If you have a goal to breastfeed for a month or longer, I strongly suggest no pumping or use of bottles for at least the first month. This includes both expressed milk and formula in a bottle. My reasoning is not because I have a concern about nipple confusion.
In fact, I'll be the first to admit that I reached for a pacifier by the second day for both of my children. The first night went okay because we were both utterly exhausted from that little thing called labor. However, by the second night, it became difficult to soothe my baby. I would nurse her those few drops of colostrum and she would drift into a deep and satisfied post-feed, newborn sleep. I would gently lay her in the bassinet beside my bed and dash to the bathroom. Next, I would drink the huge jug of water on my little table with wheels and stuff my face with a lovely turkey sandwich and an orange (because I was starving even though it was 2 in the morning). Just as I would lay my head down on the pillow, the soft cries that were so new to me would begin. I would then pull my brand new baby out of her bassinet and offer her my breast again. She would take it once more and be satisfied and asleep all over. And then back to the bassinet. But soon after laying her down, she was crying again. And you know why? Because she didn't really want to be in a plastic box with a mattress that was only a quarter-inch thick. She wanted to lay on me: her soft, warm place where she had been for 9 months. With its familiar smell and the soothing thump thump of my heartbeat. But as much as I wanted to hold my baby forever, I needed to get a few moments of real sleep - or there was a very serious risk of me dropping that sweet child on her sweet head. So, after I was certain her belly was filled with my liquid gold, I offered her a pacifier and this afforded me at least a short nap in the middle of the night.
So, no, I don't personally have a fear of nipple confusion. I do have concerns about bottles though. I wish there was more education regarding waiting to pump and waiting to offer a bottle (whether it is expressed breast milk or formula) for at least the first month and even longer, if possible. Here's why:
Every single time your baby latches she is telling your body to make milk for her: You want your baby to tell your body to make milk about every other hour in the beginning. By latching her more frequently, it will actually help your milk to come in faster.
Your baby is better at it than your pump: Your baby is way more effective than your pump at removing milk. You may have heard to attach to a pump to get your milk to come in quicker. But, your baby will do a better job, it'll be more relaxing for you and there's no clean-up!
It takes 4-6 weeks to establish your milk supply: Your baby is letting your body know exactly how much milk she needs in the first 4-6 weeks after birth. She's not just telling you how many times she needs to nurse in a day but also the amount of milk she needs (which is different at different feeds throughout the day). If you attach yourself to a pump, your pump is telling your body how much to make, not your baby, and that can cause supply problems down the road.
Engorgement: I hear it again and again. A woman says she is painfully engorged so she reaches for her pump. But each time you are overly full and then pump - you are actually telling your body to make more milk! This is, of course, the exact opposite of what you want to do and can often lead to clogged ducts or mastitis. If you are engorged, the best thing to do is nurse your baby and then your baby and your body will actually regulate your milk supply on its own. If you are painfully engorged so much so that it is difficult to nurse, you can try to do some hand expression. Check out this wonderful post from an IBCLC for great tips on engorgement.
Formula: If you have long-term nursing goals, it is best to avoid formula if at all possible. This is especially true in the first few days and weeks of breastfeeding. Pro-breastfeeders are not saying this because they think formula is the devil. It's because it is well known that for each bottle of formula that is given, it is one less time your body is told to produce milk. When your baby is feeding 12 times a day this may not seem like a lot. But, this can cause significant supply problems. One of the most common reasons formula is given is for concerns regarding weight loss in the first day or week. This study provides information on weight loss in the first 24 hours and how this can affect breastfeeding confidence. And this study actually recommends waiting 24 hours to determine true birth weight before beginning to calculate weight loss since it is known that the newborn's birth weight is falsely elevated if the mother is given IV fluids during labor. Watching a baby's wet diapers is the best way to determine sufficient milk supply but if you are ever worried about your baby's intake or weight you should talk with the pediatrician and/or a lactation consultant for recommendations.
In summary, it is best to allow your baby to establish your milk supply for the first 4-6 weeks. That's why I suggest no bottles or pump for the first month! This will help your supply for many more months afterward.
I want to remind everyone that I am only a mom that is very passionate about breastfeeding success and providing information to moms that desire it. My information is based upon personal experience, research and talking with other moms. I am not an expert. I am entirely certain that there are lots of babies that were given both pacifiers and bottles and moms that pumped in the first month and went on to have long and wonderful breastfeeding success. I also know that it is sometimes necessary to use bottles and pump during the first month. These are only general suggestions to help promote breastfeeding for as long as possible if that is, indeed, what you desire.
Check out some of my other posts about nursing here including more info on the newborn stage.
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