Need some advice on mix feeding

[hefner]

I would be really grateful for some advice on how to start mix feeding with the minimum damage to my milk supply.

The background is that DD (17 weeks) has always struggled with breastfeeding and her weight has gradually dropped through the centiles. She can only feed with nipple shields, and feeds slowly for about an hour each time. I think that because BF is such hard work, she takes just enough to satisfy herself, but not enough to put much weight on. I think if I could give her one or two bottles a day she would take more and might put a bit more weight on. I can't express enough for a bottle a day so it would have to be formula. BF counsellor thinks I'm doing fine, but I'm so sick of seeing DD looking so skinny. HV has been relaxed about her weight until a bout of diarrhoea knocked her down another centile line and HV then suggested seeing a GP, who advised supplementing. This was purely based on the charts - she didn't actually look at DD, and she suggested stopping feeds after 20 min as the breast would be empty so I don't trust her advice on how to feed and supplement, although I respect her opinion on DD's health.

So, I think I might have to start giving one or two bottles a day FF, and I'm keen to do it with the least damage to my milk supply as I want to BF long term, maintaining morning and evening BF after I go back to work next summer. DD feeds at around 7am, 10am, 1pm, 4pm, 6pm, 8pm and midnight. I think the midnight feed would be a good one to FF as I can then express while she is in bed. The 6pm feed would be convenient to do as FF and would allow me to express, but would two FF in the evening make my body stop producing milk for the whole evening? Would it be better to do one FF in the day (probably wouldn't manage to express)? Or should I FF different feeds each day - not sure whether that would trick my body into producing milk for all feeds as it never knows which will be missed, or whether it would just mess my supply up completely?

Also can anyone explain exactly what benefits of BF we will lose if I introduce formula? Obviously there is the dose effect, but I think I read somewhere that BF protection against allergies doesn't apply if any formula has been given?

Sorry this is so long, I'm so confused and would welcome any advice.

Also, forgot to mention that I give a bottle of EBM during the day a couple of times a week if we're out somewhere DD won't feed. I wonder whether it would be a good idea to make this one of the two daily FF with the other at midnight? The only trouble is that the daytime bottle feed varies from late morning to early afternoon depending on what I'm doing, would this be a problem? Also, I wouldn't be able to express as I'm usually out during the day. I'd love to hear from anyone who has experience of mix feeding, or knows the theory/evidence around it.

I'm sure someone much more knowledgable than me will come along soon, but I didn't want you to go unanswered. I mix feed my 20wk old DD after a rough start to bfing. I top up after every feed, which I would not advise as I think it will lead to DD refusing the breast eventually.

I think your idea of replacing a feed and expressing is a good one. My first inclination is to say don't drop the midnight feed. Prolactin levels are at their highest overnight, so it's an important feed. Not to mention the faff of bottles/expressing in the middle of the night.

Could you start with replacing one feed at 6pm and see if she starts to put on weight?

If you don't mind me asking, has latch been checked, tongue-tie ruled out,etc? How did you start using the shields? Apologies if you've already gone down all avenues.

My other thought is that changing the time of day would be better for supply, but that's just a hunch!

Bumping for you

Thanks featherblue, that's really helpful. Good point about the prolactin. I wonder whether expressing at the midnight feed would be enough to stimulate milk production. My reason for wanting to bottle feed that one in particular is that DD is very sleepy at midnight so I hate that feed because she is constantly falling asleep and I have to wake her every couple of minutes - feels a bit like I'm torturing her! She drinks a bottle without falling asleep as much and it's much quicker so she can get back to bed sooner. I wouldn't mind faffing with expressing as I find it easier at night when I'm not trying to deal with DD as well.

We've had a lot of help from several breastfeeding counsellors and I attend a really good breastfeeding cafe every week. Tongue tie has been ruled out. One of the BF counsellors suggested nipple shields as DD couldn't latch at all without them. They've worked well for us but I think they make her feeding quite inefficient. I'm trying to wean her off them, but she's refusing so far. After going to BF cafe today I'm feeling a bit more positive so I'm going to try another week without any formula as long as DD's weight isn't too bad tomorrow. I'd still be grateful for advice in case I use formula in future - does anyone know whether it is better to stick to FF for the same feed every day or to vary it?

How did the weigh-in go today, Hefner? Glad you're feeling more positive about not topping up. Does your DD seem satisfied between feeds/ do plenty of wet/dirty nappies? If so, then she may be taking everything she needs?

I understand about the midnight feed. If she is inefficient at feeding, maybe dropping that one for expressing wouldn't harm your supply too much.

Hopefully one of the bf counsellors will come along soon with better advice. Afraid you may have been lost in the shuffle!

about 2 weeks ago i had the genius idea if giving the 6.30pm and midnight feed as a bottle of ebm

i had so much milk and in expressing for the 6pm bottle i got loads extra and sleep appealed as i could go to bed early so though oh could do that too...

BIG MISTAKE. my milk supply dropped suddenly within days. (thread on here)
i have spent the next week buying a hospital pump and expressing loads and hand pumping at the night feed.

my milk is back to what it was (finally) but in hindsight it was a mistake... a 12pm bottle made baby go til 5am so each breast was having about 14 hours a day off (even though i expressed twice) and they stopped making milk

The weigh in went ok thanks featherblue. The Dr didn't seem concerned and DD had put a little bit of weight on. Only 120g in 2 weeks, but she still had a bit of a dodgy tummy until a couple of days ago so I hope she'll put a bit more on now she's better. She is very happy and settled, plenty of wet nappies so I think we're doing ok.

Nannyl, that's exactly what I'm worried about. I'm going to carry on without any bottles for now, but even if I do introduce regular bottles you've backed up my hunch not to drop more than one evening bf.