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Last week in my online breastfeeding class a mother-to-be asked “ What if the midwife in the hospital wants me to give the baby formula and I don’t want to? “

Other mothers in my antenatal class talk about stories they’ve heard about feeling pressured to give formula to their breastfeeding newborn. They worry if it’s the right decision and how would they know . It’s such a vulnerable time post birth, tiredness and tears abound and rational decisions seem impossible. The midwives caring for women are dedicated and have to make quick assessments and decisions if they are worried about a baby. They are generally doing their best and supportive of breastfeeding. there is always time for a 5 minute chat to talk through options..

In the class last Saturday, I suggested using  the BRAIN acronym

B. Benefits

R. Risks

A Alternatives

I Intuition

N Need Time or Nothing

How could this be applied to breastfeeding decisions? One possibility is formula supplementation in the hospital, another may be tongue tie division in the first weeks.

Generally when this question comes up in the class , we will discuss the main reasons why a baby might need extra feeds during the early newborn period. The most common reasons  are that the  baby has low blood sugars or is jaundiced or is unsettled and crying.

Everyone in the field recognises that some babies do need extra glucose, fluids, feeding etc.. The World Health Organisation states that if supplements are needed that the hierarchy of choice is..

1. Fresh mothers own milk or colostrum

2. Expressed mothers own milk

3. Pasteurised donor bank milk

4. Cows Milk-based infant formula

A more detailed list is in Marsha Walkers Book – Breastfeeding for the Clinican –  Using The Evidence ( link to google preview)

Using the Brain method for parents can help them be fully informed and at peace with decisions. They may have learned about it in their antenatal classes for making decisions in labour about interventions – it can just as easily be applied to breastfeeding too.

B What are the benefits of this intervention?

R What are the Risks ?

A Are there alternatives?

I What is your intuition … gut feeling on this …

N What if we do nothing or wait 30 minutes? 

So let’s look at  how could you use BRAIN if infant formula was being suggested in the first 48 hours after birth?

B      What are the benefits of this intervention? 

Is there a medical need for this?    Low  blood sugar, excessive weight loss, no urinary output > 6 hours.  Will it  make my baby more settled? 

R What are the Risks ?  

Will this stop my milk supply from increasing? Will this overfill my babies tummy?  Will this expose my baby to allergens? Will my baby be too sleepy to breastfeed?  If given by bottle , will my baby have a flow preference? 

A Are there alternatives?  

Can I try improving latch and doing breast compressions? Can I try expressing more colostrum instead? Can I give donor milk instead? 

I What is your intuition … gut feeling on this … ? 

Many new first time  parents feel they don’t have any intuition and ask for lots of opinions. This sometimes confuses them even more.  Helping them listen to their gut, taking a deep breath and  closing their eyes can give clarity.   Most 2nd timers and subsequent new parents are much clearer about decisions. 

N What if we do nothing or wait 30 minutes?   

Sometimes the right decision is to do nothing ( that’s actually a decision!) Reassess in 30 minutes or 1 hour… 

Sometimes giving formula is the right decision, sometimes it isn’t and its hard to pull back and establish exclusive breastfeeding … What really matters is that the parents understand, agree with the decision and know how to sustain breastfeeding and increase supply.

What other decisions could be made using the BRAIN acronym?