Introduction of formula top-ups - kiss of death for breastfeeding?

[mears]

I have been on mumsnet for a number of years now and although many Mnetters have successfully combined breast and bottle, I have noticed that the vast majority of mums who do it end up exclusively formula feeding.

I just wondered how formula top-up end up being introduced. It is always on professionals' advice? Do mums buy formula 'just in case' or do they end up finding a 24 hour supermarket in the middle of the night through desperation.

When I trained as a midwife mums were given a tin of formula home just incase they needed it. That was shown to seriously undermine breastfeeding and was stopped.

I read often of babies being offered formula after a breastfeed and baby 'wolfing it down'. They will. A baby stuffed with breastmilk will always drink formula when offered (when they take a teat that is) because it is something different. It is the same as us suddenly finding room after the maincourse when a sweet arrives. We don't necessarily need it because we are hungry - we make room for it because it is different.

I think it is so sad when women introduce formula because they feel their supply is anadequate. More ofetn that not there is nothing wrong with milk supply. Yes there are times when formula is needed to help mums and babies through a crisis but steps need to be taken early on to improve milk supply. Poor positioning, low milk supply and painful nipples go hand in hand. The cure is not formula - the cure is correcting the latch which will mean that the baby gets more milk and stimulated better milk production.

There is a myth that women have less milk in the evenings. That is not true. Babies tend to cluster feed in the evening because they like it. Mums are usually tired by this time of the day and 'feel' they have no milk. That is the time that partners, friends family can play a part by giving mum a break. Also womrn should try to go to bed earlier but they don't. Especially when you have toddlers throughout the day, you relish some hours of peace at night. However, early nights for those few early weeks could help prevent the build up of sleep deprivation so often described.

My philosophy was always if baby was crying, had a clean nappy, give them the breast. No timing, no clock watching. If I had other things to do then DH was handed baby if he was there. If not, babe got 'shoogled' in a pram. My 4th baby hardly ever got an uninterrupted feed. She got one boob, popped in a car seat to take brothers to nursery, play group etc. When I had time she got the other side. What a difference to my first baby who was permanently latched. No time for that when you are running around after a toddler. However, in the evening when toddlers were in bed I sat with babe latched while watching my favourite telly programmes.

I don't know the answer. I think the main problem is lack of confidence in our own body's ability. You can't knit that. It takes time but unfortunately the introduction of formula can be the kiss of death.

Sorry for this long post - was just thinking about it all as i did the ironing. Have slipped up this week and let the washing pile up. Need to get back on track...

[hercules]

Lovely post mears!

I was told in hospital with ds (nine years ago) he needed formula to top up as he was a big baby. I did it and really struggled to establish bf. Got advice from la leche in the end and went on to feed him for 4 years

1 1/2 years ago with dd I was also told the poor thing was hungry and my milk wasnt enough for her and she needed formula. I said no much to the annoyance of the midwives.

No problems with bf and i'm sure it was because I was confident having read so much after ds.

[jessicasmummy]

Mears... its people like you that make me determined to make BF work this time round.

With Jess I was given no support at all and resorted to formula at just 4 days old. Didnt think i had milk, and tbh, never leaked or anything so not sure what was happening.

This time i intend to get all the help i can and go for it. THank you xxx

[hercules]

One of dh's aunt breastfed her first 3 children fine but was told that she would have no milk for her third by a fortune teller. She believes in that stuff and so ended up not bf her last baby as she thought she had no milk

[fruitful]

I introduced a bottle because I wanted dh to do the 10:30 feed and let me go to sleep, and I couldn't find time in the day to express. Or not when I was relaxed enough to get anything out anyway.

Then we noticed that when he had a bottle he wolfed it down in 15 minutes and was a happy baby for the next 3 hours. Whereas a bf took over an hour, he was unsettled and cry-y afterwards, wouldn't sleep, wanted another feed very soon.

Wasn't painful to feed, latch appeared to be fine, he was getting milk (to judge by the amount he could sick back!) but he was a sad baby on breastmilk.

I don't know if it was a supply problem - didn't have time to do the hours and hours of skin-to-skin etc anyway. I think it just took him so much energy to get the milk out that he used up all the energy he got from the milk. He wasn't gaining weight (which I wouldn't have minded if he had appeared happy).

So we gave him more and more bottles and that killed my supply.

And its so much easier and I like it so much more! I never gave dd bottles at all and I never thought I'd feel this way - but I like bottlefeeding. I get to sit and feed ds and gaze into his eyes instead of his ear. Lovely.

[Nightynight]

v interesting thread.
I successfully combined breast and bottle for my 4th baby. But this was because she was at nursery full time from the age of 6 weeks. It wasnt because I felt the need for a "top up" bottle.

My 3rd baby was a big guzzler though, exclusively breastfed, and I was knackered keeping up with his milk demands. I was light headed, couldn't get anything else done, couldn't concentrate, felt grey and drained. (this was due to bfing, because I had the same problems with first 2 babes, but only for a week or so when they got big enough to need solid food) Ended up starting him on baby rice aged around 10 weeks, cos I couldnt take the strain any more. With hindsight, it might have been better to give him a bottle instead of solids. Not "natural" but sometimes nature is badly designed!

[Nightynight]

fruitful - know what you mean. All I ever saw of ds1 for about the first 6 months of his life, was the top of his head as he guzzled b/milk!

[mears]

fruitful - you should be able to look at a breastfeeding baby's eyes - head should be tilted upwards to ensure underneath part of areola is in mouth far enough. Makes me wonder about positioning? You don't always get sore nipples with poor position but feeds are prolonged.

I loved it when babies were a bit older and they stroked your face

[popsycal]

mears i love your post!!!!!
cant type much as feeding ds2 but just wanted to say i agree....ds1 was 'topped up' and it wasd the kiss of death (topped p by scbu initially i might add) and i had all the feelings you describe

ds2 is now 15 weeks.....not a bottle of formula or spoon of baby rice in sight
both very happy

[Nightynight]

none of mine did that, though both ds's used to grab my breast with both hands and shove it in their mouths, from about 6 months onwards!

[fruitful]

Mears - surely thats the "underneath" part from the baby's perspective not mine? So actually the side from my pov. Nipple tilted towards roof of his mouth? Baby horizontal across me. Baby gazing at my armpit... Possibly it depends on the shape of your breasts. My nipples point forwards...

I've had this discussion with quite a few friends and none of us could work out how you were supposed to be able to see into the baby's eyes.

[mears]

Baby's head should be tilted slightle backwards, over crook of arm so that lower lip is further back under the nipple. Nipple is almost point up baby's nose prior to fixing on. Babies vision is the distance of breast to mum's face. Have you ever had a baby smiling at you still holding the nipple in their mouth? To be fair newborns don't gaze quite so much but babies should be able to look at their mums while breastfeeding as they get more wakeful. Perhaps when baby got to that stage you were formula feeding and didn't experience it.

[tamula]

Mears what a delightful post,

Truly a great read.

I have fell into that 'top-up' breast feed predicament, but chnaged it to breast at certain times and formula at other. I do 3 bottles of formula a day, bf during the night if necessary, first thing in the morning and if a snack is in order. Which it usually is!

I do find that this suits me as it allows me to remain breast feeding whilst also having the convienience of a bottle.

[hunkermunker]

Mears, that's a lovely post.

I think part of the answer is training midwives to actually care about breastfeeding - not sure how you do that, but while women are told on the postnatal ward their milk's not good enough, or that because their baby's big they'll never produce enough milk for them, or that they can learn to use a bottle and the breast (yes, they can, but usually when they're older than a day old...), or that the baby "needs" to have "something" (usually formula) because they've not eaten since they were born 5 hours ago, etc, etc.

This continues with HVs not having good training in breastfeeding - I've been on the receiving end of "why don't you top him up with formula, he's not gaining as fast as we'd like" and I'm stubborn and confident about breastfeeding, but so many people aren't and trust their HVs more than I trust mine.

And the hospital GP I saw who told me that "they bite" and that there was no point continuing to feed past six months.

Until the myths surrounding breastfeeding are exploded within the NHS, it will be a struggle for a lot of women to feel confident in their body and their ability to breastfeed.

More women should take heart from the fact that they have nourished this baby for the nine months they've carried it without using an SMA placenta substitute

I gaze into DS's eyes when I feed him - have done since I got the latch right when he was a few weeks old!

[Tinker]

Am so glad that you posted this mears. Of 4 friends who had babies at approx same time as me, I'm the only one exclusively breastfedding...and I feel sometimes that I'm odd for doing so. So many people have said the "Are you giving a bottle at night?" kind of thing or "Are you still breastfeeding?" (she's only 4 weeks) that am beginning to feel freakish and out of kilter. I don't want to give a bottle at nighht (yet), never realised I "needed" to so thank you for posting and reassuring me that I'm doing ok.

[fruitful]

Hmm, both were latched on as you say, and resolutely gazed at my armpit. Dd was 10 months when I stopped bf'ing and switched to beakers. Oh well.

But anyway, I have no clue if the top-up feed is what did for us or not. I think probably ds' prematurity didn't help.

Although I do know that dd would never take a bottle (of ebm or anything) and that drove me absolutely bonkers. Chained to a 2-hourly bf for 6 months - aagh. So definitely no regrets about introducing the bottle this time!

[suedonim]

I introduced top-ups for two of mine on medical advice, after my babies hadn't regained their birth weight by 3/4wks. I'm pretty sure I'd done everything right and my MW's were not of the ilk that resorted to formula at the first hurdle. I think I just naturally don't produce an awful lot of milk, I only ever leaked a couple of times and couldn't express at all. I was aware even one bottle could cause problems but never had to give more than the one and was eventually able to drop it. None of my babies gained weight rapidly - a 2-3oz gain in a week was good and on one memorable occasion one of them put on 9oz. Some of my friend's babies put that on every week!

[oooggs]

I wish I had found this site and you Mears when I had DS 18 mths ago. I struggled with the feeding and was on transitional care for 6 days after the birth. I was prodded and mauled by the midwives and when DS was give that injection thing in his heel it was suggested that I went to lunch leaving DS with DH and midwife, on my return 5 minutes later he had a bottle in his mouth and that was it. After every feed he was 'topped up' and he soon worked out that the bottle was easier and refused the breast.

It still upsets me now that the decision was made for me and when you are emotional and tired I trusted the midwives on the ward to do what was best for DS. I don't think they did &

[Tissy]

I didn't top-up at all, but there was a carton of formula in the cupboard just-in case, and I was told by my HV (who also ran the BF support group in the village) that the only way to get dd to sleep more was to top her up with formula after a b/feed in the evening. Luckily I had been lurking on here before dd was born, and knew that that was a daft idea, so ignored her! Breastfed for 22 months in total.

[elastamum]

My DS2 was born shortly before my dad died and I just kept on breastfeeding him as with all the travelling back and forwards to the hospice I couldnt have managed to prepare bottles even if I had wanted to. He seemed to do OK and at over 10lb he was a pretty big boy. I once got stopped by a very nice police man whilst BF on the hard shoulder of the M25 when stuck in a huge traffic jam. Once he saw what I was doing he was very nice about it!

[pupuce]

Mears - you say : lack of confidence in our own body's ability... definitely.... and OH SO TRUE for labour !

My experience as a BF counsellor is that once formula is introduced it is quite quickly the kiss of death if baby is very young unless the mother wants to stop formula and is prepare to work at it... but I totally agree with your post.
There is a reason why BF professional try to instill in women that the 1st 6 weeks are vital, they shape your BF experience and the "profile" of your breast. this is when you develop your prolactin receptors (I think...) and the more you feed, the more you make... and the easier it is afterwards!

[JiminyCricket]

Couldn't get dd to latch on for first three days (she just screamed whatever we tried)...paed recommended first formula as she was getting sleepy (I think we felt this was pragmatic, although I know not strictly good bfing policy)..then got going feeding..but midwife (wrongly in my opinion, retrospectively iykwim) said we might have to go back into hospital because of dd's weight loss so started top ups. Phased them out and carried on feeding for 7 months. So, no, I don't think its the kiss of death BUT no one could give me any help on phasing them out except on mumsnet so I guess once most people get started giving top ups they don't really get much help to phase them out. If you're struggling to bfeed as I was at times (mastitis etc) and you're having the worst of both worlds (still having to sterilise everything and prepare bottles, try to express etc) then I guess it would be easy to switch over to formula completely..but I didn't.

[pupuce]

Jiminy - if a baby is refusing to eat/bf than formula is a temp solution... as the worry is that if the baby's blood sugar drop too low they get too sleepy to WANT to latch on.
First thing is to try getting some colostrum and syringe or cup feeding it. Sometimes that is difficult so formula is a good option.

[Pruni]

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[mummylonglegs]

Message deleted

[berolina]

Thanks for this post, mears. You know all about my bf drama . For everyone else: fed now 4 1/2-week-old ds formula, starting in hospital, due to jaundice (like you Pruni, except it was a bit worse and ds had to go under the lights) and weight loss - always along with EBM and small quantities of direct bm - but I didn't have enough to feed him just EBM. At some point (I think we were still in hospital) he started refusing the breast at most feeds. I kept going with trying him on breast at every feed and giving him as much EBM as I could get and formula for the rest. He started thriving and gaining weight on that and very gradually started going on the breast more and more until now I can gladly say I can rely on him to take the breast at every feed. However, I can see that if I hadn't a) been so determined to bf and b) had such great support from people on here (mears, tiktok, throckenholt, Eulalia and several others) and in RL, I might well have gone over to formula completely, as it really was very discouraging being scratched and hit by an inconsolable ds at almost every feed. I do feel formula helped us out of a tight spot, as it enabled ds, who was and still is quite a lightweight, to gain the weight he probably needed to get used to bf and do it efficiently, but now I'm more or less exclusively bf I'm very glad to have hopefully seen the back of formula, apart from possibly a very occasional top-up. So, in my case formula wasn't the kiss of death for bf, but I think it does take a lot of determination and, most importantly, support.