Formula Supplements Put Mothers at Risk
Nancy Mohrbacher Monday, May 23, 2011 at 7:28PM We know that anything less than exclusive breastfeeding increases health risks for babies. But what about mothers? I often talk to breastfeeding mothers who decide to supplement their babies with formula because they assume they will get more sleep and that sharing feedings will reduce the stress of the early 
postpartum. Most don’t realize this strategy actually has the opposite effect.
In an earlier post, I reported on research that found exclusively breastfeeding mothers get more sleep at night than mothers who also feed formula, even when others handled some night feedings. Now a new study1 takes this insight one step further by examining how formula supplementation affects the amount of sleep new mothers get, their risk of depression, their overall health, and their feeling of well-being. During the early postpartum all of these measures profoundly affect a new mother’s enjoyment of her baby and her ability to cope.
This study, which will appear in the June issue of the journal Clinical Lactation, surveyed 6410 mothers during the first year after birth. Although all new mothers experience fatigue, it found that exclusively breastfeeding mothers not only slept significantly more hours during the night than other mothers but also reported significantly more energy during the day, a better mood, better overall health, and a greater sense of well-being. Another surprising finding was that there was no statistically significant difference in any of these areas between the mixed-feed and the exclusively formula-feeding groups.
This means that rather than making a new mother’s life easier—which is often her goal—feeding her baby formula supplements can significantly decrease her quality of life. The authors note that some popular books on postpartum depression recommend that after birth at-risk mothers sleep apart from their babies and let others handle night feedings.2 Some hospitals have even begun implementing this strategy among at-risk mothers before discharge. Even more extreme, others recommend at-risk mothers avoid breastfeeding altogether as a way to prevent postpartum depression, despite the substantial evidence that breastfeeding mothers have a lower risk of postpartum depression.3
This new study indicates that although trying to help at-risk mothers get more rest after birth may seem to make logical sense, strategies that separate and supplement newborns are misguided. They actually put mothers at greater risk of sleep disruption, depression, and poorer health.
References
1Kendall-Tackett, K., Cong, Z., & Hale, T.W. The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation 2011; 2(2): 22-26.
2Bennett, S. Postpartum depression for dummies. Hoboken NJ: Wiley Publishing, 2007.
3Dennis, C.-L., & McQueen, K. The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics 2009; 123(3):e736-e751.
Reader Comments (12)
Quite an interesting post. I suffered from PPD/PPA after my first. I did use some formula with him. There were a lot of other factors involved - mainly a thyroid issue that wrecked havoc on my supply - but this post does cause me to wonder how much of the PPD/PPA was from our feeding issues vs my thyroid issues.
Was there any weeding out of BF mothers to compare those who co-slept vs. kept baby in separate room and those who pumped and had someone else give some of the feedings? I BF exclusively till 10 months (at which point I had to add 1 bottle of formula per day because I couldn't pump enough at work) and then weaned at 14/15 months. But I NEVER coslept because I found the side-lying position terribly difficult to figure out and just plain wanted to sleep alone in any position I felt like I could just so I COULD sleep. I don't think I could have slept comfortably with baby right there. I sleep with earplugs and if there is any light, eye shades. I wonder if it was only the co-sleeping moms who reported 'good' sleeping and being more rested. I certainly wasn't well rested and imagine it would have been about the same if I had fed formula.
Hi, I am a BF mom via bottle. My Dear Son never took to BF so I pump 24/7/365-- going on 1 year now. I sleep an average of 4-5 hrs /night. (2am-6 am). We Co -Sleep. Despite the little sleep, as far as I know, I never had PPD. am in good spirits and am very glad I can pump for him. giving him Breast milk is my number 1 priority despite the challenges it poses on me with time and schedules. I pump at home, at work, on the go anywhere I am the pump is as well. I absolutely cherish Co-Sleeping with him. Since early on, we shared such joy and comfort in each others company that we developed our own language depicting needs. He had only to make the slightest noise or movement and I immediately new exactly what he wanted (change diaper, feed me..). Our proximity made for seamless nights, early on full night sleeping (6+ hrs) w/in week of birth and quite day and night interactions. Minimal fussing, crying or tantrums. We are all happy. Best thing I could have done. Would do it all over again.
My guess is that it's not only breastfeeding but breastfeeding AND co-sleeping that make the difference
I ebf and get NOOOOOO sleep. Lo is now 7 months and we co-sleep and I am so ready to get her to the crib but the transition is not working. She would normally sleep 2 hrs and wake to nurse, but lately it's been about 20-30 min spells of nursing, fussines, all night long. She started solids at 6 mos and doesn't really care to eat as much. She prefers to nurse and I am ready to supplement, was going to call her pedi today because I am not getting any sleep and she is nursing more than less.
The abstract of the study in the third reference above states: "The results from this review suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy" Isn't this saying that post-partum depression can make it harder for women to breastfeed, rather than that breastfeeding mothers are less likely to suffer from ppd?
I cosleep and breastfeed and my daughter is 14 months. I stared introducing food to her at 6 months, but she has only recently been actually eating solids. I would say for about a year 90% or more of her nutrition came from breast milk. For the most part food was a toy. Cosleeping has really helped me sleep more. It is rare for me to wake up now when she wants to nurse. I was high risk for ppd and I don't feel like I had any. I can't say 100% it was one thing or the other, but our system really works for us.
I agree with Rina.
Correlation is NOT the same as causation.
I find it hard to take seriously any LC or breastfeeding advocate who cannot grasp this simple but important concept when referencing breastfeeding studies.
I am the author of the study that Nancy cited and I think I can answer some of the questions above.
First, there were 6410 mothers from all over the world in our study. We included all sleep arrangements in our analysis, so that within any group, there were mothers who bedshared and mothers whose babies were in the crib in another room. For this analysis, we used only a summary question to form the groups: Since you baby was born did you breastfeed, formula feed, and both breast and formula feed? Based on that question, we looked at depressive symptomatology, reported hours of sleep, overall fatigue, subjective well-being and subjective emotional health. We did not attempt to proof a causal link from our data as our data did not really allow for that. What we could, quite plausibly, conclude is that breastfeeding mothers were reporting better scores on every indicator. What really amazed me was how consistent the answer were--especially since the questions were part of a very large survey and were not near each other on the questionnaire.
And yes, depression can lead to breastfeeding difficulties, so it can be a two-way relationship.
What we were specifically trying to address was whether breastfeeding increased the risk for depression (as some claim). The answer is no. And are breastfeeding mothers more tired? Again the answer is no. And when we look at the sleep variables, we can see why that is the case with variables such as number of awakenings, minutes to get to sleep, and total hours of sleep.
I think we might find even a stronger relationship if we looked at the combo of breastfeeding and infant sleep location. For now, the sample included both.
If you are interested in looking at the actual paper, here is the link. The findings a pretty clear. http://www.kathleenkendall-tackett.com/CLkendall-tackettCongHale.pdf
I hope that answers some of your questions.
Kathy Kendall-Tackett
It is true. Synthetic and formulated food supplements are not advisable for pregnant women. Which is why natural food supplements are better.
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Since I last posted I've had another child and have figured out the side lying nursing position and because it has been easier I feed mostly in bed at night/overnight. So I guess you could say we co-sleep! But it is not at all like I envisioned and the magic is simply not there. I had this vision of a happy baby all night...as long as baby is close and within nursing distance there would be no fussing and mama would never need to get up. But it isn't that way. Between diaper changes and soothing crying baby in a myriad of ways when nursing does NOT cut it...it really is NO different at this point (baby is 2.5 weeks old). You still have to get out of bed, still need light, still might need to walk around the house. Perhaps the magic 'never have to get out of bed or wake up' of cosleeping happens later???
To me Adina, the magic of co-sleeping was a) to minimize the fuss (i.e.
crankiness of baby) and to grow tighter bonds with him. This recipe does
not in any way reduce my responsibilities i.e diaper changes or other
activities that I, as a mom, need to perform to ensure the baby relationship
is a well-oiled machine.
For my particular experience, being next to my little one, has been a dream
come true and would not change it in any way. I have been able to tune into
his needs in such a way that he has very little distress to such blessing that
he slept 6 hrs a night w/in the 1st week and has been a peaceful sleeper
ever since. Now co-sleeping alone did not do the trick, but it greatly facilitated
the process in a way that separate room sleeping could not ever have provided for.
Tools I used along with co-sleeping to make my magic happen...
I learned in the first month the Dunstan method
(materials:http://www.dunstanbaby.com/cms/index.php?page=au-research ;
http://www.dunstanbaby.com/cms/index.php?page=us-how-it-works )-- it worked
like a charm because we co-slept. I was right there to see and hear--and act
promptly. Thus-- no fussy baby but peaceful sleep.
(p.s the handout might do, but I think the audio is very helpful. I'd suggest you and your friend mommy's get the disc together and pass it around the local mommy and me groups you might belong to.)
I also watched carefully what I ate and avoided any stomach upsetting
ingredients (anything that is spicy, produces gas, bloating etc) as it
passes on trough the milk and produces the same effect in baby = discomfort.
I use homeopathics like pure chamomile 30x or 6x if warranted, to diminish
stomach or teething discomforts, -- it provides for soothing well being.
Still use it with my 15 month old.
So you see, it is not one thing but the combination of that, at least in my
experience provides for the blissful experience as it is allowed by the
close proximity.
No let me frame that...it has not been "generally blissful" as my dear son
never took to the breast and I am a 27/7-365*2 years (i hope) milk
expressing/ pumping mama. This in itself provides for very broken sleep. I
pump now at 15 months still 6 times a day/night. At your son's age I pump every
2.3-3 hrs. and the duration was for 1.5 hrs to obtain 4 oz of milk. It was
treacherous! But like anything in life, if you keep at it, you get used to
it. I do it out of conviction that I am doing the absolute best for my son,
so pumping I continue. Is it disrupting? Yes. but so be it.
So as you see, the objective of my blissfulness is not to have a "non
disrupted life" mine is very disrupted in more than one dimension, but to
smooth the interactions with the baby, to keep it low key, pleasant and that
-it has.
For bonus... just love to be there when he wakes-up. his gentle touch
nudging me, caressing me, his hugs, or to simply hear his peaceful and restful
sleep. to know that he is content, trusts, and all is well in life.
Hope this helps
Hang in there....
Adriana
P.s it took my body about 4 months to function well on 4 hrs of sleep a night. been on that schedule for about 15 months now.