For most women, breastfeeding is par for the course. But what happens to mothers who can’t, or choose not to, naturally feed their baby for personal reasons? For nearly every mom who tries and is unable to breastfeed, there is a cause begging for the right solution. Usually the answer is simple— place the baby skin-to-skin, watch for early hunger cues and improve the latch position. But too often, infant formula becomes the default solution. And while formula can provide adequate nutrition, there are other feeding options worth exploring.

Alternative 1: Pumping

Even though some mothers and babies can’t breastfeed directly, babes can still be fed a mother’s own milk by spoon, cup or bottle through the process of pumping. This option offers babies infection protection that human milk provides. However, it can be a time-consuming process as mothers need to express, collect and store milk throughout the day.

Alternative 2: Breast Milk Donor

Donor milk is available from nonprofit milk banks, which operate under guidelines established by the Human Milk Banking Association of North America (HMBANA). Moms can also share milk on a one-to-one basis.

There are some pitfalls with this option, however. Banked milk is expensive, costing an average $2.75 per ounce, and it requires a doctor’s order. And with only 12 milk banks in the U.S., banked milk is not widely available. Moreover, processing destroys some of the properties of human milk. Casual sharing of human milk from mom-to-mom can also increase the risk for disease transmission.

Alternative 3: Wet-Nursing or Cross-Nursing

Wet-nursing is the exclusive breastfeeding of a child, often for pay, by a woman other than the child’s mother. Cross-nursing is the occasional breastfeeding of a child, not her own, by a family member or friend.

Despite evidence of a comeback of both practices, HMBANA’s official position on wet-nursing and cross-nursing is clear: “The practice of casual sharing of milk or procuring milk from any source other than an established donor human milk bank operating under HMBANA Guidelines, or similar guidelines established in other countries, has potential risks for both the recipient and the donor or her child. HMBANA does not endorse the practice of selling or purchasing human milk, human milk components or human milk by-products.”

The World Health Organization (WHO) takes a more relaxed view on cross-nursing, at least in emergencies and natural disasters, such as the tsunami that devastated South Asian communities in 2004 and Hurricane Sandy is 2012.

Alternative 4: Supplemental Feeding Device

No list of feeding options would be complete without supplemental feeding devices. A supplemental nursing system is designed for mothers, such as adoptive moms, who would like to breastfeed, but simply don’t have enough milk. These devices consist of a container that hangs on a cord around the mother’s neck and two pieces of tubing. One end of the tubing is attached to the top of the container. The other end is positioned near the mother’s nipple. When the baby breastfeeds, milk flows from the container, through the tubing, to the baby. A supplemental nursing device can also be used to stimulate milk production in mothers with a low milk supply.

Alternative 5: Formula

When human milk isn’t available, infant formula is a viable option. It can also be used as a supplement for breastfeeding mothers who cannot fully meet their children’s demands. But infant formula is not risk-free. In 2007, the WHO issued guidelines for the safe use of powdered infant formula after a number of premature babies died from infection due to contaminated formula.

Formula is available in various forms, including soy, cow’s milk-based, hydrolyzed, iron-fortified and DHA-fortified. Mothers choosing to formula feed are urged to talk with their child’s healthcare provider before giving it to their baby. This is especially true of soy formula, which has recently come under FDA scrutiny for false claims by manufacturers.

Knowing infant feeding choices have life-long consequences, it’s easy to understand why mothers go to enormous lengths to breastfeed or to at least give their baby breast milk. After all is said and done, ensuring that babies are not just well fed but best fed should be everyone’s goal.

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Mothers and Healthy Babies
Mothers and Healthy Babies

Breastfeeding support from La Leche League.