Why Do So Many Breastfeeding Mothers Supplement with Formula?

According to the U.S. Centers for Disease Control and Prevention, fully one-quarter of the babies born in America in 2009 were supplemented with infant formula by two days of age, and by three months, this had increased to nearly two-thirds. A very small number of breastfed babies really do need supplements, but most do not. Why then do so many mothers planning to exclusively breastfeed supplement their babies with formula? A recent study provided some revealing answers. 

In this study, 97 English- and Spanish-speaking low-income mothers participating in a U.S. government Women, Infants & Children (WIC) food subsidy program took part in 12 focus groups. The conversations in these focus groups were recorded to allow the researchers to analyze the mothers’ responses and better understand their motivations.  

After analysis, the researchers concluded that these mothers supplemented with formula during their hospital stay primarily because they were unfamiliar with infant and breastfeeding norms and they misinterpreted their babies’ behaviors. In other words, they considered formula the solution to imaginary problems. For example, many mothers did not realize that newborns woke to feed so often and thought that giving formula would give them more rest. 

“I think I just really wanted to sleep because every time I would fall asleep he would wake up hungry and I started to become frustrated. I felt that maybe I did not fill him, because it was every 2 hours…but now sometimes it’s still like that every 2 hours.”

The mothers also believed that their colostrum, the early milk, was not enough for their babies.  Many assumed their milk would increase at birth, and when they learned this did not happen for about 2 to 3 days, they assumed wrongly that their babies needed supplements. Others perceived comments from the hospital nurses to mean they didn't have enough milk.

The mothers assumed that latching should be easy and automatic, and when their babies had any difficulty at all taking the breast, they perceived this as “breast refusal,” thought their babies didn’t “like” breastfeeding, or saw it as a sign their baby preferred formula. When they experienced breastfeeding problems, such as sore nipples, some chose to give formula rather than requesting breastfeeding help.

On the second day of life when babies are normally wakeful and fussy, many of the mothers interpreted this typical behavior as a sign their baby needed formula. As one mother said:

“I really wanted to breastfeed him, but like I said, he was hungry all the time; he wasn’t sleeping as much because of it, so I had to switch over.”

This was true even among Latina mothers, who many believe supplement routinely because of their cultural beliefs. The researcher found that cultural beliefs were not the root cause of supplementation; the Latina mothers gave supplements for the same reasons as the non-Latina mothers.

What can be done to correct these kinds of misunderstandings? Thankfully, there’s an answer.  A research team led by Jane Heinig at University of California Davis has developed a program called Secrets of Baby Behavior that was designed to give new parents the information they need about infant and breastfeeding norms to reduce unnecessary formula supplementation and to help prevent childhood obesity caused by overfeeding. These materials, which are available to everyone, describe:

• How to interpret baby’s cues
• How to deal with baby’s crying 
• Infant sleep norms

When new parents understand what’s normal, they’re less likely to interpret typical baby behaviors as indicating a need for infant formula.

The Secrets of Baby Behavior blog provides parents with ongoing evidence-based guidance and support. See its explanation of why newborns usually become fussy on the second day of life  (this is true no matter how they’re fed) and its four-part series on infant sleep. 

For the full California Baby Behavior program implemented by California WIC, including training materials, click here.

Thank you Dr. Heinig and the team at UC Davis for these outstanding resources for breastfeeding families!

Reference

DaMota, K., Banuelos, J., Goldbronn, J., Vera-Beccera, L.E., & Heinig, MJ. (2012). Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women. Journal of Human Lactation, 29(4):476-482. doi: 10.1177/0890334412445299. Epub 2012 May 24.