All three of my children were breast-fed, yet each experience was entirely different. The decision to breast- or bottle-feed depends on so many factors that no one can tell you what’s right or wrong for you. Other mothers can share their experiences and offer some advice, but in the end, you are the only person who can know what is best for you and your daughter. Breast-feeding has gained in popularity with today’s generation of child-bearing-age women mostly because of the medical benefits it offers to the baby. It is known to strengthen her immune system and help prevent allergies, asthma, and SIDS. Breast milk also contains substances that help protect a baby from infections until her own immune system matures. It’s also true that babies are less likely to have an allergic reaction to breast milk than to cow’s milk. And, of course, it is more readily available and cost-efficient than formula. But many new moms choose to bottle-feed for reasons that are equally important. They may be on medications that could pass through the breast milk and have negative effects on the baby. They may be working and need the convenience of bottle-feeding for the baby’s care-givers. They may have a chronic infection such as HIV that could pass to the baby through breast milk. They may have had breast surgery, making breast-feeding difficult. Or they have the best reason of all: They simply don’t want to. Both bottle and breast-fed babies grow to be healthy, welladjusted human beings. Don’t feel righteous or guilty about whichever method you use. Just do whichever is best for you, and enjoy every moment you hold your daughter in your arms and provide her with both physical and emotional nourishment. The joy of bottle-feeding is that it allows everyone to have a turn at feeding the new baby—your partner, your daughter’s older siblings, your parents, and your in-laws can all chip in and discover the wonderful feeling of closeness that comes from holding and nourishing a newborn. Your daughter will probably take to the bottle easily; bottle nipples are easier for a newborn to grasp onto than the breast. But if your daughter doesn’t seem interested in eating right away, don’t push. For the first few days, she probably won’t be very hungry as she recovers from delivery and adjusts to her new surroundings. Soon, however, her appetite will pick up. Once you make the decision to bottle-feed, you’ll face the decision of which kind of formula to use. (Cow’s milk straight from the dairy case in your store does not have the nutrients a baby needs in the first year.) Pediatricians recommend a cow’s milk–based formula for most babies, and then suggest switching to a soy-based formula if any problems occur. Soy formulas are recommended for infants with a family history of milk allergies. After deciding between cow’s milk and soy-based, you can purchase formula in three different forms: ready-to-use, liquid concentrate, and powder. Obviously, the ready-to-use is the easiest form, but it also the most expensive. If you choose concentrate or powder, be sure to follow the mixing and storage instructions to the letter. Diluting with too much or too little water can harm your daughter. Make sure the filled bottles are refrigerated until it is time to use them. When traveling, put them in thermal bags, which keep them cold. Once you have opened a can of prepared formula or put formula into bottles, use it within forty-eight hours. Formula should be “served” at room temperature—not warm and certainly not hot. Getting the formula to room temperature is quite an art and very different from the way your mother warmed your bottles. Do not put a bottle in boiling water on the stovetop and do not heat it in the microwave. These methods overheat the food and destroy nutrients. The microwave is especially dangerous. Because it heats from the inner core out, it is possible for some of the liquid to be scalding hot, and you won’t know it until your daughter drinks it. Shaking the bottle does not reduce the danger from one of these hot spots. Instead, cold or even frozen formula (and stored breast milk, too) should be held under warm running water until it becomes room temperature. Or, you can use a commercial bottle warmer.Most pediatricians recommend that all baby bottles be sterilized before use until the infant is three months old. You can do this by using a bottle sterilizer found at any baby-supply store. Or, you can simply use the dishwasher. But be sure to place plastic items on the top shelf and use a dishwasher-safe container to hold small items such as nipples and rings to keep them from getting caught up in the motor. You can also sterilize bottles by boiling them in a large pot of water on top of the stove for five minutes. After sterilizing, store bottles in the refrigerator to keep them bacteria-free. Once you have all your equipment in hand, it’s time to feed your daughter. No matter what your well-meaning relatives tell you, feed your newborn on demand. Although she probably won’t need a feeding as often as breast-fed babies (because formula is more filling), she will still let you know when she is hungry, and you should answer the call. Start with a four-ounce bottle and let your daughter decide when she’s had enough—don’t try to cajole her into finishing it all if she is clearly full. If you have formula left over, throw it away; it is a breeding ground for bacteria once the baby has sucked from the bottle. Breast-feeding is the most natural thing in the world—but that doesn’t mean it comes naturally. Many new mothers have a bit of trouble at first getting their babies to successfully nurse at the breast. So, if this is what you want to do, don’t get frustrated and give up too quickly. You and your daughter need time and patience to get to know each other and find a system that works best for both of you. The following tips will help you get a good start.Getting Started: If this is your first time breast-feeding, you will naturally feel uncertain about exactly how this is supposed to work. Complicating that feeling of confusion is the fact that your daughter may not know what to do either. Some babies latch on like old pros while others root around, looking for food. If your daughter is having trouble, give her some help. You can activate the rooting reflex by gently stroking her cheek with your finger or your nipple. This will cause your daughter to turn toward your breast. Now she has to latch on to your nipple and that’s not always easy. You can help out by making sure her mouth encircles the entire nipple area, called the areola, not just the nipple itself. If her mouth encircles the nipple only, you both will be uncomfortable. This can cause your nipples to become sore or even crack, and your daughter may not get all the milk she needs. Place your nipple in the center of her mouth, with the areola entirely within her lips. Make sure that your breast does not cover her nose and interfere with breathing. When you begin nursing, it’s best to start slowly. Many newborns have very little appetite for the first few days of life and your breasts need to ease into the process gradually. At first, allow your daughter about five minutes on each breast. Over the course of a few days, and depending on your daughter’s appetite, you can build up to ten minutes per breast and then to fifteen. You should also start nursing on the opposite breast at each feeding. This will keep milk being produced evenly by both breasts. To break the baby’s suction when you’re ready to switch breasts, simply place your finger into her mouth, between the nipple and her mouth. And be sure to burp your daughter before switching to the other breastand after the feeding is over. (See page 56 for a few tips on burping.) For the first few days, your daughter won’t be getting much actual milk. Your breasts will produce a yellowish liquid called colostrums that is rich in antibodies and protective cells from your bloodstream. These substances help your newborn fight off infections until her own immune system matures. After about five days, the colostrums will diminish and milk will take over. How Often to Breast-feed: Your daughter knows how often she should be fed. She will let you know—loud and clear. Some babies are voracious eaters and others are quite finicky. In general, breastfed babies eat more than formula-fed babies because breast milk is less filling than formula. But your daughter will determine her own schedule and let you know when she’s hungry by fussing, making sucking noises, and by crying. For the first week or so, your daughter will probably need to nurse quite often because her stomach can’t hold enough to keep her satisfied for long periods. Every hour is not uncommon. Because nursing can take anywhere from ten to thirty minutes, a hungry infant can take up most of your day. After a few days, your daughter will have the hang of how to suckle just as her appetite kicks in. The regular sucking motions in her face and the gulping sounds will tell you that she is feeding well. You can’t measure precisely how much your daughter is drinking, but it’s comforting to know that your milk supply is determined by how much the baby sucks. If she needs more milk, her increased sucking will prompt your body to produce more milk.This keeps the amount of milk you have and your daughter’s needs in sync. Keep your eyes open for signs that your daughter is getting enough nutrition. She should be wetting her diaper from five to eight times a day during the first few days and from six to eight times a day afterwards. And she should be gaining weight at a rate that satisfies her doctor. When this is the case, you can feel satisfied that she is getting all the nourishment she needs. Hand-Expressing Breast Milk: Most nursing mothers find that at some point they need to hand-express their milk. I found that when my breasts were overloaded with milk, expressing eased the pain. I also expressed milk into baby bottles to store for later use when a babysitter or my husband would be feeding the baby. For either need, I found expressing milk to be an easy process. Always wash your hands before you begin to express milk. Then, to express by hand, hold a clean container under your breast and place one hand around your breast with the thumb on top. Gently squeeze in a rhythmic fashion, pulling the thumb toward the areola. It’s easiest to master this technique when your breasts are full. You can also express your milk with a manual or electric breast pump. A pump is more efficient if you need to express bottles of milk on a regular basis. Carefully follow the manufacturer’s instructions and ask for help from a more experienced friend. Then wash and sterilize the pump immediately after each use, or as soon as possible. Storing Breast Milk: Be very careful about how you store your breast milk. It must always be placed immediately in the refrigerator or freezer. (If you’re away from home, store it in an insulated cooler.) It should be used within twenty-four hours if refrigerated, or three months if frozen. If the milk will be stored for a while, put a label on the bottle and date it. If it’s to be frozen, don’t use a glass bottle or fill the container completely. Milk expands as it freezes. Refrigerated or frozen breast milk may look different in the bottle because the fat separates from the liquid. It’s still good. Just warm the bottle under hot running water or place it in a bowl of hot water. Do not leave it out at room temperature. Also, don’t heat the milk in a microwave or on the stovetop. The immune properties of breast milk are heat sensitive and the uneven heating of a microwave risks scalding the baby. Never refreeze partially used or thawed milk. Using Breast and Bottle Milk: There may be times when you don’t have the time or interest to express milk, and instead choose to use formula bottle-feeding. Many new moms alternate between the two. If you decide to do this, you’ll need to be careful not to bottlefeed more often than you breast-feed. The bottle’s nipple is easier for your daughter to suck than your breast, so sucking from a bottle can make her lazy about sucking from the breast. Also, if you offer formula in a bottle too often, your breasts will reduce the amount of milk they produce. Easing Discomfort: Even with the best intentions and care, sometimes breast-feeding causes breast discomfort and even pain. A common problem is called engorgement. This happens if your breasts are not emptied during each feeding, and it can be very painful. My breasts quickly became engorged after the birth of my daughter and I worried that I had made a mistake in choosing to Here are some tips that will help you develop the art of burping and nighttime feedings.
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