Breastmilk vs. Formula: The Power of Choice

Despite today’s world of women’s rights, choices, and equal opportunity, infant feeding has fallen to the wayside. There’s no emotional choice for mothers–breastfeeding is touted as a necessary requirement to be a responsible mother. Societal pressure to breastfeed, to grit and grind through it all, is ingrained in our minds.

Yet, every single new mother will contemplate formula, whether it’s once, whether it’s to supplement breastmilk, or whether it’s exclusively formula because she can’t breastfeed. That decision is so fraught with guilt that it creates a whole host of side effects that we haven’t taken into consideration into the equation for decision making. We’re lucky to live in a time where we have options.

I’m not promoting either breast- or formula feeding over the other.
My goal is to illuminate data so women can make their own informed decision, whether it’s to supplement with formula once, in conjunction with breast milk, or instead of breast milk.

This article describes the less-well-known facts and tradeoffs around newborn feeding; please take it, do your own research, and ultimately make the best decision for your family.

This article is just as important for husbands, as it’s supremely difficult after labor & delivery to have a clear mind.

What you’ll learn

What to expect from the delivery room
How breastfeeding physically works
The claims as to why breastfeeding is better
The counter-arguments to why formula feeding can be better
Recommended reads and resources

Setting realistic expectations from the delivery room

Most often first time mothers assume that breastfeeding will be ok, because you’re motivated and want the the best for your baby. You’ll make it work. You’ve gone through worse.

But expectations are so poorly set (stemming from both the medical industry and from society) that mothers are ill-equipped to handle the event that breastfeeding doesn’t work smoothly. That curveball hits hard in the hormone rollercoaster in the first 48 hours post-delivery.

There’s tons of resources post-delivery for you, from nurses to lactation consultants. Each one brings a new technique to try: they squeeze your boob to get nipple geometry right (c-hold, u-hold, football hold, cradle hold) for a latch. Every 2 hours they tell you to attempt to feed again. Every 8 hours brings a new shift and a new person. I was so determined to do the right thing that I tried, like clockwork, every 2 hours.

Not a single nurse or lactation consultant told me to relax. Instead, I was to try and try again, and I ended up with blood blisters on my nipples within the first 24 hours of delivery. I can’t emphasize how physically excruciating it is to have a crying newborn suck on blood-blistered nipples, and mentally excruciating that I was failing. There wasn’t one mention of formula; I felt that if I uttered the word, I’d be wheeled into counseling before being discharged.

The rest of my breastfeeding journey would’ve been much easier had I supplemented a bit of formula, let my nipples heal, and then got back to breastfeeding. Instead, for 3 months after, I cycled between breastfeeding, which injured my nipples and prevented healing, and letting them heal, which drove down my breastfeeding supply.

The biggest piece of advice I have for new parents is to bring your formula of choice to the delivery room. You might not use it, but it’s a Plan B. And it’s ok because every Plan A should have a Plan B. Just throw it in your overnight bag. Formula isn’t a permanent decision–you can do it once or twice to make the rest of your experience much easier.

Breastmilk Takes 3-5 Days to Start Producing

Breastmilk takes on average 3-5 days to start fully flowing after birth. You initially produce a couple teaspoons of colostrum, which is a natural energy drink and all your infant needs in the first few days of his life. Your baby will lose weight and be inconsolable until your breastmilk fully comes in.

Have formula and bottles on hand once you get home from the hospital, whether you plan on breastfeeding or not. Your baby will be hungry and crying 24/7. You can still breastfeed so they can latch and stimulate milk production by sucking, but also give them a bit of formula to make those days tolerable. It gives you options.

I’ve never known such boob pain as when I started producing milk. My boobs were hot, engorged, heavy, and I could barely lift my hands above my head. But my nipples were in so much pain from the blood blisters that I could barely pump long enough to relieve the pressure. (Word to the wise: don’t hug a just-given-birth mother. Shoulder pats are the way to go.)

The Breastmilk Feedback Loop and Boob Issues

Breastmilk production is a positive feedback loop: the more in frequency and duration you pump, the more you produce. I came home with horribly cracked, bleeding, blood-blistered nipples. I couldn’t attempt to feed without bawling, half in pain and half from the hormone high.

I desperately wanted to hold my baby and cuddle without dreading him. The guilt from not producing enough milk made the wonderful experience of a newborn terrible, since I was dreading the thing I wanted to love: my new son.

I wasn’t pumping frequently enough because of pain, so my production was low. I got clogged milk ducts from the blister scabs. A clogged milk duct will make your boobs red, swollen, and needs to be treated to let milk out. Treatment is exfoliating your nipple. Yes, you take a wet, rough washcloth and cry as you exfoliate your blistered, dry nipple, in order to pump. That hot shower you want to take to relax? A hundred glass shards impaling your chest.

I went through cycles of pumping less to heal, then pumping more to bring up supply, then becoming too tender to pump more, then lost my supply, and then repeated. We supplemented half formula during the whole time.

The Claims that Breast is Best: true, false, maybe?

The Claim: Breastfeeding leads to higher IQ

Statistically insignificant. A study in 2015 made waves when it claimed that breastfed babies have on average 8 points higher IQ. The problem with any pregnancy study is they’re studies, and point out correlation, not causation–you can’t do a randomized trial with pregnant women. The most quoted, largest breastfeeding study done, the PROBIT trial in 1996, was based on correlations.

The 2015 study followed mothers who exclusively breastfed for 6 months and then continued in combination with food for 1 year. In any first world country, however, the only people who can afford to be home and breastfeed exclusively are middle- to upper-class, educated, usually white families, who are more inclined to raise kids who score higher on IQ tests. There’s so many confounding factors that the actual IQ benefit is statistically insignificant.

The Claim: Breastfeeding gives immunity

Not entirely. Breastfeeding provides passive, not active, immunity. Humans are the only mammals whose antibodies pass through the placenta pre-birth, not through breastmilk. During the time your baby’s mouth, throat, and stomach still have a coat of your breastmilk right after they’ve eaten, it can help fight infection, but those antibodies don’t pass through to baby’s blood system. This passive immunity is good if you have a preemie. But in reality, it amounts to about 4 out of 100 babies having 1 less incidence if diarrhea a year.

A confounding factor is the World Health Organization reports much lower infant morbidity in babies exclusively breastfed for at least 6 months. This is almost entirely due to 3rd world countries where a clean water source is an issue.

But, if your baby does have allergies and a sensitive stomach, or is a preemie, breastfeeding is a safe bet.

The Claim: Breastfeeding reduces infant obesity

It can. But if you’re reading this article, you want to do the best for your kid and I highly doubt you’ll raise an obese child. Sidenote: “sensitive stomach” formulas use corn syrup and sugar instead of milk lactose and whey protein, so conscientious of ingredients when you choose your formula.

The Claim: Breastfeeding reduces SIDS

Maybe, but it’s small. A study of 1000 infants found that breastfeeding even partially through 2 months halved the risk of Sudden Infant Death Syndrome. The study interviewed parents’ behavior in infants whose deaths were categorized as SIDS. There may be truth to this study, but correlation questions arise again, since it wasn’t a randomized control study.

The SIDS rate in the US is about 0.054%, under 4,000 infant deaths a year. It’s a catch-all for infant deaths that can’t be explained and happen during sleep. The one sure way to reduce SIDS is to keep your baby sleeping on his back.

The Claim: Breastfeeding is cheaper

Maybe. Formula costs $1000-$2000 a year. But media doesn’t itemize the costs to breastfeed, which isn’t free. If you’re working and pump, you need to rent or buy a pump (as long as ACA is around, insurance covers base pumps, but they aren’t ideal if you have supply issues). Hospital-grade pump rentals cost ~$100/month, plus the bags to store milk, the bottles, the nipple pads since you’ll leak, lanolin cream, hot compresses, new bras, nursing covers. If you’re exclusively feeding direct boob-to-baby, you have the opportunity cost of working salary.

The Claim: Breastfeeding helps you lose pregnancy weight

Sure. Breastfeeding burns up to 500 calories a day, and you’ll lose weight if you don’t eat more. On the flip side, if you’re an active, fit person already, breastfeeding will get in the way of your gym plans. I was much happier working out on my own. Breastfeeding means early on, you can’t be away from your baby or pump for longer than 2 hours at a time.

The Claim: Breastfeeding helps you recover from pregnancy faster

True. Oxytocin is secreted during labor to induce contractions and also secreted when you’re breastfeeding to help your uterus shrink back to normal size. The claims are “uterus back to normal” in 6 weeks instead of 10 weeks. However, I believe that being active as soon as possible after birth will do as much good.

The Claim: Breastfeeding reduces postpartum depression

Maybe. Oxytocin is also a “happy” hormone, helping you psychologically forget the pain of labor and helping you bond with your baby. In theory, it can reduce postpartum depression (PPD). However, if breastfeeding doesn’t come easily, it can exacerbate tendencies toward PPD. I was much happier enjoying the time with my baby not in pain and having my body return back to normal. Exercising will also give you happy hormones to combat PPD.

The Claim: Breastfeeding helps you bond with your baby

Yes, if breastfeeding comes easily. If it’s hard, I assure you, my time with my baby was spent in dread, not bonding. I had a much better relationship with my baby when I supplemented with formula.

Counterpoints: The trade-offs society ignores in the breast-vs-formula debate

Counterpoint: Formula feeding splits childcare with Dad

In the age of women’s equality, the single biggest factor for career and wage disparity is childcare. If you formula feed, feeding can truly be split between Mom and Dad. The extra sleep you get will go way further toward physical recovery and reducing postpartum depression and baby blues. My husband and I alternated feedings, so early on we were both getting up to 4 hours of sleep at a time.

Counterpoint: Cortisol passes through breastmilk to your baby

The stress hormone, cortisol, passes through breastmilk. If breastfeeding is hard and you feel the crush of guilt to continue breastfeeding, your baby is feeling it, literally.

Sidenote: caffeine also passes through breastmilk. If you pump and save milk for later, it’s best to label milk by time of day and try to feed on a regular day cycle.

Counterpoint: We as a society undervalue the value of emotional health

If breastfeeding isn’t easy, you’re going to raise your cortisol levels, pass that to your baby, you’re likely going to argue more with your partner, your baby will pick up on that tension, and your family health will decline. I can’t stress enough the incredible value of emotional well-being for your family. Your family’s emotional well-being is more intertwined than we acknowledge in science.

Counterpoint: Formula has come a long way in the last 20 years

Most of the long-term studies are from the ‘90s. Formula now has DHA, lutein, Vitamin E, prebiotics, probiotics, and a blend of nutrients. There are a lot of areas in modern society where scientific advances are a huge benefit.

Counterpoint: Breastmilk is only as nutrient-dense as you eat (and you’re likely deficient)

In other words, what doesn’t go in can’t possibly go out. Vitamin D, folate, B12, iron, and choline are only a few of the nutrients vital to mom and baby, and they’re the most common to be deficient in. Research in the last decade has shown that the RDAs for these are set far lower, especially during pregnancy and breastfeeding. RDAs were set decades ago for average males and haven’t been updated by the FDA.

Example: The RDA for Vitamin D is 600IU/day. A glass of milk is often fortified with 25% of that RDA–but it’s been clearly shown that you need 4000IU/day to get appropriate breastmilk levels. That’s 16 glasses of milk a day! The same goes for DHA (fatty acid found in fish; estimated intake of >12oz of fish/week), and choline (4-5 eggs per day equivalent).

I highly suggest reading Real Food for Pregnancy (written in 2019), which summarizes each vital nutrient, how much of each nutrient we really need based on the most recent science, and how that changes throughout pregnancy and breastfeeding, for both your body and you baby.

nutrients in breastmilk — From the book The Science of Mom: A research-based guide to your baby’s first year

Counterpoint: Formula feeding is easier to track and log

It’s actually pretty cool and convenient to know exactly how much your baby’s eaten, especially in the first couple months. Apps are pretty awesome to track feeding, especially if you’re trading off feedings with your partner. Rather than waking your partner up at 2am to ask what time baby last fed, you can check a shared app. More sleep, more win!

Note: If you’re exclusively pumping and feeding from a bottle, you can track this as well.

So why on earth is breastfeeding so hard if it’s evolution?

In reality, if you had to do it, you would. I think a big portion is that we’ve lost the art of breastfeeding. I’m sure the support systems and homeopathic aids were part of our culture hundreds of years ago. Women also had many more children, and there was always a lactating female in a village. Wet nurses were common through the 1800s.

To make you feel better, infant feeding has been a struggle for hundreds of years. And we’re just riding the current generation’s cycle of promoting breastfeeding.

Don’t sweat it, but accept that you will sweat it

Accept the pressure. Be educated. Make decisions when the time is right for you. Despite researching and knowing all this, I honestly don’t know what I’ll choose with our next baby. There’s a ton of pressure and guilt. Remind your husband to remind you of these points when the time is right.

And if it works, it works

If breastfeeding works, great! If it doesn’t, go to the store and problem solved. All I wish for is equal ground so there’s no guilt either way. Whether your family’s solution is breastfeeding or formula, happy mom, happy baby, stressed mom, stressed baby. No guilt.