Increasing Milk Supply

Concern over low milk supply is a very real issue for many breastfeeding moms.  While not having enough milk is the most common reason given by mothers for early weaning and supplementation, actual low milk production is very rare. 1 Whether it is real or perceived, understanding how your milk supply is established and knowing what to do to optimize your breast milk supply can relieve stress, worry, and ensure your body has the opportunity to make enough milk for your baby.

Strategies to increase breast milk supply

Once you realize there is a milk supply issue, diligence is extremely important to help build your supply.

  1. Ensure you are feeding your baby with a deep latch and effective milk transfer at his early feeding cues, without limiting access to the breast, at least 8-10 times (or more!) every 24 hours.
  2. Increase the amount of times your baby is nursing at the breast.  Babies with an effective suck are usually more effective at milk removal than pumping or expression.  Offer each breast more than once at a feeding and offer to nurse your baby often!
  3. Use breast massage/compression.  Think of this as “pumping” into your baby.  Breast compressions while breastfeeding (or pumping) help your breasts drain even more milk.  And an empty breast makes more milk.
  4. If your baby doesn’t completely drain your breasts, you can express following a feeding to help build your supply.  Alternatively, if your baby does empty your breasts, waiting 30 minutes (while your breasts are busy at work making milk) and then expressing will help increase your supply.  Remember, an empty breast makes more milk, whereas milk stasis in your breasts slows milk production.
  5. Don’t allow more than 5 hours to go between a feed, and only allow this much time once every 24 hours.  If your baby goes this long between a feed, make sure he is still nursing at least 8-10 times in a 24 hour period.
  6. Spend as much time skin-to-skin with your baby as possible.
  7. Consider safe bed sharing or co-sleeping with your baby.
  8. Avoid pacifiers (dummies) and anything else that would keep him from suckling at the breast.
  9. Consider taking a galactagogue.  Herbal galactagogues include fenugreek and blessed thistle.  There are also prescription medications that can help (though all galactagogues can have side effects and inherent risks) so other measures should be tried first.  Also, a galactagogue will only be effective if you are frequently and effectively removing milk from your breasts.
  10. If a supplement must be given, consider giving it through an at-breast tube feeding device.  This has the benefits of continued breastfeeding and breast stimulation while at the same time giving your baby a supplement (which could be formula or breast milk), skin-to-skin time holding your baby, and no chance of nipple confusion! But, be aware that formula takes nearly twice as long to digest as breast milk (78 minutes vs. 48 minutes) so if you give a supplement with formula (as opposed to expressed or donor breast milk) then your baby may sleep longer between feeds than he should.  You may need to express twice during this time to actually mimic how your breastfeeding baby would have nursed.
  11. If any bottles are given, make sure you pump or hand express on both sides so your body knows that your baby just ate.  If using a pump, make sure the flange is the correct size.
  12. Use caution with bottles. Babies must suck at the breast before there is a let-down of milk.  This makes it easier to self-regulate how much milk he actually needs.  With a bottle, some babies continue to eat even when they are full because it is an “effortless flow” and they can do nothing but gulp and swallow.  Taking care in how you give a bottle can ensure this doesn’t happen.

Other things to consider:

  • Make sure you are not using any hormonal medications (estrogen suppresses lactation and progesterone may also) or other known anti-galactagogues (such as decongestants).
  • Is it possible you are pregnant?  Hormonal changes in pregnancy can also decrease your milk supply.
  • Have your doctor check your endocrine levels. Perhaps there is a thyroid issue or some other hormonal imbalance that could be corrected with medication.

Colostrum in Syringe

Benefits of Colostrum

DSC_1280After giving birth, a mother’s milk is very thick, rich, and in small quantities for the first 2-5 days.  This milk is the world’s most amazing super food – colostrum.  Unable to be replicated in any laboratory, it gives babies antibodies and immune system boosting cells.  It is perfectly created for babies and helps their immature intestinal system to function effectively.  Breastfeeding often and on demand ensures that babies have plenty of stools, which helps to prevent jaundice.

A newborn baby’s stomach is only the size of a small marble.  Filling it with anything other than the richest, most perfect super food will prevent him from eating the amount of colostrum his body needs.  The thick texture causes a slower flow from the breast, a perfect primer in how to breastfeed effectively allowing him time to practice sucking, swallowing, and breathing in rhythm before a mother’s milk begins to flow stronger. It is also rich and filling, exactly what is needed in small amounts during the first few days of life.

The protective qualities in colostrum are better than any vaccination and make it difficult for bacteria and allergens to attack a baby’s body.  Even if a mother does not want to continue to breastfeed her baby, giving colostrum over the first week of life has tremendous, positive health implications.


Breast Milk Antibodies

You may have heard that breast milk has living antibodies that help protect your baby from getting sick.  It’s true!  But, how does all of that work and how can you maximize the specific antibodies your baby receives?

How it works

Immunoglobulins in breast milk produce an antibody response specific to the germs and bacteria you and your baby contact.  The most famous one is sIgA, though there are several that do this amazing work. When a mother comes into contact with an antigen (whether she contacts it directly or her baby has come into contact with it and her body picks up on this from touching her baby and receiving these germs from him) her body immediately goes to work.  Cells in a mother’s body carry these invader germs to either the respiratory or intestinal tracts where her body works fast and furiously to produce IgA antibodies that are specific to exactly what she has come into contact with.  Once this antigen response has been made it travels to the mammary glands where your baby receives specific protection in the breast milk. 1  Secretory IgA lines your baby’s intestinal tract, urinary tract, and oral pharynx and helps fight these harmful pathogens.

How long does it work

When a baby is born, his immune system and gastrointestinal tract are immature.  Ideally, they will receive breast milk alone for the first six months of life, which coats, protects, and allows these systems to mature.  A newborn baby’s own IgA system is deficient and unable to make this antibody response in the beginning.  His body slowly matures and gains this ability, though it develops more slowly and great harm can be caused when foreign substances (including formula) pass through a baby’s immature system. 2 Babies need this protection from breast milk; and it cannot be replicated in formula since it is not a living, changing substance.

In short, sIgA is found in high levels in colostrum (a baby’s first milk to coat his system) and protection to your baby begins immediately upon commencing breastfeeding!  Even better, the protection doesn’t slow down during the duration of nursing.  As a mother’s body makes more milk, the dose of sIgA increases so that the level your baby receives remains constant throughout the duration of breastfeeding. 3 So no matter how long you breastfeed your baby, there will always be these amazing antibodies in your milk specific for your child.

How can I maximize protection for my baby?

In order for your body to make specific antibodies, you need to come in contact with the pathogens.  If you know your baby has been around a person who has a cold, for example, rather than washing your hands and your baby immediately following exposure, scoop your little one up, touch him, kiss him, nurse him. Make sure whatever he’s come into contact with you also touch.  Then your body will go to work and start the incredible process of making milk with antibodies specific to that pathogen.

Think about it, when your baby is small you can protect him more from many germs, but his immune system is also weaker and he needs protection from your milk.  As he grows, he begins to explore his world and put everything in his mouth.  Once he’s at play groups, nurseries, or friends’ homes, he is coming into contact with so many new pathogens every day!  He continues to need your amazing milk to help him have a quick response with specific antibodies.  His system could become tired and worn down, if his growing body is left to do it on his own. Or, if he’s still a young baby his system will be too immature to be capable of producing this immune response at all.  But together, through your breast milk and his maturing body, you make a great team providing optimum protection from sickness as he grows.

So as your baby grows and plays with other children and toys, rather than taking him straight home for a bath why don’t you spend time together cuddling and making sure your body picks up on everything he came in contact with before washing it all off?  Typically your baby will come in contact with much more than you because he plays with more and puts so much in his mouth. If you will take time to touch what he played with (perhaps while you are helping to tidy up?!) and then nurse your baby, your body will be set and immediately go to work making an immune response in your milk.

How awesome is that? Definitely another reason to breastfeed your baby!


Uniqueness of Breast Milk

Mother breast feeding her sonThe uniqueness of breast milk is undeniable; it is an incredibly amazing and wonderful living substance!  Unable to be replicated in any laboratory, it is the “norm” for what a baby should eat.  But not only is human milk unique, all mammalian milk is specific to its kind and completely unique for its offspring.  For example, a mother polar bear’s milk has a fat content of 33% (compared to 3-5% in human milk) – perfect for a baby cub who must quickly put on weight – with an average 2100% growth rate in his first four months of life!  A mother goat and mother cow produce milk that is much higher in protein than human milk – exactly what these baby mammals need to quickly gain muscle and strength.1

Infants are born with immature immune and intestinal systems that need human milk to help them grow and mature while preparing them for food later in the first year of life.  A baby’s brain will triple in weight during the first two years so a mother’s milk is low in protein but highest of all milks in lactose – essential for appropriate brain development.  Human milk is also the only mammalian milk with higher concentrations of whey than casein – which helps a baby’s body quickly digest each serving so she will be awake sooner and ready for more cuddles and bonding that come through breastfeeding…as well as satisfying her hunger.

It seems that societies in developed countries are caught between knowledge and belief.  Everyone knows the rhetoric “Breast is Best,” yet our actions show most people don’t really believe there is much difference between formula and breast milk.  Nursing seems to be an ideal, a lofty goal, but a perfectly healthy and acceptable substitution is believed to be found in infant formula.  One need not look any farther than the CDC’s Breastfeeding Report Card which shows that while 81.1% of mothers initiated breastfeeding in 2016, only 22.3% of mothers were still exclusively breastfeeding at six months. 2

Artificial milk may be derived from a number of sources – cow’s milk, goat’s milk, soy beans or even almonds and rice. Various components are added and taken away and the milk is heated and treated to be digested by an infant. It is a very complex process to change the milk of one species (or plant!) to make it edible by another.  Not only are there multiple modes of contamination possible throughout this process (not to mention contamination that can occur later from dirty water or mixing formula for the baby), even the ingredients are so different the two substances really can’t even be compared.  Yes, both can be put in a baby’s body.  But only the norm – breast milk – was created uniquely for babies.  The variant – formula – is so vastly different that study after study consistently proves that these babies will not reach their intellectual potential.  Along with this, their physical health will suffer as a result, throughout their entire lives.

Nursing can be exhausting, difficult, and just plain hard – especially in the beginning, especially without support, especially with a preemie, an emergency c-section, a pediatrician who is not sold on breast milk, when you are surrounded with others who are not encouraging, multiples, sleep deprivation, pumping, cracked nipples, clogged ducts, a crying baby, no one to help, low supply, and so much more! But breastfeeding initiation rates are on the rise in the West.  It is not a lack of desire to breastfeed, but so many more times a lack of support, accurate information, and help.

Yes, breast milk is absolutely unique.  Yes, it is perfect for your baby.  And for mother.  Yes, it is best.  But it is also the norm.  With support and help it is something you, too, can give your precious baby!


Mixed Feeding – Using Formula & Breast Milk

Mixed Feeding with Formula and Breast MilkMany mothers decide that while they want to provide breast milk to their baby, they won’t be able to provide enough milk for full or exclusive breastfeeding.  There are a variety of reasons for this: low milk supply, higher order multiples, early return to work or other separation from baby where mother is unable to pump adequate amounts, desire for others to help feed baby, etc.

Breast milk is unique and unlike any other mammalian milk or infant formula.  Any amount of breast milk a mother is able to provide her baby is a wonderful gift and should be celebrated.  There are many health benefits for both a mother and baby.  Even some breastfeeding will help with maternal-infant bonding and decrease feeding costs, visits to the doctor, time off work for illness, allergies, and health care costs both in the short and long term.

It is completely possible to have mixed feeds; here are 5 tips to help you succeed.

  1. Establish your milk supply
    During the first six weeks following birth a mother’s body is laying down prolactin receptors (hormones intimately involved with milk production) that will affect her milk supply for the duration of breastfeeding.  If her milk supply is built up strong in the beginning, it will be easier to decrease her supply and maintain lactation.  Conversely, if she never develops a strong supply in the initial weeks following birth, she may be forced to supplement which could further reduce her supply.  It is common for this cycle to continue until a mother is no longer producing any breast milk for her baby.
  2. Allow baby time to attach well to breastfeeding
    The sucking action at the breast as well as flow of milk is different at the breast and with a bottle.  To demonstrate this, try placing your clean index finger half-way in your mouth and notice what your tongue does.  Now, place that same finger all the way back in your mouth to where the hard and soft palates meet – just before you “gag” – and note your tongue movement.  Breastfeeding is similar to your finger being in the back of your mouth, and a baby’s tongue will extend down and out past his bottom gum line.  Alternatively, when a bottle teat is placed in a baby’s mouth his tongue bunches further back in his mouth.  A disorganized suck and/or nipple preference can develop if babies are introduced to an artificial teat (whether bottle or pacifier) before breastfeeding is well established.  Just as importantly, the flow of a bottle nipple is constant whereas a baby at the breast must suck-suck-suck to have a let-down which lasts a minute or two and then there’s a pause before another let-down. These subtle differences can cause confusion in babies until breastfeeding is well established.
  3. Slowly decrease the amount of breastfeeding sessions
    Once you have developed a strong milk supply, you may now choose to slowly introduce formula.  It is best to eliminate only one breastfeed every 2-3 days so that your body adjusts to making less milk.  Introducing formula more quickly and eliminating breastfeeding sessions more than one at a time could lead to engorgement, plugged ducts, mastitis, or even a breast abscess.
  4. Continue to nurse enough to maintain supply
    Watch your body closely and if you notice your milk supply diminishing more than you need it to, add in another breastfeeding session.  Every woman is different and even each breast on the same mother has different amounts of milk.  While one woman may easily maintain milk just nursing once or twice a day, another mother may need to nurse three or four times a day minimum to maintain a milk supply.  If your supply does begin to decrease, make sure to eliminate some of the formula feeds and increase breastfeeding sessions to help build up your supply.
  5. Have partner give bottles while mom breastfeeds
    Many moms who partially breastfeed find it easier of they are responsible for breastfeeding and then baby’s father, family, or friends give the formula feeds.  This is not a must, but it can make it easy for your baby to associate mom with breast milk. This is also a matter of convenience – breast milk doesn’t require mixing, heating, cleaning bottles, etc. so if mother is available to feed it just makes sense to feed baby in the most convenient way possible.

Whatever strategies you find that work for you and your situation, you have much to be proud of providing your breast milk for your baby.  Every drop is a gift and should be celebrated!


Does Baby Need Vitamins?

vitamins-thumbIn general, a healthy, full-term baby who is exclusively breastfed does not need any vitamin supplements, except for the possibility of Vitamin D.

It has been common for pediatricians to tell mothers that “since they were breastfeeding” their baby would need to take a vitamin supplement . . . since formula is “fortified” with vitamins. In reality, breast milk has the perfect balance of vitamins and minerals, the amounts it has are incredibly bioavailable for baby, and taking supplements actually inhibits the absorption of nutrients in breast milk!

After the first six months of life, the two nutrients that there is evidence of babies needing more of are iron and zinc. Therefore, as complementary foods are introduced alongside continued breastfeeding, make sure to include foods rich in these minerals (meat is an excellent source of both; perhaps one of the reasons it is considered an ideal early food to introduce around the world).

Below is a list of the most common vitamins that can be of concern for babies, with the current recommendations for supplementation.  Please note that when there is a deficiency, it is preferable to improve maternal diet or give mothers supplements rather than beginning solids at a younger age for babies.

Vitamin D

Vitamin D is important for your bones and overall health and is the only Vitamin that is usually not available in adequate levels solely from breast milk or other foods; babies (kids and adults too!) need contact with direct sunshine in order for our bodies to synthesize this Vitamin.  It is naturally found in very few foods; Cod Liver Oil is one source as are some fortified milks and cereals, but the sunshine is the best source. Vitamin D is a fat soluble vitamin and its absorption from the sun is inhibited by clothes, sunscreen, distance from the equator, time of day, season, and skin pigmentation.

Most mothers are deficient, which is why a Vitamin D supplement beginning in the first few days of life is recommended in many countries for breastfed babies.  Recent research has shown that high-dose maternal supplementation can increase levels in breast milk. 1  Make sure to discuss your specific situation with your doctor.

B Vitamins

Vegan mothers need to be particularly aware of the fact that deficiencies in Vitamin B12 are common in breastfed babies of vegan mothers; they are also common in mothers who have undergone bariatric surgery.  Food sources of Vitamin B12 are found in animal products such as milk and beef, organ meats, sardines, trout, eggs, cheese, etc. It can also be found in fortified cereals and nutritional yeast. It is strongly recommended that babies who are at risk for Vitamin B12 deficiency be supplemented, beginning at birth.

Iron

A healthy, term baby who is exclusively breastfed has sufficient iron stores for the first 6-9 months of life.  Delayed cord clamping will increase a baby’s iron stores.  Though iron levels are low in breast milk, its absorption rate is quite high compared to formula.  The best ways to maintain adequate iron stores for the first six months of life are to exclusively breastfeed and to avoid cow’s milk 2 When a baby begins solids, it is important to offer iron-rich foods, including meat, poultry, fish, and/or organ meats.  Serving iron-rich foods alongside dairy or whole grains will inhibit the absorption of iron; serving foods high in Vitamin C will enhance iron’s absorption.

Since a baby receives 80% of his iron stores during the third trimester of pregnancy, preterm babies are at risk for iron deficiency. Preterm breastfed babies may need to take an iron supplement beginning at one month through the rest of the first year of life. 3

The Bottom Line

Most babies and young children receive adequate vitamins and minerals from breast milk, and then complementary foods alongside breast milk, with the exception of Vitamin D.  If your baby is not regularly exposed to direct sunshine (without sunscreen, hats, gloves, etc.) then a Vitamin D supplement will most likely be necessary.  Iron supplements are usually only necessary for preterm babies. Vitamin B12 supplements are usually necessary for babies of vegan mothers or mothers who have had bariatric surgery.


How Much Milk Does My Baby Drink?

How much does my baby drink during a day?

A healthy, full-term baby typically drinks between 25-32 ounces in a 24 hour period between months 1-6.1   This amount remains consistent during months 1-6. So, if you are producing enough milk for your 6 week old then you have enough to exclusively breastfeed your 6 month old as well!

Around the sixth month mark many babies begin to eat solids, resulting in their milk intake slowly declining. However, it is important to note that solids should not replace breast milk during your baby’s first year of life – only compliment your milk.

How much milk will my baby drink while away from me?

Between months 1-6, most babies drink 25-32 ounces a day. If your baby nurses 8 times in a 24 hour period, this is roughly 3 oz per feed.

However babies, like adults, may eat more during one meal and less another. Also, some babies reverse cycle when they are away from their mom during the day – they may drink less milk and then nurse much more frequently when with mom in the late afternoon, evening, and throughout the night.

Safe bed sharing or co-sleeping can be a tremendous benefit in this situation so you can still get rest while your baby gets milk! You will learn what volume of milk your baby needs while you are away, but these numbers can serve as a guide. For example, if you are away for 8 hours, you may need 12 oz (4 – 3 oz feeds, 6 oz – 2 feeds, or something in between). Send extra milk the first few days until you find a rhythm and know about how much your baby needs.


Milk Storage During Power Outage

Being as prepared as possible when a disaster strikes is critical.  If you are feeding a baby, there are some important points to consider.

If you are breastfeeding – good for you!  This is the safest way to feed a baby during a disaster!  No matter what happens to the water or electrical supply, your milk will always be available, fresh, safe, affordable, and clean.  Nursing will provide comfort for your baby as she picks up on the stress of the situation.

Breastfeeding will also allow mom and baby to relax – and helps mom to better cope better with the stress.  This is NOT the time to cut back or wean from breastfeeding.  In fact, if your baby has begun solids or cut back on nursing you could increase how often you breastfeed, not only for comfort but also to provide a safe, available, and nutritious option to feed your baby.  Don’t worry if your baby does begin to nurse more frequently while you had been in the process of weaning.  Once the disaster is over you can always return to your previous plans.

If you are breastfeeding AND expressing and have built a stockpile of frozen milk you will need to take safeguards to ensure it remains safe during the disaster.  The last thing you want to do is throw out an entire stash of “liquid gold!!”

Steps to Safeguarding Frozen Milk during a Power Outage

    1. Connecting your freezer to a generator is a great way to ensure the milk remains frozen in the case of a power outage, however…
    2. If you do not have access to a generator and your milk must stay in your freezer, move all the milk to the back of the freezer and store it together.  If there is a storm coming and you may lose power, try to plan ahead by filling your freezer full, freezing ice trays, blue ice, etc. because a full freezer will thaw more slowly.  Make sure you don’t put meat or other items that could leak if defrosted into your breast milk.  Finally, don’t open the freezer door once the power has gone out – unless you are moving the milk to a more secure location.
    3. Consider asking a close friend or relative if you could put your milk in their powered freezer until the crisis is over.  Take care when transporting your milk that it does not begin to thaw.  Milk that has been frozen but begins to thaw may be stored in the refrigerator for up to 24 hours where it either needs to be consumed or discarded.Note:  If your milk does thaw, though it is painful to have to dump, it is better to pitch frozen milk than to skip a nursing at the breast in order just to use some of this defrosted milk.
    4. Another option is to buy dry ice (available at grocery stores, etc.) to keep your milk frozen.  It depends how much milk you have and how long you would like to keep it frozen as to how much you will need.  For example, 10 pounds of breast milk will need roughly 10 pounds of dry ice to keep it frozen for 24 hours.  Ten pounds worth of milk is 160 ounces, which is roughly 6 days’ worth of milk.

If you are formula feeding – you will need to be extra diligent during a disaster to ensure the milk is safe for your baby.  If the water supply has been compromised, you will be using dirty water to mix the formula, which could cause life-threatening illness for your child.  In an emergency, you may want to consider relactation or finding a friend or family member who is able to nurse your baby until you are able to provide safe formula again.  Relactation is easier if your baby is younger, you have nursed before, and your baby is willing to latch and suckle at your breast.  Putting your baby to your breast often, not only for comfort but also stimulation, will help you relactate more quickly.

Finally, if you are a nursing mom and find yourself in the midst of an emergency situation, you may want to consider helping other moms with feeding their babies – sharing these tips, encouraging breastfeeding, and, if necessary, providing some of your milk to another baby.

Additional Links and Resources:


Importance of Breast Milk for Preterm Babies

We’ve all heard the expression “breast is best,” and it is, but when it comes to preterm babies, breastmilk is not just best; it is medicine.  The time to decide whether or not to breastfeed a premature baby is not when you give birth early.

The most important thing you can do at this time is express your milk; once your baby reaches full term you can make the decision whether or not to carry on breastfeeding.

Preterm babies have unique nutritional needs, and preterm breastmilk is also unique and different to breastmilk of mothers birthing full term babies.  Preterm milk is packed with nutrition, containing higher concentrations of fat, energy, protein, calcium, potassium, magnesium, sodium, chloride, and iron.

The milk becomes more like the milk of a mom with a full term baby about three weeks later.1

Preterm babies need increased amounts of protein and energy.  The protein in breastmilk is primarily whey, which is easier to digest than protein in artificial formula. And, it takes greater energy to digest artificial milk than breastmilk.2

That said, the “fortification” of breast milk for preterm babies is very commonly encouraged by doctors.  The reasoning is that fortification allows the baby to still receive breast milk but also increase the caloric content so that the baby can put on weight more quickly.

However, research shows no weight differences in preemies who received fortified breast milk vs. those who received breast milk alone by 12 months of age.3

Birth weight does matter, though, when it comes to nutritional needs of preterm babies.  Though any baby born before 37 weeks is considered preterm, size can vary widely depending on how early a baby is born.  A low birth weight baby weighs less than 2.5 kg; a very low birth weight baby weighs less than 1.5 kg; and an extremely low birth weight baby weighs less than 1 kg.

A low birth weight baby can meet all her nutritional needs from mother’s milk alone.  Protein needs of very low birth weight infants are high and the protein in mother’s milk can vary. . . starting out higher in preterm milk and gradually decreasing.

Therefore, the current recommendation is to individualize protein supplementation (milk fortification) based on the size of the baby and the protein content of the mother’s milk.4

One way to increase weight gain of a preterm baby on unfortified breastmilk is to use the breastmilk at the end of expressing which has a higher fat content.  Typically, moms who express for their premature babies have an abundance of breastmilk as they are trying to build a solid supply for when their baby is able to nurse efficiently at the breast.

Preemies typically can’t take in this much milk so there is additional milk.  Using the milk from the end of a pumping session, as well as milk pumped in the evenings will typically yield higher fat contents. 5

Though sometimes is it is necessary to fortify the milk of very low and extremely low birth weight babies, there are still risks.  Numerous studies document a greater susceptibility to infection as well as a risk of contamination in preparing formula, greater incidence of gastrointestinal diseases, increased risk of allergies and diabetes, and the neutralization of many of the anti-infective properties of breastmilk.  When even a small amount of formula can keep a baby’s body from being able to absorb many of the nutrients in breastmilk.

While breastmilk alone is healthiest and fortified breastmilk poses some risks which must be weighed against the baby’s need for additional calories/nutrition, formula feeding has many detrimental effects on the preterm baby.

When comparing infection rates of babies given breastmilk vs. formula, the results are staggering.  Formula-fed babies have significantly increased rates of urinary tract infections, septicemia, diarrhea, necrotizing enterocolitis, and need for antibiotics. 6

If you have a preterm baby, the very best thing you can do is give your baby your breastmilk – whether this is at the breast or through expression.  More than just nutrition, it is filled with digestive enzymes, anti-bacterial and anti-inflammatory properties, growth factors, and protective factors specific to your preterm baby.  It could be a matter between life and death.  If you doctor wants to fortify or supplement your milk, make sure you understand the pros and cons and have all the information for your specific situation.  Many times, especially in the case of low birth weight babies, your breastmilk is completely adequate to help him grow and thrive.  It can be hard to go against the recommendation of the medical establishment, but if you are uncomfortable with the recommendations of your neonatologist, involve a lactation consultant and see if there is a compromise that can be worked out that you are both comfortable with.  Finally, realize that you have those “maternal instincts” for a reason and, many times, they are exactly what your baby needs.