How to mix feed

[GuybrushThreepwoodMP]

I'm currently pg with #2. I ebf dc1 for a year.
For various reasons (a lot of bf first time round which are likely to reoccur), I want to mix feed dc2 and probably from the start or at least very early on. Can anyone tell me how you start this in terms of when to give formula, how to establish the right breastmilk supply etc? Any personal stories would be helpful as well.
Many thanks

That's a very sensible question and one I wish had been answered properly when I had DC2.

I'd advise not introducing a bottle until week 2 or 3. Then offer a bottle as a top-up after BF until about week 6. Keep a night feed as a BF as the extra prolactin at night will keep your milk supply up, but you could start to replace a feed or two with a bottle after week 6, when your supply should be well established.

If some BF is important to you then I'd avoid any bottles in the first couple of weeks. My supply never really kicked in with DC1 (he had some formula from birth) and after 2 weeks he refused all offers of boob, so to me that seems to be a pivotal point. Likewise, with DC2 (EBF) week 2 was the point that my supply really kicked off.

Good luck!

In the first sentence I meant when I had DC1, not DC2!

I would avoid adding any formula until 4-6 weeks, wait til breastfeeding is well established or your supply will dwindle.

I'm going to disagree with the previous post (sorry!) and say never top up if you want to successfully mixed feed. Top ups can cause a number of problems, the main ones being:

1. Babies can prefer the faster, easier flow of the bottle, if they come to expect this after a breastfeed, then they can be impatient at the breast and not have as much as they might have done otherwise, leading to a reduction in supply.
2. Babies will almost always take milk from a bottle even if they're full and satisfied. Imagine after you've eaten a meal and are full, when somebody offers you dessert - unless you're really, really full, usually it's quite easy and nice to eat the dessert as well. This is what's happening but it can look like oh, they weren't really full, I must not have enough milk. So it can put that doubt in about your supply.
3. When you top up after feeds it can be tempting or seem logical to supplement with extra formula during growth spurts or fussy times, which are the most crucial times to be breastfeeding as it boosts your supply for the baby's future needs.

So a combination of these things leads to a drop in supply and ultimately the end of breastfeeding, unless you're lucky. Also, it's twice the work if you're topping up at every feed.

When you want to introduce the first bottle, you need to stick to once a day at a set time, start with a smallish amount (BF babies take less milk than FF ones) and keep the FF just to that - any fussiness, growth spurts, etc, offer extra breastfeeds. Over time you can introduce more bottle feeds (once a week?) until you're up to the ratio that you're happy with. I don't think it particularly matters when you introduce the first bottle but the earlier you do, you want to give smaller amounts - no more than 60ml at 1 week, 150ml at one month, and introduce extra bottles more slowly, maybe an extra one every 2-3 weeks rather than every week.

Also pay attention to the gap between feeds. In the very early weeks (pre 6-8 weeks) you don't want a gap more than 5 hours maximum. After 6-8 weeks you're probably OK to go about 7, maybe 8 hours, once in a 24 hour period.

Until 3 months or so (when your supply changes from hormone based to demand based, you'll know because your boobs will feel floppy and "empty" between feeds rather than being engorged) I would stick to alternating breast and bottle at each feed, rather than doing two bottle feeds in a row, because that would make too big of a gap, bearing in mind you'll (hopefully!) have a gap at night as well. After this supply change has happened you should be able to shift things around a bit more easily, and easier still once your baby is established on solid foods at around 6-8 months.

Throughout the whole process stick to the golden rule: Bottles on schedule, nurse on demand. Make sure if he's asking for extra, the extra is breastfeeding. That's the way to keep your supply up to scratch and working around the bottle feeds that you're adding in.

Good luck! :)

Oh hmm I was disagreeing with the first but it took me a while to write that :)

Thanks all. I don't think I want to top up I think the ideal would be to begin with one or two ff a day really. Would this really have a negative impact on supply given that supply is defined by demand? Surely my body would make the right amount- ie less than I would need for ebf?
Last time I had oversupply throughout and ended up pumping about 3 times as much milk as I needed to avoid blocked ducts.

What happens if you don't bf at all? How do your boobs not explode in the first few days?

Place marking! We mixed fed DD out of necessity (poor initial supply and jaundice), and then convenience. Once the BF settled, we gradually dropped the top ups and just kept 2 bottle feeds a day where it suited us. It was the perfect scenario for me in the end, and am sure it was the reason I kept going with BF as long as I did (13 months). Plan to mixed feed if/when we have DC2 so the above advice is really interesting to read.

I'm guessing it's a fine line between not mucking up your own supply, but not leaving it so late baby refuses formula!

I never topped up.

With DS2 I introduced occasional bottles at around 8 weeks, then sooner after he was having an 11pm bottle every night. From 4 months I swapped some day feeds for bottles too and by 6 months it was about 50/50.

If you don't BF they don't explode but they are very painful, hot, huge and tender for a couple of days, so I am told.

Lots of people say don't use a bottle at all before 6 weeks, 4 weeks, 8 weeks, some arbitrary date. I'm not really convinced that there is much in this, as long as you're careful about what you're doing.

The problem with going straight to mixed feeding, say, 50/50 on the first day, is that your body is only producing milk on hormones at this point. If it's not getting enough milk removed then your body basically assumes there is no baby to feed and the milk will dry up. Likewise, if you very quickly drop lots of breastfeeds in quick succession, that mimics the baby's natural weaning process and again because BM is being produced hormonally at this point, as far as the body is concerned there is no baby to feed.

I'd wait a couple of weeks at least just so that both of you get the hang of latching etc before you introduce a bottle as that's when it could cause problems, because latching onto a bottle is a totally different latch type than a boob.

Was your last baby tongue tied?

I can only give my experience of mix feeding. This was forced upon us by a stay in neonatal and a dehydrated baby but I honestly think it's what's kept me sane and kept me breastfeeding so far.

Ds is four weeks old now, initially I was advised to top up each bf with 2oz of formula whilst in hospital. Now we're home I bf on demand and ds gets a bottle of formula mid morning, late afternoon and evening (4oz) and one in the night if he seems to need it. Any other feeds are bf. I would say mix feeding has definitely affected my supply, I wouldn't have enough milk to feed him exclusively now . In hospital we were advised top ups were temporary and it would be easy to wean off them but it's really hard now he is used to the bottle. The cycle of bf, bottle feed, express and sterilise is relentless though!

I say any breast milk is better than no breast milk and you need to do what is best for your family. If that's giving some formula from day 1 then do it.

No tongue tie but I had to feed with nipple shields because of completely flat nipples. Baby just couldn't find them and made no attempt to latch onto them ever. Every bf sort person and lll advisor just looked and commented "Oh yes, there is no attempt and latching there is there?" but couldn't help me make it actually work.
I exclusively pumped for the first couple of months. It all drove me insane frankly but I was absolutely determined and had some sort of irrational fear of giving formula because I thought it would ruin bf. I'm aiming for a more moderate attitude this time which puts my sanity first. I think making a plan to combine feed really allows for that.
Thanks for all the advice.

I have oversupply with DD2. I am currently on 5000mg a day of soya lecithin which is preventing the blocked ducts really successfully. I am using a latex nipple shield to blunt the worst of the letdown. The soya lecithin means I can block nurse on one side far longer without the risk of blocked ducts.

I have also looked at drug/medicine options for oversupply. Sage tea, sudafed and the combined pill (4-7 days) will reduce oversupply.

There is also a full drainage and block nursing option.

If your oversupply is like mine, I doubt ff will reduce it. I have enough milk for twins, possibly triplets.

That's odd, though. Usually even with flat nipples that wouldn't stop the baby trying to attach. That would make me think there was a problem with the baby rather than the nipple. And TT is very often correlated with oversupply, for some unknown reason.

Wagga do you have a support thread? If your baby is 4 weeks old there should be absolutely no problem getting your supply back up to capacity, but obviously you need to do it in the right way (grrr at HCPs saying "Oh it will be no problem" and then waving you off with no support as to how to do this, BTW)

Oh balls meant to post this for you OP: www.llli.org/faq/flat.html

Thanks Bertie. I tried everything listed on that page and the only thing that worked was shields. That's how I managed to bf for a year, but the struggle was immense hence thinking about a way to take the pressure off this time.

Ah, well, no not in the case of bottle refusers :) I meant in the specific situation of when you offer a formula top up after a breastfeed, which people tend to do/be advised to do in the first few days/weeks. Bottle refusal tends to start later, at around 3-4 months (unless you're really unlucky )

YY OP, totally understand that sentiment.

Here's my experience.

I had no idea how I was going to feed DD until she was born. In the end I had a tricky birth, with a EMCS followed by being totally out of it on drugs for the first 24-36 hours if her life. I honestly had no clue where she or I was. Meanwhile, the nurses were feeding her formula. I stayed in hospital for 5 days, trying to bf a little each day and never quite making it. Got home in the evening of day 5, put her to breast again and she had a little bit. Kept going like this until day 8 when suddenly my milk came in and each feed went from 100% formula to 100% bf.

I was totally paranoid, of course, that she wasn't getting enough so I topped up each feed with formula if she wanted it, which she did for one feed out of two, really.

By the time she got to 6 months, she had gone from this down to pretty much 100% formula at each feed, mostly because I was fed up of bf and had been dropping bf slowly (with absolutely no objection from her). One day, around then, she actually rejected the breast and that was that.

Just an example, here's another way it can be done.

I wasn't suggesting a top-up at every feed, Bertie. And I don't see how offering the odd top-up will alert a baby to the ease of bottle feeding while replacing a whole BF won't!

I can only offer advice based on my own experience, OP, and I'm successfully BF DC2 having offered the odd top-up while I FF DC1 after failing to establish BF because I was replacing whole feeds with a bottle.

In any case, I'd strongly advise against offering a bottle too early as that's what put an end to my attempts to BF DC1.