What if I can’t breastfeed?

There are several reasons why a mum may not want, or be able to breastfeed, and what happens then?

While we constantly hear the refrain that ‘breast is best’, breastfeeding doesn’t work out for everyone. Whether it be due to a maternal medical condition, difficulties with breastfeeding or simply a mum not wanting to breastfeed from the outset, many babies get their early nutrition from a bottle and develop just fine. If your breastmilk itself is fine, then you have the option of expressing milk for your baby to take from a bottle, and if not, an infant formula based on cow’s milk is the next-best option for most babies: While formula can’t give your baby the antibodies contained in breastmilk, it will give her all the calories, vitamins and minerals that she needs to thrive.


Reasons you may not be able to breastfeed
Medical conditions –
Although most medical conditions of the mother don’t necessarily prevent breastfeeding, a few do, such as HIV/AIDS, HTLV-1 (human T-cell leukemia virus type 1) and many cancers. Many medications aren’t contra-indicated for pregnancy and a few may only interfere with breastfeeding for a short while, so do always discuss how medications will affect breastfeeding with your doctor.

Drug abuse and dependency – The use of most illegal drugs renders breastfeeding unsafe, and in some cases (such as cocaine and heroine usage) very dangerous, for babies. The use of softer drugs such as marijuana isn’t recommended for nursing mothers but along with the legal drugs of alcohol and cigarettes, it doesn’t necessarily rule out breastfeeding as an option. If you use or are dependent on any drugs then talk to your doctor about the possibility of breastfeeding.

Difficulties with breastfeeding –
Even when a mum wants to breastfeed, she may find that either she or the baby has difficulties that may lead to them giving up. A few babies have problems sucking efficiently at the breast, meaning they don’t get enough milk and supply decreases accordingly. Meanwhile, some mums may find breastfeeding too painful, particularly if they develop sore and cracked nipples or a case of mastitis. A mum may feel that she isn’t able to provide enough milk for her baby, leading to feelings of guilt and frustration, or she may simply find that she doesn’t enjoy breastfeeding as she expected to.

Not wanting to breastfeed –
Some mums may have a medical condition that doesn’t prevent them from breastfeeding but does make it harder and more time-consuming for them to breastfeed. Similarly, sometimes when a mother has had a very tough pregnancy the idea of breastfeeding is just too much for her recovering body to face and it may make sense for her to put her recovery first. Finally, for some mums the idea of breastfeeding simply doesn’t appeal, for whatever reason.

Long term expressing
If direct breastfeeding doesn’t work out but there is nothing wrong with your milk, then you do have the option of long-term expressing. This is where you regularly express milk and feed it to your baby in a bottle. This isn’t the easiest route to go down as it effectively doubles feeding time, but it is possible, and of course other people will then be able to feed your baby. A less demanding, or more realistic, option is to give both breastmilk and formula feeds so that your baby gets at least some breastmilk every day.

If you do decide to long term express then you’ll really be glad of an electric breast pump but it is also useful to know how to express manually Key to establishing supply is to pump regularly (probably for about twenty minutes), mimicking the pattern in which your baby would normally feed. Once supply is established you will be able to cut back to as many breastmilk feeds as you’d like to give in one day, but keep the timings of pumping sessions the same each day as far as you can.

Formula feeding
Formula milk

Formula milk is a complex substance created to mimic key nutritional elements of breastmilk. Of course formula can never be the same as breast milk, but it does contain the right amounts of calories, vitamins and minerals for your growing baby.

Most infant formulas are based on cows’ milk and this is the best option for all but a few formula-fed babies. It’s important to realise that although based on cows’ milk, formula milk is not the same as cows’ milk, which isn’t a suitable drink at all for babies under six months, and isn’t suitable as a main drink until after twelve months. Cow’s milk doesn’t have enough fat and vitamins to meet a baby’s needs and also contains too much sodium and protein to be easily digested by small babies. If your baby seems to have difficulties with formula milk, such as inadequate weight gain or diarrhoea, then speak to your doctor to rule out an allergic reaction to the formula or for a recommendation for a good alternative. If there is a history of allergies in your family then your doctor may recommend a hypo-allergenic formula from the outset.

Taking to the bottle
If you bottle feed from birth then your baby will probably have no problems taking her milk from a bottle. If, on the other hand, you have started out breastfeeding or are combining breast and bottle, then your baby may be more reluctant to take an artificial teat and need some time to adjust.

If you are having problems at either time, it may be that your bottle and teat don’t suit your baby – it may seem odd, but there are different textures, shapes and flow-speeds available – so it’s a good idea not to buy a whole set of bottles and teats before you’re sure that your baby is happy with them. For a newborn baby you’ll want a ‘slow flow’ teat, switching over to a faster flow teat as he becomes more hungry and more adept at drinking. As for shapes, the main choice is between narrow-necked and wide necked bottles, but also some teats mimic nipple shape and there are even breast-shaped bottles! You can find out more about the different kinds of bottles and teats to choose from in this article.

There’s no reason why bottle feeding shouldn’t be a very intimate time between parent and baby, assisting with bonding, as you can hold your baby close and cuddle her as she feeds. Just as with breastfeeding, establishing a comfortable feeding position for both of you is key to a successful feed – you’ll need a nicely supportive chair and you may find a cushion useful for supporting your baby.

When you’re starting out it will probably help find some peace and quiet in which to feed your baby if possible, keep eye contact with your baby and perhaps reassure her by talking or singing to her gently.

Preparing feeds
When you bottle feed a newborn you can expect her to need to feed little and often at first. She may want to drink every 2-3 hours and only 1-2 fluid ounces at a time. Within a few weeks you’ll probably fall into a routine of feeding every 3-4 hours, so perhaps six or eight feeds in a day.

All those feeds mean a lot of bottle preparing and formula mixing, as each feed will need to be made up with freshly with boiled water and a sterilised bottle and teat: An electric or microwave steriliser will come in very handy. If you’re new to feeding bottle preparation then have a read of this article, and make sure you know how to warm a bottle safely.


Once you have decided to bottle feed, for whatever reason, then try not to let anyone else make you feel guilty about your decision. All things being equal, yes, breast is best, but the best way to feed your own baby is the one which you and your baby are most happy with – to be able to look after your baby best you also need to look after yourself.

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