Navigating the Formula Shortage
Problematic policies around infant feeding have caused ongoing issues for many people for a long time, often those with the least resources. Recent events, however, have brought everyone’s attention to our dependence on a system that does more to support formula companies than the people who rely on formula to feed their babies, or those who need breastfeeding support. Many worried parents are sharing their stories about searching for formula or human milk donations online. Some women are attempting to relactate. Others are sharing recipes for creating homemade formulas. Stockpiling of formula is reportedly exacerbating the situation.
The current crisis, a lack of formula on store shelves, started with pandemic supply chain issues. Abbott, one of the three main manufacturers of infant formula in the U.S., issued a recall, making the situation worse. The recall was in response to bacterial contaminations that caused illness, and in some cases death, of several infants who had ingested formula manufactured at the plant. It will be some time yet before we see formula return to normal supply levels. This is the case even though Abbot’s plant is going to start making formula again, and the U.S. Food and Drug Administration is allowing European brands to be imported.
This blog post goes over common responses and the options you have if you are concerned, are having breastfeeding/chestfeeding issues, or need formula. Some of the responses listed here are not recommended. Also, not all options are available or achievable for all women, and finding support and being able to breastfeed/chestfeed has been more challenging for some. No one should be made to feel shame over how they feed their baby; the sad fact is that there is a huge lack of lactation and postpartum support in the U.S. Below is some information to help you navigate the shortage and to know what resources may be available to you.
For Those Who are Currently Lactating or are Pregnant and Plan to Breastfeed/Chestfeed
I recommend seeing a lactation specialist* right away if you are struggling to feed your infant human milk. Lactation specialists can be doulas with lactation training, lactation counselors, lactation educators, or International Board Certified Lactation Consultants (IBCLC). IBCLCs are recognized as having the most training and are highly qualified. They are also the only specialists that your insurance might pay for. They can help with all lactation issues, including complex ones. Doulas, lactation counselors, and lactation educators can help you with basic or less complex lactation issues. Sometimes parents will seek help from their doctor, but most doctors do not have lactation training. WIC clinics often have lactation counselors who can help those who don’t have insurance coverage for lactation and can’t afford to pay out of pocket for a consultation.
Be sure to have lactation support lined up ahead of time if you will be having your baby soon or plan to nurse or exclusively pump. A lactation specialist can do a prenatal visit with you, which will include a breast exam, a pump check, and lactation education. During the consultation, you can discuss your health history, your support system, your concerns, and when you will be returning to work. The lactation specialist will take your circumstances into consideration and will create a plan with you for building and maintaining your milk supply. Additionally, taking a breastfeeding course before you have the baby can also be helpful.
I have conducted research that looked at how women learn to breastfeed and what types of help from IBCLCs were most beneficial. Many people expect breastfeeding/chestfeeding to be instinctual since it is “natural,” but it is something that you learn. This means that it takes time and a responsive relationship with your baby. It is a process, not something that you can learn very easily in a step-by-step manner. It involves getting to know your own body and your infant’s cues and responses.
If you are struggling, try lots of skin-to-skin contact with your baby lying on top of your chest in a quiet space with no interruptions. This will help trigger your infant’s instinctual breast-seeking behaviors. Don’t worry about using specific holds yet, just lay them vertically or at a slant across your chest and make sure they don’t fall off. Let them bob their head, root for the nipple, and latch on their own.
Human Milk Donations/Sharing
Women in cultures where breastfeeding is commonly practiced and where there aren’t any good alternative options have in many cases had other lactating women nurse their babies. In fact, while I was doing breastfeeding research in Hawai‘i, I learned that many Native Hawaiian women still nurse each other’s babies when needed, rather than use formula. The American Academy of Pediatrics, however, discourages any type of milk sharing practice unless the milk is screened and pasteurized by a milk bank. This is because a stranger’s milk may contain prescription or illegal drugs or may expose your infant to certain diseases. A study from 2013 (Keim et. al) that examined human milk that was purchased online, showed that some of the milk contained harmful bacteria, or was mixed with cow’s milk.
Buying screened and pasteurized milk from a milk bank can be expensive. It is also usually only available for premature or sick infants. If you opt to use informally donated milk, it is important to make sure the person you are getting the milk from is someone you trust. You will want to find out if they have a contagious disease or take medications. Using milk from someone who lives close to you may be safer than having it shipped and risking it thawing or leaking and becoming contaminated in transit.
Relactating or Induced Lactation
Someone who has stopped lactating can take measures to cause their body to start lactating again. You can also induce lactation even if you have never been pregnant before. For example, some adoptive parents, or those who have used a surrogate, have induced lactation. It is best to enlist the help of an IBCLC with this.
An IBCLC may recommend hormones, herbs, or medications that will help you produce milk, and will help you develop a plan for repeated breast stimulation. It is important to understand that you may or may not be able to produce a full supply. Additionally, herbs and medications that can help you develop a milk supply, can also have side effects. Although an IBCLC can help your baby re-learn, some infants will refuse to nurse. However, even some human milk can be beneficial, and it can be fed to the baby via a cup or bottle in cases of persistent breast refusal. The process of building a milk supply can take time, and you will need to have a plan for feeding your baby until you have enough milk for all of their needs.
Homemade Formulas, Other Kinds of Milk, or Diluting Formula
Homemade formulas are not safe to use. Infants have rapidly growing brains and bodies and require certain nutrients in the right balance. This is very difficult to achieve in your kitchen. Your homemade formula may not have enough of the nutrients that are necessary for infant development. It could also have high levels of certain ingredients, thus making it difficult for an infant’s kidneys to process. Also, an infant’s body may not be able to easily absorb and utilize some of the ingredients. Additionally, your homemade formula could harbor harmful bacteria.
Some people on social media have stated that goat milk is close to human milk, and have encouraged parents who can’t get formula to feed it to their babies. Goat milk and other mammal milk are species-specific and are not designed for human infants. Commercial formulas that are made from cow milk, are modified and fortified for human needs. Cow’s milk and goat milk are not as easily digestible as human milk or formula. They can stress an infant’s kidneys, irritate their intestines, and do not have the right types of fats. While they can be used briefly in an emergency, they are not a safe substitute for human milk or commercial formula.
Another tactic some parents have turned to is using formula designed for toddlers and giving that to their infants. The nutritional needs of toddlers are not the same as they are for infants, however, so your baby will not get the right types or amounts of nutrients. It is also important not to dilute formula to make it stretch. This can lead to electrolyte and nutrient imbalances and health issues in your baby. Be aware that if you buy formula from an online source such as Facebook Marketplace, it could be a scam. Imported formulas from other countries may not be suitable for infants who need specialized formula, even if they are marked hypoallergenic. Most babies who don’t need specialized formula, however, can tolerate switching formula brands and types without issue.
Support for Families with Infants
The government is making efforts to get formula back on the shelves. However, it brings to our attention the reasons why parents need more support around their infant feeding needs. This includes adequate maternity leave, making it easier for lactating parents to pump at work, increased insurance coverage for lactation consultations, better formula regulation, and ending inequities around infant feeding. Ask parents of infants how you can offer to help, and make your voice heard in support of policies and actions that will increase support around infant feeding.
*Birthways doulas can help families with basic breastfeeding issues, and our IBCLCs can help those who have more complex ones. Doulas can support and guide you in your feeding plan, can help to set up a nursing station for you, take care of household needs, clean and sterilize your pump, store your milk, and more.