Liberty bottle or liability bottle?

The number of mothers initiating breastfeeding has increased dramatically over the last decade but the percentage of mothers who terminate breastfeeding prematurely has remained constant. When mothers experience difficulty with breastfeeding, many physicians fail to diagnose and manage the problem effectively. Some physicians assume that mothers dislike breastfeeding and, in a misguided attempt to help, recommend the introduction of a bottle to solve the problem. They do not explain to the mother how the delicate symbiotic relationship of the nursing dyad may be upset by bottle feeding, and how a downward cascade to premature weaning may begin. Bottle feeding is a specific therapy for breastfeeding difficulties. If, after careful consideration, it is the therapy of choice, then the physician must give full and accurate information to the mother about the possible health hazards and consequences of introducing bottle feeds. Then the mother can make an informed decision about when to introduce a bottle, what to put in it, which nipple to use, and what the outcome might be. The physician should support the mother in whatever informed decision she makes. The author of this article reviews the issues of introducing bottle feeding and informed consent.