Introducing the bottle into breastfeeding: mission possible

INTERVIEW: Fabien Lequenne, midwife, sophrologist, and hypnotherapist, explains how to introduce bottle-feeding during breastfeeding. A broad topic indeed. Here are his insights on mixed feeding, weaning, and above all, the importance of the well-being of both mother and baby.

In general, how do you approach the topic of breastfeeding and bottle-feeding with the women you support?

“I’m not necessarily pro-breastfeeding, but first and foremost, I’m pro-mother. I want women to feel comfortable. I adapt the childbirth preparation sessions to their wishes. For expectant mothers who don’t know whether they want to breastfeed or bottle-feed, I offer a session with clear and objective information, which will help them decide. This is essential to avoid misconceptions. What’s important is to enjoy it, to savor a moment that’s meant to be happy: coming home with the baby. And for that, the mother needs to be rested and calm. When I see women after they give birth, sometimes breastfeeding is very complicated. In those cases, we can consider introducing bottles to help the baby cry less and gain weight better. Also, because I sense the mother is a little overwhelmed.” I'm not going to be a breastfeeding zealot, otherwise the risk is that women will be exhausted and tell me they want to stop altogether. Whereas ultimately, by introducing a few bottles here and there, we see women who breastfeed for three months in a somewhat mixed way.

What is mixed feeding?

"A breastfeeding woman may, for reasons of convenience or medical necessity, supplement breastfeeding with bottles. Depending on the situation, this may involve supplementing with breast milk using a breast pump or formula. Mixed feeding can also serve as a preliminary step to weaning.

In practical terms, how do you introduce bottle feeding as part of mixed feeding?

"In cases of problematic breastfeeding, when the baby isn't gaining enough weight, introducing a bottle will help increase milk intake. Often, it's a sucking problem: some premature or low-birth-weight babies tire quickly at the breast and don't drink enough. Breastfeeding requires much more effort than bottle-feeding, which then supplements (and doesn't replace) breastfeeding."

This can be a temporary solution, because if the baby has gained weight well, the woman can eventually return to exclusive breastfeeding if she wishes. This will be more difficult if the bottles introduced contained powdered infant formula . In that case, it is advisable to supplement a breastfeeding session with a bottle of expressed breast milk, using a breast pump, to stimulate the breast and thus increase milk production. It is important to be mindful of this if you want to maintain lactation.

Regarding mixed feeding for convenience with bottles (of infant formula or formula), it's often implemented because the mother needs to sleep. In this case, a maximum of one or two bottles per day is recommended to avoid disrupting lactation too much. However, it's important not to start too early if you want to maintain breastfeeding (sometimes the baby can become reluctant to breastfeed and prefer the bottle, and it takes time for lactation to become well established). My advice: after at least one month of exclusive breastfeeding, at the last feed before bedtime around 10 or 11 pm, it's possible to offer both the breast and the bottle. This increases evening intake, keeps the baby full longer, and thus delays the middle-of-the-night feed. The mother breastfeeds her baby on demand, then gives them a break, and within the next hour, offers a bottle.

However, if the mother plans to breastfeed for six months, mixed feeding is not recommended, given the potential risk to her milk supply. If she is very tired, the father can also help at night by rocking and changing the baby to relieve her fatigue. It's a team effort. There are many other things to do besides giving a bottle to participate!

What about weaning? How can it be done successfully?

"Weaning requires planning! It often takes place before returning to work, with the goal of replacing breastfeeding with formula bottles. This is to gradually reduce milk production. For weaning under the best possible conditions (without stress or rushing), it should begin at the end of the baby's second month if the mother is on a standard maternity leave."

A new bottle, corresponding to a breastfeeding session, is introduced approximately every four days. The idea is then to alternate between bottle and breastfeeding. Generally, it's best to avoid replacing the morning breastfeeding session first, as the woman's breasts are often full. The first bottle can be given mid-morning or late afternoon, but always before the evening breastfeeding session, which is important because it helps to empty the breasts completely before bedtime at the beginning of weaning.

Under what conditions should the very first bottle be given?

"Ideally, the breast should be given by someone other than the mother. The father, for example. Or a grandmother, the nanny. There will be less emotion involved, especially during weaning. Preferably in a calm place. Above all, it's important for the mother to let go of guilt and to verbalize things, explaining to her baby why she's going to stop breastfeeding. In France, weaning happens very early given the length of maternity leave. And expressing milk at work isn't encouraged. However, weaning is a stage that can prove difficult for the mother if breastfeeding has been going well. It shouldn't be underestimated. Women can seek support from professionals."

In any case, just because the baby is no longer breastfeeding doesn't mean there will be no more bond with the mother and that the baby will be traumatized! There are still cuddles to be had!