Updated: May 22, 2019
Breastfeeding journey is almost always hard, unpredictable and filled with emotional highs and lows that one cannot anticipate. The sleepless nights, the exhaustion from pumping and the guilt of formula feeding just adds to the already tiring exercise of breastfeeding.
However, at the end of the day it should be mother’s choice whether she wants to exclusively breastfeed, exclusively formula feed or mix the two of them for her baby.
Doctors, pediatricians and lactation consultants should empower the mother with adequate knowledge so she can make an informed decision when the time comes.
However, we experience a completely different scenario in the hospitals. Mother and baby are separated immediately after birth either for general check up or NICU admission or for other reasons. This is more so after a c-section where the mother is not even allowed to breastfeed for 2-3 days. Another prevalent myth is that breast milk is not sufficient for the new born and hence they are put on formula feed from day 1 which is a highly erroneous practice. This is what I object to and I will explain you why.
Breast milk does not come in immediately after birth. What oozes out from the nipple is a gold coloured (colour may vary) liquid that is rich in proteins and antibodies which is the first feed for the new born. This is called Colostrum. The new born gut is very permeable and doesn’t have any protection. In addition, the digestive system is very immature and any other food given to the baby at this time cannot be digested. Some cultures have a practice of giving honey or sugar to the newborn which is a very big NO! These partially digested proteins and bio-molecules easily enter the blood stream through the permeable gut barrier and cause immune dysfunction later in the baby (1).
This is why the Colostrum is called liquid gold because it is packed with growth factors and immunoglobulins (specifically IgA) which lines the gut wall of the baby and forms a protective layer. The intestinal permeability is high at birth after which it quickly drops over a period of 5-7 days (2). Figure 1 taken from a study which evaluated a group of babies delivered by c section, points to this fact. After 7 days, there is a slower drop till about a month. Formula-fed infants have a slower closure of the gut. Similarly, those fed by IV rather than gastric tubes have a slower closure rate. This doesn’t mean the gut is closed shut after 1 month but at least the vulnerability is much less after a month.
Figure 1: Intestinal permeability as measure by ratio of lactulose/ mannotol recovery in Urine in infants (2).
All this evidence basically tells us one thing: Do not hurry to start formula feed and do not give anything other than breast-milk (colostrum) for at least the first 2-3 days. All infants lose weight in the first 2 weeks and all babies cry! (It’s a natural instinct). These should not be reasons to start the baby on formula feed right away.
Whether the mother chooses to breastfeed or formula feed later is her choice but if the first few days can make such a difference to the baby, I think it should be imperative that hospitals, doctors and lactation consultants strive to achieve it.
1. Hanson LA, Korotkova M, Telemo E. Breast-feeding, infant formulas, and the immune system. Ann Allergy Asthma Immunol. 2003; 90(6 Suppl 3): 59-63.
2. Catassi, C., Bonucci, A., Coppa, G. V., Carlucci, A. & Giorgi, P. L. Intestinal permeability changes during the first month: effect of natural versus artificial feeding. J. Pediatr. Gastroenterol. Nutr. 1995; 21, 383–386.