Topping Up Breastfeeds – The Uncomfortable Truth

Are we midwives or petrol attendants?

So you’re going on a long journey and you’ve got half a tank of petrol. You’d feel better if it was full, so you pull into a petrol station and ask them to ‘top-up’ for you. That makes sense, but should we be doing the same thing with the newborns in our care – especially since ‘top-up’ feeds really mean ‘replacement feeds’? And potentially, the end of breastfeeding!

There may be a few legitimate reasons for top-up or supplementary feeds, like moms being too ill to breastfeed. However, the truth is that top-ups are often done solely for convenience, or because midwives and mothers don’t understand nursing bio-emotional physiology. Avoiding top-up feeds takes time and effort, because it means providing patient, non-directive breastfeeding support. How many midwives feel out of their depth, short on time, or simply not passionate about nursing, and take the easy way out? But there are plenty reasons the Baby Friendly Hospital Initiative’s 10 Steps to Successful Breastfeeding includes not giving infants any food or drink apart from breast milk unless medically indicated – supplementary feeds can:

• Interfere with the establishment of milk supply
• Result in engorgement
• Cause nipple-confusion with the artificial teats
• Disrupt the normal bacterial colonisation of an infant’s sterile gut
• Undermine mothers’ self-confidence
• These effects can be long lasting, and often derail breastfeeding completely – depriving babies of the irreplaceable and lifelong benefits of breast milk. We need to fight for their right to the best start in life! It’s possible to prevent many problems before they become ‘reasons’ for top-up feeds:

Latching problems

These can be avoided through proper management of birth and the postpartum period. To minimise latching problems:

• Avoid using analgesics and epidural anaesthesia for pain relief during a normal delivery
• Initiate nursing in Baby’s first hour and don’t separate her from Mom
• Place Baby skin-to-skin on Mom’s chest instead of wrapping or swaddling her
• Let moms need feed instead of scheduling feeds

Insufficient milk

Most milk production problems can be prevented the same way as latching problems: with proper birth and postpartum management. Exceptions include conditions such as previous breast surgery, and primary glandular insufficiency – but they are rare. A retained placenta shouldn’t occur with good midwifery care. Polycystic ovarian syndrome can benefit from successful breastfeeding, instead of seeing it as a cause of a poor experience.

Moms request top-ups

Where did they first get this notion, is the question! Midwifery and nursing education is what’s needed. Explain that only small amounts of colostrum will be produced for the first few days, but that it is rich enough to meet all of Baby’s early needs. Because Baby’s tummy is so small, she’ll only eat 5–7ml per feed until day 10, when it will increase to 60–81ml.

Let’s aim to work with Mother Nature instead of trying to take over from her – and from now on, let’s leave top-ups to petrol stations!