Responsively Paced Bottle feeding Expressed Breast Milk (EBM) (Formula) including related information

Although we encourage all mothers to breastfeed because of the short and long-term health benefits for mothers and babies, we know that some mothers may be unable to, or choose not to, breastfeed. Midwives will offer the opportunity to explore your thoughts about feeding, support your informed choice, and encourage you and your partner to do as many feeds in skin-to-skin.

All babies are encouraged to have their first few feeds in skin-to-skin, as this is the transition time for them to adjust from their in-utero environment to the outside world and is a lovely time for you to get to know each other.

If you have made an informed choice to bottle feed, please bring in your own supply of two small ready-made infant formula bottles as we do not have the facilities to make up feeds on the ward.

We do not supply infant formula in hospital unless it is needed for a medical reason.

We supply disposable sterile single-use bottles and teats for parents.

If you are planning on breastfeeding and bottle feeding, please make sure that you speak to a health professional first.

Giving infant formula to a breastfed baby will reduce your breast milk supply.  Bottle feeding will make it harder for your baby to learn to feed at your breast. If you mix bottle feeding and breastfeeding, you are likely to stop breastfeeding sooner than if you just breastfeed.

If you wish to mainly bottle feed, you can continue giving regular breastfeeds as often as you want - for example, just once a day.

Breastfeeding is the healthiest way to feed your baby. If you have not previously breastfed, or you have stopped breastfeeding, it is possible to try starting again at any time.

Infant Formula

The different types of infant formula, and other infant milks, marketed for babies and young children can seem confusing when you see lots of different ones on the supermarket shelf, but the information you need as a parent or carer is really quite simple.

The majority of infants who are formula-fed or mixed-fed should be given first infant milk (sometimes called first stage or stage 1 milk) throughout the first year.

Information and our concerns about formula preparation machines (including the shop-bought Prep machine) can be found on pages 37-40 of this report, alongside information on other devices marketed for preparing formula such as using hot taps and baby kettles.

See also our statement on hot taps and baby kettles below.

For families using expressed breastmilk, a hospital-grade pump will be provided and pump sets will be given on the postnatal ward.

These sets must be washed with warm soapy water and air-dried between each expression and can be used for 72 hours.

Bottle feeding responsively can help support the development of a close and loving parent-infant relationship. The parent-baby relationship will be supported as parents will be encouraged to tune in to feeding cues and to hold their babies close during feeds.

We advise parents to do most of the bottle feeds themselves (especially in the early days and weeks) as this will help to build a close and loving relationship with you and your baby. It will also make your baby feel safe and secure.

On the postnatal ward, we have a fridge and freezer for expressed breastmilk and formula

• Breastmilk can be kept at room temperature for six hours and in the fridge for six days.
• Frozen breastmilk can be kept in the freezer for up to six months
• Formula is not a live fluid so can be used within two hours of preparation and within one hour of when feeding begins and then it is to be discarded
• Formula can only be made up at the time of the feed
• Ready-made formula bottles (not powder) can be kept in the fridge for 24 hours

If you want to combine breastfeeding with bottle feeding, take a look at these tips to help you breastfeed as much, and for as long as you would like:

www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/03/Unicef-UK-Baby-Friendly-Initiative-Maximising-breastmilk-and-re-lactation-guidance-2.pdf

We will support you to bottle feed your baby as safely as possible in a responsive, paced way —this includes having a discussion on:

• Avoiding overfeeding by bottle – Many of the health risks of formula are related to the increased risk of obesity in childhood and later life. It can be tempting to encourage a baby to feed when they are no longer hungry, hoping to get them to sleep for longer, or simply to use up the amount of formula milk you have made up. It is safer to feed your baby little and often in response to their signs of hunger
• Bottle feeding in a way that promotes a close mother-baby relationship. Skin-to-skin is a perfect way of close contact with your baby, especially in the first few days after birth. These close and loving relationships have strong influences on your baby’s brain development and make them feel secure. This maximises opportunities for developing language and communication skills.
• Try to limit the number of different people who bottle feed your baby - preferably just the mother and one other person - so that the pleasurable feelings associated with feeding are linked to that person.
• Making up formula and sterilising equipment correctly. If you make up powdered milk feeds, please read the bottle feeding leaflet for detailed information on making up feeds and sterilising equipment. Current guidance is to make up only one bottle of formula at a time and to add the milk powder to freshly tapped boiled water which is 70°C. This is approximately the temperature if you boil a large kettle (at least 1one litre) and leave it to cool for no more than 30 minutes in order to reduce the risk of infection.
• Using the correct formula - babies only need Stage 1 or First Infant Milk until they are one year old. Then they can start drinking full-fat cow's milk. There is no need for them to have ‘follow-on milk’.

See the UK Baby Friendly Initiative guide Responsive bottlefeeding and more detail about how to bottle feed in the Formula Guide for Parents leaflet which answers questions like ‘How often should I feed my baby?’, ‘How do I know if my baby is hungry?’, ‘How do I know if my baby is getting enough milk?’ (https://www.nct.org.uk/baby-toddler/nappies-and-poo/newborn-baby-poo-nappies-what-expect), and ‘

How do I help my baby to feed from a bottle?’. 

The UNICEF Bottle Feeding Assessment Tool helps families and midwives/health visitors to recognise if bottle feeding is going well.

If you make up powdered milk feeds, please read the Guide to bottlefeeding leaflet for detailed information on making up feeds and sterilising equipment.

• Bottle feeding leaflet (unicef.org.uk)
• Bottle feeding | Bliss
• https://www.firststepsnutrition.org/parents-carers
• https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/bottle-feeding-resources/
• https://www.unicef.org.uk/baby friendly/wp-content/uploads/sites/2/2021/03/Unicef-UK-Baby-Friendly-Initiative-Bottle-Feeding-Assessment.pdf
• https://www.firststepsnutrition.org/making-infant-milk-safely
• https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2022/10/Bottle-feeding-leaflet.pdf
• https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5f02e03e6e62565b9d557ff3/1594023999289/Making_up_bottles_of_infant_formula_from_hot_taps_and_baby_kettles_Nov19.pdf

https://youtu.be/KGVgdLK2kkA

https://www.youtube.com/watch?v=5hEq2QpQFT8