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The Top Up Trap - How Early Formula Supplementation Affects Breastfeeding.

In this blog post I delve into the top-up trap and its impact on breastfeeding. We explore how supplementing breastfed babies with formula can inadvertently disrupt breastfeeding success and lead to challenges for new mums. I step you through the two common reasons why women find themselves in the top up trap, some of the long-term effects of early formula introduction, and we discuss strategies for navigating the top-up trap, and getting off the cycle and back to exclusively breastfeeding.

This is one of the most common hurdles that I work with clients to overcome, and I would so love any pregnant mamas to have a read/listen so you can hopefully avoid this cycle in the first place!

One common hurdle that many new mothers encounter is the top-up trap. This occurs when supplementing breastfed babies with formula inadvertently disrupts breastfeeding patterns, leading to a cascade of issues that can impact your breastfeeding journey.

Parent Initiated vs. Health Provider Initiated Top-Ups

The introduction of top-ups can stem from two primary sources: parent-led or health provider-led. In the first scenario, mums may perceive their milk supply as insufficient and resort to offering a bottle of formula to their babies. This is often fuelled by concerns that their little one isn't getting enough milk. Unfortunately, this initial supplementation can set off a cycle that can be detrimental to breastfeeding. The scenario often goes something like this...

Baby is unsettled or mum feels her breasts are 'empty' in the evenings, and so gives a bottle of formula because she is worried she doesn't have enough milk. Babies often guzzle the bottle because the milk flows quickly from a bottle, and because formula takes longer to digest in their stomach than breastmilk, babies will often have a longer sleep and sometimes skip a breastfeed. This then causes her to think 'oh they were hungry' and she doubts her supply more. The next day when the situation arises again she gives another bottle. As a result over time, the baby spends less time at the breast, causing the mums milk supply to dwindle. If the breasts aren't being stimulated frequently then they will slow down milk production. This then becomes a vicious cycle as the supply drops, baby demands more milk so more formula is given. Then unfortunately many babies start to refuse the breast and prefer the bottle, and many mums stop breastfeeding altogether.

That is essentially the 'top up trap' that so many breastfeeding mums and babies find themselves in.

Perceived low milk supply ranks among the top reasons why women discontinue breastfeeding within the first three months postpartum. This is perceived low milk supply, not actual low milk supply.

Another scenario that contributes to the top-up trap is the early introduction of formula by heath care providers, often initiated by a midwife or paediatrician in the days after birth. This is often introduced as a formula 'top up' after a breastfeed. This may sometimes be medically indicated, but I encourage you to ask about the risks and benefits, and any other alternatives that could be trialled first if possible. Early introduction of formula is seen more commonly in some hospitals than others, and I believe this to be predominantly to do with the maternity unit culture and beliefs of individual midwives. This is why it's so important to be informed and empowered to ask questions! If we are giving early formula top ups we want to ensure it is absolutely medically needed.

Remember formula digests differently to breast milk, often leading to longer intervals between feedings and a subsequent decrease in milk supply. This is especially important in the first few days breastfeeding when we want lots of breast stimulation and frequent feeds.

Babies may also become accustomed to larger volumes, stretching their stomach capacity which means they may now expect large volumes each feed - often much more than a mother would naturally be producing.

Donor milk, a potential alternative to formula supplementation, is seldom discussed in hospital even though the World Health Organisation recommends it to be considered. It is an individual decision but can prevent some of the risks associated with formula supplementation (listen to the podcast ep to hear more on this). The option of using donor milk is something we often discuss with our clients.

Navigating the Top-Up Trap

Addressing the top-up trap requires a multi-faceted approach. Firstly, it's essential to question the necessity of top-ups and ensure that any supplementation is medically indicated.

Secondly, consistent professional support is paramount to help you wean off top-ups gradually. This is something that we regularly support clients with in our Postnatal Midwifery Packages and Lactation Consultations.

This plan may involve boosting milk supply through increasing breastfeeding frequency and other holistic/medical support for increasing supply. We would also consider increasing the number of times a baby is offered the breast. Or using a SNS Supplemental Nursing System to deliver the top up directly at the breast. But an individualised plan is where we see the most success.

In conclusion, the top-up trap is a huge challenge that many breastfeeding mothers face, and unfortunately something that can mean that their breastfeeding journey comes to an end before they had hoped. This doesn't have to be the case and we would love to help you to succeed with your breastfeeding goals!

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