Mixed feeding from day 1

[FlossyCat]

Hello, has anyone got any advice about how to successfully combination feed from day 1? After feeding problems with my son which resulted in being readmitted with a dehydrated baby on day 4, I'm determined the same will not happen again when baby no.2 arrives. I've decided to combination feed this time, I know it reduces supply etc, but would really appreciate any advice from people who managed to successfully bf and give top ups. Thanks x

I did it for DS from about day 4 (he was tube fed in special care for the first few days)
I had a pretty rough pg and birth and just didn't produce enough milk, so bf'd and then offered top ups as required. After a couple of weeks, I replaced a night feed with a bottle feed completely as I was just so exhausted - DH could do that one.
We continued with no problems until 6 months when I went over to formula only.
I did try expressing, but never got anything!!
It can work - Ds never seemed to have any problems swapping between bottle and breast - he just wanted food

Thanks Seeline, sounds like you had a really tough time. Likewise I could never express anything, there were more tears flowing than milk, so I'm not expecting to be able to this time (especially with a toddler also needing attention!). It's good to hear a positive story :)

I did from day 1. Expressed a lot though (he couldn't BF). Managed to express enough feeds for day time, and tended to give him formula overnight. Whether you are expressing or not there are a few things you can do to boost your supply in the early days.

Btw - never got anything much while expressing after DS1. For some reason it was much easier second time around. Hth. X

Thanks, any suggestions for boosting supply Robot?

I did. It's very important to me that my children go to bed at 7pm, and my breast milk supply is very low by then, not enough to get a baby off to sleep. So the 6:30 feed was always a bottle. he then woke up around 11pm and about 2am. These were both breast feeds. I've been told that breast feeding in the night is important for your supply.

I used very slow 1 hole teats so bottle feeding wasn't too easy compared to bf. I also expressed in the evening to make up for the missed feed and stored the pitiful amounts that came out!

I also co-slept. Not for everyone I know, but it allowed for frequent night time feeds which I really think helped my supply.

I did mixed feeding from the beginning and still doing it now at 7 months. If possible try to breastfeed in the early morning feeds, apparently this helps supply. My daughter is a very big and hungry girl (on 91st centile) and in the early days would feed for hours and hours - and I offered top ups after breastfeeding. She never had any difficulty with switching from bottle to breast, just wanted her milk! Good luck to you!

Thanks Camper and Cheese, good to hear success stories. I tried to talk to my DH about it last night to discuss how we would manage practically, the only pearl of wisdom he offered was 'well we're not going to have a screaming baby this time', which got my back up, meaning just give formula if he's not satisfied. It's so hard when you don't know if they're getting anything via bf, which is what happened last time because DS lost nearly 13% body weight at which point we had to introduce formula. I have beaten myself up enough about my 'failure to bf', just hope I can make mixed feeding work for longer this time by building a better supply x

After the first week I did a day of pumping every hour of the day for 12 hours straight (think you're supposed to keep this up during the night as well, but just couldn't face that!!) It did work, and increased my supply by a third within a couple of days. I repeated this again at about day 20, though you could do it as often as you like.

The other thing that helped was using a proper hospital grade pump. I had a medela one for the first two weeks, and then DD had to go into hospital so used one for a while and it made a massive difference to the amount I could express.

Also took fenugreek. I'm not sure if that had such an effect though.

Sorry, i realise most of this will only really help you if you express, and not so much if you BF.

I mixed-fed from pretty early on with ds3, having had lots of problems feeding ds1 and ds2 - I did my best to ebf ds2, but he ended up in hospital with them saying he was 'failing to thrive' - and he only started to gain weight when I introduced formula feeds.

With ds3, what I did was to breast-feed during the day, and then gave formula for the last couple of feeds of the day - just before my bedtime and the night time feed.

I found that, if he had no formula during the day, he lost weight, if he had just one formula feed a day, his weight stayed the same, and with two a day, he gained weight sufficiently well to satisfy the HVs.

Of course, you might find that it works just fine this time, Flossy - each baby is different and you might find you have none of the feeding problems that led to dc1 becoming dehydrated - and this time you will know much better what you are looking for, as signs that there may be problems developing.

How would you feel about giving breastfeeding a try for the first few days, and monitoring closely to see if your new baby is doing OK on that, and getting enough hydration? If he or she does no wet nappies in 6-8 hours, that is a sign of dehydration, or if the soft spot is sunken, if the baby is lethargic or if their skin is dry and cool, and stays up if you pinch it gently up between your fingers - and you could immediately introduce a formula feed.

Whatever you decide to do, I wish you every happiness with your new baby and their older brother.

Thanks for taking the time to reply ladies. I think I will push for extra support from the midwives this time, like you suggested Genius monitoring closely then giving formula if there are any signs. Hopefully things will be easier this time, and the sleep deprivation won't be so much of a shock! x

I found it much easier - less of a culture shock - going up from one child to two, than going up from none to one.

I think you learn lots of little time-saving tips and wrinkles with your first baby that make having a second baby much easier.

I hope you have a lovely time with your little one and your new, squidgy baby - it is such a lovely time!

flossy yes do ask fOr more help this time. A baBy readmitted day four has simply not been transferring colostrum well or often enough and this should be spotted well before there is a problem. Don't wait for dry nappies. That's a really late sign. It's also difficult to be sure of, as disposables absorb a lot. You could pop a cotton wool ball into the nappy to check for wearing, but as I say this would be a late sign. More accurate is your baby's poos. They should be changing by day two to three and coming often. Black or brown meconium on day three still is an urgent sign things need amending.

Hope this helps and good luck whatever you decide to do.

Thanks Tiktok that's helpful advice. Even the midwife missed signs when she visited on day 3, she didn't weigh him that day because it wasn't technically 72 hrs post birth. So it helps to have some idea what to look for. How often should you feed a newborn if they are sleepy? DS was sleepy and full of mucus, I remember having to try different ways to keep him awake.
So much happened last time, I think being induced didn't help, I was in so much shock from the whole experience of childbirth and the overwhelming responsibility of looking after a newborn, I couldnt sleep in hospital so had 4 hrs sleep in 4 days, added to this the stress of DS having a heart problem (which thankfully has not needed treatment), so I think I was hardly producing anything through stress. I had mixed advice about how often to feed and for how long, whether to wake him or not. When I asked someone in hospital to help me hold and feed my baby in the middle of the first night, because I really wanted to hold him but felt so weak, I was told to leave him if he was sleeping. I had Mother in law telling me he was distressed because he had wind and taking him off for a couple of hours one night to try to comfort him so I could rest (when really he was starving). I felt like I could not have tried harder but there were missed opportunities to feed. Sorry just need to offload! I also have doubts my flat chested boobs are not up to the job, maybe I am one of those women who really can't produce enough!? Any tips on boosting supply other than expressing? Thanks x

Hi i am currently mix feeding 15 day old ds , it really is working very well , he was born at 37 wks and weighed just 5lb 5oz , I listened to my instincts and ignored midwife telling me to keep trying to ebf and as result he only dropped 1% of his birth weight and is now just over 6lb , if you don't think dc has had enough milk on the breast then top up with formula , the more you nurse the better your supply will be , I personally put ds on the breast every 3hrs then top up with around 3oz formula so that even if he doesn't get anything from me he is still getting food , it can be tiring but at least you can be certain baby will thrive whatever happens . I'm only getting 1-2 oz of breast milk at the moment when I express so I know that ds needs the top up lol.

Flossy it sounds like you had a really stressful time and also you had poor care :(.
Your breast size would have no impact whatsoever on your supply. Neither would stress.
At that stage you would be producing colostrum not milk. This is in small amounts but new babies need it frequently to stay hydrated. If transfer is not effective for some reason you should have been helped to hand express and then to give it to your baby as well as continuing to bf direct. Did anyone assess his nappies and explain what to look for? He definitely should have been weighed as a help to evaluating what was happening.

If bf is important to you, even as part of combi feeding, then there's nothing in your post to suggest your problems would happen again. With good info and proper care there should be no repeat.

Glad things are going well Debbylou, I know I won't beat myself up so much if I have to give formula this time, good to hear it's working well for you both.
Tiktok I tried hand expressing but all I could get was less than 1ml, it was depressing! A midwife did help me express into a syringe but it was tiny drops. I couldn't get anything with a hospital pump, it just made me sore. Although DS was suckling I don't think he was really swallowing, although midwives said the latch was ok. In the end I couldn't compete with formula, he would fret when I tried to bf, as he could get milk so quickly from the bottle so we only managed 4 weeks combination feeding. He wee'd on the midwife when she assessed his nappy on day 3 so she thought he was ok. Hopefully the care will be better this time and I will be more pushy asking for help.

Flossy, one wee on day 3 does not mean all is well and midwife should have weighed. That's shocking.

Sounds like you needed a bit of help with the hand expressing technique.

Hope things go better this time.

Just a note on boob size - I have humongous boobs that are rubbish at making milk, all the really successful breast feeders I know are flat chested! however I've managed to combination feed until 7 months.

Tiktok will know better than me, but if you're going to mix feed, don't top up after a BF, replace a whole feed with a bottle. They'll always take a bottle after a BF (just like I can always eat pudding), but it doesn't mean they hadn't had enough, and it can really knock your confidence. Also, it can damage your supply as they don't keep on sucking to drive up production if they get a bottle afterwards.

Also, bf on demand, bottle feed on schedule. For me personally, my supply could handle me giving one bottle feed. Once I moved to two (desperate for a nights sleep!), my milk dried up really quickly.

I also took 3 fenugreek tablets 3 times a day. I'm a bit torn on whether this is snake oil or not, but I was willing to try anything to get bf working second time around. I took them into hospital with me and started them from the minute DS2 was born.

I really hope all works out well.

I didn't have enough milk with dd1 and mixed fed from day 1 as she was just screaming. She lost a lot of weight and expressing didn't work.

Same story with dd2. I mixed fed both of them for 6 months. I tried various things but what worked best for me was topping up after every feed. It is definitely not convenient and the worst of both worlds in a way, but it meant I could sustain breastfeeding.

I found no health professionals knew anything about mixed feeding so were unable to give advice. They were just happy the baby was doing well and I continued breastfeeding for so long.

Looking back it was a pain doing mixed feeding and my babies probably weren't getting much breast milk, so ff would have been fine, but while my babies were happy to breastfeed I carried on.

Camper, sorry, that's the wrong way round. Topping up protects the milk supply better than replacing a whole feed with formula. Individual experiences will vary, but the physiology of breastfeeding is that it is gaps between feeds that depress the milk supply (though topping up can do a good job of that, too, because it increases the length of time between breastfeeds).

The milk supply is driven by the frequency with which the baby breastfeeds. Long gaps between feeds send a powerful message to the production line to stop making milk.

Thanks for the replies ladies. I'm feeling more positive about giving bf another go, all I can do is try my best again and this time make sure I offer more frequently. I find it hard to imagine my body is capable physically and mentally of ebf but who knows, I've managed to grow a baby so it may happen!

I shall pipe down with my out of date advice! Just ignore me flossy, and best of luck!

All sorts of things might be different second time around, glad you're feeling positive.
DS1 was readmitted with dehydration and jaundice, and it led to a rocky start to BFing. With hindsight, he was sleepy and did not feed frequently enough in the first days, and his latch was not great. He ended up with formula top-ups for a few weeks while I did a lot of pumping before we got back on track with EBF, which was my preference.
I was determined not to have the same issue with DS2, so he got fed every time he showed the slightest cue, and we did not have the same supply issues at all. I don't think it was just knowing more that helped, lots of things were different (like his latch and his interest in feeding). Good luck, see how you go!