Is mixed breastfeeding / formula feeding so bad?

[DH2R]

DW is desperate to breast feed but DD is underweight and dropping below the bottom centile on the chart.

We were planning to "top up" after bf'ing with expressed milk, but after an hour of trying with our new Medela Harmony we've found that it just won't produce more than a couple of drops despite ensuring it's working as it should and the breast cup is the right one.

So we're left with what DW seems to think is the "dreaded" formula option. Even mixing it she feels is quite a bad thing for DD.

But if we don't give her formula her weight seems unlikely to increase fast enough.

DW's worries are:

1. Less hungry DD at the breast after a previous BF then top-up means DD takes less from breast and so breast supply begins to drop.

1. Formula messes with DD's digestive system.

1. DD will get used to the ease of the bottle and formula and not want to go back.

1. Bottle feeding is a major PITA.

1. Even if baby did want to go back to the boob, the supply would have diminished by the time we've got her weight back on track.

Thoughts?

I mixed fed for 9 and a half months, and it was wonderful. The way I did it was always to give the breast first, and then when the supply was finished to give a bottle. My dd switched happily and without trouble.

No 3. is a risk but some babies are not bothered. Top ups are often a temporary (and necessary) measure and it is possible to get back to ebf if that is what you want.

How old is the baby? And is she losing weight, not gaining fast enough or just a small individual?

I always found pumps useless and painful but hand expressing much easier - see here for more info.

How old is DD and what have the MW's / HV's suggested? If baby's weight is considered that low are they worried about blood sugar levels?

I'm mixed feeding, my milk dried up on day 3 and DS's blood sugar plummeted and we therefore didn't have a choice, his health comes first. My milk properly came in 3 days later and although he wouldn't go back on the breast I'm expressing 90% of his feeds. I've had no problem with supply since my milk came in, I express for him every 3 hrs and that keeps my supply going.

Hi, thanks for the replies. In answer to all of the questions:

How old is your DD: 6 weeks, and is 3kg.

And has your DW seen anyone in person to help? Yes. Doc and HV together yesterday suggested 2Oz post BF formula top ups.

How old is the baby? And is she losing weight, not gaining fast enough or just a small individual? She is small (so is DW and myself) she is gaining weight, but seemingly not fast enough.

If baby's weight is considered that low are they worried about blood sugar levels? Blood sugar levels were not mentioned but they said they were "quite concerned" by her weight.

Have you called La Leche League or NCT breastfeeding line? They are amazing and function at the weekend? Not tried them yet. Will do so. Thank you.

DW's weights (paste into xl or similar):

DATE WEIGHT IN KG
16/12/2011 2.81 (birth)
21/12/2011 2.56
23/12/2011 2.55
28/12/2011 2.6
05/01/2012 2.66
11/01/2012 2.75
12/01/2012 2.78
15/01/2012 2.8
22/01/2012 2.9
27/01/2012 2.95

Yes, the helplines should be open at the weekend. There is a box with the different phone numbers on this page . Sometimes it might take more than one go before you get through, but definitely worth it - the first time I called one was when my DS was having weight gain issues too, and I only wished I had called them sooner.

If the only advice you have had is from a doctor and HV, please please call one of the expert helplines. The training both these groups receive on breastfeeding is extremely patchy and limited - some will know there stuff and some automatically recommend formula because anything more complex is out of their comfort zone.

You both sound lovely and your wife is lucky to have such a supportive partner. You deserve an expert opinion.

ps. if you do need to top up, they can also advise you on ways to do it to try and ensure that it does not damage breastfeeding, with the hope it can be phased out in time.

I mixed fed with both of mine.
At the ante natal classes they told us to do one or another.
I took this as gospel. After a night of feeding DS1 from 1.55am until 4.00am (approx) and him still not settling DH said 'Bolllocks to this, The lad can have formula' I remember saying 'But he can't, the health visitor said he can only have one or the other otherwise he will get confused and won't know how to switch from one to the other'

DH nearly cried laughing and said 'is that the pile of crap they teach you in ante natal classes, of course he will'

Next morning DH went out and got formula and I did both for the next 6 months. Wonderful.

The boys are 15 and 12 and fantastic!!

Didn't you post yesterday about your DW having anorexia? Is she eating/drinking enough at the moment? I know I find that if I don't drink enough I can only get drops out when expressing. She doesn't need gallons, just to drink to thirst.

Also is she experiencing a let-down when expressing? I have to think about my baby being born to get a let-down, otherwise I get nothing at all. If you google Jack Newman and breast compressions - this helps me get more out.

Phoning the helplines is a good idea, they might be able to advise whether there is a local BF counsellor who can check the latch etc.

I don't know about your wife's situation, but if she had anorexia through her puberty it could well be that she didn't develop a full complement of milk ducts in her breasts (breast hypoplasia) which would definitely make ebf-ing very difficult. That was my situation. HCPs that I came into contact with were unaware of this, but I wish I'd known from the start with my first rather than feeling so confounded as to why my supply was so low.

Ah yes......is it the same mother?

DH2R - you gotta tell people this stuff :(

On the info you give here and in your other thread, I think this is a situation beyond a talkboard, beyond breastfeeding counsellors and helplines, and prob beyond a GP and HV. Any and all of these sources can support and encourage and share info, but beyond this, it needs a specialist informed person to observe and take a decent history.

The history of weights show a concern going right back to the first week.

Insufficient breast tissue is rare, but Ephrussi is right, it may well be relevant here - breasts are typically 'conical' in shape (rather than a woman being merely flat chested).

Can you find someone/be referred to someone who can examine and observe and take a proper history, OP?

It may be (as I said on the other thread) if the baby is in urgent need for food, formula may be necessary - but it could be temporary if the breastmilk supply can be rescued.

Hope this helps.

I wonder if a certified lactation consultant would be a good idea?

You can locate one on this website.

I really hope you can get some good real life support and you can both arrive at a situation that you are happy with.

DS is 1 month old on Monday. Exclusively breast-fed for first 2 weeks. I found it hell because he wanted to be on the breast every 1-2 hours. Evenings were worse - often 6-8 hour stretches. I was an emotional and physical wreck. DS was gaining weight but I was scared of losing the plot being so tied down that DS would pick up on it and the whole family would suffer.

Been combination feeding for 2 weeks now. Never looked back. Express breast milk which he gets from the bottle. I find less time to express, sterilise bottles, make up formula and feed than exclusive breast feeding.

Breast may be best for a number of reasons but in my experience, mental health comes first.

Well. HV came for a weight check 1 week after the doc got worried. She weighed in at 3kg on the nose which we were surprised at.

We'd not "topped up" with formula and instead had really stepped up the breastfeeding including a trip to a local BF group, switch feeding, breast compressions etc.

So Doc rings and says, right, off to paediatric unit. So I've just got back having left DW there with DD.

At a bit of a loss for words really. Sanity check me please or is this really daft...

1. First doc we saw did not know how many ounces there are in a pound. She said "i'm sorry i don't know how many ounces are in a pound".

1. Our local doc and the paediatric doc who didn't know how many ounces were in a pound both took the birth weight as the one to calculate on which percentile of the growth chart DD should be... when in fact I think you should take DD's weight at the start of those lines, at TWO weeks in, as their centile, surely, that's why the lines start at two weeks! So they're all like - she's dropped from the 25th centile to just below the 0.4th so that's TERRIBLE and we're like, " but she was following the 0.4th from week 2 and has just dipped a little below it".

1. Milkmaid assistant down at the milking parlour in hospital heard DW was co-sleeping and told her off saying "if you saw the number of co-sleeping people coming into casualty you wouldn't do it - don't do it"... but milkmaid woman doesn't work in casualty and is talking bolox!

1. So they're milking DW to check how much she's making - but that's not relevant! What's relevant is how much DD is GETTING surely. Nothing else. So they should be weight DD pre and post feed, not milking my wife FFS! What's the point og that!??!

1. They provided a bed with no sides that's barely big enough for DW to lie prostrate in while DD has to sleep in a fish bowl. Oh so natural.

So DD and DW are tired and stressed and nobody is any the wiser (except I'm wiser than the health service is bonkers) and DD is probably getting less to eat tonight than she does on a normal night.

FFS!!!

Aaaagh!

Thank you!

Didn't want to read and run, I don't know much about this except that I think you are right about the growth chart and I think milkmaid woman is talking crap as well. I occasionally co-sleep with DS and got told off while in hospital, I smiled and nodded and carried on.

I hope things improve for you all, it sounds really quiet stressful. I hope it works out.

It does sound really stressful. Hopefully you get good real life help from the HCP. I think someone upthread suggested a lactation consultant. If you can afford one, it's a good idea once your wife and daughter is discharged from the hospital. They are very well trained professionals dealing with bf issues.

Sorry you seem no further forward, DH2R.

To take your points:

• Perfectly normal for doctors who have trained outside the UK (or even young ones inside the UK) not to know imperial weights. Imperial weights are a PITA! Calculations are much easier with metric. I dont think that's an issue, personally :)

you're not quite right about the charts. The charts start at 2 weeks for* babies who have reached their birthweight or beyond or who are clearly gaining weight anyway, even if they have not reached that point yet. Your baby was well under birthweight at 2 weeks and only gaining tiny amounts - should have been red flagged for concern.

• your baby may be fine - but she is still not gaining (still the same weight a week on) despite extra feeding, breast compressions and so on. This deserves investigation

• the assistant who spoke about co-sleeping needs reporting

• expressing is not a good guide to anything at all - but nor is weighing pre- and post-feed (it's called test weighing, has not been done in the UK for about 30 years because the info it gives is misleading)

• your wife needs to be able to snuggle up comfortably with your baby - have they got clip on cots for this?

Someone who knows about breastfeeding really needs to come in to the situation and sort it out - but the hospital are right to take your baby's growth seriously. What about the suggestion before about breast tissue? Does this seem relevanrt?

www.007b.com/breast_size_breastfeeding.phpis a useful site - scroll down to hypoplastic tubular breasts.

Hope you get good help.

How has today been, DH2R??