How to do bottle feeding?

[AgruminoMum]

Hello ladies

It turns out that I only have half of the milk that my 7w old DD requires... I am now doing mixed feeding (breast + bottle) - and I need advise on how to do the bottle feeding. Tried to list the questions I have here, but any other piece of advice on the topic is very much welcome...

• What equipment do I need - 6 bottles, brush to clean, steriliser, anything else?
• Is it true that once babies get used to a certain shape/brand of teat, they refuse other shapes/brands?
• Do teats get worn out with time, and need to be changed?
• Rubber or silicone teats?
• I am currently using the slow teats of Medela, suitable for newborn, as I don't want DD to go off the breast completely. How long should I continue using these, and when should I move to medium flow? And why should I move to medium flow teats? DD is sucking very fast and efficient with the slow teats and drinks the bottle in no time...
• How does going out with baby in town work - carry a warm prepared bottle in an insulated bag? For how many hours is this milk safe before bacteria starts multiplying?
• Do babies really stop when they have had enough milk? DD seems to be ready to drink any quantity offered...

Thank you! I prepared only for breastfeeding and never researched any bottlefeeding questions, really lost right now....

I might be a bit out of date, but I figured it was better than your post just sitting there, lol.

'What equipment do I need - 6 bottles, brush to clean, steriliser, anything else?'
I can't think of anything else

'Is it true that once babies get used to a certain shape/brand of teat, they refuse other shapes/brands?'
Some do, some don't - it depends on her personality really, lol

'Do teats get worn out with time, and need to be changed?'
yes, how quickly depends on what type you're using

'Rubber or silicone teats?'
www.babydirectory.com/health_clinic/baby/bottle_feeding/171/choosing_the_right_teat_for_your_bottle
though, I think rubber are hard to find?

'I am currently using the slow teats of Medela, suitable for newborn, as I don't want DD to go off the breast completely. How long should I continue using these, and when should I move to medium flow? And why should I move to medium flow teats? DD is sucking very fast and efficient with the slow teats and drinks the bottle in no time...'
if she seems to be getting frustrated while feeding because it's not going fast enough, or starts to get really windy - but that's not as likely to happen with mixed feeding as she'll be used to how it comes out of a breast rather than how it comes out of a bottle

'How does going out with baby in town work - carry a warm prepared bottle in an insulated bag? For how many hours is this milk safe before bacteria starts multiplying?'
this is where I think I might be out of date, lol, I used to make the bottles up, cool them down straight away (in cold running water) and keep them cold, then reheat - warm bottles were a big no no

I genuinely haven't a clue what the current advice is, but you do get little pre-made cartons

'Do babies really stop when they have had enough milk? DD seems to be ready to drink any quantity offered'
That's a problem with mixed feeding, it comes out of a bottle easier and faster, so it is easy to overfeed...stop and wind her every couple of ounces (you might not need to do it as often as that, but that's a good start till you're both used to it), to give her time to register that there's milk in there, lol

Sorry not sure about equipment but if you want to carry on breastfeeding as well, it might help to try and make the baby latch on to the bottle teat as if it were a nipple. Ie hold in bf position and rest teat on top lip, wait for the gape etc. And remember the less she feeds from you, the less milk you will make.

Babies have to actively suck from the breast so will probably give up when they've had enough whereas milk comes easier from a bottle. So a compliant baby combined with a persuasive bottle holder might mean some babies takes more than they need, as I understand it. Using slow teats and only offering small amounts at a time should help but I don't know about speific of how to do this, sorry.

Kellymom has some information on how to bottle feed the breast fed baby - see here.

How to make up formula here.

I'm wondering who told you/how they worked out you produce half of baby's requirements? Was it weight gain, pump yield, before and after a bf weighing or something else?

Hi, I know that it can be a bit daunting at first - I planned to BF too and didn't anticipate bottle feeding (I mixed fed, just FF now) but it will become second nature soon, honest.

To answer your questions:

1. What equipment do I need - 6 bottles, brush to clean, steriliser, anything else?
   Nope, I don't think so. As for a steriliser, I like our electric steam steriliser - it's very quick, doesn't need any solution (or a microwave) and efficient, and easy to clean too. As for bottles, I don't know how many times a day you are planning to bottle feed, but I find that having some more bottles than I need in a day handy so I'm not constantly washing up and putting the steriliser on

2. Is it true that once babies get used to a certain shape/brand of teat, they refuse other shapes/brands?
   Err, not sure. My DD has had every kind of feed possible (Breast, cup, syringe, several teats and bottles). I think it can be trial and error. As we were mix feeding the midwife suggested getting tommee tippee closer to nature teats as they mimicked (sic) the latch needed to BF. But the BF clinic didn't agree - I think the speed of teat may be more important

3. Do teats get worn out with time, and need to be changed?
   Yes. Apparently about every 3 months but check them every now and again for wear and tear (especially when teeth come in!)

4. Rubber or silicone teats?
   Err, don't know. We use Tommee Tippee, and I think they're silicone. We like them, as does DD.

5. I am currently using the slow teats of Medela, suitable for newborn, as I don't want DD to go off the breast completely. How long should I continue using these, and when should I move to medium flow? And why should I move to medium flow teats? DD is sucking very fast and efficient with the slow teats and drinks the bottle in no time...

We were advised/I read somewhere that slow flow was better as the baby has to work a bit at getting the milk (i.e. it's not gushing out and in their mouths!), as they do with BFing. But not sure about this. My health visitor advised using variflow/breastflow, which we use, and we're happy with. I moved to these after the slow flow as she seemed to be taking ages drinking her bottle and kept making wee 'sigh' noises like she was getting quite tired.

6. • How does going out with baby in town work - carry a warm prepared bottle in an insulated bag? For how many hours is this milk safe before bacteria starts multiplying?

See page 13 of the 'Support for those who FF' thread under this forum. It has lots of downloads/info on the safe prep of formula, including if you need to make it in advance. Using cartons is by far the easiest (and safest) way to feed when you're out and about. But you can also use vacuum flasks and make it up when you need it, or take a chilled milk that has been safely prepped in advance and warm when you need it. See page 13 though, for more info. I use a mixture of everything - if I'm just popping to a cafe and know I'll be using a bottle within an hour or two, I take one out with me in an insulated bag.

7)- Do babies really stop when they have had enough milk? DD seems to be ready to drink any quantity offered...

Mine does, and I couldn't make her drink more if I tried. But some babies will drink what they are offered, I think it's to do with comfort sucking. Sorry I can't be more help with this question!

AgruminoMum - on the point about not enough milk I take it you've seen a BF counciler? I only ask as a lot of mum's feel they don't have enough milk at some stage or another but there are things that can usely be done with BF before resorting to formula feeding.

Feel free to ignore me if you've already had this sort of help.

Thank you for your replies - really really helpful!

Sorry for not explaining the whole story immediately. I stubbornly breastfed exclusively DD for 7 weeks. She was born 3.5 kg, fell to 3.25 kg initially, went back to birth weight within 2 weeks (so, gain of 250 gr for 2 weeks). Then her weight gain slowed down and she gained only 250 gr for the next 4 weeks. I did everything I could - saw breastfeeding consultant, kept her on the breast the whole time, co-slept, woke her up for night feeds (DD is one of those few babies who don't wake up at night), drank the special tea that increases milk supply... She was crying a lot and I kept worrying about other reasons for that (colic, reflux, etc), and I kept getting angry with anyone who suggested that my milk might not be enough.

Last week she regurgitated a lot - which combined with the very low weight gain triggered admission in the hospital and all kinds of exams. Doctors initially feared urinal tract infection (one of the symtoms is low weight gain) but tests were negative. While in the hospital I was asked to weight her before and after every feed and give her formula top-up. We did this for five days - and my milk was about 450 ml and she would take additional formula of about 400-500 ml. I know this is not exact since I would be producing less milk under stress, and she would need a lot of milk now to catch up with the initial slow weight gain, but it is clear that breasts are not producing enough... Ever since we started give her top-up formula, she is content, doesn't cry and sleeps during the day (previously she didn't sleep for long during the day, would always wake up screaming and only calm down on the breast).

Now, I know I should have figured this out earlier, and I feel terribly guilty... I had read so much about how if the baby is put on the breast often enough, there should be enough milk... With hindsight, I was really stressed over the first 6 weeks, and probably that was the reason why the whole process went wrong. My plan now is to start each feed with the breast, then offer the bottle, and then stimulate breasts with a pump. Most probably I would not be able to go back to exclussive BF, but I will try to make BM last longer.

It's a bit of a losing battle that I am fighting against the formula... Plus, DP is extremely worried, so would probably not agree to ever drop the formula unless I literally start spraying milk over the next weeks...

Agruminomum - You really sound like you have had everything thrown at you since your DD's birth! But well done you for persevering. Are you still in contact with the BFC? Have you had any advice about using a Supplementary Nursing System (SNS) - they can help you bf more by any supplement is given at the breast not via cup/bottle which in turn can stimulate more milk.

If I may ask a few questions?

-Were you allowed a day with out top ups to see how much you made when you were ebfing? How many sides were you allowed to offer before the weighing? Was your DD allowed to come off the breast of her own accord before weighing?

-Have you any reason to suspect you might not make enough milk? Breast surgery, baby not allowed to feed for hours after birth, does this ring any bells?, do you have Polycystic Ovaries?, are your breasts different cup sizes (e.g. left an A cup, right a D cup)?

-Has she had an experienced BFC/IBCLC/Dr look at her mouth to rule out tongue tie or any other oral abnormalities?

TruthSweet,
I know about SNSs, but feels like additional hassle (and I already have too much on my plate). And DP doesn't trust any alternative suggestions any more (that what happens when you try to get the fathers involved as much as possible, they try to take over the process which has been women's only territory...).

In the hospital, I was allowed a day of no top ups (did 430 ml only). I did both sides, and did switch nursing as much as possible. But the problem is that once there is little milk in the breast, and/or let down is slow, DD kept falling asleep (no wonder, she has been starving for weeks and had no more energy left for vigorous sucking :( ). I was very stressed and had not slept enough - yet I don't think I would be able to produce significantly more than 430 ml in better conditions. Her mouth and latch on was checked in the hospital as well.

DD birth was a bit traumatic - it never started, I waited more against doctors' advice, and finally agreed on an induction on 40w+12. Induction was slow and difficult and painful (all the easier methods failed to produce much effect). DD only latched on on the second day (we were still under the effect of the epidural), and my milk only came on the fifth day. I also never had a big engorgement in the first week that everybody keeps talking about... There are no other reasons that might have prevented me from producing milk. However, I was under significant stress in my personal life in the first six weeks (+ a screaming DD) - and failed to forget this and focus only on the baby. I kinda of thought that just by mechanically attaching DD on the breast all the time, she would do all the work, which I now know is not the case...

AgruminoMum - Sounds like a rough start! I guess you had syntocinon drip to induce? Synthetic oxytocin has been linked to milk supply problems (and I have had problems with milk supply following syn. induction myself).

Have you heard of breast compressions - they can be useful to get extra milk into a slow feeder and to stimulate suckling.

Have you talked over all your options with a breastfeeding counsellor? Could you get your DH to go along with you so that he is on board with what ever you decide and knows why you are doing it whether that is switching to just formula or working to increase milk supply or anything in between.

AgruminoMum said Now, I know I should have figured this out earlier, and I feel terribly guilty... I had read so much about how if the baby is put on the breast often enough, there should be enough milk... With hindsight, I was really stressed over the first 6 weeks, and probably that was the reason why the whole process went wrong. My plan now is to start each feed with the breast, then offer the bottle, and then stimulate breasts with a pump. Most probably I would not be able to go back to exclussive BF, but I will try to make BM last longer.

You don't have anything to feel guilty about. You had a rough start and it can be very hard to recover from. Your baby needed fed and was fed, please don't agonise over how things could have been different. I did, and it wasn't good at all. In my case, I've learned to accept that what happened happened, and I did the best I could at the time in very difficult circumstances. Sounds like you have done too.

If you really want to recover the BFing and aim for exclusive BFing then by all means go for it, but I found it helpful to think over if I had done everything that was possible at the time (that is, everything possible that I was willing and able to do) to get to EBFing, or do I accept that this is where we're at and go from here?

Your breastfeed/top up/express regime sounds like what I was doing (recommened by a BF clinic) but it was exhausting and time consuming. I'm not saying that it will be for you (I was crap at expressing and could get dribbles out) but be aware that it can be.

Also, has your baby been properly checked for tongue tie? Another reason we had a rough time was that my baby was simply not milking me efficiently when she was on the breast, and being followed with formula top ups, combined for a bad supply (despite expressing also), in my opinion.