Mixed Feeding Routine - Any Suggestions?

[shepster]

I've just joined today, but have spent many a night in the nursing chair perusing various posts particularly concerning mixed feeding. I thought I'd sussed my routine, but find it's all gone to pot lately and am in need of some suggestions.

The brief summary is that I introduced formula, upon the advice of the nurses at NICU, a week after my son was born. He lost nearly a pound that first week, even though I was exclusively- and continuously!- breastfeeding. They put me on a breast pump, saw I was only producing 30 ml (barely) and concluded I wasn't producing enough. That's where it all began and that's where I've been ever since.

To begin with, they put me/us on this routine of: 20 minute breast feed, followed by 5 minutes expressing (on the pump) and then top up with 90 ml. Not sure how long I stayed with that intensive routine, but it has since evolved, and I've stopped expressing. Currently, I pretty much exclusively breastfeed at night (which is a whole other matter as DS seems to be waking up every 2 hours after going down and then every hour after 2:30am. Ugh!) During the day, however, I start by offering the breast, then if he gets fussy (at the breast), I offer him some formula. Sometimes he takes the formula, sometimes not. My constant worry is: is he getting enough! As he has been gaining weight, I would say yes, but this haphazard method is putting me through the paces. And, now, he appears/is constipated (not gone for 3 days), so I'm wondering if he's been taking in enough fluids.

At the moment, he's been taking in roughly 400ml of formula (as he is 15 lbs., I assume he must be drinking another 600 ml in breastmilk, roughly, gauging it by the old 30ml to 1lb of body weight estimate!) TBH, though, I can barely imagine that I produce 600 ml.

What I wonder is: Is there a better system? A friend suggested that maybe I just breastfeed at night and in the early morning and early evening feeds, while offering formula through the day. My ideal would be to keep up the breastfeeding until I introduce solids and THEN maybe (just maybe) exclusively give him breast milk when he is not eating solids.

Apologies for the huge ramble. Anyone who has developed a more successful, less stressful system, please share!

Some women have good results choosing a particular feed to feed formula rather than ending every feed with formula. However I really think talking it over with a bfing counsellor either in person or on one of the bfing helplines would be a good idea as I don't know how sustainable your current regime is, the one your friend suggested would almost certainly spell the beginning of the end of bfing in a young baby, if your son was 6m+ and you had a full established supply then it would probably be feasible but not at such a young age.

As to the is he/isn't he constipated - formula fed babies have hard stools than bf babies so that might be why he appears to be struggling. Wet nappies would be a good judge of adequate fluid intake - 6 wet disposables or 8 wet clot nappies a day is considered a good amount. The wee should be clear/pale straw colour not dark too.

How many feeds does he have at the breast a day and how many 'sides' do you offer before formula feeding? If he has had both sides you can still go back to the first and offer that one again (and the second, and then the first again) as breasts are never empty they constantly make milk. The emptier a breast the quicker the milk production, the fuller the slower the milk production.

I can't believe though that a week post-natal the MW told you that 30mls wasn't enough! That is truly shocking and just plain bad practice as pump output does NOT equal what baby can get at the breast. I'm so sorry they did that to you. BTW 30mls is a pretty good out put for the first time at a pump and at only 1 week so they were talking unmitigated twaddle as well.

Post script: DS is 4 months old now!

shepster, I go along with TruthSweet here - sorry to hear about the difficulties in the first week, and while a loss of a pound in the first week is something to take seriously, getting you to pump to assess production is a huge clue they actually are not informed enough to help anyone fix their bf.

In any case, 30 ml is just fine and a lot more than some women would manage :(

90 ml top ups are huge for a new baby - and from what you say, I would guage you to have a brilliant milk supply as most people's bf would have gone out the window now on that regime...you almost certainly have an excellent supply to withstand that onslaught.

(The old rule of thumb is 2.5 oz (not 30ml) per pound of body weight. This is usually translated as 130 ml per kilo (I think).)

I second talking all this through with a bf counsellor to work out a plan that will keep your bf going - you might want to think about increasing your breastfeeding in place of the formula, by reducing the formula . Up to you. I reckon you could do it, as your breastmilk supply remains good.

Why do you think you are not producing 600 ml? I wonder if your confidence in the whole thing has been affected by the (sounds like rubbish) support you had in the beginning?

I agree with Truthsweet that maybe making some feeds breast and some formula would be easier - if you make the ff ones the ones you want to drop after your introduce solids then it'll be easier. I gave a formula dreamfeed from 4 months then dropped that at 8 months so was just bfing again.

Also agree about the pumping, 30mls is pretty good! I've never pumped more than an oz at a time, even when I was away from ds for a day at 6 months and full to bursting.

The amount of breastmilk comsumed isn't the same as formula by the way, as it doesn't increase with age/weight - the fat content increases instead. A breastfed baby takes about 25oz (750ml I think) a day from 1-6 months.

I would do something like breastfeed first feed, bottle for second feed, breastfeed again, bottle mid-afternoon, breastfeed at bedtime, bottle at 11pm, breastfeed in the night. Then when you introduce solids the bottles can be dropped for meals and eventually the 11pm bottle will go when he sleeps through.

Thanks, TruthSweet. I agree that they were a bit hasty at the hospital to put us on top ups. So be it though. I must now just make sure my DS is fed!

TBH, I don't really have a system of how many times I offer the breast before I turn to formula. I sort of 'test' my breasts to see if they are flowing, how they feel and go from there. I would say that I probably offer both sides first though. The trouble is that, at night, he is totally receptive and will happily drink away. During the day I find that sometimes he is restful at the breast and, at others, he squirms and fusses. Not sure if he is just not hungry at those times or if my letdown is slow and the flow just not quick enough. When he gets really fussy like that, I offer some formula. Sometimes he gulps that down, sometimes not! I'm a little frustrated as I feel like I should understand him by now, but some days (particularly those following the sleepless nights!) I feel so confused and uncertain. I'm sure this doesn't do him any good. And to throw another spanner in the works, he's teething! Aaargh.

Anyway, will try calling a helpline again, though I do feel in the past I've received vague information. But try try again!

Hope you have better luck with the helpline, though to be honest, your situation is really tricky for a volunteer breastfeeding counsellor to tackle in a phone call (I am a bfc). They will want to know you are in touch with an informed health visitor whom you trust because the worry is that your ds does need to be kept well fed. Your situation (in my experience) is resolved best with ongoing contact, preferably including face to face and an observed breastfeed or two - I'd want to know of the squirming and fussing is 'normal' squirming and fussing or if your ds is finding it hard to transfer milk....just as you are wondering!

The bfc would also want to know if moving towards full bf is an option for or whether you would feel you needed more confidence to do it.

Don't expect too much of a telephone helpline, is what I'm saying, I think! You might ask them if there is someone in your area you could actually see.

Oh my! Thank you all for your quick replies. That helps me enormously. Yes, TikTok, my confidence was completely blown by that first week visiting NICU. Whenever I have pumped, I've always felt dejected at the amount produced, thinking: There should be more! And thank you for correcting me about the rule of thumb. My brain is addled lately with these frequent late night feeds.

I did not know that BF babies consume less than formula fed. That's very heartening to know that it is the fat content that really counts. Oh, what a godsend this site is!

RitaMorgan, that seems a very acceptable routine to me, especially because I can then substitute the formula feeds with solids when we do introduce them. Ah, I see some order to the day forming again!

One other question: should I offer both breasts at each feed do you think? I have read some conflicting advice about this. Thoughts?

Many many thanks all!

Offer both breasts every time - and go back and forward between sides as many times as necessary until the baby doesn't want anymore. Even now my ds will switch sides 3 or 4 times before he's done, especially late afternoon for some reason.

If you are concerned (and you are) about maintaining your milk supply and increasing it, and getting it into your baby :) then yes yes yes offer both sides - at least - at every feed. Three or four sides ('switch nursing') is even better :)

It is absolutely true that bf babies take less volume than ff babies - it's also because the ff babies need more calories in order to have the energy to digest the formula (which is harder work to digest than breast). The amount taken by any individual baby varies massively anyway.

What a shame you have had your confidence affected and all this faff on and worry since the 'help' you had in the first week :( :(

By 4 months my breasts never felt "full" anymore, and I can never squeeze milk out, so don't use that as an indication of whether there is milk there iyswim.

I just wanted to chip in and say that I'm also impressed - both with keeping up the breast feeding, and with 30ml output in the first week (my milk took a week to come in at all, and even now at 9 months I struggle to express anything significant)

I always give the other side a go once he's stopped trying (unless he's fallen asleep) and he'll often take more (not always) - especially when I was in the midst of those first couple of weeks getting him to put his 10% weight loss back on.

shepster - rather than offering formula first thing when you feel your baby is disliking your 'slow flow' have you thought about using breast compressions before offering? They can help 'perk' up a flagging interest in feeding and encourage baby to go for a bit longer on the breast.

Also, the 'emptier' your breasts are the fattier the milk is as well as the faster it's made so waiting to feed from a 'full' breast is counter-productive (i.e. the milk production is slowing the longer you wait and the milk is getting less fatty). I am now 19m into bfing DD3 and if I didn't actually know which breast I fed from last I couldn't tell by feel or by hand expressing milk. That only works in the early days TBH.

I agree with the rest of the lovely ladies, by the time DS was four months my breasts were soft the majority of the time.

Tiktok I never knew that.

Thanks everyone. If I had had a 'hands-free kit', I would have posted my gratitude at midnight, 2am, 4am, 5am. Ha! So, reading through your various posts, I think I might adopt a policy of alternate breast and formula feeds with the proviso that I offer both breasts (or more! :0) at each breast feed. I think this will allow me to make sense of my day.

The 'soft breasts' reassures me immensely. During the day they are definitely soft, but at night, if he hasn't fed in a few hours, they definitely become engorged (not painfully so, but noticeably so.) I take it that if a breastfed baby sleeps through the night, this isn't a problem for women, in terms of keeping the production up?!

And, I know every baby is different, but is there a period of time which babies should optimally feed for? I think you all will tell me no. I think they become more efficient, don't they, so 5 minutes or so can be good, yes? I guess it all depends on how satisfied he is.

Lastly, silly question I'm sure, is it possible to offer the breast too frequently? Sometimes, in my zeal to increase my bm production, I find I offer the breast and he just nibbles for a few seconds and then gets distracted. Is there any disadvantage in this? I feel this may happen a bit while I get my routine in order.

Oh, so much I did not know about breastfeeding. This information is so invaluable to me.

Someone told me you can feed too little, but you can never feed too often! My policy even now is offer a breast first, and if that doesn't work try something else At 9 months ds only has 4 proper feeds a day - but if he is a bit whingy/tired/bored/hurts himself etc I always offer extra feeds.

If I were you I'd keep the formula feeds to pretty set times/amounts (100ml at 10am, 100ml 3pm, 200ml at 11pm - or whatever works for you) and then breastfeed as frequently as possible the rest of the time.

Thanks RitaMorgan. A set of jabs today threw a spanner in the works with regard to a pattern, still we will fall into one. That, and teething frustrations, make for one unsettled little boy. Will keep at it though and find something that suits me and, more importantly, makes for a happy, well-fed, growing babe.

keep going shepster, am so impressed by your determination.... you are doing such a good job! lots of skin to skin and lots of boob contact, perfect.
really proud of you. (in an unpatronising way) (sorry if it sounded like it was )

Thanks, MummyElk. I am proud of myself too! I really can't believe I've made it this long, and I've managed to reduce the top ups somewhat. Not easy though. I will do what I can but I feel good that at least I've made it this far, whatever happens next. Next big challenge: the horrendous waking-up-at-night phase! Ah, the joys of first-time motherhood.

I am going through exactly same issue. I am getting frustrated with this top up thing. It is so difficult. Even during nights I am topping up like 10 ml sometimes to 40 to 60.