Combination feeding - how do I get this right without messing up my supply??

[unblissfullyignorant]

So, backstory (a bit long-winded - soz):
My DS is now 10 weeks, he's been a really good feeder from birth, latching on no problem and has always been very very hungry. So hungry in fact, that I'm worried he's not getting enough from me.

From the beginning, I've had 'issues' with expressing - every time I've tried, not very much has come out - I'm talking less than 10ml...my boobs have never 'sprayed' milk, even when overfull (and I've tried to make them spray) and I've never had to wear breastpads for leakage - in fact, I think I've only ever leaked twice - once in the early days from the opposite feeding breast at the time, and once in the middle of the night a few weeks ago when he had been frantic feeding a lot that day (growth spurt?) and I was really engorged...

A few weeks ago I came close to throwing it all in (nipples felt shredded as he was on the boob every two hours, 20 mins per side, all day and most of the night) so I had a lactation consultant come over to help. She told me to

1. Have him feed from only one breast at each feed, for 40 mins,
2. to then top up with formula if he was still hungry,
3. then express from both boobs afterwards, 10 mins per side to keep them stimulated. Any milk that came out to be seen as a bonus, to be used for the top ups instead of formula, if possible

So, far, so good. Except his weight gain, while overall, has been going up, is still erratic and I've not been that committed to the expressing thing either. So, I've recently tried feeding him before bed (40 mins, one boob), giving him a bath and then DH will give him a bottle of formula before he goes to sleep.

We've noticed an immediate improvement on the length of time he has been sleeping afterward (from about 2/3 hours to 4/5). He also gets the occasional bottle during the day which I try to give him after feeding - he ALWAYS takes it and sucks it all down greedily. And he just seems happier afterwards.

I want to continue in this vein but I can't help worrying I'll start to lose my milk supply - it feels like a slippery slope - first the bottle before bed, then the one in the afternoon....

Can anybody share their combination feed 'routines' with me? I'm told it's a very delicate balance - obviously all I want is for DS to be happy and healthy, and I want to be able to be his primary food source and not dry up completely.

Any advice anyone can give me on how to make this work would be wonderful. Am I trying to have my cake and eat it too??

Do you want to combination feed, or do you want to have more breastmilk?

I can't be helpful - when I tried combination feeding with my DS (4 years ago) he found the bottle was easier that the breast so was no longer incentivised to suck to stimulate milk, the once a day bottle got bigger and bigger until he was drinking 10oz from it (thats all that fitted) and the amount I produced got smaller and smaller. I pumped in the morning and fed that to him in the evening as well but it was still a slippery slope.

As you say yourself breast fed babies can stimulate the amount they need by having a growth spurt. Although it was good advice to feed from one breast for 40 minutes I would have thought better to offer the other side first before offering formula??

I have never ever been able to express a drop after a feed - because babies are much better than pumps at extracting milk. I can only express either in the morning when full or if I miss a feed (like when I went to work yesterday.)

IME the best way of increasing milk supply is getting baby to suck for as long as possible as often as possible for a few days in a row. Offer like extra top ups.

Also the fact that your nipples were "shredded" after so much feeding time perhaps implied his latch is not great. DS2 has had days like that (for an hour at a time every 2 hourly) without causing any damage at all.

Long feeds and shredded nipples imply a bad latch. Your lactation consultant sounds ... a bit odd, tbh.

As you have said, added formula endangers your supply.

Are there other BF options local to you? This page lists BF groups nationally, although of course some may be rubbish.

Thanks for the feedback, MNWL and NQC. To be fair to the LC, she did check my latch at the time (and you're right, it was a bit off) - she got my positioning sorted and ever since then the feeding is not painful at all. It's just that the expressing is rubbish.

I guess I do need to ask myself if I'm happy with having my supply reduced by the very act of combo feeding, which I think I am - I'm just really worried it will go too far in the other direction and before I know it, I will have dried up and won't have a choice...

Also, I live in the Middle East and there really is no bf (or any new baby) support here (except in the form of paying someone like an LC to come over or visiting a clinic) - MN is proving to be a lifeline!!

Ah, right, hadn't realised you were in the middle east.

From what I know about expressing, it's worth trying:

• different pumps/methods. Some mums prefer electric, some prefer manual pumps, some mums prefer manual expressing (no pump at all)
• by any method, it can take time to get the hang of it. Keep trying, and more may come.
• if you are peering fixedly at the pump, that doesn't help the letdown to happen. Better to relax, watch TV, ignore it, or do yoga breathing.

Thanks NQC, will persevere with the expressing, it's just been quite difficult - will try what you suggest - my friend has offered me the use of her pump which she is really happy with. Manual expressing for me has yielded a few drops, nothing more!

In the meantime, I am very curious to hear from people who have managed the combo feeding successfully without drying up or basically ending up on ff because of diminished supply? If you have, how did you keep it going? Am I being thick here - is it a case of expressing anyway to make up for the formula, or can it be done?

Hi, Its a few years ago since mine were babies, oldest is 17, youngest is 9.
However, I combination fed all 3 for 6 months then chose to stop and switch to bottles as they were starting to take solids.
Like you, I never had any success in expressing, so I didnt bother! Instead I would offer 2 bottles instead of breast feeding, one during the day and the other round 11pm-midnight. I quite enjoyed the break, and Dh loved the opprtunity to feed the baby his nighttime feed while I went to bed early to catch up on some sleep.

TBH I didnt find my milk supply changing particularly, and over the course of the 6 months I gradually brought in extra bottles every 3-4 weeks.

The only thing I did notice was that with DC3 I had quite a difficult pregnancy and put on virtually no weight. I think that because I didnt have those reserves I noticed a definite difference in the milk supply after a big meal

I

I combined Bf, ebf and ff with my eldest who is now 4. It wasn't intentional, but she had a tongue-tie and the pain was horrendous. I found trying to combine the feeding was messy and I struggles to know when she had enough. When her tongue-tie stretched a bit at about 10 weeks and the pain eased I was able to increase the bf, stop expressing and decrease the formula. By that stage she was taking an 7-8oz ff at night and sleeping for 8-10hours. When I stopped the ff at night in an attempt to exclusively bf she started wakenening a couple of times at night. I expected this but after more 3 nights I decided to give the ff at night again as I was very close to losing my sanity and didn't think I was going to be a great mum being so flippin miserable. Of course then I was miserable as I was riddled with guilt about the ff (how ridiculous it seems now). Thats just my experience, but in hindsight I think that if you want to combine bf and ff I would do as JGBMum did and give the ff at the same time(s) each day (not by the clock but eg. always the 2nd and last feeds). If you are trying to increase your own supply then feed 40mins on one side and offer the other side before ff. Good luck. Great work so far.

I mix fed DS for 4.5 months - like the previous poster he had tongue tie and breastfeeding was agonising. I think eventually formula took over and breastmilk contributed less and less to his diet, but then I didn't do anything to actively maintain or increase my supply. I saw any breastmilk he got as a bonus tbh.

I for one don't believe the party line that giving any formula will kill your supply. How can that possibly work? How does your body know that your baby doesn't have a smaller appetite than he/she actually does? For my money the situation is that if you supplement with formula without working to actively increase your breastmilk supply to match your baby's appetite, then of course the proportion of breastmilk will go down over time. But I reckon that if you deal with growth spurts by extra breastfeeding alongside or instead of extra top ups then your supply would stand up just fine. I'm no expert though, this is just my gut feeling from a common sense point of view.

I am currently mix feeding baby number 2 by the way as she has also been very difficult to breastfeed. So I hope I'm right, but I'm not going to beat myself up about it either way. And I really can't see the point in scaring mothers into not giving any formula with dire warnings about their breastmilk disappearing, when they might otherwise give up altogether.

Hand expressing or boob massage is very important alongside machine expressing. I saw a video from an American Hospital NICU and they found that women who did this got twice as much milk out.

Thanks, all.

I'm going to keep trying to express anyway, just to see if I can in fact get more out and then be able to give him that by bottle at other times.

By the same token, I'm going to try not to beat myself up about giving him formula as and when I have to - two bottles day for the same feeds as JGBM did and Stilsmiling suggests. I've done this two days running now, and he just seems more content after the bottle, you know? I want to make sure he's happy and satisfied and I shouldn't feel guilty about whether or not that bottle is formula or my milk should I? But I did/ still do!

Isn't it strange how we're somehow sold the idea of all or nothing? Like, it's either ebf or ff and nothing in between. God, I've enough fodder to make myself feel bad about as it is (crying in the car when I can't pull over, going back to work, even part time - and on it goes).

Thanks again for the input guys, you've really helped me to make up my mind about the way forward.

UBI xx

"I for one don't believe the party line that giving any formula will kill your supply. How can that possibly work? How does your body know that your baby doesn't have a smaller appetite than he/she actually does?"

I think that this depends on the baby. My DS1 was not prepared to suck when there wasn't much milk unless he was starving. He was always a quick feeder, but was hungry again an hour later [hmmm]. I just couldn't get him to fed for more than 5 mins at a time. Once he'd got the fast milk bit he'd had enough and stopped feeding.

By 4 months he wanted to feed hourly (but for just 5 mins) day and night. (He had slept through the night from 11 weeks - 17 weeks). I had no nipple damage but I was so tired. I didn't mind the day at all but I gave in and gave him a bottle of formula after the breast at 10pm because I was so tired and needed one good bit of sleep. Initially he took just 4-5oz from a bottle and slept all night but over the course of a couple of weeks he was waking at 9pm and then 8pm rather than going until 10pm, draining a 10oz bottle and crying when the bottle was empty if I tried to give less. By 5 months he was waking up again hungry at midnight, and then hourly in the night again. I gave up breastfeeding it as we both (him and me) prefered the bottles.

But again MumNWLondon, that's to do with your own preference and your baby's. It's not your body saying "oh, I notice you are no longer feeding your baby 8 times a day, but only 6. I am now going to stop producing milk altogether". I feel that the latter is the message that is given out. The fact is it only impacts your supply if you change your mind and your supply hasn't kept up with your baby's new demands. Or if you and your baby find bottles easier (which let's face they are) and use them more in preference to breastfeeding. In each case this is personal choice, not nature closing the door.