Can wise people here give me some references to support formula reducing supply?

[thunksheadontable]

Going home in a fortnight to visit my family and inlaws for the first time since ds2 was born (he's 6 weeks).

My SILs both have small babies (14 and 18 weeks at the moment) and are both GP's. They also both give a bottle of formula before bed.

I am going to get lots and lots of questions about why I won't give ds2 a bottle, but I did give ds1 a bottle (was advised to as I had supply issues) and as you might imagine my supply dipped and dipped and dipped and it affected his weight gain and it made for a horrendous experience overall.

I've had the experience before that they scoff at my suggestion that introducing formula might have had an impact on my supply as they have done this with all their kids and it hasn't affected theirs. This typically happens at the dinner table (oh why won't you give him a bottle etc etc) and because they are both GPs their word is taken as gospel.

I'm not going to quote references at them at the dinner table but for my own confidence I'd really like to know I'm not talking out of my backside.

Thing is it's not introducing formula which reduces supply, it's the missing a feed which reduces supply. Basically the less you feed the less milk you make. Generally, one bottle of formula given before bed shouldn't be an issue as long as they stick religiously to this one bottle, if breastfeeding is already established, and especially if they tend to pump at around the same time, although this isn't necessarily an issue (the body will just assume the baby has dropped a feed/does not need a feed at this time).

The problem comes if formula ends up as a regular back up, either at random or because the parents are unduly concerned about supply, or because they're misreading the baby's behaviour as hunger when actually it's a natural response which increases supply in the body. Topping up because of initial low supply is sometimes necessary but almost never supported with advice on how to increase supply successfully and move back to full breastfeeding. (As it should be).

TBH I don't know whether there is research on this or not, because it has to be hard to measure - how do you judge whether supply is dipping? It's not something you can measure because expressing isn't a good measure. The only thing I can think of is the infant feeding survey which shows that the earlier the introduction of formula, the shorter the duration of breastfeeding as a general trend, but it's hard to separate out causation from correlation - perhaps people who introduce formula earlier on are less likely to want to breastfeed for a longer time, for example. Of course it could (and I agree is likely!) to be that introducing formula in a lot of cases causes problems with supply but there is no way to separate out the two situations in the survey results.

Either way whether a bedtime bottle affects supply or not you don't have to do it! :) Just smile and say "Oh, we're doing fine thanks, yes, I might try that if it becomes a problem, we're happy as we are for now though."

The thing is it can also be quit an individual thing as well. Some women may cope fine with one formula feed, where as others would fine just missing that one feed could be quit detrimental to the whole supply.

One of the issue it can cause is if giving as the last feed at night and then not pumping, you can then have a long gap between feeds. epically when baby starts sleeping longer and this can have a negative overall effect on supply. So it may be find while baby is still waking for feeds but could turn into a problem later on when they are going longer at night.

What mite be interesting for you to tell them is that introducing a bottle of formula seems to have no impact on more sleep a mum gets. and there is some research on this.

that should have been the amount of sleep mum gets.

Yes but my experience last time was with one bottle and I would feed before it and pump during and fed on demand and my evidence of poor supply was that his weight stopped progressing and he fell off the charts, output reduced, he was angry and frustrated feeding. He never had more than one bottle. It just totally messed it up and he gained incredibly slowly going from 75th centile down and down. Everyone said he was just skinny like his dad but as soon as solids were established at 7 months, he started to climb back up and is 75th centile now. It just disrupted the whole thing from four months, they have all given bottles from very early AND they have nights out etc and have never had issues with their older kids.

He could have just been skinny, though. Weight gain isn't the be all and end all. It's impossible to know what happened in any case now. But DS did a similar thing - was on lower centiles for ages and then once he started eating properly at 22 months ish he shot up and is now between the 75th and 90th but he doesn't look overweight.

Just say you don't want to. Even if it doesn't affect your supply, using bottles is not compulsory so just say you are happy with things how they are. Just because they are doctors does not mean they get to tell you how to feed your baby. Simply say you are happy with exclusive breastfeeding and therefore you see no need to use formula at this point in time. There is no proof that formula makes babies sleep through earlier anyway. If they have "advice" for you then smile and nod and say you will bear their tips in mind if you decide EBF is not working for you anymore in future. Then change the topic of conversation.

When I get questions about my parenting choices by my In laws. I say the following " It works for us as a family" It's calm, it's kind, it's not argumentative but it stops the questions that In laws seam to be able to dish out.

As a side note I also used the "it works for us as a family" with my GP who was questioning why I was continuing to feed my baby.

Or if you are feeling brave you could just quote the World Health Organisation
"WHO recommends mothers worldwide to exclusively breastfeed infants for the child's first six months to achieve optimal growth, development and health. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond."

WHO Link

Then if you are feeling particularly brave add something like "I though seeing you were trained to follow evidence based gold standard scientific research in your practice you'd have heard of WHO and their recommendations"

I wouldn't be that brave myself but I wish I was as my FIL always sport medical rubbish and everyone agrees with him because he studied medicine 45 years ago(never practiced)

Good luck what ever you decided to say/do

Kellymom has some good info on this, all evidence based.

kellymom.com/nutrition/milk/infant-formula/

Sadly being a GP doesn't seem to have any bearing on BFing knowledge. Lots of people I k ow have stopped BFing at 12 weeks because the GP has said its enough

Will try that again ...

kellymom.com/nutrition/milk/infant-formula/

You may have been having other issues hard to know. But some women are that sensitive as well you may have pumped but puking doesn't trigger the same hormone release and can effect supply. It doesn't always work.

But it doesn't mater what they think if it doesn't work for you and you don't want to do it, then you shouldn't have to justife your choice.

BertieBotts, he ws 75th at birth, he plummeted off the charts and looked, frankly, emaciated and unwell. Only one in a thousand babies is 0.4 of a centile and he was less than this. As soon as he started eating he careered back up the charts. I know he wasn't getting enough food and he wasn't just skinny, anyone who looks at pictures of him at birth, at 5 months and at 9 months would know so even the "look at the baby, not the scales" thing really doesn't apply here. I think it's weird the way that we say there's individual variation in everything but apparently all women have adequate supply no matter what.

Anyway, apparently there's no "evidence" that formula had anything to do with this but I'm willing to bet good money it didn't help. I find the amount of conflicting info on bfing very tiring. One minute dummies and bottles are inevitably going to reduce supply, next minute they're fine etc etc. Why do they persuade you not to give formula if one bottle can't affect supply, I am really surprised at this because why would there be such a kerfuffle if it's all the same either way?

Hazchem I like this response .. will try that.

Or you could just remember that GPs are General practitioners and not infant feeding specialists , and therefore, as such, the only guidelines they have (which, the NHS's official guideline is the WHO one) is the WHO one, so that's the one they should be telling you - they are giving you a personal opinion, not a professional one, and as such, you should say "we'll follow the WHO guidelines thank you"

:)

And I thought having an ex-Midwife as a MIL was bad/hard enough. Best of luck