Can we have an honest discussion about combined feeding

[LavalavalavaLamp]

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?

I appreciate that LLL is not everyone's "flavour" of mothering or breastfeeding- we do get lots of Mums that practice AP and extended breastfeeding for instance- although not exclusively. We also have a wide range of GPs, shop assistants, lawyers, SAHMs.

For women who like the LLL style I have heard it described as "coming home"- although I am sure that applies to other groups too.

It's great that we do have a range of different support organisations-and although different in style all have pretty rigorous training for their volunteers.

I agree, and while I know it is confusing to mothers to have four different bf organisations and five different helplines, in fact the 'service' to mothers is very similar. The training is not much different. I am happy to recommend any bf helpline to mothers.

Deep blue, I am not confused.
I referred to the WAY in which it is said. You quoted me.
It is perfectly possible to say the words that mixed feeding might be the best option for some families, but to use a tone which shows that the speaker really believes ebf is the best option for all. It is possible to speak in a patronising way, suggesting the speaker thinks they have all the answers and the person they are speaking to has no idea about even their own circumstances.

I think that feeding advisers often come across as patronising g and condescending. They are committed to breast feeding fully and have usually done ebf themselves,most struggle to truly empathise with those who want to do mixed feeding. And this comes across despite the words.

I have been to lots of NCT events. I often find that the people running the events and who are also ante natal or breastfeeding teachers are very well intentioned, but come across as overly earnest and narrow in their views. Many of them have trained long and hard to give the advice they do and have a lot invested in it. What they are doing is worthy and brilliant, but it is often delivered in a patronising way. And I am a highly educated, middle class, confident person, who rarely feels like I am being patronised. It just makes me wonder how the message and the way it is delivered makes those from less affluent backgrounds feel.

So, tone as well as words are extremely important in terms of information and advice given. It is perfectly possible to say the words which suggest mixed feeding could be right for some people, but to imply that those people are the rare exception and failures. Yes, people may be overly sensitive, but there is work to do in this area.

" but there is work to do in this area."- perhaps you would consider becoming a volunteer yourself?

I have a lot of respect for the thousands of unpaid volunteers who work for the breastfeeding charities. They are often busy mothers themselves with young children but feel motivated to give a great deal of time and years of training for no pay to help support other mothers.

Mothers seek out the help of these volunteers often because the NHS has failed them- they are not part of the "establishment", they force their help on no- one, but are often criticised.

The criticism is often because of their perceived "attitude" rather than the quality of the technical advice they give.

And did I mention that these women mostly work for free?

Is is so surprising then that the unpaid volunteers are sometimes zealous in their approach? Because otherwise what is their motivation? Not the cash, no it's because they believe passionately in what they do and the value of breastfeeding.

Go to the NHS if you want advice without passion, if they fail you criticise them, not the hundreds of volunteers who do a brilliant job of supporting breastfeeding.

Deepblue Im going to have to correct you on the advice without passion from the nhs. The main reason I am still managing to breastfeed through all my troubles is because of an absolute angel of a lactation consultant at my local hospital. Her advice is great and realistic and the support I have had from the nhs re breastfeeding is absolutely second to none.

I am putting my money where my mouth is and joining our hospital breastfeeding support team when I can, they've inspired me and I want to be able to give something back, regardless of how my feeding journey ends. At the moment, thanks to them and the nhs it looks like its going to be breastfeeding for a good long amount of time. I have to do the odd formula top up when I cant express enough but thats going to support me in probably extended breastfeeding past 12 months, which is what I dreamt of when I had my baby.

You are too sensitive.
I did clearly say that they do a brilliant job.
I myself am a volunteer for a charity and I am very aware of the many people who put in hours of work as unpaid volunteers in all kinds of charities, which is often a thankless task.
We are discussing the issue of mixed feeding. People have raised the way they felt and how others reacted to their desire to mixed feed. I think that what I said is valid. It does not negate the value of what the volunteers do. And I think the NCT themselves would like to know that people often perceive the advice that is given as not being open-handed, but given with a ebf agenda, even if the words say that mixed feeding can be right for some people.
Im sure the NCT and other organisations are always looking to improve the service they offer. One of the things all breastfeeding organisations aim to do is to reach a broader section of society and I think they would be more able to do this, if the tone was slightly different and more inclusive of different approaches.

Perhaps you are right that more people like myself who have mixed fed should work with the NCT so that a wider range of experiences can be fed through. One of the key issues is that the NCT volunteers have almost always ebf and so understandably are zealous and struggle to empathise with other experiences. I agree that a wider range of people with different experiences could be involved. Do you think the NCT would be keen for those who have mixed fed or totally bottle fed to volunteer as feeding counsellors?

"Deepblue Im going to have to correct you on the advice without passion from the nhs"

I too know many NHS workers who are passionate about their work- you don't have to correct me at al mango- bu the point is they get paid for the work they do- and that is the main reason they do it.

" Do you think the NCT would be keen for those who have mixed fed or totally bottle fed to volunteer as feeding counsellors?"

chocolate- I think you may be confusing me with tiktok on some points here- it wasn't me who suggested you were confused at post 17:06.

I can't speak for the NCT- I have had no dealings with them.

I know that LLL would not accept a woman for training who had totally formula fed, if the formula had been used to support a breastfeeding realationship, then yes, that would be no barrier.

Deepblue, my last post was directed to you. But yes, you are right that I did muddle you up with tiktok who thought my earlier comment was confused. Sorry about that.

At the end of the day, I'm sure we all agree that mothers need support. I think it is absolutely right that the message 'breast is best' gets out there and people are supported to do it and continue in the early stages. However, I think that there need to be more people out there involved in the promotion of breast feeding, who have done it alongside formula feeding. These people can have more genuine empathy for the reasons behind mixed feeding and understand the practical issues involved with it. When they say 'mixed can be the best option for some people' they can genuinely mean it, rather than having a sneaky feeling, that comes across even though they say the right words, as ebf mothers, that people only ever mixed feed, if they have not tried hard enough, have been a bit lazy or selfish, have not sought enough advice and persevered for long enough ....ie ultimately believe that breast feeding is always the best option for everyone.

I suspect there are few mixed feeding advisors in LLL or NCT for several reasons. Firstly,n they don't volunteer, because they are not so evangelical about breast feeding. Secondly, these organisations want to promote ebf and so the mixed feeding experience and the advocation of it doesn't seem pure enough. There is an inbuilt spoken or unspoken understanding that ebf is THE WAY, so those who have done mixed feeding are ultimately at odds with that understanding. So really these organisations prefer those fully committed to ebf and the mixed feeding mums who might volunteer know that. It is exactly the same message that is received, even if not ever spoken verbally, by those mums who are wanting to mix feed and who feel condemned by the advice they receive.

Fair points, but remember that LLL or NCT don't exist to promote breastfeeding or formula feeding.

LLL ( which is my experience) is a support organisation, not a promotional one.

Also bear in mind that the promotion of formula milk (for eff or mixed feeding ) is banned in the UK. Yes you are right though, most volunteer counsellors would not have used formula- many under no circumstance.

I can't see it any other way though- I can't see anyone zealous about "feeding their baby". That is an obligation parents have.

Sorry, I didn't understand your last sentence.

You are right that most feeding counsellors would not have fed their babies formula under any circumstances. Regarding their own experiences, they would mostly say 'over my dead body' about it. And that is problematic, because although they are trained to tell people they have choice and that in some situations mixed feeding might be best, they have an underlying sense that THEY managed to ebf, they have been trained to help all women breast feed and so anyone not doing this/wishing to mix feed is going against the grain....those people are not saying 'over my dead body' so in some way are less committed to the best for their babies. This sounds extreme, I know, but is the feeling many mums get who are/want to mix feed.
And these mums can seek feeding advice from several sources. However, they often feel that the same underlying message I mention above, comes across persistently....not just once.

I think counsellors need to be prepared to give more flexible answers than just 'breast is best. Keep trying. Keep seeing an advisor to help you with your latch. If you introduce formula, they can get allergies. Big you introduce formula now, you will end breastfeeding sooner'
How about 'breast is best for baby, but baby is best served by being in a happy family which is in a good place and sometimes mixed feeding helps deliver that. I can tell you about people who have mixed fed successfully. I can talk to you about ways to mix feed which mean you dont need to give up breast feeding sooner. I can talk to you about some of the difficulties involved in mixed feeding, so you can fully consider what to do, but I can also talk to you about how to best avoid those difficulties. I can put you in touch with someone who has successfully mixed fed.....or I successfully mixed fed and can tell you how I did it'

Chocolate, you say "One of the key issues is that the NCT volunteers have almost always ebf and so understandably are zealous and struggle to empathise with other experiences."

How many NCT volunteer bfcs have you met? I'm amazed you think zealotry is a major issue. The training for NCT bfcs is very careful to avoid zealotry, and empathy is one of the 'core conditions' of our work. I have no idea how many NCT bfcs have exclusively breastfed - probably more than the rest of the population, for sure, but it is not a condition of training. Clearly, NCT bfcs value breastfeeding but their own experience of it may be very varied. Part of the training is to understand your own experience and then to 'park it' when actually helping other women.

NCT does not promote breastfeeding - we promote the conditions that enable women who want to breastfeed to do so, and we support the removal of barriers to this eg bf in public, better support for women who return to work and want to continue, better training for HCPs. We don't contact mothers - we wait for them to contact us. Even online, you'll see people like me rarely start threads and never actually invite dialogue, but only respond to others.

Am I 'zealous'? No, I am not. Do I have empathy with women who use formula? Yes, I do, whether they are solely or partially using it. I don't judge and I don't secretly think they 'should' be exclusively bf. I am typical! All the bfcs I know and work with think like me :)

You have been unlucky if your experience is very different.

In addition, NCT bfcs number about 300. This is a tiny, tiny number to have the influence you seem to think we have.

I am still not convinced. While mixed feeding may work for some mothers, for just as many others it will bring about a sure decline and termination of breastfeeding.
So many women are advised to top up with formula, when in reality breastfeeding management support is needed.

Good breastfeeding support is thin on the ground anyway, it is an uphill struggle for many to breastfeed, rather than sing the praises of formula.

Formula milk and the formula culture has caused breastfeeding difficulties by and large anyway.

Chocolate, NCT bfcs speak to women every day who use formula or who are thinking of using formula. Many of them do not know, or have not really considered, the possible effect on their choice to breastfeed.

If someone wants to breastfeed, using formula is an intervention in this choice. The implication of this intervention does need to be discussed and the mother can then make her decision - and this might well include thinking of ways for the intervention to have a lesser impact.

I really don't recognise this breed of trained breastfeeding supporter who says nothing more than " Keep seeing an advisor to help you with your latch. If you introduce formula, they can get allergies. If you introduce formula now, you will end breastfeeding sooner'

Hoe it happens, it can be helpful to have someone look at the way the baby latches. Formula does have a health impact (I don't think the allergies risk is clear at all, but there are other effects) , and the introdction of formula has an effect on supply and maintencance....obv not the whole story, but these nuggets are not untrue!

I am very interested in the points made on this thread, breast feeding is such an emotive issue that understandably people have strong views.

Deep blue /tik tok in terms of the number of women for whom formula brings about decline or termination of the breast feeding relationship, I wonder how this compares to overall feeding statistics? Would be good to know how many women actually do mix feed and for how long they breast feed as a result.

Edgar, the figures can prob be worked out from the Infant Feeding survey - I'll have a go at fishing them out.

I think the feed you'd be most likely to substitute with formula would be a night feed, to get some sleep - my bf group hv always said that we needed to feed at night to maintain supply for the next day (in the beginning I think she meant, not going to wake my 2 year old up to feed him!). Hope she was telling the truth!

Right, having read through there are some interesting points. I have not used an nct or LLL bfc so cannot comment on their practices, however I have experienced zealotry from a peer supporter at a support group. She told me about cereals in formula stretching babies' stomachs. Now this was with no knowledge of my breastfeeding journey and was before I was advised to introduce formula, however it contributed massively to me delaying doing so, possibly at the cost of my child's health, and to my guilt and sense of failure when I did.
I find it interesting that a pp felt that mixed feeding was suggested too often in lieu of bf support - I can see from peers that this can be the case, another reason why I resisted as I was aware of the regret they felt even a year or two on.
I am not certain, but I am pretty sure, that often mixed feeding is recommended by paediatricians following baby's initial weight loss. I think what causes issues is that throughout pregnancy the message 'breast is best' is promoted, then on day 3, a day notorious for making mothers tearful when you have had precious little time to master breastfeeding which for many women isn't straight forward, you are told that breast is not sufficient for your baby and I think that for many women this causes a feeling of failure.
My personal experience was a little different, day 3's weight loss wasn't too terrible but a dr expressed concern over the psychological effect ebf would have on me.
I wondered if mixed feeding was presented as a reasonable option rather than a last resort if it would encourage more women to continue with some breastfeeding and minimise some mother's feelings of guilt and failure. I am now wondering if the issue is really conflicting attitudes of the health professionals that new mothers encounter.

"I wondered if mixed feeding was presented as a reasonable option rather than a last resort if it would encourage more women to continue" - but it is also extremely likely that using formula will end a breastfeeding relationship altogether.

There are many ways to solve breastfeeding problems without using formula- breastfeeding supporters are reluctant to use formula because they know of the negative impacts that it can have.

Many health professionals within the NHS are likely to suggest formula use because they are poorly trained in breastfeding suppor and will turn to it as a first step, not beacause they think it is a magic wand. They often suggest it because they are supporting fro, a position of ignorance, not a position of knowledge- that's the problem.

Formula does have a place- of that there is no doubt, but for women who wish to continue breastfeeding and avoid the use of formula there are usually better breastfeeding solutions.

lava it is concerning that the peer supporter thought there was cereal in formula milk. This is quite false of course. I have not heard this myth before. Hope it's not common.

Formula is presented a lot as a first solution to many bf issues. Mumsnet boards have posts every day which detail situations where mothers have been told to top up, and where nothing else has been explored.

How could anyone considering mixed feeding, for whom it really would be the better option, read the posts above and not have a sense that they are letting their baby down, or have failed to seek enough breast feeding advice. The message is loud and clear.
The message that mixed feeding is second rate comes across so strongly. 'There are usually better breastfeeding solutions' clearly says that if you are one of the people who introduce formula alongside breast (or perish the thought, instead of breast) you have opted for the lesser solution.
There is again no sense or experience of the fact that in some family situations, a bottle of formula, perhaps in the evening or whenever, may be exactly what is needed for everyone in that families well being.

I think it is virtually impossible for those who are committed to ebf to talk about mixed feeding or formula feeding in a helpful, empathetic and constructive way to those who want to or who are considering mixed feeding. Many of these mums had planned to ebf and the idea of moving to mixed feeding is not achieved easily. I agree that all breastfeeding options should be considered fully but if mixed feeding is still what is best for them, they need support and advice from people who have successfully done mixed feeding, not a sense that they have somehow failed to do what the advisors said.

Advisors surely need to consider the situation of the mother and the whole family. A pragmatic, tailor made response, rather than 'breast is best in every circumstance' message needs to be heard.

" 'There are usually better breastfeeding solutions' clearly says that if you are one of the people who introduce formula alongside breast (or perish the thought, instead of breast) you have opted for the lesser solution."

But the truth of the matter is that a breastfeeding solution will usually be a better solution to make sure a breastfeeding relationship continues. This is not a perjorative view as you seem to suggest.
These are not solutions based on principal.

Formula can and does negatively impact on breastfeeding that is a hard fact I'm afraid.

chocolatewombat you are misunderstanding.

For a start, bfcs don't give advice. They discuss information and options with a mother. Often - very often - a mother has already considered or has been advised by an hcp that giving formula might help. My role in that situation is to help the mother explore her reactions to that, to ascertain if there are other possibilities to address the situation either instead of formula or alongside the formula. She has contacted me and it is entirely reasonable to draw the inference that she is interested in continuing to breastfeed. You know, what with me being a breastfeeding counsellor.....even so, I do always find out if she is ok about exploring alternatives to formula or formula alone.

Bfcs often talk to mothers already using formula. The mother may well feel it is NOT the best thing for her. Or she may be conflicted. Or she may want to cut down on the formula. Or she may want to continue and to protect what bf she is doing.

You honestly seem to have no idea of how we work, or the variety of different individual situations mothers bring. You talk as if we have a consistent one size fits all message. We don't.

PS. Please indicate any post where words or tone suggest I think a mother who uses formula is letting her baby down.

we support the removal of barriers to this eg bf in public, better support for women who return to work and want to continue, better training for HCPs

Good on you for supporting hCPs - though part of me things "why should a charity even have to do that for a normal, legitimate health issue? Why has the government neglected to train and think handing out a DVD and bossy MWs just telling people to BF is enough because the charities will pick up the pieces if the mum has any issues..."

They should put their money where their mouth is!

I am still struck by how the Government seems to rely on the good will of volunteers on such an important message (which they advertise in every hospital, clinic etc' so women know that breast milk is best) ... I see it time and again not just with breastfeeding and volunteer with other things the government has advertised but not put in grass roots support for.
Volunteers and charities are wonderful... but let's say 90% of women who have babies want to/can BF to some extent: that's millions of NHS patients with queries, questions and needs, and 300 volunteers' goodwill being relied on to help all of them is a bloody cheek from on high.

Gets off soap box.