other breastfeeding supporters, educators, blogs, organizations, and my own readers, I didn’t want to risk being accused of being a WHO Code violator by posting pictures of my babies with their bottles. Specially since I do make some income from The Leaky Boob, I was concerned that if I ever even showed bottle feeding some would think it was sending the wrong message.
But message or not, this is the truth: my babies, all 6 of them, got bottles. One got mostly formula in her bottles. Back when I was attending women as they had their babies, often I was helping a new mother and baby pair with their first few feedings while my baby was at home getting a bottle of my milk. And every single bottle my babies have received was manufactured by a WHO Code violating company. I’ve never once regretted that, never once felt guilty for it, never once wished it was another way. But I did feel afraid to show it.
My incredible husband, Jeremy, The Piano Man, has never had a problem sharing these images though and not because he doesn’t understand the WHO Code or is unaware of the barriers women face when it comes to breastfeeding. When he came home one day with a new bottle and I stressed about having a WHO Code violating bottle in our house, that it couldn’t be posted anywhere online, and that I felt sick giving money to a Code violating company, he simply looked at me and calmly said “I thought this was about feeding our daughter.” I sterilized that bottle and moved on, knowing I wouldn’t post any photos of the offending bottle. But he did. And the very first comment on the photo was this:
I understand where the commenter was coming from and she wasn’t giving anyone a hard time but it’s true, because of the half truth I had shared, it was strange to see one of my baby’s drinking from a bottle. But it wasn’t strange that she was receiving one, it was actually a part of our normal infant feeding routine.
Bottles were an important part of me reaching my breastfeeding goals. Without bottles, I’m not sure I would have made it as far as I have and I’m pretty certain I would never have even started The Leaky Boob. I have talked about using bottles and formula feeding my second daughter, but I never shared images and I carefully couched sharing those experiences as safely as I could so as not to invite controversy.
I have let go of my shame and my fear.
By intentionally keeping that part of my breastfeeding journey quiet, by not sharing images of my baby receiving a bottle, by just sharing images of my babies feeding only at my breasts, and by neglecting the real life bottled-up aspects of the breastfeeding journeys of others, I perpetuated a romanticized myth of what constitutes successful breastfeeding.
I am sorry. Please forgive me.
With all my love, sincerely,
Do you use bottles? How do you feel about using bottles? Do you share pictures on social media of your baby receiving bottles? Need help bottle-feeding your breastfed baby? Check out this article, Facebook page, and this book.
We’re well into the 21st century yet breastfeeding appears to still make many people uncomfortable. I keep hoping those individuals that get upset about the biologically normal way to feed a baby are really a rarity but, unfortunately, it still seems to be a hot button issue. Regardless of how a woman is most comfortable feeding her baby, be it uncovered at the breast, covered at the breast, a bottle of expressed breastmilk, or a bottle of formula, plenty of people are uncomfortable witnessing a woman feeding her child and any form of breastfeeding seems to especially elicit vocal expressions of discomfort from others. I identified 9 reasons people may be uncomfortable seeing breastfeeding be it on social media or in person settings and tried to offer some solutions in overcoming what is essentially a discomfort about babies being fed. And that brings us to our first point:
What would you add to our list? Why do you think people may have issues with witnessing breastfeeding or encountering breastfeeding images? If you’re uncomfortable seeing breastfeeding, why do you think that is? Did you used to be uncomfortable seeing breastfeeding but are ok with it now?
by Tanya Lieberman, IBCLC, with Amy Peterson, IBCLC
We’re very pleased to share an interview about bottles and breastfed babies today. We asked Amy Peterson, IBCLC, co-author of Balancing Breast and Bottle: Reaching your Breastfeeding Goals, to answer our questions.
For those of you who combine bottles with breastfeeding – whether you’re pumping at work, supplementing, or use a bottle for occasional separations – bottle and nipple selection can be confusing. For those of you whose babies refuse bottles, it can be very frustrating!
We hope that the information she shares below is helpful. Amy offers more information on bottlefeeding breastfed babies on her website.
Many bottles are advertised as “easing the transition from breast to bottle” and back again. What do you think of these claims? Are they independently verified?
These claims are very misleading. Just as every mother’s breast has a unique shape and flow, every baby has a unique suck/swallow cycle. What works well for one baby might be terrible for another. Parents need to observe their own baby sucking on a bottle nipple and analyze if the latch and swallow look similar to that on the breast. In our book, we use a tool called the SIMPLE Method that guides parents step-by-step on how to choose a bottle nipple for their own baby’s unique latch.
We are not aware if such advertising claims have been verified. However, we do know that this type of marketing is in violation of the International Code of Breastmilk Substitutes. This international health policy document, adopted by many countries excluding the U.S., is designed to protect families from underhanded marketing ploys such as words or pictures idealizing artificial feeding. Comparing a bottle to breastfeeding—even if it contains breastmilk—is idealizing that brand.
In our professional experience of helping babies combine breast and bottle-feeding, we have found that the nipples which claim to be best for breastfed babies are often the worst choice. The bottle nipples that are best for breastfed babies have a gradual transition from tip to base.
You and your co-author tested 37 bottles. What were the features you were comparing, and what did you learn about the range of bottles that you’d most want parents of breastfed babies to know?
We tested two different aspects of bottle nipples. First, we measured dripping by looking at the number of drips and the size of each drip. Then we hooked up bottles to a hospital grade breast pump to determine how fast bottles flow. After performing these tests, we compared the results to see if bottle dripping and flow rate were related.
The results were surprising. First of all, about half of the nipples, regardless of a non-“no drip” label stopped dripping within five seconds of tipping them upside-down. That was important for us because many bottle companies claim their nipples are “no drip,” implying that bottles that don’t drip are a better choice. To rule out the importance of dripping, we did further testing.
Second, we measured the size of the drip for those bottles that did drip. The most important thing we found was dripping does not equal a higher amount of liquid. Bottles that appeared to drip a lot often had less volume. Frequently it is assumed that a fast dripping bottle has a large amount in the drip. We discovered that a bottle may drip frequently, but with a low output. So, it is impossible to judge the size of the drip with the naked eye. Stated another way, the number of drips doesn’t mean more liquid is coming out.
As for flow, the term “slow” is not standard. To determine flow, we hooked up bottles to a hospital grade breast pump and measured the amount of liquid collected after 20 cycles. We found there was a wide range of “slow.” For example, the fastest nipple was eleven times faster than the slowest nipple. Following testing, we ranked nipples from slowest to fastest in Appendix C of Balancing Breast and Bottle. This is important because if a nipple flows too quickly, a baby’s suck will become disorganized. Likewise, a nipple might be too slow for some babies. A parent needs to watch their baby’s response to bottle-feeding rather than relying on package labeling. If a parent thinks the bottle is flowing too fast, try a different nipple in the package, and/or try a different brand.
The most fascinating results came from comparing the data of these two tests (drip and flow). Dripping is different than flow; they are not related. Most breastfeeding books suggest turning a bottle over to see how fast it drips in an effort to select a bottle with a slow flow. This suggestion is not accurate. We tested a nipple that dripped an average of 56 times when tipped over, but had a slow flow. Then, we looked at a no-drip nipple and much to our surprise, found it flowed 10.6 times faster. Big difference! Dripping is not related to flow.
Parents are often advised to begin breastfed babies on “slow flow nipples,” but even nipples advertised as “slow flow” can seem very fast. Are there any that are as slow as you think is appropriate?
As mentioned earlier, the term “slow” is not standardized. Nonetheless, it is important to begin with a slow nipple. If a nipple flows too quickly, a baby’s suck will become disorganized. For breastfeeding babies, it is best to choose a flow that mimics mom’s flow. For this reason, it is hard to say one or two brands are “best” since flow varies from mother to mother. Likewise, a nipple might be too slow for some babies. This is why we ranked the bottles and listed them in our book.
It is also important to remember that flow is only one aspect of choosing a bottle. If the baby’s mouth placement is wrong, regardless of the flow, baby will bring bad habits to the breast and still be in danger of early weaning.
For parents who are struggling to get their breastfed babies to take bottles, and who are exploring different bottles, what should they be looking for?
Moms need to consider the nipple shape and their baby’s mouth placement on the nipple. Ideally, the nipple chosen will gradually flare from the nipple length to the nipple base. This shape allows the tip of the nipple to reach far back into the baby’s mouth as the breast does, and then helps the baby to feed with the mouth open. Quite often a “narrow neck” nipple has a shape that reaches far into the baby’s mouth and allows for gradual widening of the baby’s lips.
A shape that often does not work well is a wide neck nipple where the nipple length meets the nipple base at a right angle. This nipple shape promotes what we call “straw” sucking, where the baby’s mouth closes around the length of the nipple and doesn’t open for the base. When babies “straw” suck on a bottle nipple, we often see gaps in the corners of the baby’s mouth which leads to leaking milk, gulping air, etc. This is quite different than breastfeeding.
One bottle feeding method is called “paced feeding.” Can you describe it and explain why it might be helpful to a breastfed baby? What are some signs that a baby is becoming overwhelmed while bottle feeding?
Paced feeding refers to helping a baby eat more slowly from the bottle. Pacing became popular in 2002, before flow had been studied. The idea behind pacing is that by helping the baby rest briefly during bottle-feeding, moms can more closely mimic how the baby naturally feeds at the breast. When a baby breastfeeds, the mother has several let-downs during the feeding. Between let-downs, the baby’s sucking slows and baby can rest briefly. If a baby is feeding from a fast flow “slow flow” nipple, the suck/swallow will be disorganized. Pacing helps the baby have rest periods while bottle feeding that naturally occur at the breast. Now that we know flow can be controlled by choosing an appropriate nipple, we have another technique in our bag of tricks to help babies be more coordinated when feeding from a bottle.
It is important to note that most babies can pace themselves once they master bottle-feeding with the right nipple. How do you pace? First, listen for swallowing while the baby is breastfeeding, noting when the baby naturally pauses and rests. Then apply the same rhythm to bottle-feeding. Also of importance is positioning. With bottle-feeding, support the baby in a more upright position because the flow of some bottles increases when the baby is laying back to feed (another element we tested).
Do all breastfed babies require pacing? No, in fact, imposing pacing can disrupt the natural feeding rhythm of a baby and cause harm when over used. Babies who are “good” feeders, meaning they have a normal, rhythmic suck/burst cycle, do not need pacing. It has been our experience that once a baby has mastered bottle feeding, it is no longer necessary for the parent to impose pacing.
Some signs of a poor bottle-feed include gulping, catch-up breaths, fast feeds, leaking milk from the sides of the mouth or down the chin, baby who has a furrowed brow looking very concerned, and a baby who pulls away from the bottle. For these babies, nipple shape and flow need to be double checked, and this becomes a good time to use pacing. Pacing also is an excellent technique for NICU and other high risk babies that are having feeding difficulties.
Lastly, we would like every caregiver who uses a bottle to know that dripping bottles given before a baby begins sucking usually cause the baby to pull back or flat out refuse the bottle. Caregivers need to be sure the nipple is not dripping when the bottle is offered to the baby. Allow the bottle to stop dripping or keep the milk tipped down in the bottom of the bottle. This topic is further explored on our website.
On January 17, 2012 in the United States, Medela, best known for their pumps, launched their latest “feeding innovation”, the Calma. The Calma is a bottle that seeks to eliminate nipple confusion and flow preference by making a bottle fed baby work for its milk, similar to how your little one must compress and suck at your breast to get milk out. According to Medela, this “supports an easy transition from the breast to the teat and back.”
As a registered International board certified lactation consultant, I am very skeptical of these claims.
I have often heard that nipple confusion is a myth, foisted on mothers to keep them stuck to their brand new babies, to keep them from leaving the house, to subjugate us all. This is simply not true. Nipple confusion happens. I have seen numerous cases of it in my practice. Babies become nipple confused for three reasons – flow preference, difference in movements, and difference in feel. Medela has the right idea on part of the equation. Babies that are given a lot of bottles in the early period can decide that it’s not that fun to work a breast when this plastic thingy is way easier. Most bottles, even the slowest flowing, flow faster than milk from a breast. However, your baby also moves their mouth differently to get the milk from a bottle than from a breast. The jaw and tongue movements are not even close to the same, and trying to transfer the movements from one to another can frustrate and upset your baby. After all, if your baby is new, this whole eating thing is new, too. Why complicate it? There’s a bonus too: a baby nursing at the breast will develop their mouth in a way that will help with prettier smiles and better speech, too!
The third part of the equation is the different feel. If you are giving your baby a softer breast and a harder silicone, they may very well like the way that a bottle feels more – especially since that silicone is, again, delivering milk faster and the mouth movements are different. Medela hasn’t really done anything to cure that. I’ve seen and felt the Calma, and, I assure you, it will not be mistaken for breast tissue anytime soon.
The easiest way to prevent nipple confusion is by waiting to introduce a bottle until four to six weeks (three to four at the earliest) and to simply offer the breast more than the bottle. Some families have other situations, though, that don’t make the whole four to six week thing possible. So what is a modern mom to do? For many of us, it is not feasible to never give milk from anywhere but the breast. We have work, and school, and other children, and obligations, and, man, sometimes Mommy just needs a day (or an hour or two) off. But babies still have to eat during that time! And what if your baby has issues with latching at the breast, or you are inducing a supply, or you need to do some supplementing?
Luckily, being a modern mom means that we have some awesome options available to us. There is spoon feeding, where you can hand express colostrum or milk directly into a spoon and give it to your baby. This works best in the beginning, when your baby isn’t taking in much milk yet – it would be a fairly long process for a family feeding an older infant. To spoon feed, you simply use a clean spoon, hold the baby in an upright position (like sitting) and put the spoon at the lower lip, giving small amounts and letting the baby go at their own pace. A spoonful can be considered a full feeding if you are dealing with a newborn.
Cup feeding is another option. Cups are widely available, cheap, and easy to use. Your infant won’t take the cup from your hands and drink like a big kid, of course, but will instead lap at the milk kind of like a baby animal might. There are special cups sold for cup feeding, but it might be easier and cheaper to just use a shot glass. With cup feeding, like spoon feeding, you’ll hold the baby supported and upright. You’ll put the cup to the lips and tilt slightly so that the baby can easily lap at the milk (not so it’s pouring into his or her mouth.) Allow the baby to eat at his or her own pace. It may take a while, but that is ok! Babies shouldn’t be gulping down their feeds – when they do, they often overeat, which can hurt their tummies and set a bad precedence of wanting more than they need.
You can also use what’s called a supplemental nursing system, or SNS. SNSs are generally a bottle type thing hooked to a long tube. You put the milk in the bottle part, and then you can do one of two things with the tube. First, you can use it on the breast, either by sticking it in a nipple shield (which you should only use if followed by a lactation consultant for sizing and to negate any potential complications that might arise) or by taping the end near the nipple so that the baby gets an extra boost of liquid while nursing. This can be really helpful if you’re relactating or increasing a milk supply, if your baby needs to be supplemented but is nursing well, or if you have a preemie or baby with suck issues that maybe doesn’t milk the breast as effectively as they should be. You can also use a SNS to finger feed your baby. With that, you attach the tube to your finger, and the baby sucks the finger to get the milk. A lactation consultant can even help you use this method to train or retrain your baby to suck properly. SNS systems can be hard to clean, so please carefully read the instructions and check with a health care provider for any extra precautions you should take if you have a preemie or immune compromised baby.
If you have an older baby (4 months or so) that’s just now getting around to taking milk in another way, you can try forgoing bottles altogether and working on cup training or using sippy cups. Sometimes the difference is interesting enough for an older baby who has rejected bottles. As with any of the other methods, the goal is to allow your baby to learn and go at their own pace. Be prepared for this to be a messier endeavor with an older baby who is starting to show some independence. You will probably have to help them to hold and tilt the cup – they may not be content with the idea of you holding it all yourself, and you may have some spills in the process.
But what if none of these methods work for you? Maybe your care provider is balking, or you are annoyed and uncomfortable with one or all of the methods, and you really, really just want to use a bottle. In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding. In fact, any time you are bottlefeeding, you should use this method. It is the ideal way to feed a baby from a bottle and encourage any care-takers that will be feeding your baby with a bottle to utilize this method as well. In choosing a bottle, there is no really good evidence that I have seen showing that a certain bottle or nipple is better than another for breastfeeding. There are a lot of nipples that are supposed to be similar to your breast in look and feel, but in my time in the bottle aisle, I never saw any that made me go, “That looks EXACTLY like my boob. That one, right there, with the wide base and medium sized nipple!!” My kids never really liked the wide bottomed nipples, although they are often touted as being awesome for breastfeeding babies. When it all boils down to it, most of that is hype. When selecting a bottle, select the one you think might work that is in your budget.
If you are giving milk due to a breastfeeding problem, be sure to discuss methods and supplements with a medical professional with good lactation training. Ask a lot of questions. If supplements are ordered, get a LOT of information on them. Why do you need to supplement? How long does your medical professional want you to supplement? How much should you supplement? How often should you supplement? Can you use your own expressed breast milk? What is the plan of action for weaning from supplementing? If your baby isn’t nursing well at the breast, you will likely need to do some pumping along with the supplementing to keep your supply healthy while you work through the problem. Find out how often you need to pump and how you should store your breastmilk – especially if your baby is hospitalized and you are transporting it.
There are other feeding options for more serious problems, such as cleft lip/palate as well. That type of situation needs to be followed very closely by a lactation professional and physician to ensure that the baby’s unique situation is being addressed.
If you are going to be separated from your baby for another reason – work, school, or just going out – remember to think of your magic number. This is the number of times your baby breastfeeds in a normal day (and, yes, that can vary. Just take an average.) You want to be sure that you are replicating that amount of times by a combination of pumping and nursing. This will help to keep your milk supply plentiful.
In the end, there is no product on the market that can magically be just like your breast and provide your baby the exact same experience. Luckily, there are many options for your baby and your family that will help you to achieve your breastfeeding goals.