Any advice on how to cut down formula top ups?

[Gahrattwice]

Strap in for a massive essay:

I have a six week old baby. She lost a lot of weight on day nine and we got sent to a&e and put on bottle top ups of 60ml after every breastfeed, so eight per day usually. Which I now realise was a full feed.

Weight gain now good and I have been trying to reduce the formula and get back to EBF. I have sought help and advice from various sources (been to all the groups, called all the helplines) on how best to do this, how much to reduce by, but have been given conflicting info. I have very slowly reduced to around 350ml of formula per day over four approx 90ml feeds, plus anything I have managed to express. But baby is constantly hungry, never seems satisfied. Even when I have broken and given 125 ml in desperation she roots around for more. I'm not sure I'm doing the right thing in trying to get back to EBF when she is so unsatisfied all the time. Last few days since TT snip have been the worst, constantly rooting and crying if not attached to my boob for hours on end, but is angry and frustrated when on the boob too, I'm guessing because she prefers the bottle now.

She is still putting on weight of around 25g per day on average, and has plenty of wet nappies. Only poos every couple of days but they are massive! Tongue tie was cut couple of days ago. I am trying to express as often as I can, but she won't be put down so is hard, and I am really struggling to cope. She hardly sleeps so neither am I!

Has anyone else had success with going back to EBF from formula? I have been trying so so hard with it but am on the verge of giving up, which is making me feel like shit. I don't even know why, there's nothing wrong with formula, and I wasn't that bothered about breastfeeding when I was pregnant!

Damn it, I meant to put this in chat!

Um...AIBU to not want to think about my bloody boobs ever again?

I feel like I could’ve written your post! My little girl is 7 weeks tomorrow and after a huge weight loss on day 3 (over 10%) and over 3 weeks to regain birth weight we are also on bottle top ups, though we’re doing 30ml each feed. I was also advised to give 60ml initially but after speaking to the infant feeding team at the children’s centre they confirmed that was a full feed and to only give 30ml, though occasionally I will give her a ‘double’ top up of 60ml if she’s particularly hungry. I find I have to stop myself doing that too often though as I’m worried she’ll get used to it and then the 30ml top ups won’t be enough.

We’ve tried 3 times to reduce top ups, all which resulted in tiny weight losses so back to top ups each time. Personally I’m at the point where I’ve accepted we need the top ups - I’d love to be back to EBF but it just doesn’t seem to work for us unfortunately. Our issue is my milk supply as I just don’t quite produce enough for her, we’ve tried all the natural advice like breast compressions, lots and lots of skin to skin, feeding very often etc. I didn’t get on with the electric pumps but find the silicone letdown pumps (naturebond or haakaa) are amazing and I can get almost an ounce each side now (previously got less than 5ml from an electric pump) which means every other top up can be breast milk.

I have found out today that I’m very low in iron so will be starting iron tablets twice a day, not sure if this will help my milk supply but we’ll see!

I don’t have much advice as like I said we’re at the point where I’m just accepting it now, but I will say don’t beat yourself up over it, I’ve spent almost 7 weeks worrying about it but you know what, they’re still getting all the good stuff from Breastmilk and the top ups are just that extra something to help with weight gain etc. Good luck!

Ah Pickett, sorry you're having the same problems, but thank you for the reassurance. I am angry at the hospital for just telling me to give the 60ml
without any consideration for the fact I was breastfeeding, but more angry at myself for not questioning it.

It's so much more bloody work breastfeeding and then bottle feeding then pumping, it's the worst of all worlds! I will give the haakaa a go, I think I have one somewhere a friend gave me.

When you tried to cut down the formula, how did you do it, reducing each bottle a little or cutting a bottle out?

God I could have written this 10 months ago. Remember 6 weeks is a big time for cluster feeding so if DD is constantly wanting to feed I'd be inclined to just get comfy and let her. I used to express the other side when my DS was feeding, with mixed results but he just would not be put down. I was only ever able to get more than 1oz after months so you're doing really well.
We too ended up in hospital after he lost a lot of weight and they recommended formula top ups. I managed to slowly stop giving them but it was stressful. I just pumped as often as I could, let him feed as much as he wanted, and made sure I was drinking A LOT of water.
Have you tried taking fenugreek? It's often recommended to up your supply.
You should see if there's a La Leche League in your area. Total wealth of advice at my local one (they have a Facebook group).

I just went to a la leche meeting this morning as it happens! They were very nice and did say it was possible to get back to breastfeeding. The lady didn't seem that worried about him being so hungry all the time.

Yep have fenugreek, keep forgetting to take it

Ahhh I feel your pain. I had similar issue except I starting expressing to top up as I didn't want to use formula. DS eventually decided he preferred bottles and totally refused the breast at 10 weeks. 8 months later I'm still expressing. No advice sorry, but

that's so tough, must be very time consuming. So far she seems ok with boob and bottle but I can see her eventually preferring the bottle.

I was going to to try and cut back the formula a little again this week but if she's going through a growth spurt i'm worried it'll stunt her growth. Not sure if that's how it works!

It’s very stressful and upsetting - I had my heart set on EBF and ended up mixed feeding due to being in agony with a detached nipple and being completely shredded. After a LOT of crying, I made the decision that baby just wanted milk and as long as he had the benefits of breast milk then he could also have the benefits of formula too. I really had to ask why I was so desperate to EBF and tbh it was difficult to accept. If baby is showing signs of being hungry and dissatisfied then I wouldn’t contemplate cutting back on milk. But you have my sympathy because it’s much easier to see when you’re out the other side.
I very happily mix fed for over 6mths.

I just realised how incoherent my post was (I'm so tired). It's great that you've been to LLL and that they were confident you'd be able to get back to EBF.
Its a supply/demand thing I suppose. The more you substitute BM for FF, the less BM you'll make. Which is all well and good when you don't have a hungry little soul screaming at your nipple. When I reduced the FF I started mixing it with BM and set a limit, so if it was 25ml after each feed I'd see how much I could express then top it up to that 25ml line with FF.
I also started leaving baby for a couple of hours with DH or DM. Generally I would still be in the house (in the bath or bed), but I found DS wasn't quite so frantically hungry when I wasn't there (they can definitely smell the boobs). Not every day, but occasionally. It let my boobs fill up a bit because otherwise he was just constantly sucking and sucking.
We managed to get to EBF at about 10 weeks I think, but it was stressful and I definitely felt like a terrible mother at times. Remember fed is best, and if it starts impacting you mental health take a look at what's really important. Plenty of babies never taste a sip of BM in their lives and go on to become outstanding human beings. Anyone who judges you for it is an idiot.

Does she take a dummy? DD2 is a very sucky baby and was permanently clamped to me and seemed hungry. At 6 weeks I gave her a dummy in desperation after about 8 hours on the boob a d never looked back. She just wanted to suck a lot of the time instead of feed. She is much calmer now

Thanks Mary. I don't know why I am now so desperate to breastfeed when I wasn't previously, I really don't know if I'm doing it for the baby.or for me anymore.

The LLL lady said to give as little formula as I can get away with giving without baby screaming. Another breastfeeding person told me to just cut out one whole bottle a day to start with. another tolde to cut down by 30ml a day.

But I hate hate hate her being hungry. Even though I know she is putting on good weight I feel like I'm starving her.

Divgirl your post made perfect.sense! I might be leaving her with her dad this eve for a couple of hours (me and the dad are not together, so don't usually), will be interesting to see if she is less hungry.

Yes she will take a dummy, though not for long. This is definitely hunger though I'm sure.

6w they do cluster feeding and everything they want is feed after feed. I could be some days 6-11pm non stop feeding my baby.

She has been going from 9.30 this morning with only two half hour naps . She did eight hours straight yesterday.

Blergh.

Don’t know if I’ve got much advise, but in a similar situation here.
5 week old, we were put on top ups whilst still in hospital, initially full top ups which were halved as we were discharged. I’ve expressed the majority but use formula when needed. We were kept under the hospital outreach team for a few weeks to monitor growth while reducing top ups. Their method of reducing them was to make them less frequent, rather than reducing the volume of each top up.
We now just have two top ups a day. I want to be off them fully but alternate between feeling really positive about it, and feeling like we will never be off them.
We have periods in the day where all she seems to want to do is feed, but I’m pretty sure that she’s cluster feeding rather than hungry so just going with it.
It’s absolutely exhausting though, feeding for hours, then trying to get her to sleep somewhere other than on me so I can express. She’s my second and I had a similar situation with my first so just keep reminding myself that one way or another it will get better!

The most important thing is to make sure your baby is fed. I think the support available for breastfeeding mums is great now but some can be a bit militant and actually give quite poor, or even dangerous, advice. Breastfeeding has to work for everyone. You can't BF at the expense of everything else. I managed mixed feeding for 3 months (same scenario, baby not putting on weight. Eventually diagnosed with silent reflux and CMPA) but I found it so stressful and we haven't looked back since switching entirely to formula. I was like you, I felt a bit sad about it but I couldn't be precious about it, my baby desperately needed to put on some weight. Best of luck!

I am angry at the hospital for just telling me to give the 60ml without any consideration for the fact I was breastfeeding, but more angry at myself for not questioning it.

What a terrible hospital imagine wanting to make sure your child puts on weight and thrives. Total fuckers.

Personally I’d drop the pumping and just have her on the breast all the time until your supply hits her demand with formula top ups only when you can’t take any more and she is still hungry. Pumping plus ff and bf is hideous. If your baby is now feeding from you ok, she will be much more efficient at stimulating supply and extracting milk than pumping (which can be useful to maintain supply if a baby is struggling to latch or stay awake during feeds, etc). I’m not an expert though, just someone who has been through this.

Also just to say, if you do decide to ff that is great and establishing supply after being instructed to top up is hard. From my experience, hospitals are quick to insist on top up feeding with no regard to what it does to bf and how soul destroying it is for the mother. Sometimes there are important medical grounds, sometimes not.

timeforteaplease1 no need to be sarcastic, 60ml is a full feed for a newborn and therefore not a ‘top up’ as is used when supporting breastfeeding. Consistently giving a newborn a full bottle feed is not going to help breastfeeding which the OP has clearly stated she wants to get back to. My hospital did the same - I questioned it and was told the above and therefore only gave 30ml top ups. I don’t know if you’ve ever wanted to breastfeed or what your journey was like if you did, but it can be really really hard for some women and shitty comments like yours do nothing to help. Of course she wanted her baby to gain weight, I’m not sure where the OP has stated otherwise, but the hospital should’ve also considered the aim to return to breastfeeding and therefore given better advice to support the OP.

I had a similar issue. I sat in bed and kept baby on the breast to increase supply. Toddler would read stories with me watch tv play in the garden while baby was on me. I found oat porridge and fennel tea increased my supply.

It's so incredibly hard, lots of sympathy

I had similar problems: DD struggled to latch and was very sleepy, and my supply was low. We did mixed feeding after a similar a&e visit.

I did finally get to ebf at about 8 weeks. I always did bf first, and just kept reducing the formula even though it seemed impossible. DD spent a lot of time on the breast: about 50% of the daytime in the early weeks, and woke her for feeds every 3-4 hours in the night.

I remember almost getting to ebf at about 5 weeks, and then it slid backwards for a few weeks: I was told there's a growth spurt. So don't be discouraged if that's what has happened with you too. You're not losing, it's just a setback.

I do remember getting very upset when my HV told me at about 5 weeks that if I continued mix feeding, it would soon change to completely formula. It was probably a harsh truth though, since I was starting to think that mixed wasn't so bad. It did inspire me to keep cutting down the formula.

It's hard. Really hard. If you want to ebf, you need to persist, and give lots of boob. It's possible, and personally I was really glad that I did. But formula is also absolutely fine, and there's nothing wrong with choosing to do that. There really is no wrong answer.

I know it's a huge worry that your baby is hungry. But my DD (6 now!) is 75th centile (she was 50th at birth) and very strong and sporty, so her early difficulties feeding haven't had a long-lasting affect. Your baby will also be fine, whatever you choose. Best wishes

When you tried to cut down the formula, how did you do it, reducing each bottle a little or cutting a bottle out?

So we’ve attempted to reduce 3 times. First time I was told to totally cut them out which in hindsight was a terrible idea, thankfully we only did that for 3 days and got her weighed and she’d already lost weight so we stopped that method. The second time we’d reduced to 15/20ml top ups but she lost (albeit very slightly - 50g over 10 days loss) so that wasn’t working. Third and final attempt we gave her 40ml every other feed and again a very very small loss but a loss none the less. So far the only method whereby she hasn’t lost weight is consistently giving 30ml top ups at every feed, and 60ml top up at the bedtime feed. It’s tiring, but I’ve accepted it for now. Not sure what we’ll do as she gets bigger and needs more - the dream is my supply will cope and she’ll be okay but aware that there may be a time I need to up the top ups rather than reduce.

And I agree, this whole unwillingly having yo combi feed is shitty! I constantly have either an infant or pump attached to my boobs, weekly weigh ins, obsessively checking she’s doing enough wet nappies etc each day. Hang in there though, you and I are doing what we feel is best for our babies and although it feels really crappy now it can only go up from here, eh!

Have you tried putting her back on the breast when she roots around for more? In theory it could help increase your supply, but she may also be looking for comfort too.

Could you try giving a slightly reduced top up, and if she is rooting afterwards, put her back on the boob and see how she gets on?

But at the end of the day, although combi feeding isn't your ideal situation, you're doing what's best for your baby. Do you pace feed when feeding her from a bottle?