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?

PS. My comment on the DVD and MW is purely based on my experience: MW has lovely but just said what was on the DVD.
And yes, when I asked about support (I have a sleep disorder and anxiety so may well need support to ensure I stay well... actually let's face it with FF or BF!) I was handed a list of phone numbers: local LLL etc' and asked "have you joined NCT?"...

Which I took to mean "the government says do this, the charities do the leg work" on both the feeding and the mental health concerns.

squizita, you mke some really interesting points. I live near a large teachimg hospital, sometimes when the infact feeding advisor was off on holiday she would give my telephone number to the midwives working on the post natal ward if they ran into difficulties.

-Me as a LLL trained volunteer!!

Breastfeeding support had landed into the lap of the NHS like a giant white elephant. At its best breastfeeding support isn't a medical issue, its a community and social one.
Given timely and subtle support tiny breastfeeding problelms are best solved at home, with experienced aunts, grandmothers and sisters who all know how to breastfeed.
New mothers have even watched as toddlers and know themselves how to breastfeed.

But formula has robbed our society of that breastfeeding expertise, so tiny problems escalate into huge ones and often do need medical help.

Squizita, I hear you! But volunteers can do a great job and I am glad hcps refer mothers to us. Hcps help and support bf in a different way.

I think it's a disgrace that in too many cases we are replacing what the nhs should be offering as a matter of course. It's also a poor show that bfcs often pick up the pieces or deal with the train wreck that has messed someone's bf up in the first place.

Yes, it may not be an NHS issue - but certainly it seems to be typical of the current political trend (e.g. with my work ... the 101 changes per day on what a teenager 'should' be often based on political pandering to the Daily Mail and where is the support? I work all day with teens then volunteer in my spare time, because parents are worried and teens are feeling the pressure).

I know I am extremely lucky because my own mother BFed no issues with my siblings and also mixed fed (I was premi and in the unit) but did so successfully ... but equally she can be almost blase! "I put your sister on {my boob} -she was a hungry one, it saved me loads of money... then she started hungering for food and I weaned her starting at 6 months. And that was back when we didn't have all this equipment and rules..." Which is all very inspiring but also rather daunting!

Just to clarify. There are about 300 Nct bfcs, maybe a total of about 200 more in the other organisations. About 450,000 mothers start bf a year. Bfc support punches above its weight with something like 20,000 nct contacts a year according to our annual returns and let's say another 15,000 for the other orgs.

Drop in bucket, even so.

Peer supporters prob reach several thousand mothers over a year but the figures for that are not collated.

There will be overlap ie a mother may talk to more than one bfc and maybe also a peer supporter.

Even if we all were mad zealots as has been suggested, making women feel 'terrible guilt' we could not be held responsible for women's feelings about mixed feeding.

We just don't have the contact!

I've had this discussion with tiktok before, but I'm going to recount it here because I think it's relevant.

After crap support from HCPs in first few days, my DD had lost 13% of her birthweight at day 3. We were readmitted, formula/EBM top ups, discharged with good weight gain but no plan.

Rang NCT counsellor, who came round to my house the evening we were discharged. I was feeling very very fragile, but buoyed by the fact that at least she was now gaining weight. Wanted to get from mixed feeding to EBF, but had no clue how to do that, and no clue how to use formula in a way that supported the health of my DD but would do the least damage to my supply.

NCT counsellor was new to the job, and I suspect what happened next was a result of that.

She criticised the care that we had received. In my fragile state, I took that as criticism of me and the fact that I had allowed my DD to be weighed at day 3 (day 5 would apparently have been better), allowed formula to be used to top up, and restricted BF (3 hourly routine was feed for 10 mins each side, top up, pump for 20 mins each side, sleep for an hour; in the early hours I was pumping a second time instead of sleeping).

In terms of practical help, she wasn't able to answer my questions about how to get from mixed to EBF. Which, with tiktok's help, I now understand was fair enough - not her area of expertise - she's an expert on BF not mixed feeding. What I really really wanted to know was how long to BF for, how long to express for, how much to top up. No-one (NHS or NCT) was able/willing to give me that information.

The practical advice she did give me was to get a SNS and/or a doula, neither of which were financially viable at the time.

What happened was that I cup-fed EBM & formula top-ups for 5 more days, then decided to cold turkey and have her attached to me day and night instead of a pump. She gained no weight for the next 4 weeks. Having felt like I'd had a telling off the last time I spoke to the BFC, I didn't ring her but instead relied on my HV (who told me to eat more cheese. Wrong decision there!)

So at 6 weeks, we were back to formula top-ups and there we stayed until 10 months.

I think it's odd to criticize LLL for being extremely pro bf! Isn't that rather like going to a vegetarian restaurant and complaining that there's no steak? They are a bf support group and it's not mandatory to call them. When I spoke to them their help was very firmly based on me getting back to ebf ,but that came from me. I don't think I'd have asked them about mix feeding really.
My experience of NHS bf support was mixed. All very encouraging at first, lots of you're doing the right thing/giving your baby the very best start/breast is best. Then when DS still wasn't gaining weight at 10 days it was- top him up, formula's fine, you did your best. The (NHS) bfc I saw was,quite frankly, a bit nuts. She just emphasised how bad f was-("full of nasties")the and asked me what I'd do if f didn't exist. Not helpful but not nearly bad enough to cause my guilt.
And I do feel guilt. I just can't explain why. It's clearly not the "fault" of nct, LLL or other bf charities. Given that most babies are ff it's not the ubiquitous "society's fault". It's not other mums as, aside from one comment, they mainly don't care.
It's absolutely ridiculous really!! I don't think anything about my friends who ff but imagine ebf mum's to think less of me for mix feeding!I think I felt guilty that I couldn't ebf DS in the beginning, then when i got on so well mix feeding that I felt bad for putting my sleep/convenience ahead of what's best for him.

Nicky I think you and I are on the same page. It feels like the nhs provide conflicting advice and I suspect that's a symptom of different hcps having different opinions. I also wonder if midwives encourage ebf during pregnancy because they are told to but when women are encountering issues in the early days they don't know how to resolve them apart from offering formula. This seems like a u turn and I think causes some vulnerable new mothers to feel incredibly insecure about their ability to ebf and guilty about giving up.
So perhaps it is more an issue of better support being made more widely available.

The (NHS) bfc I saw was,quite frankly, a bit nuts. She just emphasised how bad f was-("full of nasties")the and asked me what I'd do if f didn't exist

That's awful! If only because back in the days there would be wet nurses or relatives perma-pregnant with their umpteenth baby, which was how the lucky ones dealt with issues. Sadly as I understand some would have got mushed up bread in cow milk - not ideal - if mum couldn't BF or wasn't around. That's why so many orphans died.

I think in her mind she was being......encouraging??? She also contacted me out of the blue when DS was 6 weeks old to see "if I was successfully feeding him"- I assured her that he wasn't going hungry but I was mix feeding him. She said "Oh well, can't win em all". Charming! Nuts. Hopefully not typical.

Some of these stories are quite shocking to read.

I had my DS in a Breast Feeding Friendly hospital and ironically they weren't very supportive when I was struggling. DS lost just over 9% of his birth weight in 48 hours because I just couldn't attach and feed him and rather than staff address that issue I was told to just give formula top-ups. I was far from impressed and said I didn't want to go down that route. I was in hospital for 2 nights and they wanted to keep me a 3rd but I wouldn't because I knew that if I stayed in they'd break me and I'd end up giving formula.

I think people who mix feed have their own totally genuine reasons for doing so - be it for their benefit or their baby's - but I imagine for women who feel very strongly about EBF then offering formulas usually is seen as a last resort.

Spindelina, as you say your story was discussed at length in October 2012, and I did of course acknowledge than that the bfc you saw was not coping well with it - I don't want to go through it all again :)

I would just add that during training, nct bfcs are specifically assessed on being able to support mothers without criticising the help they have had so far from their hcps. Mothers absolutely do take criticism of previous intervention or lack of it as a personal criticism, when they are feeling vulnerable. In addition, it's just not what nct bfcs do - we don't always know the full story anyway so commenting on what has already been said is outside good practice.

Having said that, sometimes mothers come to their own conclusion that what they have been told is poor.