Breastfeeding mothers and babies have a special relationship through the act of breastfeeding itself. Breastfeeding is much more than breastmilk, more than just another method of delivery of milk to the baby. Breastfeeding is a close physical and emotional relationship between two people who are usually very much in love with each other.  This is not to say that mothers who bottle feed their babies do not love their babies.  Only that the relationship of breastfeeding is different and special and good, good for the baby and the mother, good for the toddler and the mother.   Even if the mother and baby are in skin to skin contact during a feeding, bottle feeding involves a baby’s mouth in contact with an artificial material which feels nothing like the mother’s breast to the baby and the bottle nipple feels nothing.  Breastfeeding involves the baby’s very sensitive mucous membranes of the mouth in close and intimate contact with a very sensitive part of the mother’s body.  Surely everyone can understand this, though many do not.

Help with breastfeeding

The “physicality” of breastfeeding, as well as the ease with which breastfeeding can work when breastfeeding is free of “breastfeeding devices” is one reason that so many mothers want to get rid of the bottle or the nipple shield, even if the breastfeeding is “going well” with the nipple shield. As an aside, too often the nipple shield does seem to work for a while, but may cause the milk supply to decrease with time, especially if the mother doesn’t start out with an abundance of milk.

The “closeness” of breastfeeding is something that both mothers and babies cherish, and yet it may become a point of contention between mothers and physicians, especially, somewhat surprisingly, pediatricians. And also between the mothers and their own families, all of whom may tell mothers that feeding the baby according to the baby’s needs (“on demand” a phrase that speaks volumes how normal breastfeeding is perceived) causes the baby to be “spoiled”, overly dependent, aggressively “needy”, unable to “self-soothe” and, of course, “demanding”.

These adjectives would not be used in tribal societies not yet exposed to “modern ideas”, where babies are automatically breastfed, cuddled, held close and carried much of the time.  See photo 2. In modern societies, the needs of the baby have more and more become subservient to the parents’ needs and breastfeeding babies are required to be “efficient” and not impose on their parents.

Toddlers love to breastfeed

Photo 1. This twenty month old toddler loves to breastfeed, enjoys breastfeeding, and does not want to stop breastfeeding. He is breastfeeding for more than milk – he is breastfeeding because he loves to breastfeed.

Baby at the breast

Photo 2. This mother in the Central African Republic lived, at the time I took this photo, in a society little touched by Western values. Babies were constantly carried, never refused the breast. And fathers spend as much time carrying the baby as well.

Looking for comfort

Photo 3. What does the baby’s hand inside the mother’s dress mean? Most breastfeeding mothers know. It means the toddler breastfeeds. It means comfort and security for him.

One of the nicest aspects of breastfeeding is that it is an easy way to put babies to sleep; yet, mothers are also told not to let the baby fall asleep at the breast, to prevent the baby from “needing” the breast to fall asleep. Interestingly, I cannot remember a mother being told not to let the baby fall asleep while drinking from a bottle.

True, mothers are told not to let the baby sleep with the bottle in his mouth, as it may cause dental caries in the older baby, but they are not told to pull the bottle out of the baby’s mouth just as the baby starts falling asleep on the bottle.  Falling asleep on the breast is not “allowed” for the breastfeeding baby, however.  Falling asleep while breastfeeding is seen as a prelude to “sleep problems”. Falling asleep on the bottle is not seen as a prelude to “sleep problems”, but rather “great, the baby fell asleep because he is full”.  Incidentally, breastfeeding the baby/toddler to sleep does not cause dental caries because of the complete difference between the way that bottle feeding works and how breastfeeding works.  And how breastmilk is different from formula.

The notion that breastfeeding is merely just another delivery system for milk leads to other wrongheaded advice from health professionals. So, frequently mothers are told that a baby does not need to feed during the night by 6 to 9 months of age (some pediatricians will say even by 4 months of age), and the fact that a 7 month old baby is still waking up in the night means he has a sleep problem and needs “sleep training”. How was it decided that a baby waking in the night is abnormal behaviour? Bottle feeding mentality!  Bottle feeding formula often “stuffs” the baby at the “last” feeding of the day and so the baby sleeps longer.  Bottle feeding parents are also more likely to “sleep train” their babies, which, essentially ignores the needs of the baby and teaches the baby to ignore his own needs.

Parents are frequently told to ignore the emotional and other aspects of breastfeeding  because the baby doesn’t need them, the “adviser” completely unaware that these may actually take precedence over the “food” aspect of the needs of older babies. That older babies don’t always perceive breastfeeding as food or drink can be seen when watching an older child breastfeed and ask for water or food in the middle of the breastfeed and then happily return to breastfeeding. All these good things breastfeeding provides are turned into negatives more and more as the baby grows older. So a 2 year old falling asleep on the breast or wanting to breastfeed is seen as far more “dependent” than a young baby and a sign of the parents’ failure to “train” the baby earlier on.  In fact, the security of the breast and breastfeeding results in a much more independent child and adult.  A child does not become independent through insecurity; a child becomes independent when his need for security is assured and satisfied, by breastfeeding amongst other things.

Why is breastfeeding not always “ideal”, “beautiful”, as suggested above?

Unfortunately, breastfeeding is not always ideal or as beautiful as suggested above, not by a long shot.  Many problems arise for many mothers and babies, most often because mothers are not getting started with breastfeeding in the ideal and beautiful way and not getting good help during those crucial first days or even after the first few days.  Mothers get sore nipplessore breasts, the baby is not getting enough from the breast or the mother is not getting the help that she needs in order to get the baby more milk from the breast.  Even something as simple, (simple, if the helper is experienced and skilled), as how to latch a baby on is rarely taught well.  Mothers are burdened with “rules” and less than helpful advice on how to breastfeed, such as “feed the baby on only one breast at a feeding“, feed the baby by the clock, use a nipple shield, interrupt breastfeeding for medications all of which lead frequently to difficult breastfeeding.

In some countries, particularly the US, maternity leave is so inadequate, so pitiful, that breastfeeding often stops because the baby refuses the breast after being bottle fed much of the day, or the mother’s milk supply decreases and cannot kept up with pumping.

And so many more ways breastfeeding is messed up for the mother and baby.

One example of how equating bottle feeding to breastfeeding causes problems for the mother and baby.  From the article mentioned in the first line.

From a mother’s email: “My baby was not gaining weight well, so the doctor suggested that I pump my milk and feed the baby by bottle so that we know how much he is getting.”  There is so much wrong in this one sentence, which, unfortunately, is a frequent suggestion to mothers of babies not gaining well on breastfeeding alone!

This “suggestion” by the doctor implies that what a mother can pump is what the baby gets from the breast.  This, from both clinical experience and more than one study, is clearly not true.  A baby who is latched on well and breastfeeding well can get more from the breast than the mother can pump.  A baby who is latched on poorly will usually not breastfeed well and thus get less from the breast than the mother can pump.  If the mother can pump as much as the baby needs for the baby to gain weight well, then the baby should be able to gain weight well by breastfeeding only.

When dealing with breastfeeding issues, the mother and baby need competent help in order to get the baby breastfeeding well.  If, based on the above suggestion, the mother cannot pump or express all the milk the baby needs, the mother will be discouraged and may abandon breastfeeding altogether.  Many mothers whose babies are gaining weight well breastfeeding exclusively cannot pump or express milk in sufficient quantities for the baby’s requirements, even if the mother is separated from the baby for a day or two and pumps her milk regularly. Pumping or expressing tells us only about the mother’s ability to pump or express, it has nothing do with breastfeeding, no matter how much some people try to identify pumping with breastfeeding.

Furthermore, the baby’s “requirements” are based on what a formula fed, bottle fed baby would need and there is no evidence that quantities based on the formula fed baby’s requirements apply to the exclusively breastfed baby’s needs.

Even if there is breastmilk in the bottle, bottle feeding is a completely different feeding method than breastfeeding and the flow of milk from the bottle is constant.  The result? The baby will drink different amounts of milk than from the breast and would likely drink too much.   Breastmilk is different and studies seem to show that between one and five months after birth, a mother’s milk supply does not increase substantially.  Breastmilk whose composition changes with time is different from formula that is constant in composition (if prepared properly) and thus, to make up for the inadequacy of formula, the formula fed baby’s requirements increase with increasing weight.

What is most wrong about the advice given to the mother mentioned above is that too often the baby, after being on bottles for several days or longer, refuses to take the breast again.  And that loss is a big loss, because breastfeeding is more than a method of delivering milk to a baby.  Breastfeeding, actually feeding the baby at the breast, is both a physical and emotional relationship, a close intimate relationship between two people who almost always love each other very much.  Bottle feeding, even when there is breastmilk in the bottle, does not duplicate this relationship in any way.

See also the articles Breastfeeding a Toddler and The Right to Breastfeed

Copyright: Jack Newman, MD, FRCPC, Andrea Polokova, 2017, 2018, 2020, 2021