Thinking about topping up with formula, advice please!

[ElodiesDotingDad]

Hi all,
(First post,please be kind!)
My wife and I have a 20 day old little girl, who was born by planned cesarean for extended breech, at full term. She weighed 6lbs 6oz. She has been putting on weight nicely, had a day of conjunctivitis, a day of diarrhoea, has prolonged mild jaundice, and may or may not have oral thrush at present, but she is well. She feeds well from the breast, however we're starting to worry she's not being satisfied by the breast alone. She passes the day well, but after bathtime her feeds seem to become really drawn out, and as soon as she's put down looking all full and sleepy she roots about and starts chewing on her fists again. By the evening my wife feels her breasts are 'empty', and that the baby isn't getting enough milk. Last night we tried giving her a bottle of expressed milk after she fed from both breasts, and she took the for ounces we had and still kept showing signs of hunger after. My wife feels exhausted from the amount she keeps feeding, and Elodie isn't sleeping well either - but that's another thread!

So, we're contemplating using formula at night to top up, because Lucinda feels she couldn't express enough to keep up with that demand. Obviously this raises issues of interrupting the supply/demand feedback loop and reducing milk supply, and also the feeling of failure at not being able to meet Elodie's needs.

Any advice would be gratefully received, thanks for reading,
Max

Cluster feeding in the evening is an entirely normal but thoroughly exhausting baby thing. Her breast aren't empty - breasts continue to produce milk constantly as the baby feeds.

If she can keep going through this phase, then it will set her up with great supply.

I found the kellymom website really really helpful through this phase. I think I read the same pages over and over every night for weeks!

Other things that can help are switching positions, having a break for 20 mins and letting someone jiggle the baby, switching back and forward between breasts as often as the baby wants.

Your wife will still be establishing her supply - this happens by your DD cluster feeding like this. Particularly at night.

Your wife will end up making enough milk for DD if you keep feeding her. The risk with introducing formulas now that a supply will drop. Psychologically once you introduce formula too then there does seem to be a trend of giving more and more as it's comforting to see how much they are drinking from the bottle (which you can't see with breast feeding). That then causes further supply drop and it becomes a vicious cycle.

It sounds a like your wife is a getting on well with expressing so she could keep doing that and top up with expressed milk. There is a risk of nipple confusion and breast rejection with that but I've never been worried about that.

My DS had a traumatic birth and undiagnosed tongue tie so never got him properly latched on. I exclusively fed him expressed milk til 22 weeks when I started introducing some formula. I very quickly got my supply established and could express 40 fl o a day in 3 sessions so it can be done as a top up if you get a good pump.

If she is gaining weight nicely then she is getting what she needs. It is incredibly hard going in the beginning but it should get easier as she gets older.
Ultimately you have to do what works for you as a family and there should be no feelings of failure. Every day of breastmilk makes a difference.

I can't add anything else but reassure your wife that its entirely normal to feed like this in the evenings, and it does great things to establish a good milk supply. It's exhausting though and it can make you doubt yourself but it doesn't last too long.
My baby is 12 weeks and he hasn't done it now for some time but I can't pinpoint when it stopped! It's also true that the breasts never empty but the less full they are, the fattier the milk is which is why cluster feeding usually occurs before a longer sleep.

I think its all been said above - its normal cluster feeding to establish supply, and adding in a formula feed is likely to reduce the effectiveness of obtaining a decent supply.
You never run out of milk - its a supply on demand situation - hence the size of your breasts doesn't affect how well you can feed your baby.
6 weeks seems to be the time frame when things start to get easier.
That said, if your wife is unhappy being glued to the sofa most evenings for a couple more weeks, perhaps you need to add in the formula.
When you say your daughter is sleeping badly, what do you mean? waking for food every couple of hours is completely normal at this age. Their tummies are tiny (size of an egg at this point, I think), so feeding often is a result of this, not a bad sleeper!

Congrats on your new baby girl.

Thanks for the replies. My wife is exhausted and very unhappy with the situation as it is, so I'm not sure how valuable the 'just keep going' advice is going to be.

Regarding sleep:
The baby sleeps about ten hours in 24, and that takes a lot of persuasion. She will almost never sleep for more than half an hour continuously, seeming to have great trouble linking two sleep cycles together, and being unable too self settle. She will often be awake for a 4-6 hour stretch in the day, getting very over tired as you can imagine. She sleeps on my chest better than anywhere else, and when our morale is at it's lowest that's where she ends up. We have a Troll bedside cot, and the longest she's ever gone for in that is two hours.

She can feed for over an hour, come off of her own accord, all sleepy and floppy, but the minute you put her down she's awake and rooting, chewing her hands and crying.

My wife always wanted to breastfeed, never formula. I can see that she's just so exhausted and unhappy that she's ready to abandon all her previous ideals. I'm concerned that if she carries on like this she will resent the baby, and be too tired and upset to feed, even if her supply didn't drop

If it's making your wife unhappy then top up with formula!

I used to stress so much and was getting pnd. Having the formula as a back up really helped me to relax and dd is still fed 90% breast milk.

So don't worry about supply, I expressed and mine didn't drop.

Seriously do what feels right for you both

I have no strong feelings either way regarding people's choices to BF ir FF. however, in my experience, all of what you say is perfectly normal behaviour for a baby of that age. We spent hundreds of pounds on NCT courses and none if that was stressed enough

Your DW can certainly decide to ff of course - but it needs to be an infield decision based on the fact that the behaviour you describe is perfectly normal for a baby of that age and formula feeding is not an automatic solution to that. It will not immediately make the baby sleep through the night or for longer stretches

Unfortunately babies are not born being able to sleep for long stretches or self settle ( again, would have been helpful if you had explained that, NCT woman). I know lots of formula fed babies who didnt and don't sleep very well.

So, I think it's absolutely fine to ff but ideally you should take the foregoing in to consideration to make sure it is an informed decision.

Hi. My sympathies go out to you and your wife - having been in a similar position very recently.

Have you considered co-sleeping at all? It might help your wife feel like she's getting a bit more rest. I also had a bedside cot but couldn't get my ds in it for any length of time. For a while my partner slept in our spare room and I slept with my ds in our bed. He would sleep more, and if he did wake up for a feed it was quicker. Has your wife tried feeding lying down? It's a bit tricky to begin with but once you get the hang of it then it can be a lot easier in the night.

I gradually managed to move my ds into the bedside cot for longer periods, and then into a big cot at the end of the bed. He now sleeps in his own room and sleeps through - something I never believed could happen when ds was little!

I know all the advice about it getting better is not helpful now, but it is true, or at least it was for me.

Ds2 (5 weeks) sleeps on either my chest or dh's chest most of the time! The advantage of him being our second child is that we know this is totally normal and will pass - I remember well the worry that ds1 should be sleeping in his cot at all times or he never would. We'd be lucky to get as many hours sleep as your dd does in her cot, but he drops off fairly easily being held and can sometimes then be transfered to the cot if he's deeply asleep.

I agree that cluster feeding in the evenings is normal, as is topsy turvy night/day wakening. It's shattering though and when you're in the middle of it (which at nearly 3 weeks you are probably bang in the middle of it - she will be unrecognisable at 6 weeks which if you think about it is her whole life over again) it seems endless.

This time around we've introduced a dummy as ds2 often actually wants to suck rather than actually feed and so the dummy settles him. Ds1 spent many hours attached to my finger when I couldn't bear to have him latched on any longer (I had very sore nipples so I couldn't just let him cluster feed all evening).

You should do whatever suits your family best, but if it's any consolation at all, many of us have trodden this road and come out at the other side. This too will pass!

It sounds like you're all shattered!
When our oldest was like this, I used to feed in the evenings til he seemed to drop off, and then shuffle him over onto Dad's chest. Then crash into bed. He would sleep for 3-4 hours on my husband, and I got a few decent hours. Then I did the rest of the night. DH classed it as computer game playing time!
When you say she sleeps on your chest, please don't do this on the sofa - it is highly risks if there is a chance you may drop off (sorry if you already know what).

Ignore me if I'm speaking out of turn, but have you tried putting her down to sleep about an hour after waking - we used to sleep, feed, "play", feed, sleep (usually on me in the day).

I also used to have a lot of success with extending sleep cycles when I was out and about by using a sling. I had a stretchy wrap, and he would easily sleep for a couple of hours in the day if I was out doing jobs in town, or round tesco. It was the longest he would ever sleep - and I couldn't rest when he did, but it did enable me to achieve something.

I always think happy mum = happy baby . so if you think topping up with formula might help her wellbeing that then go for it. Give yourselves permission. Sometimes (as said previously) if you have a back up in your mind then you might find you don't need it. Just knowing you have it helps.
I don't think formula will necessarily change any of the sleep issues you describe. I have yet to meet a baby that self settles at such a young age so rest assured you are not alone.
No one can prepare you for the first 6 months of parenthood. No matter how much they tell you... Until you experience it you cannot appreciate the torture of sleep deprivation. But it does pass.

Its normal when a baby is having growth spurts and the frantic cluster feeding increases the supply.
Best advice given to me with DD1 was to take her to bed for a couple of days ,forget everything else and just enjoy/cuddle the baby. Lots of skin to skin and allowing the baby to feed.
All chores kept to minumum and done by someone else ,easy meals,keep a supply of drinks,snacks etc next to the bed.
Is your wife eating well ? I "forgot" to eat due to the demands of DD1 and it really affected my supply .

Second time around was way easier .Btw you sound like a lovely DH

Thank you for your thoughts, and for empathising.

LookingforwardtoMarch, I think that's the bottom line - if it's a matter of formula or PND, there's only one option. I think she would express when we used formula, so hopefully supply would be relatively unaffected.

Gobbolino, it's not a matter of wanting to make her sleep more by feeding formula, it's about knowing she's satisfied. And yes, NCT didn't teach me much of any use either.

ExBrightonBelle, yes we tried lying down to feed, and co-sleeping, but my wife couldn't get on with it. Baby found it hard to latch lying down, and Lucinda couldn't sleep because she spent the whole time worrying about hurting the baby. Other thing is our little one is an incredibly noisy sleeper!

I think we'll try supplementing the 10pm feed tonight and see how she goes

Just saw all the replies that came up while I was typing mine! No, we don't co sleep on the sofa, we have done our reading on safe co sleeping. She's eating ok, could be more regular. We do have good balanced meals for lunch and dinner, but breakfast may just be a banana and a cereal bar :( I will make a concerted effort to bring her breakfast from now on.

Putting her down an hour after waking, well, we try the E.A.S.Y way, but aren't t having much success, as when we put her down, she shows sis of hunger again, so my wife fed her a bit more, then she poos so we have to change her, then she demands feeding again... etc etc

Some good info already on this thread...your baby sounds fine, OP, and the behaviour you describe is 100 per cent normal (and doesn't last :)). It is also normal for breasts to feel empty after a period of normal cluster feeding but in fact they are not empty at all - truly. Breastmilk is replaced very rapidly with cluster feeding but you might not actually feel it as 'full' breasts. There is always milk there.

Babies will often wolf down a bottle of ebm/formula - they need to suck and be close and the sucking need is very strong. If the bottle is there, they will often take it. It doesn't mean the breasts were not doing their job.

Expressing to 'take the place' of the formula to reduce the effect on supply is logical in that it will protect supply - but if the baby goes longer without a feed as a result of longer-to-digest-formula then this effect will be reduced. Also the effort/time involved expressing and storing may be greater than just breastfeeding the baby.

OP, I wonder if this is a confidence and expectations issue rather than a feeding issue? Looking after a baby is exhausting - are there other ways that might help her manage the tiredness more effectively, I wonder?

It all sounds very normal but it will pass. Our little girl wouldn't really sleep anywhere but on us either at that stage, and it is exhausting. To get her to sleep in her crib, we swaddled her, had fleecy blanket on the crib sheet, warmed the crib with a hot water bottle before putting her in and played white noise. It took a while but she did manage it in the end. It's a case of finding what works for you and your baby. I couldn't co-sleep either, still can't. I think it was about 6weeks she'd sleep most/all of the night in the crib, excepting wakings.

Re the feeding, it is so hard at that age. You wife is doing a brilliant job. Try to remind her to eat every time she feeds. I kept flapjack with me at all times, used to eat that and dried fruit in the middle of the night! Plus make sure she drinks lots. Also, I find you do have to limit feeding times sometimes, then have an enforced break (where someone else takes the baby for at least 30 mins) to stop her getting too sore.

All sounds very normal but please also make sure that you have a proper tongue tie check by someone who knows what they are doing, just in case there's a catch there.

I also found that I needed to eat in a different way through that period, a banana and a cereal bar for breakfast won't cut it. I made up an oaty slice, roughly flapjack but full of bananas, dried apricots etc. I also found, for some reason, that cheese at lunchtime helped my milk supply.

It's a tough tough period but as others have said it does pass! Enjoy the snuggles

In terms of her not sleeping and getting overtired, my baby was like that, and the sling saved me. Once I hit 90 mins after him waking up, I popped him in the sling. He protested for about 2 mins then fell asleep and would pretty much stay asleep until I took him out. It really helped him learn how to sleep.
And I remember the feeling of not having enough milk very well. It does pass. I second the eating a lot recommendation. You do sound shattered :(
Congrats on your daughter!

Ironically your baby is probably struggling to nap for longer than half an hour because she's overtired rather than not tired. Sleep begets sleep and it sounds like you need to work on getting her to sleep more, 10 hours is probably not enough. Babies that age can only usually stand to be awake for 90 minutes tops, sometimes less and if they are awake longer than that they become much harder to get to sleep, and sleep less when they do go to sleep. They also become overtired and moany, and this can be confused with hunger.
Forget about self settling for the moment, most babies that age don't self settle. If she sleeps on you but not in the cot, then go with that, or in a sling, or the pram or the car.
After 90 minutes of awake time, try to get your baby to sleep. Rock, pat, shush or walk in the pram. If she looks like she's waking after 30 minutes, keep up the rocking or walking to try to bridge the danger period.

I also agree that it all sounds completely normal. The first few weeks are just so exhausting.

I'm fairly relaxed about BF v FF, having done both. What I would me ruin is that formula is not magic, and doesn't automatically make a baby feel more satisfied. My eldest (FF from 10 days) cluster fed formula feeds from 4pm until 10pm every night for 10 weeks, and it was exhausting. I'm not convinced it was good for him either, but he screamed blue murder if he didn't have a bottle in his mouth (wouldn't take a dummy, and would spit it out in fury!).

Ironically, one of the reasons I was FF was because I was exhausted by the constant feeding - it didn't stop, it just changed to formula.

Having a new baby is utterly exhausting. Plus, there is often a growth spurt around 3 weeks old, so feeding may settle in a few days.

I think, that if your wife has always felt quite strongly about breastfeeding, it's worth thinking about how supplementing may make her feel when she's not so tired, although of course, it's fine to supplement if that's what she wants. Is an alternative for your wife to express some milk for you to give your DD while she rests as a one off or occasional thing? Could your wife sleep while you take the baby for a long walk in the evening? Or just while you hold the baby? My DH certainly spent hours with our DD sleeping on his chest when she was newborn so I could rest.

I personally found that trying to get DD to sleep on her own was a waste of time. Like you said you DD does, she would wake, then need feeding again. If your wife struggles to sleep next to our baby, would she sleep better if the baby slept on her chest? I found this much easier when they were tiny.

It sounds like you're a great support to your wife and I know it's hard, but things feeding wise do settle down from about 6-8 weeks and it just sort of happens that one day you feel it's been hours since the last feed.

If she's only 20 days old, she sounds quite young to have what you're calling a "10pm feed". New babies have tiny stomachs which means that, even after feeding for an hour, she can be hungry pretty quickly afterwards because her stomach is tiny and breast milk is processed more quickly than formula. It really is normal for your baby to feed what seems like most of the time.

If possible, can your wife feed somewhere in the daytime that is really comfortable with lots of pillows around so that she can just like back when Elodie falls asleep in a milky daze. If you try to move her, she's much more likely to wake up. Expecting her to self-settle is way too soon: she wants to stay with a nice warm person whose smell she loves. So just see how much she can rest with the baby on her.

If your wife has had a C-Section, she's probably still pretty uncomfortable and shouldn't be up and about expecting to be back to normal. Best of luck.

Congratulations on your daughter - and you poor things, I remember this stage well. It is absolutely exhausting.

I found it easiest to just "go with" the baby for the first 6 weeks. I didn't read any books or try any techniques. I think they're too young for routines. So I fed her when she was hungry, she gained weight so I trusted she had enough, i slept whenever I could.

My little one didn't sleep on her own at all - not even for 10 minutes - until she was 6 weeks old. She would sleep next to me, or in my arms, or in the sling. We just went with that, my boyfriend and me. From about 7 weeks she started sleeping unbelievably well - 10 hours uninterrupted a night - in a moses basket - with no effort at all - not saying everyone's baby would do that, but just trying to reassure that you don't create bad habits or any habits really at this age.

Obviously you must do what is best for your family and you shouldn't feel guilty if you decide to feed another way. I echo others that I'm not sure it would make baby sleep better - I know people who did this and had no sleep improvement - and may not actually be less effort in the long wrong, though I appreciate it would get your wife some sleep now.

Your wife is producing enough milk - it's so easy to doubt this though, with a hungry baby and empty-feeling breasts. I remember all the doubt! But it does pass. I found after a particularly gruelling few days (growth spurt) baby would have a more settled day and sleep more and I could recharge.

I found the most helpful things were

1. people telling me I was doing it right and doing brilliantly
2. people taking the baby at times (particularly late evening, I found the 9-2 stretch the hardest to manage alone) and just bringing her to me for the feeds
3. drinking plenty

I also found it hard not to worry about squashing baby in the first few weeks (and she was and remains at 7 months a bloody noisy sleeper) but you do adjust.

Good luck and all the best to all three of you.

By the way, I meant to say that you sound very supportive and wanting to do the best by your baby and your wife. Do be aware, though, that your desire to "solve" what looks like a problem may not be quite what your wife wants (in fact she may not know what she wants other than more sleep than she's getting now).

There's a risk that it comes across as undermining of her desire to bf your wish to try to help by getting advice on ff here. So do your best to go with what she wants to do rather than assume that there is a magic solution to a "problem"; it's not a problem, just normal for a tiny baby. She may just want you to cook her a meal she can eat while feeding, do the washing (and hang it up), make sure there is chocolate in the house, all the little things, as well as give her a hug without her asking.