Can we have an honest discussion about combined feeding

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I am currently breastfeeding my 10 week old with 2 x 100ml formula top ups a day. This was born out of necessity as she wasn't gaining very much weight at all.
I resisted formula for longer than I should have for a few reasons which seem unimportant now:
I was told that the cereals in formula would stretch her stomach, increasing the chance of her being overweight in later life.
I was told that even a small amount of formula would have a negative impact on her gut.
I had in my mind that I wouldn't mixed feed, too much effort, I would do one or the other.
Also all the usual breast is best stuff all medical professionals tell you when you're pregnant.

I am now finding the mix effective in weight gain, sterilising bottles isn't that much effort and I still have the convenience of bfing most of the day and all night. I also now realise that the above is not necessarily accurate.

I am also told (again, I've no idea how accurate this is) that a new study shows no difference in bf or ff children.

I feel that the emphasis is on the benefit of exclusively breastfeeding but I wonder if mixed feeding is actually a much more practical solution for the health of both mother and child. What are your thoughts and experiences?

With NCT classes I think it will depend on the person running the class - the one I had was away with the fairies to be honest, she made everything from home births to breast feeding sound like it should be easy and natural and to even be considering a hospital birth or thinking about bottles was wrong.

Almost all of us had an awful time and we all felt completely unprepared for the reality. She asked for feedback after we'd had our babies, I think she was a little taken aback. I found the NHS classes much less judgmental and practical.

Finding this thread very interesting.
I mixed fed DS from 3/4 weeks with no supply issues, really struggled to get advice from MW on how to do it in the end I found my own way and managed to keep BF all milk feeds except bedtime one/ occasional day time one until 7mo. I do think that there would be merit in health professionals supporting mixed feeding more. I certainly had the impression from several midwives & NCT classes that I had to make a choice for either breast or bottle.

Squirrelled mine is doing her qualifications to be a BF counselor and keeps telling us if we do it 'right' it won't hurt at all. This concerns me because I know for a fact let down etc' can hurt some women, and nipples get chapped even if all is well - yet the idea of 'covering up' the matter seems compatible with NCT's official line for supporting women (if this is what she is being trained to say)?

TikTok "Nct's position on bf is pretty clear. No judgement." ...the problem is what their official ideal is and what we are getting in RL seem to be 2 different things. I have heard all those comments you dislike ... where? NCT. Not actually always from the group leader but certainly a culture is flourishing (the things you say to be 'good at NCT' and the things you hide...) and in my area I joined the deliberately non-judgemental group.

TBH it's like any college/organisation saying they have a policy ... if some -influential -people are just flouting it time and again and it's being ignored, what is to be done?

I just mentioned someone all revised up for passing a BF support course who doesn't believe it can hurt if done right (which seems at odds with other BF support material about let-down and sore nipples).

...the patronising comments were things like "formula isn't poison" or "you'll damage his/her virgin gut" etc' which are utterly patronising and as you say shouldn't be banded about to women when they feel vulnurable.

squizita- that's a difficult line for breastfeeding counsellers to tread.

Breastfeeding already has a bad press in terms of split, chewed and bleeding nipples, but the truth is most of these problems can be resolved.

If women enter into breastfeeding with the notion that it is going to hurt then she may struggle on with a problem and fail to seek help.

Timely intervention is one of the main keys to breastfeeding success- which is why in part indiginous cultures are so good at it.

Sometimes fine tuning when things start to become uncomfortable can avoid a whole lot more serious issues, thrusth, mastitis, abcess etc.

I would say to any women experiencing breastfeeding pain to get checked out.

Surely both things can be true - "pain (and especially damaged/bleeding nipples) means there is a problem that can usually be fixed" and "most women experience some soreness/discomfort/pain at first even if everything is going right, but it won't last forever".

Either saying breastfeeding is always painful/bloody/difficult or breastfeeding is never painful unless there's a problem isn't true.

I had one experience where breastfeeding was sore at first and took a few days to get the hang of, and letdown hurt for a couple of months, but basically by 3 weeks was a breeze. And one experience where it was actually painful, I ended up with blistered nips, the afterpains were as bad as labour contractions, and the baby needed a tongue tie snipped but still by 3 months it was fine.

But Deep the problem is when it stops being "remember you can always seek help if it hurts" and becomes held up as a sort of "do it right and it feels good"- meaning if something doesn't feel good, people might feel a failure if something's wrong OR if nothing's wrong, they might feel conned and lied to because no one told the full story.

IMO many things with women's health need to be less about marketing/making healthy choices 'appealing' and more about funding low level grass roots support: HCP ready to help, with nothing but the wellbeing of the patient in mind (so none of these stories about HV saying they're "not allowed" to answer questions on hygiene for FF because of an edict from on high). I've looked into budgets for campaigns vs budgets for actual day to day support for both MH and healthy living for lower income families and the balance is massively skewed - Considering how charities do most of the BFing support in my area, I guess this is the same situation?
These campaigns always seems to be about nutrition and get some people smug and judgey from BFing leaflets to Jamie Oliver rooting through our imaginary negligent cupboards.
Many of my family are not from/living in the UK and seem to be far more relaxed about feeding ... I wonder if it's because to them it has no more marketing/judgement than anything else and thus emotionally they go and see an expert at the drop of a hat (because there's enough provision for that in Spain, Japan, India) without worrying.

No one who is a qualified nct bfc would be saying stuff like 'if you do it right, it won't hurt' but someone in training might, I suppose. The point about soreness is that it is common, but it can usually be fixed or at least improved. Telling women it is bound to hurt at first does a real disservice.

Expressions such as doing it wrong or right are not a bit helpful.

Pain on let down that persists after the first days is very unusual.

You can complain about an nct practitioner if she is failing to be supportive of parents' choice.

Tiktok thanks for clarifying that. I was a bit because as you say, it simply doesn't chime with what I was expecting based on other HCP information.

squizita of course you will hear all sorts of stuff 'at Nct' and I suppose the occasional teacher/bfc might say the wrong thing at times. But naturally because the daft phrases and unhelpful remarks are at large in the culture you will also hear them in nct groups. Actual nct antenatal education comprises between only 10 and 20 hours and covers a huge area of knowledge. The bf bit is small. The rest of a persons life and culture and upbringing are likely to remain more influential.

tiktok- does nct have specific training for breastfeeding counsellors? How long is the course?

I mixed fed. I started doing it after 1 week. My husband gave baby a bottle at 11pm,meaning I went to bed at 8pm and slept to the next feed at about 2ish. It gave me 6 hours sleep.
As someone who does not cope with a lack of sleep this was a big help to me.
Over the next months I gradually increased the formula until at 4 months I stopped bf. this coincided with baby sleeping though the night.

There are advantages for mothers returning to work of mixed feeding. I have known many ebf babies who refused to take a bottle at around 8 or 9 months when their mothers needed to return to work. There seems to a window for taking a bottle, that can be missed. These women had to delay returning to work, which created great financial,problems for them.

So, or seems there are many PRACTICAL benefits of mixed feeding, although I accept ebf is better health wise. Like most things, I think we have to be a bit pragmatic. There are many things that come into play in deciding how to feed. Babies health is clearly most important, but the well being of the mother and practical things like returning to work, need considering too.

And I agree that if the benefits of mixed feeding were made known, fewer people would totally give up bf.

Nct training to be a bfc is changing at the moment but currently all bfcs have done a diploma level course ie level 5 and they also have to show a minimum safe level of working to get an nct licence to practice, every year. Takes 3 to 4 years of part time study.

Wombat, Bottle refusers certainly exist. But they can have a cup. There is no need for a struggle at that age.

It does seem a bit OTT to delay returning to work because a 9 month old doesn't like bottles! I'd assume there were other things going on there too.

I don't get this idea that if the benefits of mixed feeding were better known then this would mean more breastfeeding. The stats show the opposite!

In cultures where everyone breastfeeds more or less, and for a long time (compared to the UK), then formula tends not to have a great impact on continuing to bf.

These cultures have never gone over to formula. Bf is still the unremarkable norm (see link to that blog previously cited).

But in the UK, the stats are crystal clear. Bottles of formula - even one -given early dramatically shorten the time of any breastfeeding. Obv this is not true in every case and mothers absolutely need to know that there are ways to preserve bf alongside formula if their choice is to bf.

But the link is there, and it is clear.

Is it clear that introducing formula shortens breastfeeding, or just that formula is associated with shorter breastfeeding?

What I mean is, there are many reasons why women might only breastfeed for a short about of time - because it is difficult/painful, they aren't really that keen to breastfeed, they are going back to work soon. Those women might be more likely to introduce formula.

In the "breastfeeding culture" we have here where exclusive breastfeeding is really pushed and mix feeding discouraged, women who enjoy breastfeeding or are committed to doing it long term might be less likely to introduce formula anyway.

fleder no one can say that introducing formula causes early cessation of bf and I should not have implied it was as cut and dried as that. There may be problems with bf, and a bottle of formula is given, without a full switch to formula being intended. The early cessation of bf that happens in that case is, you could say down to the original problem that led to the formula. And there are women who are just less committed to bf and they might intro a bottle early, so the cause of that cessation is just the fact they were not that keen anyway.

But we have no evidence that promoting mixed feeding would increase bf, and what evidence we do have, shows the opposite.

Speaking from the point of view of observing what happens outside the statistical recording, it seems clear to me that mothers who encounter a problem with bf and who introduce formula often find this hits their morale and their confidence. They lose heart. In addition, early formula really does affect production of breastmilk.

This is a problem with the "exclusive" breastfeeding ideology though isn't it - it becomes a choice between ebf or no bf, and the case against mix feeding is rather overstated without much to back it up.

Early introduction of formula might affect supply, but the message becomes "if you give formula, you will have to stop breastfeeding". And judging by the number of women who quite routinely and successfully give an occasional bottle, or a bedtime bottle, this isn't the case.

Anyone saying that - that if you give a bottle of formula you have to stop bf - is talking rubbish, though. This is not the message heard by many women. In fact, mothers are advised to give formula and they are told it won't make any difference, and it will be temporary, or they can continue bf alongside the ff.

Then when it does make a difference, the hcp who advised them to do it is long off the scene.

When formula is necessary for the health or well being of the baby or the mother, it is certainly possible for bf to continue happily longer term. But the right moves have to be made.

I come across women who have been told to top up without any discussion of what they might do instead, or of what they should be doing if they want to continue bf.

"Bottles of formula - even one -given early dramatically shorten the time of any breastfeeding"

Do you not think that is the message coming across here? Even one bottle = premature end of breastfeeding. If you want to breastfeed, it has to be exclusive.

With regard to babies being able to have a cup, or resisting a bottle not being serious enough to delay going back to work....I would challenge both.

Babies need to be fed, clearly. It is not possible to return to work if a baby will not feed. Some women find trying to give a bottle, or a cup is SO resisted and rejected, that they feel it will never work (who knows I'd it would eventually..but time is often not on their side) so don't return to work.

With cups, many women find baby will take a tiny amount, but not the quantities needed for a full tummy.

I am not saying that because of this, everyone should mixed feed, simply that one of the benefits of mixed feeding is this problem is avoided.

Regarding the idea that just one bottle means breast feeding will end sooner.....this may well be true, but is put in a way that gives people that terrible guilt they get over formula or mixed feeding. It maybe true....well so what, if it means breastfeeding ends a bit sooner, if the net benefit for the whole family makes it worth it.

And I find that even when NCT people or other advisors are advising, in a so-called open way, which says everyone has choices and mixed or formula feeding might be the best thing for an individual, it is said in such a way, as to make clear that this is an INFERIOR option. There is never really a suggestion that in this particular situation and for this particular family, it might be best. I understand breast is best. However, I think we really do need to recognise what we are aiming for is the best outcome for that family. The baby is well served by being healthy and having a family who are in a good place to parent them. This might not be best provided by ebf in every situation, but mixed might be better. I think this message needs to come across.

I understand there had been a mass move away from breast feeding altogether and amongst certain groups that still occurs. I understand that the breast is best message needs to go out. However, for many groups, they have a sense that ebf is not for people like them, so they never try. If they thought they could do both, they just might try it.

So overall, we need to aim for the best outcome for a whole family. Baby is part of the family and whilst ebf is best for their health, baby will be best served by having parents in a good place. And people saying they didn't find ebf inconvenient or tying or painful or tiring, or not providing enough milk, does not help. Because lots of people who do mixed feeding DO find these problems with ebf and are not wrong because of it.

As a believer in the whole virgin gut idea (I don't know how else to express it) I really didn't want to use any formula. Was surprised that it was advised by bf clinic (as a top up) when he wasn't gaining enough weight in the first three weeks. I noticed everyone's feeding plan was slightly different but almost all involved expressing and also formula at the end.
I went with expressed milk top ups and their feeding schedule: he gained weight nicely then and I was able to give up expressing. I do feel the mixed feeding was offered too quickly - why not even suggest a few days of expressed milk prior to formula - and if I was already using a wee bit of formula I'm sure I'd have started adding a bottle at night etc. When it wasn't needed, and wasn't what I wanted.
He's still feeding at two but magically manages a bottle when I'm at work! think it worked too well and he'll be feeding at 12