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Can anyone recommend a good book on mix feeding?

(57 Posts)
mears Sun 06-Jul-08 15:07:26

Just wondered if there was a decent book out there for women who want to mix feed, with tips and advice on how to keep breastfeeding.

I particularly am looking for information out there for women who feel exclusive breastfeeding is not for them, but who want their babies to have some breastmilk.

For those of you who do not know me, I totally believe that exclusive breastfeeding is the ideal, however there are women out there who do not wish to exclusively feed but want to mix breast and formula.

Is there any decent advice around?

girliefriend Sun 06-Jul-08 20:26:04

hello i combination fed for the first 3 months due to my ill health when my dd was born (and than went on to exclusive breast feeding) and found the most useful and sensible advice came from the baby whisperer by tracy hogg, she is very common sense and quite down to earth which worked for me! In terms of increasing milk supply I went with gina fords contented baby which will probably get me hate mail on here for admitting but it worked for me! xXx

ilovewashingnappies Sun 06-Jul-08 20:31:01

Wish I'd found the advice! Every person I asked 'warned' me about milk production and that I would only make enough for the feeds I was giving her... (which is kinda the point of breastfeeding eh???)

I personally found the only diffiuclty we had with mixed feeding was a slightly negative attitude towards mixing - almost, I thought, worse than it I hadn;t breast fed at all.

I found it easy not to 'slide' into purely bottle feeding as I loved the satisfaction of breastfeeding and found that if I ever had a choice I always chose to breastfeed. (reasons I didn;t were to do with problems I have with my arms which made feeding when not cosy on my sofa painful, when very very tired (e.g. if I or dd had been ill) or if Daddy would enjoy some feeding and sleeping time)

I have loved breastfeeding (as has dd) but I wonder if I'd been able to continue successfully if I hadn;t had the last resort of giving her a bottle. (we have similar attitude to real nappies and disposables)

I have often wondered if mixed feeding was more tolerated and advise was available (not people advised to mix feed) if more mum's would feel confident in breast feeding.

ilovewashingnappies Sun 06-Jul-08 20:32:35

No hate mail (well,,, not here in such civilise comapany) but lots of love for Tracey Hogg - she talks much sense about mixed feeding. Does she have any web resources....?

sabire Sun 06-Jul-08 22:11:27

"I have often wondered if mixed feeding was more tolerated and advice was available (not people advised to mix feed) if more mum's would feel confident in breast feeding"

First off - the best person to get advice on mixed feeding from would be a breastfeeding counsellor. As long as they know you are making an informed choice they would be happy to help you find a way of mixed feeding that did the least damage to your chances of long term breastfeeding.

Mixed feeding IS more than 'tolerated' I'd say, most bf mums in the UK mixed feed from week 2 onwards.

But then the majority of mixed feeding mums have given up bf altogether by 16 weeks, most claiming that the reason why they gave up was 'insufficient milk'.

I think all a good hv or midwife would want is for a mum to be able to make an informed choice: to understand that while every day of partial or full breastfeeding benefits a baby, by mixed feeding she is losing many of the health benefits of exclusive breastfeeding, and that mixed feeding before milk supply is well established is likely to shorten the overall duration of breastfeeding. As long as mums are given this information and they understand the research behind it then it's fair play to them - they can do what they want.

Re: Tracy Hogg on breastfeeding - you might be interested in this review from Kellymom

"On the issue of breastfeeding, Hogg again plants herself on self-proclaimed middle ground. She laments the "controversy" over feeding choices and sympathizes with new moms who must wade through "huge propaganda campaigns." (I would think her attempt to equate the efforts of volunteer organizations such as La Leche League with the money-driven marketing of formula companies must be insulting to many readers, regardless of their feeding choices.)

Even as Hogg congratulates herself on her "even-handedness," she manages to vastly understate the benefits of breastfeeding while giving considerable ink to the merits of formula, which, she informs us, "is more refined and chock-full of nutrients than ever."

The section of her book titled "Making the Choice" reads more like a defense of formula than an objective overview of feeding choices. Among other things, she poo-poos bonding as a reason to breastfeed, complains that the health benefits of breast milk have been overblown, warns that nursing mothers must carry an extra five to 10 pounds to ensure proper nutrition for their babies, makes a point of emphasizing that studies merely suggest - not prove - that breastfeeding might offer women protection from a variety of health problems, and maintains that women concerned about body image might be better off using formula since breastfeeding can leave them "flat as pancakes" or "sagging."

Hogg seems so eager to make up for the breastfeeding advocates who are, she implies, out to make mothers who choose formula feel guilty, that she can't seem to discuss breast milk without plugging formula in the same breath:

"The proverbial bottom line is that while it is good for a baby to have some breast milk, especially during the first month, if that's not the mother's choice or if for some reason the mother can't breastfeed, formula-feeding is a perfectly acceptable alternative - for some, the preferable alternative."

When it comes to the practical how-to's of breastfeeding, Hogg provides nuggets of accurate information, but she offers up numerous duds as well, including such incorrect or incomplete information as:

"After breastfeeding, always wipe off your nipples with a clean washcloth. The residue of milk can be a breeding ground for bacteria ." (Just not true; there is no need to wipe your nipples after every feeding.)

". always wait one hour (after exercising) before breastfeeding." (The lactic acid buildup she's warning about has not been shown to cause harm, and though some babies seem to dislike the taste of mother's milk after heavy exercise, many babies show no aversion whatsoever.)

And for a mother worried she isn't producing enough milk: "Once a day, fifteen minutes before a feed, pump your breasts and measure what you are yielding. Taking into account that a baby can extract at least one ounce more by physically sucking at your breast, you have a good idea of what you're producing." (While this test might work well for some mothers, it can be misleading for others. Many mothers find that, though they get very little milk when they pump, their babies are getting plenty at the breast. Weight gain and the number of wet diapers a baby produces are better measures of milk production.)"

My comments:

But then as the writer of popular parenting manuals, Tracy Hogg has to make sure that she didn't alienate the ff and mixed feeding mums who make up the bulk of her readership. Interestingly she described herself as a 'lactation consultant', among other things, but her biography gives no details of her training. I suspect she's like Claire Byam Cook (writes a lot on mixed feeding) - an ex-midwife who doesn't actually have any proper qualifications in lactation and gives non-evidence based advice. She wouldn't be alone there - most of the writers of baby manuals do this - Gina Ford also. She's constantly giving out advice and information and making proclamations about breastfeeding although she is unqualified to do so.

girliefriend Sun 06-Jul-08 22:13:05

Sadly I think Tracy Hogg died so not sure about web resources and am with you 100% washingnappies about the negative attitudes to mixed feeding, don't understand it as surely it has to be better than no breast feeding at all?! xXX

girliefriend Sun 06-Jul-08 22:21:36

Yeah well at least she didn't make me feel guilty and for a new mum she was a lifeline to me and prob the reason I was able to go on and exclusively breast feed. Evidence base and qualifications are fantastic but so is common sense and a down to earth attitude. Anyway I am probably 'unqualified' to type so am off to bed. XxX

tiktok Sun 06-Jul-08 22:35:37

Tracey Hogg died some years ago. She was unqualified in infant feeding. She was a mental health nurse, IIRC, and had had some neonatal nursing experience. Her book has an understandable appeal to mothers and some people have found it helpful to them. However the information in it is patchy at best.

Qualifications matter - as does membership of and supervision by some sort of professional body. That way, people who are dissatisfied or feel they were misled have an official organisation to complain to, and the person concerned can be offered retraining or in extreme cases prevented from practising. It gives the consumer some confidence, I would say.

mears, I don't know of any book that fits the description you offer. NCT have a couple of leaflets which talk about the use of bottles - probably on the website - and give information on the possible impact on breastfeeding. Any bfc or informed midwife should be able to help a mother work out how to minimise the impact of bottles on her choice to bf, though - can't imagine there would be enough to write about to fill a book just on mixed feeding.

quaranta Sun 06-Jul-08 22:39:33

Hi mears, your advice has helped me several times...for which thank you. here are a couple of thoughts..

As a mixed b feeder to two boys - NOT out of choice but because after trying EVERYTHING to get my milk supply up to their needs and failing, but as a committed bfeeder i wsanted to give them what i could. managed til 9 mos with ds1.

PS but mears - worst experience was health visitor writing down FORMULA FED on my son's red book, when he was about 5 months old and i was bfeeding, (6 times a day) f feeding (5 times a day) and expressing ( 6 times a day)... totally exhausted with the effort but so pleased for him and proud of me even thought it was not always a good experience. topping up was soul destroying after DS1 had been on the breast for 20 mins and seemingly contentedly feeding. mixed feeders are often doing the best they can.

ps Girliefriend - neither you or me are 'unqualified' or 'qualified' to post our thoughts on here. we are just offering our opinions .. and like you i found tracy hogg's book helpful because she didn't make me feel guilty either.

sabire Mon 07-Jul-08 08:55:52

"Evidence base and qualifications are fantastic but so is common sense and a down to earth attitude"

Yes, you need BOTH.

Unfortunately some of the most influential 'baby gurus' of our time have sold themselves as being especially in touch with new mums' feelings, while at the same time dishing out advice and information that can be harmful to breastfeeding. It's a shame really.

girliefriend Mon 07-Jul-08 21:01:20

Will prob get shot down in flames for saying this but some of the advice I have found on this website would have been the most harmful thing to me being able to breast feed if I had read it at the time. It's not realistic for many mums to exclusively breastfeed, for mums without support, without confidence, mums who are scared and alone, mums with babies that cry endlessly, mums that have to go back to work - combination feeding should be encouraged as like I said before it is got to be better than no breast feeding which is the alternative. I am myself a qualified nurse so appreciate the importance of regulation of course but evidence is always very debatable and often bias and what works for some won't for others. Anyway am very tired and have been on mumsnet for far too long so am off to bed (its 9pm!!!) Night night xXx

sabire Mon 07-Jul-08 22:57:38

If mums want to mixed feed they should be helped to make it work for them.

If mums want to exclusively breastfeed then they should be helped to achieve this.

There are no 'regulations' - just recommendations and mums can make up their own minds as to whether they wish to follow these or not. The important thing is that they understand the pros and cons of mixed feeding and can make an informed choice.

The vast majority of bf mums are using formula by the time their babies are two weeks old. I'm amazed that anyone could think it would be even better if MORE bf mums were using formula than are already! But there you go girliefriend - it's obvious that you don't have any confidence in breastfeeding and don't believe most people can make it work for them. Despite my own problems with bf, I personally do - but then I know lots of people who have exclusively bf. The main thing these people share is a) a belief that it's possible and b) the knowledge of where and how to get expert help if they run into problems. And by the way - these aren't mums who have one child and a nanny helping out at home - these are ordinary women with other children and busy lives and yes, a lot of the time jobs too! The evidence from other countries shows that it's quite 'realistic' for most mums to exclusively bf - if they get reasonable help with breastfeeding and aren't constantly made to feel that formula is always the only answer to all their postnatal problems, such as crying babies and tiredness......

mears Tue 08-Jul-08 09:36:18

Perhaps there is not enough information required for a book, but it is obvious for those mums who choose to mix feed, there is little information around for them to refer to.

Perhaps it is a book with a section on it or a leaflet advising how to maintain breastfeeding when combining both.

I personally was an exclusive breastfeeder and loved it. I didn't care if I was feeding all day for growth spurts and didn't get much else done.

I have been supporting my sister breastfeed her twins and the bottom line is that she does not wish to endlessly breastfeed. She cannot cope psychologically with it and she feels happier using formul;a too.

What she has found is that there is little information around for women like her and thinks I should write a book (which I won't!). She had real problems getting a good latch with babies that were born 2 weeks ealy by elective CS. Despite all best efforts her nipples were very painful and she supplemented her babies till her nipples were healed. Whenever she uses formula she does express to maintain her supply. She finds expressing easier than breastfeeding.

She feels that she should have some support for giving some breastmilk rather than none, but doesn't feel that breatfeeding literature supports her choice.

She feels there should be breastfeeding and exclusive breastfeeding information.

sabire Tue 08-Jul-08 09:52:25

"Perhaps there is not enough information required for a book, but it is obvious for those mums who choose to mix feed, there is little information around for them to refer to.

Perhaps it is a book with a section on it or a leaflet advising how to maintain breastfeeding when combining both."

But aren't women who attend bf education antenatally are often given basic information on mixed feeding: ie, avoid if possible until breastfeeding is well established, regular pumping if missing feeds to avoid engorgement and mastitis, cup feeding one route to avoiding nipple confusion...... ? Just wondering what more they need. And whether it's difficult to give evidence based information about formula use as it doesn't exist! I mean - what are the 'essentials' other than this that women need to know about mixed feeding? (looks interested and waits for someone to chip in with good ideas).

sabire Tue 08-Jul-08 10:03:57

"She feels that she should have some support for giving some breastmilk rather than none, but doesn't feel that breatfeeding literature supports her choice"

So what she really wants isn't so much a 'how to manual' but something which will reassure her that her babies aren't losing out by being given formula, and that she won't risk her milk supply in the medium or long term by continued mixed feeding?

There are books around like this: try Clare (Claire?) Byam Cook's stuff. She's an ex midwife who writes books for new mums on feeding, works as a private lactation consultant for 'slebs' (despite lack of qualifications for this role) and regularly pops up in the media slagging off the voluntary counsellors from la leche league, the nct and the abm.

The problem is that what you get in her books is non-evidence based information that's primarily designed to lessen women's sense of guilt about not breastfeeding. You know the sort of thing - encourages women to breastfeed because breastfeeding is 'best' but at the same time tells them that it won't actually make any difference to their babies if they don't. A sort of 'have your cake and eat it too' approach adopted by the likes of Tracy Hogg and Gina Ford - very successful stance as guarantees you the maximum numbers of happy readers.

That's about the long and short of it. If you want evidence based information then you have to accept that it's not going to tell you that mixed feeding a) doesn't disadvantage your baby in any way compared to exclusive breastfeeding and b) isn't likely to shorten the over all duration of breastfeeding. If you would prefer flannel then Gina Ford, Tracy Hogg and Claire Byam Cook are your girls.

tiktok Tue 08-Jul-08 10:28:23

mears, the two NCT leaflets will help. One is intended for bf mothers early on, probably in the first days, who are thinking of using formula. The other is aimed at mothers who are using bottles (ebm or formula) later on, and it has info on helping a bf baby take a bottle.

Neither is full of flannel, and both are honest without being overly-detailed, about the fact that using formula has a health impact, while explaining that breastfeeding still remains a positive thing to do (ie it's not that using formula 'wipes out' the effect of breastfeeding ).

girliefriend Tue 08-Jul-08 21:24:47

Hello am finding all this a bit stressfull (and strangly upsetting, it appears I can't even do confrontation on the internet) so this will be my last note on this subject. I don't know how I gave the impression that I want more b.f mothers to f.f, that is not what I meant at all, just that if women knew more about the option of doing both rather than not at all then that should be supported, sorry if did not make that clear. I am so pro breast feeding and would like to think that I have helped several friends continue to breast feed for longer than they would have done if wasn't for my support. I have probably said this before but I breast fed against all odds and know first hand how hard it can be. I was doggedly stubborn in not gving up b.f despite a baby in special care, gall stones and being in hospital myself having a cholecystectomy two weeks after having a c.section, plus I am a single parent. I manged with the support of my mum and a being a naturally stubborn person. I find some of the advice on here slightly over the top, ie going to bed with your baby and staying there, demand feeding all the time. That sort of advice would have been the straw that broke the camels back in my case but obviously if it works for some then great. Anyway for some reason feeling rather emotional so am going now too much mumsnetting obviously not good for the soul! XxX

PotPourri Tue 08-Jul-08 21:57:18

My mum didn't breastfeed any of her 4 children and my MIL bf all 4. Both were talking about how they didn't know that you could combine the 2. My mum said she might have tried that, and my MIL said she is sure she would have been able to carry on longer had she known that was an option.

Of course it is not ideal, but it is alot better than no breastmilk at all. I realise it might reduce the length of time you breastfeed in the long run in the stats. But the stats can never capture how long people would have bf had they not had that option (to let nipples heal, to get a rest physically and psychologically).

IME there was alot more comment and judgement from health professionals regarding mixed feeding than when I went to ff full time.

girliefriend Tue 08-Jul-08 22:00:51

thanks potpourri, I feel better now XxX

sabire Tue 08-Jul-08 22:19:24

Sorry girliefriend if I upset you. I didn't mean to.

I just think that most women DO know about doing both, and that most women do DO both!

It's great you've been supportive to your friends and that you overcame such a difficult start to bf your baby. Your determination is probably the most inspiring thing to those people you've helped.

I feel a bit sad though when you say that you think going to bed with your baby is 'a bit over the top' as a way to stimulate your milk supply. I'm wondering if you understand the context in which women would do this. Usually the advice to do this for a couple of days is given to women in the first 3 or so weeks after the birth, when they're trying to build up their milk supply, particularly if they've had a difficult start and want to get back to exclusive breastfeeding.

It's really great advice - it allows a mum to rest and to enjoy her baby while getting bf back on track. Obviously it's harder for people to do if they have other children and don't have a partner or family support at home, but if it IS possible it's very good and sound advice, and would have been considered completely normal a few decades ago when ALL new mothers were encouraged to stay in bed (or very near it) for the first few weeks after the birth to really rest, breastfeeding or not.

Podster Tue 08-Jul-08 23:46:54

Girliefriend - am with you all the way.
If I hadn't started to mixed feed dd I would have given up bf altogether. Realising that I could give dd a bottle a day and give my body and mind a break enabled me to se bf more positively and stop dreading it.
I am the quoted 'classic' bf type - mid 30s, university educated etc. but the reality of bfeeding a baby (once I'd got over the reality of actually having one) is hard. It is very easy to tell people to ask for support, but that is easier said than done. Tiredness, fear, failure and even the seemingly trivial matter of how to get myself and a two week old baby to a breastfeeding cafe prevented me from asking for help to pursue exclusive bfeeding. After feeding one night for about 4hours on and off from sore, blistered nipples convinced my baby was starving (or why would she be feeding so much) I gave her some formula. There was no way in the world I had the courage to call anyone at that point for fear of completely breaking down over the phone. I then had to deal with the overwhelming guilt I felt at giving in and letting down my child.
Obviously with hindsight, more reading I know the answers, but at the time I was so caught up in myself that I wasn't in the right frame of mind to get the help I needed.
Given the mentioned statistics of numbers of women who mix feed it is shocking there isn't more info on it. I would have loved to have known how mf impacts the benefits of breast milk, when is the best time of day to bf vs ff, how much formula should you give a baby if you are also breastfeeding etc.
I would also say to the hardcore pro BF I did think about posting on MN about mf, but saw that in general when people asked questions about ff they would get responses from people asking them why they weren't breastfeeding etc. Whilst the majority of these are well meaning when someone is having issues they don't need to hear it, they just want an answer to their question (see above at how Girliefriend now feels).

sabire Wed 09-Jul-08 09:35:38

So what do you think the answer is Podster?

Do you think health professionals should be saying to mums 'it's fine to mixed feed if you're struggling with breastfeeding'?

I mean - they DO say that a lot of the time don't they?

And if they don't say it, it's usually because the mum has told them that she really wants to continue breastfeeding and they are trying to help her protect her milk supply.

You do really need to remember that for every mum who finds mixed feeding helps them continue breastfeeding, there will be many others whose continued breastfeeding is utterly sabotaged by it and who end up with all sorts of issues about this too.

HolidaysQueen Wed 09-Jul-08 17:20:17

I think you may be right sabire that info on this could sabotage the bf of people who may be able to continue excl bf with some support, but for many people, they'd like to mix feed (for many reasons) but end up ff because they have no info on how to mix feed and end up on a slippery slope to full ff so I think it means that fewer babies receive bm than could if there was decent info on mixed feeding available. Is it fair on those babies that could be getting some benefits of bm to deny their parents the information on how to do it in case it stops a few babies receiving exclusively bm?

I am mixed feeding (excl bf just did not work for me and my DS - won't go into details here) and am amazed at the lack of studies and evidence on it given that I think it may well be the dominant form of feeding for infants. In my NCT group, one baby is fully ff at 3 months, two babies are excl bf and 3 are mix fed (2 of which are just one bottle of formula a day and have been happily for 2 months which proves it can work). We had no info on mixed feeding and have worked it out between ourselves. It would have been much easier if we had had some info on it.

I had various problems at the start and am so proud of myself for only giving one ff per day (despite a couple of tough points where I thought about moving to more - good support on here and from DH and dogged determination on my part prevented that) but when I come on here and read about how mixed feeding doesn't work or how excl bf is the only way to go and how evil ff is, it shatters my confidence and pride and makes it that much harder to keep going. I end up thinking I'm a breastfeeding failure because I'm not exclusively breastfeeding when actually I need to tell myself that I am a breastfeeding success because the vast majority of milk my DS receives is from me and me alone despite the hurdles we've had along the way.

Podster - I thought you eloquently described exactly how I felt

tiktok Wed 09-Jul-08 17:59:41

HQ: where on mumsnet doe it say that formula feeding is 'evil' (except in posts which accuse people of saying this!)? Where does it say 'excl bf is the only way to go'?

I spend a lot of time (too much....) on here and I don't see this. I have contributed to many threads on mixed feeding, and I have explained that experience is variable, and that preserving breastfeeding is best done if formula is kept to a minimum, but that for some babies, even one bottle a day can have an impact on the mother's bf....if the supply is fragile, if she uses ff to stretch out the gaps between breastfeeds - this is not a state secret, any of it, and when people understand how bf works, it is clear that mixed feeding is a bit of an unpredictable unknown when it comes to individual mothers and babies. One mum might be fine with one bottle a day; another one might find it has an impact that's hard to recover from.

There are no rules about who is going to be affected and how.

Not sure what studies you are after - there is quite a bit of research on partial breastfeeding as opposed to full breastfeeding, and any NCT breastfeeding counsellor (like me) will be able to explain how best to continue with some breastfeeding if formula is used for whatever reason.

I do see lack of information, but not in the way you mean.

I see many mothers denied the information that using formula risks affecting the choice to breastfeed - at least one thread a week or more on here alone will involve someone in some sort of a pickle with a dwindling milk supply who has never been told that the top ups she's been advised to give, or the ff in the evening or ff at night or whatever may reduce her milk.

sabire Wed 09-Jul-08 18:22:22

"I am mixed feeding (excl bf just did not work for me and my DS - won't go into details here) and am amazed at the lack of studies and evidence on it given that I think it may well be the dominant form of feeding for infants."

Pretty well all the studies that form the backbone of current government recommendations on infant feeding look at the impact of partial as well as full breastfeeding, so the evidence IS out there for those who want to read it.

Like Tiktok, I have NEVER seen any post describing formula as 'evil' or using any other sort of moralistic language about it. I have read posts that flag up the health issues connected with using formula. Is this what you mean?

I find it difficult to believe that your antenatal classes didn't touch on the impact of using formula on establishing breastfeeding, and timing when and if to introduce bottles. If they didn't cover this then you were short changed because as far as I can see it's part of a basic curriculum of antenatal breastfeeding education.

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