Combination feeding - Clueless. Please help.

[Heavenscent86]

I have been exclusively breastfeeding since my baby was born 4 weeks ago but tonight after a whole day and most of the night of baby constantly screaming we offered a tiny bottle of aptamil formula. It was from one of those pre sterilised packs of 6 tiny bottles. He took it streak guy away and became much more contented. I'm now thinking he may need formula top ups for a while but how do I achieve this while increasing my supply for him? Is this possible? And what do I need to buy bottles/pump/sterilising wise to formula top up successfully? Baby had a tongue tie which has been recently snipped and we are now trying to push through so we can continue breastfeeding

Firstly congratulations and sorry to hear you've had a tough night.

Can I ask, what makes you think you haven't got enough milk for him? Is it because he took the formula straight away and settled?

With the recent the tongue tie cut, potentially your baby is learning to feed again? Is his latch good? Is your positioning good? Have you sort some professional guidance on this?

Combination feeding whilst trying to build your supply needs some professional advice / support. It isn't easy. Ultimately when you feed baby milk not from you, your body won't produce that milk unless you tell it to, i.e from pumping or baby feeding from it. Your body works in a supply and demand way - baby suckles, your body makes milk / baby doesn't suckle or feed, your body will reduce the milk it makes over time.

The odd top up like you've done, shouldn't have huge effects on your supply, however you may find you're full a bit later, so express it off (hand express if you havent got a pump) so that your body knows to continue to produce milk.

If you want to regularly top up with formula, you will need to decide how often and when, so that your body can get in a routine matched to it.

Remember your baby is only 4 weeks old. Having a rough night and your baby taking a bottle of formula doesn't necessarily mean you are not producing enough milk. It could be a whole host of reasons why baby hasn't settled. Have a read about The Fourth Trimester as this may help set your expectations of what a newborn baby will be like.

My baby seemed to "prefer" the bottle to breast! But we still mostly breastfeed. Baby's are just fussy sometimes. 4 weeks is very young, newborns have fussy stages, sounds like you're doing a good job. We offer one bottle of formula a day, in fact my DH does it so I can get some rest. All other of the feeds are breastfeeding from me. Some types of bottles can be sterilised one by one in microwave. Don't get ahead of yourself, your baby doesn't "need" formula unless you've been medically advised otherwise, but you might choose to offer it to give yourself a few hours off (sleep!).

Formula settled your baby quickly because it is a lot heavier on the stomach than breast milk. A formula fed baby generally tends to go through the night far earlier than a breast fed baby for that reason. Your milk supply is not yet fully established - this takes at least 6/8 weeks (I don't remember exactly so if someone else knows better please correct me). If you do want to exclusively breast feed, the most important thing to do is to feed your baby as often as possible to get your supply fully established. The night time feed is the most nourishing and richest milk your body produces. It is normal for a weeny baby to feed 4 times in the night. I don't know why your baby screamed all night. It may not have been hunger at all. The most important thing is that you felt assured that He/she was ok because it sent him/her to sleep. From my experience, a baby tends to cluster feed in the afternoon (thats where they feed, stop then feed again quite soon after).

Anecdotally, when my baby was around 6 weeks I went out for the day and decided I didn't want to go to a room for an hour and feed and I whipped out a bottle. My boobs did fill a lot that day. For the next week or so, I substituted that feed for formula. Then decided I actually wanted to exclusively breast feed and never gave her formula again. So your supply can recover.
My friend tried to exclusively breast feed and it didn't work. He was a very fussy baby who preferred the bottle and was advised to combination feed. I don't think you are at that stage yet.
With regard to equipment I used a dual electric pump and bought a plug in steriliser (the microwave ones are also fine) - you could probably get a steriliser from eBay really cheaply btw. I didn't have masses of milk. A hand pump hardly produced anything. But the most important thing is that you feed regularly. I didn't start expressing until DD was around 4/5 months old because I didn't have a ton of excess milk. If your baby's tongue tie has now been addressed, it may be that your supply needs to be increased by feeding regularly and I would try that in the first instance feeding is far better than expressing for increasing supply.

Hi thanks for the replies. I thought maybe I am not making enough milk for him because he was so settled after the bottle but from seeing the replies on here perhaps that is not the case. I wonder if maybe his mouth could be hurting as the cut to his tongue tie was only done on Thursday.
The lady who did it showed me how to get him to latch on properly. This is a struggle as he has got used to only having my nipple in his mouth and now he has to take a lot more breast so feeds are still frustrating for us both. If I, for the next couple of days, offer the breast first and only top up with the tiny formula bottles if he seems very hungry this isn't likely to affect my supply too drastically is it? And hopefully he will learn the new way to feed before too long.
I think his crying was something to do with being hungry as I tried so many things to settle him prior to the bottle and nothing worked.

One problem is that he is not opening his mouth wide enough to latch on and take enough breast into his mouth. Could nipple shields help with this or are they likely to have an adverse effect and make things worse?

Try lifting your boob up and holding your nipple back so he has to root for it, the sort of flick the whole nipple in his mouth.

So I've had a quick google. From what I understand yes, generally 48 hours post op the pain is a lot better. So maybe he was in pain. (Full tummies make babies sleep so formula will have relaxed him as well). This is all still googled stuff: Regarding the op, he will take time to adjust to having a free tongue, both in terms of released muscles and his brain understanding he can do things differently.
So in the short term, I would say if he's crabby and really wont settle, I would top up bottle feed him. There is no reason to believe you don't have enough milk as this is rare. However, some babies can get used to the immediate reward of bottles and refuse the breast. The more you put him to the breast, the better your supply. Try the technique pp said above where you lift the breast, flap your nipple (now pointing down so stretched a bit) in his open mouth and let him latch on.
Two things I would consider. Seeing a cranial sacral osteopath who treats babies to release neck/back/skull muscles, which will help with the jaw and mouth as well and seeing a breast feeding counsellor. These are both online recommendations post op. The site also recommend a Bowen therapist which would also be good, however, there are lots more cranial sacral osteopaths around (both will do a similar thing with different techniques). Just ensure they work with infants. See nurturedchild.ca

About nipple shield. I didn't get on with them at all. Anything is worth a try but I would have thought this would make him have to try harder to suck. Yes I know you maybe in pain. Get some lansinoh and a friend swore by very cold cabbage leaves. There's lots of info online.

Thank you. I will give that technique a try and also avoid the nipple shields I think. It does hurt but I'm prepared to put up with that while we are getting things sorted as I really want to crack the breastfeeding. Lansinoh has been amazing. I will take a look at that website you have recommended. He does seem a lot happier today so I'm pleased with that. Still having difficulty latching him on but at least he is calmer.

OP, my little one (10 weeks today) had tongue tie. She definitely struggled with latching after as initially her mouth was sore, then she had a very strong gag reflex so didn't like the nipple being far back in her mouth like it needed to be. She had her TT snipped at 10 days and like you I found she still didn't open her mouth wide enough to take in enough breast. Tbh this didn't really get substantially better until about 7/8 weeks, when her head and mouth grew! (We also saw a cranial osteopath for 3 sessions around this time but I'm not convinced it made a huge amount of difference and may have just coincided with her head growing!) I used nipple shields from shortly after her TT snip until about 3 weeks ago. A lactation consultant recommended that they would help her get used to having more in her mouth, and lessen her gag reflex. My nipples were ripped to shreds anyway and they helped me to heal. So I would recommend, even though they are a faff. I tried all brands and found Medela best. Hope that helps and it works out for you X