Another idea I wanted to add to the discussion is that structuring the conversation, "which is better, formula or donor milk." limits thinking outside the box.  The choices are much more diverse than these two options.

The mom in question had a baby who was rejecting her expressed milk.  If I were counseling a mom in such a situation, I would encourage her to try scalding her expressed milk because it is possible that the milk was rejected by baby due to the breakdown in fats caused by excess lipase.  Next, I would ask the mom if it would be possible to visit baby at lunch-time (or have baby brought to her- a lot of people don't consider this option) to directly breastfeed once during separation.  Then I would explore with mom her willingness to bed-share and nurse frequently at night.  Many breastfed babies will choose to reverse-cycle nurse (nursing all night long and refusing to take bottles during the day) and need no milk during separation.  Some moms are able to do this and still get a good sleep, and their babies get a full supply of breastmilk when they are with mom.  Then, real foods with high water content such as broths and broth soaked veggies and meats, and possibly sips of water would allow baby to be comfortable when mom and baby are separated.  Especially if mom and baby could be together once a day, but even if not, this would be a very workable solution.

Babies in the second half of their first year still need plenty of milk but they do not need it a a specific time during the day and they do not _have_ to take bottles when separated from mom.

Because formula is so readily available, we can forget that there are so many other options and because it is so commonplace, we can forget that it is not really proven to be a safe option for feeding babies.

Laura Spitzfaden, LLLL, IBCLC

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