Can anyone help me advise a friend who has been offering formula top ups to her 6 week old?

[Okonomiyaki]

My friend has been giving her ds formula in the evening as she felt/was told that she was not producing enough milk for him as the day went on. She is now struggling as the hv is concerned his weight is not increasing quickly enough. She would like to continue bf'ing but I can see that she is likely to end up ff'ing...I would like to offer some useful advice.

I'm aware of baby-mooning, skin-to-skin, offering baby the breast at every squeak, how cluster feeding in the evenings is normal etc....is there anything I've missed? Also, I'm unsure how slowly it would be advisable to drop the formula.

I appreciate any advice!

How much formula is he having and how often is she breastfeeding him? What does he weigh and what centile is he on/what was his birthweight?

Good questions :)

I will check and come back!

Hi oko

Has your friend spoken to a BF counsellor? Sadly, Health Visitors are not always up to date with their information. Your friend's best bet to improve her DS's weight is to feed him herself, more, and by introducing the formula, she is giving her body the message that it needs to produce less milk, rather than more.

I don't think there is any particular advice about how slowly to drop formula, if that is what your friend wants to do. Instead of offering the formula, maybe she could try changing sides and offering the second breast, then changing back again (this is called "switch feeding" and encourages milk production). If your concern is whether she has enough milk now in the evenings, she may find she needs to feed her DS a lot over the first few days, as you say - cluster feeding, which will again help to build up her supply.

For professional advice, your friend could speak to the National Breastfeeding Helpline on 0300 100 0212, open until 10.30 at night
or the nct breastfeeding helpline on 0300 330 0771, open until 10.00 at night
There is also a list of local support groups here so you might be able to find one in your area.

Actually, the Health Visitor should be able to pass on the contact details of a local counsellor, too.

You sound like a lovely friend

You could put her in touch with the NCT Breastfeeding line 0300 330 0771 - 7 days a week 8am - 10pm.

BTW, has your friend asked for your advice? I know I got a little bristly when I felt people were trying to preach at me over feeding DC1, with hindsight I know it was meant kindly, but at the time it felt like criticism.

Thanks everyone.

Pip I think you raise an excellent point. Up until the other day my friend has only said how hard she has been finding it etc and so I have been very careful only to say she is doing fabulously and that I am sympathetic. However, she has now asked if I have any ideas and I would love to help her as it wasn't so long ago I was struggling myself. I am being very careful only to support. If she decides that she doesn't want help, or she wants to move to formula as she is finding it so tough then I will back off/be totally supportive!

I was in a very similar situation to your friend. My dd had not gained any weight after 6 weeks and ended up in hospital. Despite getting all the advice and help in the world I simply wasn't making enough milk for her and so started to offer formula top ups. It was the best solution for us and may well be for your friend. Each feed I would Breastfeed first and then offer a bottle. It worked a treat and I mix fed for 6 months. My experience was that there was a lot of pressure to ebf and that contributed to the problem - ie my reluctance to give top ups until the situation became critical. On reflection, the bf advisers, while meaning well, gave poor advice for my situation. So, in short (sorry long post) please tell your friend that if she ends up giving formula top ups it will likely be the best thing she can do for her child.

Giving formula sounds like an ideal situation, you don't want a hungry baby overnight and milk production can reduce at night especially when you're tired.
I mixed fed both of mine from about 5 weeks, usually giving a bottle of formula at night time. DH often gave it and I went to bed! I mixed fed til both were about 4 months. I'm due with DC3 in a couple of weeks and intend to do the same again.

You're right, everyspring - this is a misleading myth. There is nothing likely to be 'wrong' or 'under par' with milk quantity or quality when a mother is tired or at any particular time.

A lot of people believe this, though :( :(

Is your friend looking after herself?

I think one of the reasons why I didn't manage BF for very long is because I wasn't eating very well so perhaps encourage your friend to think about her nutrition too.

I was just thinking that too, gallic - it's so easy, especially in the early days, when you're tired and thinking about looking after your baby, to forget to feed yourself.
Makes sure she knows to keep snacking and drinking loads, like she did in pregnancy.

Oh dear, another myth :(

What you eat and drink may have an impact on your energy levels and well-being but it has zero effect on whether or not you bf effectively - fortunately :)

but your well-being will have an impact, surely?

It's just one of a whole load of things which contribute.

gallic - how will your well-being have an impact? I suppose if you drink so little you become ill with dehydration (who's going to let things get that far?) you might faint a lot or have to be hospitalised and be away from your baby. Eating badly can affect energy and cause fatigue if it's done for long enough - I suppose that might make you feel listless and less willing to do night feeds....but that's as much of an affect as I can see :)

no, tiktok, neither us meant that it would affect the milk, but eating and drinking is important to make the mum feel like she's capable - it's amazing the difference to your mental state it can make!

OK - not worth fighting about, but instructions and advice about eating and drinking in these situations massively miss the point. The OP makes it clear that this mother has been told (or assumes) she is not producing enough milk and the baby's weight is causing concern, and she is giving formula.

She could eat and drink and snack for England and it will make no difference to any of this.

true.
But it's partly self-esteem, isn't it?
if the HV is telling her to top-up because she's not got enough milk, just being told to eat and drink better might make her feel she's doing something productive towards helping herself.
(missing the point, but helping her?)

OP, you do indeed sound like a lovely fried.

From what you've said, it sounds like your friend has anxieties about whether her baby is getting enough milk....and if baby's weight gain is indeed slow, then this might be the case, although because he/she may not be feeding effectively rather than because there is something 'wrong' with her.

Can you suggest a good source of real-life skilled support for her, eg a drop in group or helpline? She may or may not want to look at these sources, but at least you will have let her know they are there, and if there are issues with how effectively her baby is feeding, she can explore them. It might also be worth emphasising that these sources of support should not judge her about her feeding choices or browbeat her.

Re the evening feeds, both my dds were little and often types, and dd1 was particularly manic in her feeding activity between 4 and 7pm....the way i rationalised it was that they were tanking up for the night ahead and the longer stretches of sleep....and that it's a behaviour that they all grow out of, and that your evenings do return. So one option is to accept that for a relatively short few months, the rhythm of the household adjusts to that of the baby rather than the other way round

Re the myths...well they are just that but they can feel real...so it is worth knowing that WHO and other research has consistently shown that women who have lived on subsistence diets for most of their lives still make nourishing breastmilk....and that fatigue similarly has no physical effect....but of course being tired and hungry affects how you feel about life, your baby and breastfeeding

Hello all, thanks for your posts. I have pointed my friend in the direction of the LLL helpline, the Kellymom page on reducing formula top ups and, of course, the MN bf and ff forum :)

I am miffed on her behalf that she seems to have fallen foul of some of the myths, but it's so hard not to as a first time mum, isn't it? Heck, my own mother went on about my milk 'not being good enough in the evening'. And she originally trained as a midwife!

Oh, and her Ds had only gone from 50th to the 25th centile so unless there are issues I don't know about I think she is being worried unnecessarily there too. Speaking as someone whose small but perfect Ds went from the 25th to the 9th!

Mine went from the 75th to the 25th and is absolutely fine - a drop of two centiles is normal.