The Pros and Cons of Breastfeeding vs. Formula Feeding
One of the most important decisions a new mom makes is how to feed her newborn: breastfeeding or formula feeding? The answer doesn’t always come easily. Some women are anxious about breastfeeding or lack the support they need to feel comfortable with their choice. In some cases, breastfeeding is difficult due to a traumatic delivery, post-birth complications, infection or a baby’s latching problems. And then there are the critics of formula, who look down on moms who don’t breastfeed.
During an already emotional, stressful time, the pressure on moms to make the right decision can be overwhelming. Ultimately, only one thing matters: what makes the most sense for you and your baby. To help you make that call, here are the pros and cons of breastfeeding versus formula feeding.
Official Recommendation: ‘Breast Is Best’
The World Health Organization (WHO) describes colostrum (the yellowish, sticky breast milk produced at the end of pregnancy) as the “perfect food for the newborn” and recommends that breastfeeding is first attempted within an hour of birth. Thereafter, WHO recommends exclusive breastfeeding up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.
This recommendation is echoed by the American Academy of Pediatrics (AAP) and other international health organizations.
Breastfeeding Benefits Baby
Breast milk is considered the gold standard for infant nutrition because it contains the right balance of nutrients and boosts the baby’s immune system. Breastfeeding is said to protect against a wide range of conditions and diseases, including bacteremia, diarrhea, necrotizing enterocolitis, otitis media, type 1 and type 2 diabetes, lymphoma, leukemia and Hodgkin's disease.
By transferring immunity from the mom to the baby, breastfeeding reduces the rate of infection, and the benefits may extend beyond infancy. For example, a 2017 study linked breastfeeding for six months or longer with a reduced risk of lower respiratory tract infections in preschool children. Breastfed babies are also believed to be less likely to become overweight or obese in childhood.
Breastfeeding Benefits Mom, Too
Maternal health benefits to breastfeeding include decreased postpartum bleeding, more rapid uterine involution, decreased menstrual blood loss and increased child spacing, an earlier return to pre-pregnancy weight, and a decreased risk of breast and ovarian cancers. On a practical level, breastfeeding saves time and money, as there’s no need to buy and measure formula, sterilize nipples or ensure bottles are at the right temperature.
Breastfeeding also benefits the environment because it doesn’t require the use of energy for manufacturing. Nor does it create waste or air pollution. Additionally, there is no risk of contamination, and it is always at the right temperature and ready to feed.
When to Pump
If a mom wants to breastfeed but is unable to do so — for example due to infection or she has to return to work, which means time apart from her baby — expressing breast milk is an option. Some moms choose to use a breast pump to provide relief if they struggle with engorgement (when the breast tissue overfills with milk, blood and other fluids, causing the breasts to feel very full and become hard and painful).
“Many mothers will feel pressured to begin using the pump as soon as they start breastfeeding,” says Lactation Counselor and Dietitian Catherine Brennan. “But the truth is that it is most important to establish a breastfeeding routine first and to think about the pump later.”
When to begin using a breast pump depends on the needs of the mom and her personal circumstances. If a mom is planning on going back to work or school or is planning on being away from the baby for an extended period of time, Brennan recommends pumping in the early postpartum period or a few weeks before the separation, to become comfortable with it and to build up a supply.
“For many moms, it is good to pump in the early part of the day for a couple of days to collect enough for a bottle,” she says. “When the baby is taking the bottle, the mom should pump to replace that milk as well as to signal the body to continue to make milk and to avoid engorgement.”
Formula Is a Healthy Choice
Formula feeding also has many benefits. For starters, it’s convenient. Babies can be fed formula by anyone, at any time. It may be a more flexible option, particularly for moms who have to return to work. They don’t have to worry about pumping because they can leave formula with their partner, the sitter or daycare center.
Bottle feeding your baby also allows your partner to share that special bonding experience with the baby. Formula-fed babies may get into a routine quicker than breastfed babies because it’s easy to monitor how much milk they’re getting. Because formula isn’t digested as quickly as breast milk, they also don’t need to eat as often.
Formula Can Be a Positive Solution
Even when a mom is 100 percent committed to breastfeeding, unexpected medical situations can lead to complications. Sometimes, a difficult delivery or medical challenges post-delivery make breastfeeding problematic. Those can include premature birth or other issues that require admission into the NICU, or a cleft lip, cleft palate or other condition that prevents the baby from suckling at the breast. In these cases, formula can help.
“When problems arise, I believe formula is the perfect solution and source of nutrition for babies,” says Midwife Risa Klein. “I believe every practitioner needs to discuss with expectant moms the unlikely, but real possibility that delays in breastfeeding could occur.”
Proper Nutrition Is the Most Essential for Baby
While the health and well-being of both mom and baby should be the basis for every breastfeeding versus formula decision, the paramount concern should always be the baby’s nutritional needs. If you’re concerned that your baby isn’t getting adequate nutrition or hydration from breast milk, talk to your healthcare provider.
Sometimes, breastfed babies don’t gain enough weight from breastfeeding alone due to milk supply or latching issues, in which case supplementation with expressed breast milk and/or formula is the answer.
Prolonged Breastfeeding Pain Isn’t Normal
While it’s normal for breastfeeding to be a little uncomfortable in the early days, particularly when the baby is first latched onto the breast, it shouldn’t be a painful experience in which sore nipples are the norm. Cracked or bleeding nipples or searing pain is an indication that there are underlying issues, such as a poor latch and/or positioning, engorgement or an infection, says Brennan. Her first tip for moms experiencing pain with breastfeeding is to recognize that the pain is real and that it should be acknowledged as so. In other words, you don’t have to “grin and bear it.”
“You do not have to go through this alone,” adds Brennan. “I recommend visiting with a professional who can help you find the source of your pain. Non-judgmental support with an experienced and qualified practitioner is key.”
If you don’t feel you’re getting the support and knowledge from your doctor, who may not fully understand the ins and outs of breastfeeding, contact an International Board Certified Lactation Consultant (IBCLC) — they can be found in most birthing hospitals.
A Good Latch Is Key
If the baby’s latch causes pain, the mom can try various different positions and latch techniques. “Sometimes, a painful latch can be remedied by tweaking the position of the baby and the mom,” says La Leche League Leader Leigh Anne O'Connor, IBCLC.
She recommends aligning the baby’s eyes to the nipple and holding the baby super close — belly-to-belly with mom — but not pressing on the baby’s head, which can cause his or her chin to tuck and make the latch shallow. “Sit back and roll your shoulders back,” she says. “If needed, flip open baby’s top lip and press open their chin. Hold for several seconds to achieve a deeper latch.”
Different breastfeeding positions moms can try include the cradle position (resting the side of your baby's head in the crook of your elbow with their whole body facing you and supporting your baby’s belly against your body), the football position (lining your baby's back along your forearm to hold your baby like a football, supporting his head and neck in your palm) and the side-lying position (snuggling close to your baby and using your free hand to lift your breast and nipple into their mouth). The right position for you is simply the one that feels most comfortable and encourages the best latch.
Self Care Is Crucial When Breastfeeding
Taking care of yourself goes a long way toward breastfeeding success. Eat healthy, drink plenty of fluids and rest as much as possible. Go to bed early, and nap when baby naps! Life with a newborn can be chaotic, but try to take time for yourself. “A hot bath, or taking time to nap or read a good book can make a world of difference in your mental health,” says Brennan. “And when you take care of yourself, you can then take better care of your little one.”
And don’t feel guilty about assigning other tasks, like diaper changing, bathing, household chores and preparing meals to your partner or other members of your support team to let you focus on feeding. O’Connor recommends attending breastfeeding support groups and La Leche League meetings for additional support. Friends and family members who have breastfed can also be a great source of information and reassurance.
The Law on Public Breastfeeding
It took some time, but in 2018, the right to breastfeed in public finally became legally protected in all 50 U.S. states. Other countries have supported public breastfeeding for a lot longer, with national breastfeeding laws already in place in the U.K. and Australia. (The act is also simply accepted in many other countries, with no need for specific legislation.)
However, the scope of breastfeeding laws vary by state. For example, while New York goes further than simply protecting the act of breastfeeding itself, requiring breastfeeding rooms to be available in all state buildings open to the public, the bill in Utah — the second-to-last state to pass legislation protecting the right to breastfeed in public — includes language that requires people to cover their breast while feeding.
Legislative change is crucial, but it may take some time before breastfeeding is accepted as a social norm in the U.S., where many women are still ostracized for breastfeeding, especially in public. “Unlike many other countries, where breastfeeding is seen as the norm, having to go to the bathroom or to a private space to feed her baby may cause a mother to have second thoughts or lead her to give up on breastfeeding all together,” says Brennan.
Breastmilk and Formula Can Work Together
Combination feeding — feeding a baby both breast milk and formula — works for many moms. “If I have a client who is not comfortable breastfeeding and doesn’t have a medical issue, I suggest that she try pumping for a few weeks, and then transition to feeding her baby formula, so that the baby can receive as many immune factors as possible from her colostrum and early milk,” says Klein.
To help you find the right balance of breastfeeding and formula feeding, Klein suggests seeking support and guidance from your healthcare provider, your midwife or doula, a lactation consultant and breastfeeding support groups. Formula can help supplement breast milk if the mom does not make enough milk, for example, due to previous breast surgery or breast reduction, hypoplasia of the breast or early mismanagement of breastfeeding. “If a mom has to be separated from her baby and is unable to pump, she can do a combination of nursing and feeding her baby a supplement of formula,” says O’Connor.
The Bigger Picture
In the long term, there do not appear to be major differences between formula-fed babies and breastfed babies. In one study, which compared siblings who were formula fed versus breastfed, there was little difference in how they turned out later in childhood, raising the question of whether the health benefits of breastfeeding are overstated.
Researchers measured several outcomes previously shown to be impacted by breastfeeding, including body mass index (BMI), obesity, asthma, hyperactivity, parental attachment, intelligence and scholastic competence, and concluded that the benefits of breastfeeding were not “statistically significant.” Another study found that while breastfed babies may experience a reduced incidence of asthma and allergy in the early years, they may actually experience a higher risk of asthma and allergy in later life.
There’s no denying that breastfeeding can be a wonderful bonding experience, but there’s no reason that formula-fed babies can’t have equally strong bonds with their parents. A strong emotional bond comes from the act of holding, comforting and feeding your baby when they are hungry, which reassures your baby that their needs are being met.
It’s Your Call
When it comes to feeding your baby, the best choice is an informed one, made after taking into consideration all the available information about different feeding options and considering all the needs of you and your baby.
While breast milk may be nutritionally superior to formula, and most health professionals will always advocate exclusive breastfeeding as the best option, every mom has the right to decide how she wants to feed her baby, without shame or judgment. “Breastfeeding versus formula feeding is a choice that is up to the mother, and though she should be informed about her options, she should be able to make this choice free of judgment from others and, hopefully, without guilt,” says Brennan.