After reading the initial findings from a national study “Breastfeeding support in Ireland'' by Bainne Beatha. It has got me thinking about the use of top ups in our maternity services. The findings from the recent study show 23% of participants were encouraged to use formula when they didn't want to. Formula was offered as the solution to most breastfeeding problems instead of specific breastfeeding support.
A top up is the administration of formula or expressed breastmilk, usually given via a bottle. Top ups may be suggested or indicated for a number of reasons, for eg. jaundice, low blood sugars or concerns re: weight loss. As with every medical intervention the risks should be discussed. Unfortunately, this often doesn’t happen and a parent can find themselves in a cycle of top ups and a reduction in breastfeeding.
Risks of top ups:
Impact on milk supply- breast milk production relies on supply and demand, the more milk that is removed the more the breast will make. The more top ups your baby has the less they will go to the breast therefore, impacting supply.
Babies may develop a bottle preference. The flow of milk from a breast and the flow from a bottle are very different. Baby’s have involuntary sucking reflex, so when a top up is offered they will drink it. The milk also comes easier from a bottle. When the baby goes to the breast they can become frustrated as the flow isn't instant. It can take a minute for a let down to start the flow of milk.
One of the big reasons top ups are initiated by a parent is the perception that their baby is hungry. There can be a misunderstanding of normal newborn behaviour- unsettled/crying, waking frequently, wishing to breastfeed frequently. All of which are normal behaviours. Newborns love to be held, the breast is their security as well as food. A mother might use a pump to express and only yield small volumes of milk and can mistakenly think her supply isn’t adequate. A baby latched on well to a breast will always get more from a breast than any pump will. It is very easy for a woman’s confidence to be knocked, it is distressing to think her baby is hungry. So….
A bottle is given, the baby will take it (due to this involuntary sucking reflex), the baby may take in a larger volume causing them to sleep for longer. There are big gaps when the baby would normally be breastfeeding and the supply/demand is impacted. So you can see how this can become a vicious cycle.
If it is suggested to you to top up your baby, ask are there alternatives- eg. more experienced lactation support, expressed breast milk, using cup feeding or a syringe. If giving formula the supply must be protected, hand expressing or using a breast pump is very important around the time the top up is given.
If giving a top up via a bottle pace the feed by using a teat with slow flow. Follow up to phase out these top ups is also very important, many women can be discharged using top ups with no plan in place to reduce/ stop them. As always seek help if you need.
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