Confused about mixed / combined feeding

[butterflylove16]

Hi everyone, I'm probably just being really silly but wondered if anyone had any advice.

Dd has issues with latching & feeding, losing weight/slow weight gain. She is now 1 month & only just over her birth weight. She has a slight tongue tie but they aren't sure if that's the issue & have been checking dd with blood tests today & a urine sample tomorrow. I have been ebf & started expressing a few days ago which has helped - I try bf first then expressed milk after. The Dr today thinks my supply isn't enough & would like me to use formula to top up which I started this evening. She wants dd to have 70 ml, and said express as much as I can (I'm unable to express this much) then top up with formula.

I don't know if it's lack of sleep but I'm confused - say I express 30 ml I would need 40 ml of formula, but as I have the powder I need to make it up but it doesn't say how much powder for 40 ml. For 90 ml I would need 3 scoops so for 30 ml I would obviously need 1, but for other amounts I don't know how to do it.

Also, would it be better to mix them together or take it in turns - say a formula feed followed by an expressed milk feed?

I'm sorry if that made mo sense I'm currently on 2 hours sleep a night as expressing takes do long! Thank you

We take it in turns and save up the expressed milk until there is enough for a full feed - topping up with formula inbetween. This way makes it easier to monitor how much expressed milk you're getting and you don't have to worry about making up different amounts of formula milk each time.

I'm in the same situation as you and we have been topping up our DD every 3 hours for 5 weeks now. It's hard, what helped me is that my DP does the bottle feeds while I express. So if there is anyone who can help you by giving her a bottle, that may saved you some time (and sanity).

Thanks for your reply it's nice to know I'm not alone!

Yeah that makes sense & is what I've been doing this evening but I was unsure if that was the right way to do it - I've struggled to find much information online. It's also a good idea getting someone to bottle feed while I express - I'm sure dh would be happy to do this when he's at home. It wasn't in my plan to use formula but I think it's what's best, especially at night times because I can't keep this up!

Just make up 90ml but don't use it all? Or buy some small ready made cartons. When they are open they can be kept in the fridge for a day I think? So you can just pour out the amount you need.

I don't think mixing the two milks will make a difference either way except your baby might like the taste the formula more with breast milk mixed in as it's v sweet.

Haha that does make sense - I'm running on 2 hours sleep so logic seems to be passing me by! I did want to buy the cartons but they work out as more expensive which we can't keep up long term.

Thank you for your response

You shouldn't mix the formula and breast milk together. Or so I was told by my HV.
I mix feed. Never managed to express when my baby was little as he was on me all the time, either feeding or sleeping. I don't think there is a lot of help out there for those who are told to 'top up' with formula. I was just told to give 2 small bottles a day (at 6 weeks) and muddled along myself since then. I always bf first and let baby get what he could, then gave formula. I now, at 5 mths make a 180 ml bottle 4 times a day and he usually has 120 to 150 ml of it. I make extra as he's sometimes hungry enough for the lot. He has boob before the bottle and in between ( I suspect mainly for comfort) and during the night.
Don't be surprised if your baby fusses at the boob a bit more after having a bottle. Hopefully yours won't but my supply was a bit low and he always struggled to latch on one side more than the other, as the nipple is flatter, so the bottle was easier and faster for him. This meant he got frustrated with the boob. Things are much better now and his latch improved so much as he got bigger.
I'd check again how bad the tongue tie is. My sisters baby had 80% tie and they didn't pick it up when he was born (midwives too busy) and it took them 6 wks to sort.
Good luck op. It's bloody hard isn't it but it's worth using formula to get them up to weight. Baby doesn't care as long as it's getting fed.

I second what a PP suggested regarding making up more than you need and not giving it all / pouring it out so you have the exact amount. Also, definitely get an electric pump to use for expressing if you haven't got one already. I was able to get one on loan from the local children's centre basically for free.

And do get the tongue tie checked out again by someone with tongue tie experience - it may well solve your issues, and it can also be the cause of low milk supply if your baby is struggling to stimulate your supply! We got in touch with a private tongue tie practitioner but she actually organised for our DD to be seen on the NHS (due to potential complications). Our appointment is on Monday so we are really hoping this will resolve all the issues we've been having.

Forgot to add there is some info on tongue tie practitioners here: www.tongue-tie.org.uk/find-a-tongue-tie-divider.html

Thank you both for your advice. I've just been feeling a bit confused by it all as the Dr wasn't clear, so it's nice to have some more understanding. DDS tongue the has been checked by health visitor, two gps & at the hospital.after a referral yesterday, & they've all.said it's only slight so I'm doubting that is the issue. Not that I'd wish for dd to have to have the procedure to have it cut, but a part of me wishes that was the issue as then her feeding problems would.most likely work themselves out. The Drs haven't ruled out cutting it, but I'm doubting they will. DDs patch has already gotten worse because of the bottles, I always try her but she's pretty much unable to latch now so unfortunately I think breastfeeding is over for us now. I've accessed so much help for bf I don't think anything else can be done. At least she's getting some expressed and to be honest I don't even think she's bothered as long as she's getting milk.

DDS tongue tie*

DDS latch* sorry about the typos!

We've also ordered an electric pump as the manual pump takes so long, it should come in a few days.

The closer to nature type bottles help. My partner bought traditional style ones and I noticed his latch got worse. I got some tommee tippee ones from my sis and bought new teats and they were def better. I also used nipple shields. When he was about 10 wks he latched by himself, without shields and his latch has just got better ever since. Though he's is still lazy when tired. Don't give up on the breast feeding yet, your baby is still tiny. Keep offering for a month or so, you never know, your baby may surprise you, like mine did.

Just to add, we were told by our doctor that it's not just ok, but encouraged if you can, to mix the formula with the breast milk. Apparently, there are enzymes in the breast milk which help your baby to digest the formula.

We used the little bottles and kept the leftovers in the fridge (good for 24 hours). I know they're expensive, so if you are using the powder, I'd just round it up to the next quart.

I'd not thought about using nipple shields, that's definitely worth a try. I do feel sad if breastfeeding is over, I always wanted to do it for at least a year. I'll keep trying dd on my breast before her bottle, & buy some nipple shields too. I did try the closer to nature bottle that came with my manual pump - dd took it okay but seems to take the self sterilising mam ones a bit better, it's just a shame she's losing her latch with the bottles.

Okay it's nice to know you can mix them, I'll have a think about how to do it & what's best for us. Thank you all again

The madela calma bottles are designed for mix feeding no as the baby has to suck for any liquid to come out so in theory helps with nipple confusion issues. Definitely get nipple shields - I love them! My girl is 1 month and only just back to birth weight. On Tuesday we started mix feeding (hence why she's managed to get back to birth weight). Hv advised 4oz twice a day of formula so that's what we've been doing. I'm hoping to drop the am formula feed eventually. I'm
Going to Loan an electric pump too as my manual one doesn't get me much.

Thank you I'll look into those. My dh has just ordered some medela nipple shields that should come tomorrow, I'm really looking forward to trying them out (haha, I feel like such a mum looking forward to things like this). I struggle with my manual pump too, I'm getting an electric pump which should hopefully help. I tried hand expressing but that's even harder.

I'm glad to hear your dd is gaining weight, hope things go well for you both.

If I were you I'd get ready made cartons for the next few days / week. Just till things settle. It's so much easier. They last ages in the cupboard so even if you make up with powder when your Dh is around to help but have cartons when it's just you or you're particularly harassed. Believe me I inow how mad it is with feeding and expressing and storing bm.
My ds had a tt snipped at 2 weeks and was instantly feeding fine after. Before that I was pumping his top ups.

Yeah I do feel like my life revolves around pumping, trying to bf, making formula & sterilising - it would definitely help when dh is at work.

I've been given a lot of great suggestions so thank you everyone, I was feeling a bit clueless before!

I got the aptamil bottles (and nipple shields and everything ever made) off Amazon as it works out cheaper than the supermarket. I predict you will love the nipple shields. In case you don't know already some brands come in different sizes. I have small nipples and found the med uncomfy. Good luck with everything X

Ahh we got the nipple shields off Amazon but didn't even consider buying the formula (we're using Aptamil) from there too!

Thank you