If human milk were developed by scientists, packaged by conglomerates, and sold in six-packs in the supermarket, it would be considered a miracle food. It provides balanced nutrition; prevents diarrhea, ear infections, and other illnesses; needs no heating, cooling, or preparation; and is free for the taking. That’s some product!

The American Academy of Pediatrics (AAP), the World Health Organization, the American Dietetic Association, and the American Medical Association strongly concur that breast-feeding is best for most babies. The AAP puts it this way: “Human milk is uniquely superior for infant feeding.”

But deciding how to feed a newborn— breast or bottle—is not always so simple. The decision is often a deeply emotional one. When we surveyed parents, we heard from many who said breast-feeding was the best decision they ever made, a unique source of joy, pleasure, and satisfaction. We also heard from women who stuck with it because of its benefits to the baby but found it confining or difficult. And we heard from women who said they were made to feel guilty because they couldn’t breast-feed or didn’t want to. Some said that advice to breast-feed “no matter what” had made their baby’s first weeks a struggle, and they expressed bitterness at breast-feeding advocates who they felt were unreasonable or overzealous.

Breast-feeding and bottle-feeding each has advantages and disadvantages. The final decision is a personal one that only the mother and her partner can make, based on what they think is best for their family. Either way, you can have a healthy, happy, welladjusted baby. Either way, you can be good, loving, nurturing parents who will bond with your baby. Either way, you should not feel guilty about your choice. Only you know what is best for yourself and your family. It’s your decision and no one else’s. Having said that, we must make one point clear. Medical evidence strongly supports the exceptional benefits of breast milk for infants, and this is the choice we strongly encourage. Even if they encounter some difficulties at first, most new mothers can breast-feed successfully, especially if they get the support they may need. But we understand that medical and personal circumstances sometimes can make it difficult or impossible for a mother to breast-feed; in these situations, bottle-feeding is a safe, nutritious option.

If, however, you have the freedom to choose breast-feeding or bottle-feeding, we strongly encourage you to breast-feed. As you will learn in this section, it provides the perfect nourishment for an infant. If you’re not sure what you want to do, consider giving breast-feeding a try. After all, you can always switch if you don’t like it. But if you start out on the bottle and later want to try breast-feeding, you may not be able to get the milk flowing. Besides, even a few weeks of breast milk can help protect your baby from illness at a time when his immune system is not yet fully functioning. If you try, you may find it easier than you expected and more rewarding than you imagined.

Making Your Choice: Breast or Bottle?

Let’s look at some of the issues concerning infant feeding. If you’re undecided how to feed your baby, this information may help you choose. If you’ve already decided, it may help you to accentuate the positive and minimize the negative of whichever method you’ve chosen. That should make your feeding experience as happy and healthy as possible.

Nutrition

Human milk is uniquely suited for human babies. For most babies, it meets all nutritional needs in easily digested form. It also provides antibodies and live immune-system cells that protect babies from disease. Moreover, each mother’s milk is uniquely suited to her baby; its makeup varies, for instance, with the baby’s age. Many of the elements in human milk have not been identified, let alone duplicated. Good as formula may be, all baby formulas “differ markedly” from human milk, according to the AAP. On the other hand, millions of healthy, well-nourished babies—most U.S. babies, in fact—have been raised on commercial formula, which is safe and nutritious. The content of formula sold in the United States is regulated by the U.S. Food and Drug Administration.

Health

Many studies have confirmed the health benefits of breast-feeding. There is strong evidence that babies who are breast-fed for the first six months are less likely than bottle-fed babies to get certain illnesses including diarrhea, lower respiratory infections, ear infections, and urinary tract infections. Most of the studies looked at the first six months of life, when the protection against infection is thought to be most important; after that, babies’ immune systems have matured, and they are more able to fight infections on their own.

There is also evidence, although not as strong so far, that breast-feeding may help protect babies against sudden infant death syndrome (SIDS), as well as possibly help protect them later in life against diabetes, obesity, allergies, and chronic digestive diseases such as Crohn’s disease and ulcerative colitis. Although breast-fed babies as a group do have a health advantage, we all know that many bottle-fed babies sail through childhood as healthy as can be. Many do not suffer any more cases of diarrhea, respiratory infections, or ear infections than breast-fed babies do. And some breast-fed babies get sick, develop allergies, and have long-term health problems. Clearly, breast-feeding does not guarantee good health, and bottle-feeding does not promise illness. What breast-feeding can do is improve the odds that a baby will avoid illness.

Intelligence

There is debate over whether feeding methods affect intelligence. Some studies have found that children who had been breast-fed did better in tests of intelligence by a small but significant amount and performed slightly better in school than children who had been formula-fed. The greatest effects generally were seen in lowbirthweight babies who were exclusively breast-fed. Not all studies, however, agree on this: Some did not find a cognitive (or intelligence) benefit at all. Others found a benefit but linked it to social factors rather than to breast-feeding. (In these studies, the mothers who breast-fed tended to be better educated and more affluent than those who didn’t. Children who have educated, affluent mothers tend to do better in school, whether or not they were breast-fed.) Nonetheless, the evidence at least suggests a benefit, especially for low-birthweight babies.

Freedom and the Mother’s Lifestyle

The bottle-feeding mother can more easily leave her baby with someone else while she goes out for chores, recreation, exercise, or the like. More important for many women, she can return to work without having to worry about pumping and saving milk. She can work as much as she wants, and sleep as little, without depleting her baby’s food supply. She can travel for her job more easily. The bottle-feeding mother can wear whatever she wants, while the nursing mother needs to stick to washable clothes with easy access for the baby. If the bottle-feeding mother is out in public and hears a baby cry, she doesn’t have to worry that her milk will start to flow (seeing or hearing a baby can trigger the release of milk). If she needs medical tests or treatments, she can have them without considering how they might affect her milk.

But compared to all the life-altering changes that come along with any baby, the extra limitations on nursing mothers are relatively minor and last only a few months. For most women, no dietary changes are needed, for instance. Leaving a newborn home requires planning, no matter how you feed her, and breast milk can be saved in bottles to allow Mom time away from the baby for work or play. Besides, breast-feeding mothers generally find it easier to take their infants with them on outings because they don’t need any feeding paraphernalia! Juggling nursing and full-time work outside the home can be a more challenging problem—it’s one of the main reasons women stop breast-feeding.

Stress on the Parents

In the first few weeks after birth, feeding an infant can be exhausting for any parent. Breast-feeding round-the-clock can be extra tiring for the mother, especially if she had a difficult birth or is having trouble getting her milk flow established. Because human milk is digested more quickly and easily than formula, breast-fed babies generally eat more frequently, wake more frequently at night, and begin to sleep through the night later than bottle-fed infants. Although they tend to sleep less overall, breast-fed infants can be taught to sleep for longer periods at night.

With bottlefeeding, the father, another relative, or a paid helper can share round-the-clock feeding duties or take them over entirely if the mother needs rest. Another source of stress for many parents is the worry that a newborn is not eating enough. With bottles, you can keep track of every ounce at every feeding. For parents who are worried about this issue, that can be a big relief. Whatever stress breast-feeding may bring, however, it’s usually limited to the first few weeks and can be eased if someone offers a helping hand.

With help, the breast-feeding mother may be able to spend a week or two mostly in bed if she wants, doing nothing but nursing and resting. Similarly, weight checks and the attentions of a concerned doctor can help parents be sure their baby is getting enough milk. Once nursing is going well, breast-feeding can be more relaxing than bottlefeeding. If your baby sleeps in your room, you won’t have to get up for a bottle. Travel with your baby is simpler. And many women report that nursing triggers deep feelings of relaxation and well-being (perhaps linked to hormonal changes). It’s important to remember, too, that for some families, nursing is as easy as bottle-feeding right from the start—the milk flows and the baby grows.

Convenience and Cost

Breast-feeding moms never run out of milk and don’t incur the expense of buying formula. Those who breast-feed exclusively and stay at home with their baby don’t have to wash or sterilize bottles, cool or heat formula, carry feeding supplies along on every outing, or run to the kitchen in the middle of the night. But if breast-feeding mothers begin to leave their baby at home, things begin to even out. They have to express and store milk, invest in equipment, and prepare and clean bottles.

For bottle-feeding, convenience is closely tied to cost. Powdered formula that is mixed with water is relatively inexpensive but takes time and care to prepare. Single-serving, ready-to-eat formulas in disposable bottles are simple but much more expensive. There are also options in between. As a bottle-feeder, you will also need a kitchen full of bottles, nipples, bottle brushes, and maybe a sterilizer. And you will need an insulated bag to cart all these things wherever you go.

Emotions, Embarrassment, and Sex

Breast-feeding is (check one): (a) a turn-on, (b) a turn-off. People are sometimes reluctant to discuss the sexual aspect of breast-feeding, but it is a concern for many couples. You and your partner may want to discuss how you feel about the sexual and emotional sides of breast-feeding (although it’s not always easy to predict how you’ll feel once you’re doing it). Some women are repelled by the idea of handling their own breasts in a matter- of-fact way and think their partners will be repelled at seeing them do it, too. They may be uncomfortable about the whole idea of breast-feeding and embarrassed at the prospect of doing it in public (even though, with practice, it can be done while revealing nothing). Some men have similar feelings about their partner’s breasts being used for a nonsexual purpose. Other men and women find these prospects sensual and exciting. Be honest about how you feel. Studies do suggest that breast-feeding women tend to be less interested in sexual activity in the first few months after birth. Fatigue may be a factor, along with the feeling some women get of being physically used up by breast-feeding “all touched out.”

Others complain of vaginal dryness caused by low estrogen during lactation, a problem that can be helped by using a lubricant. But even when negative feelings do exist, they often fade after breast-feeding becomes established. Some women say that breast-feeding improved their sex life by making them more comfortable with their bodies and more responsive. Some couples find they are aroused by the milk, which may leak or spray during sexual activity. For some women, the act of suckling an infant itself causes feelings of sexual arousal. More commonly, it causes pleasurable, comfortable feelings that aren’t erotic. Either reaction is normal. If you bottle-feed your baby, this choice should have no effect on your sex life (beyond whatever effect parenthood itself might have).