I agree with you, Judy, on many aspects.  First, babies should never feel unsafe or not in control with feeding, nor should they have a fast flow or “big” bottles.  We can teach moms how to control these problems.  And yes, there are risks and consequences in giving bottles too early, particularly if a nipple shape is chosen that creates poor mouth placement, and if flow is not chosen well and then controlled for in how the bottle is offered.   As far as “many” unnecessary bottles, we can give mothers information about how to avoid that, too.  In my book (referencing, not plugging) we discuss using ½ - 1 oz of breastmilk in a bottle once every few days for moms who wish to keep tabs on the baby’s willingness to accept the bottle; and this ½ oz is between feedings, so it doesn’t disrupt normal feeds.  This doesn’t require “lots” of pumping and “many” bottles.  It’s not a requirement for moms to do these things, but if she is inclined to do so, I’m inclined to tell her how to do so safely, with the least disruption to breastfeeding, rather than withholding the information or making her feel guilty. 

“Practicing” isn’t a guarantee that a baby will accept the bottle later.  However, I know of many moms who only bottle-fed breastmilk to be sure the baby would eat during separation because the first baby refused.  If “permission” to practice is what it takes for a mom to be willing to breastfeed, I’m okay with that.  It’s not a requirement, but it also shouldn’t be forbidden. 

The study referenced didn’t actually study what is cited.  The author included bottle acceptance as an aside; it’s a retrospective study within a prospective study.  Bottle acceptance is not the focus of research.  There were no controls.  The terms “refused, resisted, [and] took easily” are not defined. Also, the researchers report “half of the mothers [offered] bottles starting at two weeks after delivery,” but were type of bottle, mouth placement, flow, etc. controlled?  It doesn’t specify (I’m guessing not).  If we use the numbers in the study anyway, one could look at the chart and say “most” babies will take a bottle.  But if you frame the numbers in a way that shows how many babies might not, we could say that 37% of babies will resist or refuse a bottle.  Glossing over the figures and reassuring moms that “most” babies won’t have a problem is not quite truthful in my opinion.  

I am not aware of a study that actually focused on bottle acceptance.  It would be hard to control for, because many babies use a bottle that flows too fast or creates poor mouth placement.  I think we need to use caution in referencing the old "study" that didn't actually study what we tell mothers it did.

The take away for me is it’s okay to give moms all of the information in a factual, non-biased way, listen to what her intentions are and dialogue, then support her in the way she wishes to be supported.  I believe many mothers are closet pacifier and bottle users, afraid to tell their breastfeeding helpers about artificial nipple use because of the reaction they might receive.  It is a normal part of my breastfeeding conversation before discharge or in the early weeks, because my goal is to support moms in all infant feeding questions, because they all influence breastfeeding.

Amy Peterson

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