With all due respect to Cheryl, I think that it may be too simplistic to say that the goal for all moms should be to get them to stop using formula as quickly as possible, cold turkey if they will do it.  Over the many years that I have been doing this, I have come to see this as a very complicated issue.

I also strongly believe that one should look at the baby to decide what to do.  A healthy baby that is just gaining slowly may not have any problem at all.  A baby who is lethargic with a poor suck may be in desperate need of calories and nothing good is going to happen until that baby gets some.  If the mother also has a supply problem, which is often the case, and banked milk is not an option, then formula is it.  And I would say, pile it on as much as the baby will take by any means possible until the baby is awake and alert and regaining some kind of decent suck.  Then you can go from there.  Sometimes this involves just one or two formula feeds, sometimes much more.

The SNS is a great tool if the baby is willing to go to breast and can suck - if not, you're out of luck.  Also, some moms do not see the SNS as such a great timesaver - they would rather pump and bottlefeed, considering that someone else can do the feeding;  I'm not saying that this is the ideal, just that the mom has to make the decision as to what is best for her situation and it might not always jive with what the LC would really like to see her do.  It does help to be very positive when introducing the idea of using the SNS as some moms are very put off by it.

I do see moms that are holding on to that last few ounces of supplementation when they really don't need to - they just need a gentle push in the right direction.  On the other hand, there are some cases where mom just can't produce that extra couple of ounces a day that is needed to keep the baby gaining at all and  long-term supplementation may be the only option. Each case is so individual, as are the moms and babies involved.

So I guess my philosophy is simply to evaluate each situation as it presents itself and try to suggest appropriate care plans based on what I see.  It is a fine line sometimes between informing a mother of the risks involved with formula feeding and scaring her to the point that she will not consider using it even when it is necessary - and I have been in those situations when a mom is adamant about not using formula while holding an almost-starving baby in her arms.  It is very scary.  So never say never. But whether the use of formula is temporary or permanent, you can still remain an advocate for breastfeeding and can positively influence that mom so that she, too, will be an advocate to her friends and family.  Who knows, she may even become an LC someday.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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