Early introduction of formula - but keeping up breastfeeding?

[dodi1978]

Dear all

my little boy was born on the 2nd of August, at 36+1 weeks, with a birth weight of six pounds six ounces.

Unfortunately, he lost too much weight during his first week and his jaundice levels got too bad, so we were back in hospital the next weekend for blue lights. We also needed to introduce formula to flush out his jaundice and for him to put on weight.

Since Saturday morning now, we have been on a strict three hourly routine of breast, formula and expressing milk. The expressing of milk was supposed to get my flow going, but frankly, it had little effect - I never managed to express more then 10 mill, despite doing it religiously every three hours. The routine also meant that I and my husband slept in 1 1/2 hour bursts, because the whole routine in itself took 1 1/2 hours each time. This will be absolutely unsustainable once my husband goes back to work - I really don't want him to have an accident on the M25 due to fatigue.

The midwife visited today to weigh the little one and luckily, his weight is now on the up. She also suggested that I stop the expressing, because it seems to have little effect and just tires me out.

I would like to keep up the breastfeeding though, but am worried that I won't be able to as he will get too keen on the formula. He still takes the breast, but only for a fairly short time. Plus of course, all the advice says that you shouldn't supplement breast with formula before six weeks.

Does anybody have any experience with introducing formula early on? Were you able to continue breastfeeding? I'd like him to get as much of the good stuff as possible! Should I offer him less formula so that he stays on the breast for longer?

Any advice, opinions and experiences are welcome!

Doris

Hi Doris, congrats on your little boy, he sounds perfect! :)

My DS was born in Nov at 38 weeks, was 6lb 7oz and had to go sunbathing for jaundice, so lots of similarities! I fed him constantly, co-slept with him so that he could get boob at night, and I think this is what helped to establish a good supply. There are people on here much more knowledgable than I am who'll be along with advice, but just wanted to let you know that I think you did the right thing dropping the expressing: just offer him boob as often as possible in these early weeks, and it should be possible to breastfeed exclusively if he's now gaining well.

PS some babies (mine included!) spend a v short time on the boob - he might be getting all he needs in a 5 minute feeding frenzy. Again, just keep offering!

Hi Doris,

My DS was born in January. We had some problems with his latch at first and by day 3 I was in so much pain I couldn't latch him on - I think he was sensing my tension and wouldn't latch as a result. Fortunately we had bought some formula just in case so we gave him that. I was really upset at first as I didn't want to give up breast feeding. We mix fed for about a month I think in the end before giving up the bottle completely. He's now nearly 7 months and has been exclusively breast fed so far (though obviously now having solids too!).

I would just make sure you offer him the breast first, so he doesn't fill up on formula if you can help it. Feed frequently if you can as this will build up your supply. I never had any luck expressing either, and my supply is plentiful to say the least.

Try not to worry too much though - any breast milk is good!

Congrats on your little boy :)
We started formula top ups on day 2 due to jaundice & my woeful supply. Persevered with this and attended breastfeeding cafes a few times (they lent me a pump for a month). Pumping is exhausting isn't it - but after a few weeks my supply did improve. I was strict about always BF before a formula feed, even in the middle of the night. Gradually we were able to reduce the formula to twice a day - which we kept for our convenience! DD now 7 months & that's what we're still doing - might drop the lunchtime one as weaning progresses.

Short version, it is definitely possible but it was bloody hard work for 6-8 weeks for us. And there were many, many, many times I almost packed it in. Just take it one day or even feed at a time and do what feels best for you. Good luck :)

Not quite the same position as you, but my ds had an infection after birth and was in SCBU for a week. We had to supplement with formula as I was ill initially myself and then was struggling to "catch up" with him via expressing.

We did get back onto just bfeeding after about 4 weeks, after reducing the amount of formula top up he got. Gradually we got to no top ups, although it was quite intense for a while as he would feed and feed and feed! Once my supply got going though we didn't look back and he's still bf now at 13 months. My HV was very good and didn't get stressed about his weight gain slowing a bit during this process. His weight gain then increased and eventually stabilised.

Hi, firstly congratulations on your little boy :)

Me and my DH introduced a bottle of formula as a last feed at around 10pm from around 3 weeks old, and I breast feed on demand the rest of the time. We had to introduce it as I was struggling with no sleep, painful episiotomy, and painful nipples from latching problems. He is now 12 weeks old and have had no problems with him taking the breast or bottle :) perfectly healthy little boy, putting on weight and plenty of dirty nappies :)

We also had to mix bottles and breast from the start and never suffered from breast rejection or nipple confusion. It may happen, but I suspect midwives overstate how common it is because they don't want people to use a bottle. I also had a fast feeder - 8 mins on the breast and she was done! Not all babies need 25 minute feeding sessions. Like others, we gradually reduced bottle to once a day at 10pm. The bottle certainly helps the sleeping!

Congratulations on your A little bundle of joy!!

For various reasons we used formula early on. I also double pumped 8 times a day for a few weeks. It's hard work!! I could not get much either. But console yourself with the mantra that pumping is no indicator of actual output when baby is nursing.

I stopped pumping around week 7 and we stopped the formula top ups before then.

At 15mo DS is still bf. all the hard work was worth it!!!

Make sure you have plenty of hands on support when daddy returns to work. I had a post natal doula 2 mornings a week from week 3 to 7. I also attended the local Nct bf cafe every Monday and joined my local la leche league group who met monthly and have a private FB group to share stories and advice.
We also had a private LC on hand if needed.

It all helped.

Good luck!

I did this from about 3 weeks due to "failure to thrive". It was tough at first, but we got the hang of it after about week 6 and mix fed very successfully through to 8 months.

I had DD at 35+6 and I'm afraid it didn't work for us.

Similar story: in SCBU, jaundiced, sleepy baby, couldn't latch on, big weight loss, poor supply despite regular pumping.

I tried for a month, then admitted defeat. I still feel very sad about it, but it just wasn't working & I had a 4 year old too who was being more or less ignored as I pumped/attempted feeds constantly.

Good luck & I hope things work out - please be kind to yourself no matter what.

Hello,
In a similar situation with my 11 day old. Initial jaundice and weight loss and suckling problems led to a sleepy baby with poor latch and low supply. Still struggling through, not knowing how to balance bf and formula, only getting 10ml on the pump. So just wanted to say I'm there with you and it's so hard. So scary. And takes more patience than seems possible given the stress.
Xxsunflower

Weight loss & hence mixed feeding here. Swapped formula for cow's milk at 12 months but the breast feeding is still going. It can work.

Congrats on your baby and don't feel bad about using formula- I beat myself up about it too, but you have to do what is best for the baby.

My baby was born on 5/8/13. I really worked hard to breastfeed on demand for the first week which was utterly exhausting. I had a 3rd (possibly 4th) degree tear and stitches, and having to sit and feed for such long periods was so tricky. Lying dow to feed didn't work for me! Breastfeeding is really exhausting!
Poor hubby is exhausted as he was often burping baby/getting baby to sleep on his tummy (i know, not ideal, but baby would not settle in his carry to) in the night. Mild jaundice occurred but a marathon weekend of almost constant breastfeeding brought his weight slightly higher and reduced the jaundice. However, I tried to follow the MW's advice to express for topups or use formula- I only was able to express 15ml! No wonder baby was always hungry and not sleeping properly! Now I have just started formula- I give him breastmilk to calm him down and then follow with formula, though that can be an hour or so later as he falls asleep! Seems to be working. I don't know how long my breast milk will last though.
I am also confused about making up formula- One cannot use cooled boiled water? But what do you do in the middle of the night? Could we use thermos water? I have the tommee tippee dispenser thing designed for use out and about-presumably people have to use boiled cooled water in that case? I understand it is because the powder is not sterile- the water isn't the issue?
Sorry for confusing post, but maybe someone can help?

sksk, can I just point out that the amount you can express does not indicate in any way how much the baby is getting. Some women aren't able to express anything but have plenty of milk for their babies. Your baby seeming hungry is probably him trying to establish your supply. But don't take my word for it - I would strongly advise seeking out real life help eg La Leche league, or the national breastfeeding helpline, or your midwife/HV.

Also, as regards making up formula, there are many threads about this here which might be of interest to you. The NHS advice changed relatively recently to the advice that you should always make up formula when you need it, using water of at least 70degrees. This is to kill any bugs in the powder. However the NHS advice also says that if you have to prepare a feed in advance, you should prepare it as described and then flash cool as quickly as possible and then store in the back of the fridge. Here's the NHS page for the precise explanation.

You can avoid all this faff however if you use the ready made cartons or bottles of formula, as they can be stored at room temp and are ready to go.

I had to give formula in first few days for similar reasons. Once his weight was up we kept formula to one bottle a day in evenings and breastfed the rest of the time. Occasionally he went through a stage of rejecting the bottle for a few days but never the boob. I think they prefer it. I mixed fed for nearly a year like this with no problems.

Thanks for the information- I suppose you have to do what is best for the baby and follow your instinct. My MW did suggest topping up with either expressedmilk or formula. Can the ready made cartons be used for 24 hours if stored in the fridge? I know you can get the little bottles like the ones they have in hospital but maybe the carton is more economical? One more question- if you do have to prepare in advance and store the formula in the fridge, how do you heat it for use?

The large 1 litre bottles can be stored in the fridge for 48hrs once open. The small 200ml ones can be stored in the fridge for 24hrs.

Some babies will drink formula cold from the fridge - warming it is optional. I would sit it in a jug of hot water until at body temp-ish. Some people microwave, but that's potentially dangerous due to hot spots.

lettherebecupcakes would you mind giving some details like how many formula feeds you gave and which feeds. I'm in exactly the same situation & DD is 4 days old. I'd appreciate it.

I'm at 12 days now with ds. Mixed feeding, hopefully just to get over the hump of low weight and supply. We are currently (bearing in mind this is ever changing with his needs) doing as much boob as possible before he stops, falls asleep or I get too sore from his under enthusiastic sucks and then we give him formula until he's no longer hungry. 40 or so mls at the moment. And then a mammoth winding session.

Just finished the routine now. It takes about an hour, so that's ok.

I've had the most pro-breast feeding midwife say it's ok to top up in the short term, so of they condone it, it can't be an awful idea!!

On the topic of correct storing of formula... if you read the instructions on powder, you are supposed to chuck it after it's been open for two weeks. So if you are only doing one bottle a day and following the instructions to the letter, then the small cartons are the most economical!

(We started buying powder and using it way slower than one box in two weeks once DD was 6 months. Before then, we bought cartons for convenience - 62p a day wasn't breaking the bank.)

dear all

thanks for you answers.

my lo is still taking the breast although i think a lot less enthusiastically

• but maybe that is just my impression. My biggest hurdle is actually dad who would like all feeds to be precisely measurable, but that is of course not possible with boob. We had some terrible arguments made worse by fatigue.

On the positive side, the expressing is going much better, pumping now and by the way it goes expecting at least 20ml.

I never thought I would feel so strongly about breastfeeding... it is just a nice feeling, and I don't feel ready to give up on it yet...

dear all

thanks for you answers.

my lo is still taking the breast although i think a lot less enthusiastically

• but maybe that is just my impression. My biggest hurdle is actually dad who would like all feeds to be precisely measurable, but that is of course not possible with boob. We had some terrible arguments made worse by fatigue.

On the positive side, the expressing is going much better, pumping now and by the way it goes expecting at least 20ml.

I never thought I would feel so strongly about breastfeeding... it is just a nice feeling, and I don't feel ready to give up on it yet...

Don't give up - sounds like you're doing really well.

I ditched both formula and expressing against (albeit inconsistent) medical advice and we've had much better weight gain (and less stress) since.

It IS hard for dads though as they can't feel how right the breast feeding is and how well baby suckles.

Good luck.

Update - I think we are winning!

LO is getting much better at taking the breast, and I am getting better in putting him on. Since then, he is taking less formula. I am still offering him formula though for peace of mind for all of us.

So I think we'll probably keep up mixed feeding, hopefully with more breast than formula. Not a bad solution on the whole, as it will make it easier to have an evening out etc. once things are properly established.

Good luck to all of you, however you are feeding!

Well done OP!

You can always offer the other side before the formula after breast feeding to help cut back the formula some more... my little monkey can do several 'sides' at a go but will get to a point where top ups are refused which is very satisfying :-)

Onwards and upwards!