Saturday, July 21, 2012

Are There Differences Between Breastfeeding Directly and Bottle-feeding Expressed Milk?

From the breast or from the bottle, fresh or frozen, your milk provides all of the nutrition your baby needs for normal growth and development and much more. The nutritive and health-supportive properties of breastmilk can be bottled, making it the next best alternative when breastfeeding is not possible or feasible. Mothers may need or choose to offer their milk by bottle for a variety of reasons as individual as each mother and baby pair, and as a result of this need, there are many solutions for expressing milk. It is easier than ever before to provide a baby with breastmilk long-term, even when a mother cannot or chooses not to breastfeed directly. Exclusive expressing and breastmilk-feeding can be necessary and even life-saving, especially for fragile premature babies. In most societies, the value of breastmilk is well-known, but the value of breastfeeding is not. Breastmilk is a wondrous living fluid that cannot be replicated, and breastfeeding is the normal and optimal way to deliver it.

Antibodies are blood proteins produced in response to substances that the body recognizes as alien, such as bacteria and viruses. Close physical contact with your baby helps your body create antibodies to germs in his environment. When you breastfeed directly, your body creates antibodies in response to cues from your baby’s saliva and other secretions. After exposure to new germs, your body can make targeted antibodies available to your baby within the next several hours (Chirco 2008) (Cantini 2008). While a bottle of milk from a previous date will provide your baby with immune factors, it will not contain antibodies to germs he was exposed to today.

Breastfeeding supports the normal development of a baby’s jaw, teeth, facial structure, and speech. The activity of breastfeeding helps exercise the facial muscles and promotes the development of a strong jaw and symmetric facial structure. Breastfeeding also promotes normal speech development and speech clarity. An increased duration of breastfeeding is associated with a decreased risk of the later need for braces or other orthodontic treatment. One study showed that the rate of misaligned teeth (malocclusion) requiring orthodontics could be cut in half if infants were breastfed for one year (Palmer 2008). Bottle-feeding requires a different tongue action than breastfeeding does, and over time may affect the growth and development of oral and facial tissue. Sucking on bottle nipples, pacifiers, and even thumbs and fingers can eventually affect the shape of a baby’s palate, jaw, teeth, and facial structure. In this presentation, Position and action of the tongue during breastfeeding, dental expert Dr. Brian Palmer shows how breastfeeding promotes normal facial development and provides illustrations showing what happens inside the mouth during bottle- and breast feeding (Warning: Slide 2 of the presentation shows a picture of a cross section of the mouth of a human cadaver for illustrative purposes).

When breastfeeding on cue (as your baby shows signs of hunger), you produce milk in response to your baby's demand: your body makes milk to replace the milk your baby removes from the breast. When exclusively expressing, you produce milk according to how much milk you are able to remove with the pump and/or your hands. Some mothers find it is more difficult to maintain milk production long term with a pump for a variety of reasons including difficulty scheduling time to express (frequency of milk removal) and the overall effectiveness of the pump at removing milk. Understanding how long term milk production works can help mothers who are dependent on their pumps for milk-removal maximize both the amount of milk they are able to remove and the length of time they are able to continue producing milk.

Bottle-feeding expressed breastmilk is more time-consuming than breastfeeding directly because you have to spend additional time expressing milk, washing pump and bottle parts, and shopping for necessary equipment: this time might have been spent enjoying your baby or taking care of yourself. When your breastfed baby is hungry or needs to be comforted, you simply put him to the breast. When bottle-feeding breastmilk, you must first attend to preparing a bottle before you are able to meet your baby's needs.

Skin-to-skin contact (also known as “kangaroo care”) is important to your baby’s development (Bigelow 2010). Babies held skin-to-skin stay warmer, cry less, and have better-coordinated sucking and swallowing patterns. Mothers who hold their babies skin-to-skin enjoy increased milk production, increased oxytocin release, improved mother-baby bonding, and more confidence in their mothering abilities (Moore, Anderson & Bergman 2009). When you are breastfeeding, you will naturally be in a position to offer skin-to-skin contact to your baby. When you are bottle-feeding, it is important to find additional time each day to hold your baby this way. 

Research has shown that breastfeeding directly correlates with a positive mood in mothers. One study examined the effects of breastfeeding and bottle-feeding on maternal mood and stress. After breastfeeding, the mothers in the study were found to have both a reduction in perceived stress and a more positive mood. In contrast, after bottle-feeding, mothers were found to have an increase in negative feelings. The researchers suggested that the higher levels of oxytocin released by breastfeeding may contribute to both reduction in stress and better mood (Mezzacappa & Katkin 2002).

Bottle-feeding gives your baby less control over his milk intake. Milk flows easily from a bottle nipple even when the baby is not actively sucking, and the faster flow can cause a baby to continue feeding after he is full. When bottle-fed, babies may drink more than they need because the care-provider may encourage the baby to finish the bottle rather than waste the milk inside. While breastfeeding, your baby can control the flow of milk by the way he feeds. You are not able to see how much milk your baby consumed, but you can watch for signs that your baby is satisfied, and you will be less likely to coax your baby to continue eating after he is full. Research suggests that infants who are breastfed, rather than bottle-fed breastmilk, are better able to self-determine fullness as children and may have a lower risk of overeating and obesity later in life (Isslemann 2011). Recent research suggests that it is the act of breastfeeding that helps prevent rapid weight gain (Li and Magadia et al 2012).

There are some variations between milk that is obtained directly from the breast (or that has been freshly expressed) and milk that has been stored. For example, freezing has been found to decrease the effectiveness of some of the antibodies and kill some of the living cells in milk (Orlando 2006) (Buckley & Charles 2006). In order for your baby to get the most anti-infective properties from your milk, it is best to offer it fresh whenever possible.

Getting the most out of breastmilk-feeding
  • Spend time in skin-to-skin contact with your baby to help your baby grow, improve milk production, and promote breastfeeding behaviors. 
  • Build and maintain milk production by expressing milk at least as often as your baby would breastfeed and draining your breasts well with “hands on” pumping
  • Use a paced bottle-feeding technique that promotes breastfeeding behaviors and respects your baby’s natural suck, swallow, and breathe patterns 
  • Beware of marketing claims. There is no such thing as a bottle or nipple that is “just like” the breast. Choose a bottle and nipple that fits your goals and your baby’s individual feeding style. 
  • Always hold your baby to feed. Bottle-propping is a choking and aspiration hazard. Eating is a naturally social experience; propping is isolating. 
  • Feed your baby when he shows hunger cues rather than on a schedule and let your baby determine when he is full (applies to healthy, full-term babies that are feeding well) 
  • Store breastmilk in smaller quantities to reduce waste 
  • Offer freshly-expressed milk whenever possible. 
  • If your baby is hospitalized, and you are unable to nurse or hold him, spending time in his environment (including touching equipment and even shaking hands with staff) will help you produce antibodies to germs to which he has been exposed. 
  • Baby-wearing and co-sleeping (room sharing) promote bonding, attentiveness to your baby’s hunger cues, and production of antibodies to germs in his environment 
  • If you are bottle-feeding due to low milk production, consider the option of using an at-breast supplementer so that your baby can receive supplemental feedings while nursing at the breast.
If you are bottle-feeding your baby exclusively or partly, and you would like to increase his feedings from the breast, or if you need more information about exclusively expressing your milk, an International Board Certified Lactation Consultant, WIC Peer Counselor, or volunteer breastfeeding support counselor would be able to offer information and support. The same holds true if you are feeling pressured to provide your milk by bottle even when it is not absolutely necessary; the often-suggested solutions for daddy- or grandparent- bonding time or feeding in public is “just pump.” Remember, whether by breast or by bottle, every ounce of breastmilk matters! You are doing something very special for your baby, your family, and your community.

More information:

It’s Not Just About Breastfeeding

Weaning from formula supplements

Help-My baby won't nurse!

It's Not Really About the Milk

Bottle Vs Breast, A Mother's Story

Milk Sharing, Good or Bad?

Buckley, K. Charles, G. (2006) Benefits and challenges of transitioning preterm infants to at-breast feedings International Breastfeeding Journal 1:13

Cantini, A. (2008) Pediatric Allergy, Asthma, and Immunology. Heidelburg, N.Y. Springer.

Chirico, G. et al (2008) Antiinfective Properties of Human Milk Journal of Nutrition 138, 1801S–1806

Isselmann Disantis, K. (2011) Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? The international journal of behavioral nutrition and physical activity 17;8 (1):89

Li R, Magadia J et al (2012) Risk of bottle-feeding for rapid weight gain in the first year of life Arch Pediatr Adolesc Med 166(5):431

Moore ER, Anderson GC, Bergman N. (2009) Early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Summaries

Mezzacappa, E. Katkin. E (2002) Breastfeeding is associated with reduced perceived stress and negative mood in mothers Health Psychology 21(2), 187-193

Orlando, S (2006) The immunologic significance of breast milk. J Obstet Gynecol

Neonatal Nurs 24(7), 678-83

Palmer, B. (2008) The Influence of Breastfeeding on the Development of the Oral Cavity: A Commentary Journal of Human Lactation, 14(2), 93-98

St. Francis Xavier University: Dr. Anne Bigelow. Enhancing Baby’s First Relationship: A Parents’ Guide for Skin-to-Skin Contact with Their Infants

© Jolie Black Bear, IBCLC, Serena Meyer, IBCLC, Teglene Ryan, IBCLC, and Adrienne Uphoff, IBCLC--All Rights Reserved