I want to talk about infant weight loss/gain and breast feeding. (Seriously, Crystal!? Again!?......yep.)
Believe it or not, how your baby loses and gains weight after birth relies heavily on what went on in the hospital before they ever even made it earth side. I'm talking about routine interventions during labor and delivery.
I'm saying this confidently based on research, yet cautiously, because there are exceptions to every rule. I'm addressing the majority of babies whose parents are told they have to supplement because baby isn't gaining enough weight or has lost too much weight. Like I've said before, parents choose to feed their children based on what the child needs- it's about what is best for the individual baby. When a medical care provider tells a parent that breast milk isn't enough, that they need to supplement to get their baby to a "normal" weight, it has incredible impact on the parent's priorities. It tells them that their baby is not developing adequately on breast milk, and that baby needs nutritional supplementation (formula) to be normal. If breastfeeding equals "not normal", but formula equals "normal", despite the undeniable benefits of breast milk over formulas, how likely is the parent to continue breast feeding? The truth is, breast milk IS enough. Breast milk is the normal. Babies on breast milk serve as the base line for normal because that's what their bodies were designed to digest and utilize. I'll go against the grain here and go as far as to say that anyone who argues that breast milk raises IQ or prevents allergies or asthma is flat out wrong. If breast milk is the base line, then it's the milk substitutes that improve or decrease those things..not the other way around.
So, that said, why is everyone obsessed with needing to supplement formula to increase weight? If breast milk sets the bar for what normal growth is (formula is designed to imitate it, after all!) why the rush for nutritional intervention? This brings me back to the relationship between intranatal interventions and baby's weight changes.
You see, when a birth includes intravenous fluids, typically present with "routine" interventions like epidurals, spinals, and cesareans, mommy gains pounds in water weight (in a 12 hour labor with IV fluids at 150mL/hr, that's almost 4 lbs of fluids..granted, some of that fluid makes it's way out, but the water retention is actually an intended side effect). And what goes into mommy, goes into baby. As such, infants born to mothers who received interventions have gained water weight in utero as well. So, their birthweight is a few precious ounces heavier than they would have otherwise been, giving a false base line for the healthy infant. For this reason, it has actually been recommended by some researchers that healthcare professionals use the 24 hour weight of an infant, rather than birthweight, to determine whether there is a medical cause for suspecting a failure to thrive. On average, breastfed infants born to mothers who received IV fluids lose between 16-19% of their body weight within 24-30 hours (this number is higher in BF babies because colostrum is a laxative, naturally designed to evacuate baby's system of meconium and bilirubin). At 10% loss, formula supplementation is pushed, and in many scenarios if a mothers milk has not come in by day two, supplementation is suggested regardless of weight loss. Early introduction of supplements prevents baby from hungrily suckling at the breast as nature designed. That early suckling is vital to kick starting milk production. Without it, mom is already missing an opportunity to stimulate milk production.
Now, I know of zero studies that investigate the direct correlation between milk production and IV fluids. Even so, one might think that the excess water retention would aid in milk production, but consider this: When administered to mom, the same chemicals that block pain receptors also affect the natural hormones like oxytocin that are naturally there to, among other things, stimulate milk production! With water retention diluting the natural hormones in the body that are already being stifled by pain blockers, it's possible to delay that chemical initiation of lactation. Such a delay corresponds to that initial infant weight loss as well. As the water weight of IV fluids leaves the body (baby's urine, in higher volumes due to the body needing to evacuate excess fluid to return to the true bodily balance) parents are faced with rapidly dropping weight coupled with delayed milk production. Here we have the typical "..milk didn't come in," or "...didn't make enough milk."
After an epidural, the medication can be detected in baby's urine almost 8 hours later. After a spinal, the medication lasts up to 36 hours in baby's system. The effects of those intranatal interventions have a bearing on baby's alertness and willingness to nurse as long as they are present in baby's body...adding, again, to lack of stimulation of milk production.
So, when birth involves IV fluids baby's birthweight is bloated, leading to the appearance of excessive weight loss, which leads to unnecessary nutritional supplementation, leading to mother's lack of confidence and drive to breastfeed. Ultimately these events result in over half of those mothers who intended to breastfeed switching to alternative nutritional sources.
Is formula healthy? I have no reason to promote anything but this: Babies thrive on both formula and breastmilk. In some cases, formula is a Godsend. For parents sanity and medical reasons, formula has an important place. But, that doesn't mean breast milk and formula are equal. One offers a measured, consistently manufactured source of nutrition. The other offers a set of antibodies, hormones, and nutrition that changes from feeding to feeding depending on what baby's body tells mommy's body, all the way into early childhood. These differences do affect the long term growth of a child, which is why pediatricians and parents need to know that there are separate growth charts for breastmilk and formula fed infants.
Research has found a definite gap in infant growth depending on what they eat. This difference is essentially non-existent until about 2 months old. From birth to 2 months old a child needs a high protein diet. After the 2 month period, breast milk regulates to match baby's needs. However, because of the consistent, unchanging components of their food, formula fed babies continue to ingest the high protein diet that formula provides. Formula fed babies show higher insulin, insulin-like growth factor-1, and amino acids than breast fed babies, which results in heavier babies. In contrast, breast fed babies are leaner and have been found to be at a significantly lower risk for obesity later in life. This is where I need to reiterate that breast milk is the "normal" base line for growth, because this is where pediatricians and parents run into the weight-gain trap that leads them to believing their child is not "normal" and needs formula supplementation.
Why would it matter what chart they use? A breastfed baby at 2 months of age is receiving a need-based dose of proteins. Meanwhile, even though formula fed babies' bodies actually need less protein after 2 months, they continue to eat their measured intake of high protein. The excess protein produces heavier babies. On a typical growth chart, it would appear that breastfed babies are lagging behind. But keeping in mind that breast fed babies are the base line, what were actually seeing is formula fed babies gaining excess weight. (That doesn't mean it's unhealthy excess weight! It's just one factor that needs to be mentioned.)
Now, putting it all together, you can get a better idea of why supplementation is so frequently, and so unnecessarily, a recommendation. Between bloated birth weights, chemical delay of lactation, and misunderstanding of normal developmental curves, it's no wonder so many moms believe they "..don't make enough," or that their milk "..didn't come in", or felt that they HAD TO supplement or switch to formula.
When formula is a conscious choice, I see nothing wrong with it. What I do have a problem with is the perpetuation of the idea that a mother isn't ENOUGH. That her baby "deserves" something "better". Too many women are told that their milk isn't good enough or their breasts don't work. That their baby isn't normal. That numbers on a chart mean more than letting their baby grow as nature designed. It's time to stop the obsession with weight and remember that babies, just like adults, come in all shaped and sizes!
http://www.ncbi.nlm.nih.gov/m/pubmed/16902325/
http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
http://chriskresser.com/natural-childbirth-v-epidural-side-effects-and-risk
http://www.ncbi.nlm.nih.gov/m/pubmed/21843338/
http://www.ncbi.nlm.nih.gov/m/pubmed/21173007/
