We hear lots of different reasons mums choose to introduce formula when breastfeeding; pain, a very unsettled, hungry (or perceived to be) baby, feeling overwhelmed at being the sole person responsible for nourishing their new bundle (who perhaps may be growing slower than health professionals are happy with), returning to work or fear over feeding in public are a few of the common ones.
Society has researched, surveyed and tried to explore these reasons, in the hope barriers to success can be broken down. But something I don't see examined with such scrutiny, is why mums so often "switch to" formula.
What I mean is why does it have to be a straight swap from 100% of one to 100% of another? Why does it have to be all or nothing?
If we think of the breast purely as food, it perhaps seems logical. If baby is getting adequate nutrition from another source, why continue any feeds at the breast?
But it's not.
Breastfeeding is about so much more! Hormones, antibodies, bonding and comfort, often a "go to sleep" switch for all involved, to name just a few from a long list.
The problem is how often does a new mum know all this?
Whilst mums often hear oodles of tales about cracked nipples and mastitis, how often does someone who has breastfed successfully for longer than a few months, sit at a baby group regaling others with tales of all the upsides? Er no, that's the definition of smug, judgy breastfeeding mum is it not?
For women who have never breastfed, have no family or friends that can share their insight into what lays beyond the early days, the sad thing is most don't even know what they're missing.
Of course the norm should be that all mothers get fast, effective help to resolve their problems; that all should be supported to exclusively breastfeed for as long as they wish. But at the moment this isn't the reality. For those who haven't managed to resolve problems and are about to switch 100%, don't they deserve to know they have other options?
To be supported to even share one breastfeed per day? To know they can put the baby to the breast before or after the bottle (a baby causing lots of nipple damage may be more patient in adjustments and suck less strongly when he's not as hungry) at every feed, at some feeds or even for just one if that's all mum feels she can manage.
Once nipples have healed, mum may then choose to increase this if desired. If we remember babies who (for whatever reason) are not able to transfer milk as effectively as they need, may consistently feed for very long stretches or very frequently, and that baby is most likely not transferring well because of shallow attachment - the combination of the two can quickly cause cracking or bruising to the nipple. Once this has healed mum may find combination feeding doesn't permit frequent enough feeding for trauma to reoccur.
I think mums also deserve to know that even if baby's main source of nutrition is formula, that doesn't mean they must also switch to an artificial pacifier; mum can continue to use the inbuilt original aka her breast should she wish to do so. I've known babies suckle at breasts with barely any milk supply, which surely only confirms that to them, it's definitely not always just about feeling full.
Using some formula doesn't mean mum has to also miss the special little moments; baby pulling from the breast smiling, milk running down his chin. The instant soothing of a teething pain, learning to sit bump, or 3am fussies with a simple lift of her shirt?
Some mums who feel baby just wasn't getting enough at the breast might choose to supplement feeds during the day and breastfeed only overnight. If we think calories over a 24 hour period, if low intake was the issue (and increasing supply isn't an option) the extra milk can be given during waking hours, giving the ease and convenience of being able to roll over and feed baby instantly without either party fully waking.
For mums returning to work with younger babies and not wanting to express, you can continue to breastfeed your baby when you're with them. Yes supply may drop compared to exclusive feeding, but if the alternative is a complete swap, then any feeds are a bonus right? If baby drains the breast well when you do feed, and this happens with any regularity, supply is unlikely to dwindle altogether.
Even if baby isn't drinking lots of milk when at the breast and supply does reduce, it is likely to happen more gradually; this reduces the chance of mum suffering blockages or mastitis. As supply reduces the breast begins a process called "involution", and milk gradually reverts to a more colostrum like substance to give the weaning nursling a boost of antibodies.
We could go through lots of scenarios to show how breastfeeding can work in different situations, and it is worth noting there is the potential for a baby finding breastfeeding difficult to become increasingly fussy or refuse the breast once nutritional needs are met elsewhere. But if the alternative is no breastmilk anyway, some may feel they want to give it a try.
Lastly, and perhaps a key reason to not jump feet first, is that it leaves a window open for a change of heart. Mums often choose to stop breastfeeding when emotionally at their lowest; tiredness may be overwhelming and she's aching for the situation to stop, never wanting to breastfeed again! But a few days down the line feelings can change, if partners go back to work the realisation of just how much of a faff formula is (not to mention the ongoing cost) can hit. If not, mix feeding may feel more doable, but if mum does want to stop entirely that option is still there. At least then the decision has been made rationally and not because things are so unbearable mum feels she has no choice.
I think we have to recognise that whilst there are such gaping holes in the support mothers receive, and a culture still so pro alternatives, any continued breastfeeding should be celebrated as one small step for mothers. Perhaps instead of focusing on what we can't or don't do, we need to look more closely at what we can. Celebrating every single feed as one more than might have been; after all every day matters.