We so very often hear about "Breast is Best", and then frequently we might hear "Fed is Best" right afterwards. Why might this be? I think part of it is because no one wants to feel judged, guilty and shameful; which is a huge part of many parenting circles. Everyone has an opinion, and they will often tell you exactly what they think is best, and sometimes it’s not always said in a nice way.
"Fed is Best" I believe came from a lot of people feeling guilty, shamed or judged when they weren’t able or did not want to breastfeed. Seeing "Fed is Best" can help relieve a lot of complicated emotions around breastfeeding that many parents have. In one way, it is correct. We want baby fed at the end of the day, and very importantly, we want parents feeling good and supported with their decisions. It’s not easy to be a parent, if someone tells you they have the answers for everything - they are lying, everyone is just trying to do the best as they go.
I often hear from co-workers that I must also tote "Breast is Best" being a lactation consultant. To be honest, I don’t particularly like using either phrase actually because they both can bring lots of judgemental views of the way that you feed your baby. My major goal is to keep my patients, clients and parents informed, so you have the information your need to make your decisions. I want to make sure that I, as an RN and IBCLC, have the most up-to-date information to be able to give you, hard-working and well-meaning parents. So instead of "Breast is Best" or "Fed is Best", I like call it more of a Hierarchy of Feeding Methods.
Basically, there are multiple different, viable options for feeding your baby, and when done appropriately, all can sustain life of an infant. Some are just better than others.
Top of the List:
1. Mother’s own Breastmilk from Breastfeeding.
This sounds a little redundant when you first look at it, but it is actually two different components that make it the top-tier for your baby. Your own breastmilk is part one, and given to your baby by the breast is part two. This combination is going to be the most complete form of nutrition, medicine and bonding that you can have with your baby. Breastmilk is more than just nutrition, it has thousands of different components and a thousand different supports for your baby, it's way more than just "milk".
2. Mother’s own Breastmilk at the Breast.
Is this the same as the one above? No, not exactly. Having the breastmilk at the breast, doesn’t necessarily mean that the baby is getting it directly from the breast at the time of feeding. This is one is perfect for that NICU baby that maybe can’t suckle yet; or the baby that needs more supplementation while feeding for the breast. This one means putting the baby skin to skin at your breast, whether they can suckle at the nipple and areola, or they just lay their cheek on it, and feeding baby your pumped breastmilk using whatever supplemental device you use.
3. Mother’s own milk.
We’re still in the territory of using your own breastmilk. It’s still the best possible nutrition and medicine, but sometimes we can’t feed directly at the breast. Expressed breast milk can be given by multiple different routes or by different people. It can be given while your baby is swaddled; in an incubator; or while you’re at work.
4. Donated Breastmilk.
Donated breastmilk can come from milk banks, where pasteurized milk from other mothers is available for your baby, or from private donators that you know personally or seek out. We are still within in the realm of breastmilk, and it’ll still be better for baby, but it’s not quite as tailored now. Others' breastmilk will have been tailored for their babies, but there will still be loads of benefits for yours. Often, if you have your baby prematurely, especially before your own milk comes in, your NICU team will talk to you about donor milk. Donor milk is better than formula, as their tiny stomachs are incredibly delicate and can catch infections easily. Donor milk matches more what a baby’s biology is expecting, has different sugars, fats and proteins content, than formula does and will help your little one grow better.
Last on the hierarchy of feeding is:
5. Formula
Formula also has a mini hierarchy within it. Starting with Ready-to-Go formula, then concentrated and then powdered formula. Ready-to-Go formula, where you just crack the bottle and pour, is recommended for the first four to twelve weeks of life. Babies stomachs are incredibly delicate, and while you may be super careful when preparing the water to mix for formula, it’s actually the powder that’s the issue, not the water. Powdered formula, even when cleared and declared safe, has bacteria in it that an older infant can handle, but a younger one cannot. Concentrated, coming in a can, also reduces the risk of a bacteria in powdered formula that can cause problems, but still not recommended for under three months. Once baby is past the three month stage, it becomes much safer to use powdered formula.
The reason why formula is on the bottom of the list, is that it just can’t compare to all the components of living breastmilk. It doesn’t have the antibodies, it doesn’t have the same combination of fats and proteins, and it can’t change depending on how your baby is feeling that day. But, it is a viable alternative when you have no breastmilk available. It will keep your baby nutritionally fed, it will allow them to grow and, when prepared correctly, it is safe. Most importantly is that you pay attention to the mixing and dosing instructions. Formula is expensive, but it can’t be watered down, otherwise your baby is loosing valuable calories that can lead to malnutrition.
If you end up having to go with formula for your baby, for whatever reason, make sure that you are very careful in choosing the type of formula. There are so many options out there, and not all of them are going to be even helpful. Keep in mind, that one ‘sensitive stomach’ is not the same as another ‘sensitive stomach’ and that each brand puts something slightly different in their formulas. It may have to be a trial and error until you find the one that works for you and your baby.
So, at the end of this, what’s best for baby? What’s best is what’s going to be easiest, safest and feasible. Try for breastmilk from breastfeeding it will give your baby the absolute best going forward. Keep trying and seek help if needed, to keep yourself at that breastmilk from breastfeeding tier. Of course, if things don’t work out, it’s not your fault, you’re not a bad parent or making poor choices, don’t beat yourself up about it. Try the next tier down, or the one after that, until you find what you are comfortable with, and can afford physically, mentally and financially.
Breastfeeding is hard. Parenting is hard. As long as you are trying, learning, growing and accepting you’re doing amazing.