Combination fed baby not satisfied after breastfeeding - is my milk any good?

[Lunalovepud]

Hoping for some Mumsnet wisdom here!

I am combination feeding DD (5 weeks). She has approximately 3 formula feeds per day and for the rest of the time is breastfed on demand.

Breastfeeding seems to satisfy her for a shorter period of time than formula feeds and this evening I have run dry with the constant feeding.

Is it possible that my milk isn't good enough?

Is it normal to run out of milk?

She seems to be putting on weight - at least she had at her 2 week check - and she is producing wet and dirty nappies... She isn't dehydrated - her fontanelle isn't sunken or anything like that and she is alert and interested in everything...

I couldn't BF my first baby and was devastated so I am very resistant to giving up breastfeeding DD - I am just not sure that my milk is good enough for her and am not sure whether to up the formula a bit as she seems to get really hungry.

I am pretty ignorant about the specifics and mechanics of BFing so I am not sure if this is normal - I took a class before DC1 but my knowledge really only extends to the fact that it is a supply and demand thing - nothing more.

Any help really appreciated.

Also - not sure if this helps at all but she always gets the boob first before a formula feed...

Lots of good questions! Breastfeeding in the early weeks works on supply & demand, so the more you feed the more milk you'll make (and vice versa) It's normal to cluster feed in the evening at this stage and it doesn't mean you've run out of milk, but rather your baby is fuelling future supply! I'll try and find some good articles that explain it all and post links...
Kellymom is a great website

Breast milk production is very much supply and demand so the more your daughter feeds the more milk you will make which unfortunately means that the more formula you give the less milk you will make.

I.e if you are giving 4oz of formula three times a day that's 360mls of breast milk that isn't being produced because your body doesn't know your baby needs it.

As your baby grows and needs more milk the less your milk supply will be able to satisfy her as you haven't been producing enough due to formula having been given in replacement of breast feeds.

Breast milk is digested a lot quicker than formula, that's just the nature of it so it's common for breast fed babies to feed 2-3 hourly, sometimes even more frequently. It's not a case of her wanting regular breast feeds because you aren't satisfying her it's because that's how breast fed babies behave.

What times are you giving the formula? The hormones involved in breast milk production are at their highest overnight between midnight and 4am I believe so it's important you breast feed during this time.

Have you tried pumping after you breast feed as this will also stimulate your supply and then the expressed milk could be given in replacement of formula.

Well done on maintaining the breast feeding through difficult times, it's a very draining and confusing process but if you want to breast feed as long as you then just keep letting your baby feed and feed at the breast as that's the only way to maintain your supply to meet her needs.

Writer has explained it well.

Three formula feeds a day in the very early weeks is probably too much to maintain a long term breastmilk supply. The breastfeeding production line is likely to slow down and cease activity with this volume of formula. Some women get away with it, true, but most women just won't - in the early weeks, bf round the clock with no long gaps between feeds is the way bf gets established. Formula tends to increase the gaps between bf - that's usually why it is used. But it's not helpful if you want to maintain your bf.

Can you discuss your options in real life with a bfc or knowledgable hcp? I think you need a plan . If you continue doing what you are doing your milk supply will decrease, based on what you have said now.

Combination feeding may well be easier in a few weeks.

Rough routine is:

7am ish - breastfeed both sides
8 - 9 ish - 100ml formula
Rest of morning / afternoon - breastfeed on demand
4.30 / 5ish - 100ml formula
rest of afternoon / evening - breastfeed on demand
Before bed - 120ml formula
Night wakings - all breastfed

I thought if I kept the formula feeds roughly the same my supply would increase with her increased demand? The formula gives me a chance to feed and play with my 2 year old son and also to get a chunk of sleep at night which is invaluable with a newborn and a toddler who still wakes up twice per night.

I was going to start pumping at 6 weeks.

Luna, I think the thing is that this may not be enough BF for you in your own individual circumstances. It's a lot of formula - you don't say how much your baby weighs but let's say she's nine pounds. She's getting about half of her necessary intake in formula. This isn't sustainable for most women in terms of maintaining a good milk supply - not in these vital early weeks.

The formula is increasing the gaps between BFs, and this reduces supply. This is not something you can do anything about 'cos that's how it works! All you can do if you want to maintain both BF and FF is to work on reducing the formula in volume and frequency. Then the impact on BF will be less.

Hope this helps.

Thank you both - that's really helpful.

I am going to try to ditch the daytime feeds and only keep the last thing at night one so I remain sane.

I think I am just a bit worried that my milk isn't good enough nutritionally and that is why she is so hungry all the time... I don't suppose there is any way of telling for sure whether it is ok? Apart from weighing her regularly?

Your milk IS good enough. As pps have said breastmilk is much more easily digested by your baby as that is what it's there for. Formula is much harder to digest, so your baby seems to stay fuller for longer. This is why formular fed babies are much more likely to get colic-y - the guts struggle to digest the formula.
As pps have said - the only way to increase milk supply is to breast feed more. Don't try and get hung up on constantly weighing your baby. Just feed her on demand, she will be ok!

Your milk will be fine nutritionally. Quality of milk remains constant. It's volume that is affected. Milk supply is usually not established as early as this and 300 MLS plus of formula is undermining establishment every day.

Work on boosting breast milk supply by dropping formula gradually. You won't make up the deficit immediately. If you want to keep one formula feed going you will need to work towards it over a period of several days at least - bf more and more. Good luck!

I having discussed this with DP and trialled reducing formula feeds in volume over the weekends, I really can't see how breastfeeding on demand with no formula is going to be sustainable for our family - I have no time for DS and that's with DP here to play with and entertain him.

I'm currently breastfeeding on demand for about 4 and a half / 5 hours per day - I just don't have the time to do any more! I am going to talk to a lactation consultant to see if we can make some kind of a plan where my supply increases along with her demand but means we can keep formula feeds as part of the daily routine. If this was my first baby I would ebf no problem but I have another child to consider and he has already finding the adjustment very difficult - I don't want to make it harder for him.

I'm hoping for some answers from the LC otherwise I'm not sure what we will do...

How old is your other child?

I have a 3.5 year old and was very worried whilst pregnant how I would manage breast feeding whilst entertaining him but thankfully he's not been as bad as I thought.

He does play up a little whilst I'm breast feeding (my baby is 3 weeks old) but he can be reasoned with and distracted. It probably means he's watching far too much youtube on the iPad than I'd like but needs must.

I just make sure that I spend one-on-one time with him when I'm not breast feeding. One thing I try and make sure I can do every night is his bath time and his bedtime just so we can have that hour together. It hasn't been possible every night but I try and achieve it as best I can. A few nights I've sat breast feeding next to the bath but I always pass baby back to DH when it comes to reading bedtime stories and tucking DS1 into bed.

I have felt a lot of guilt about not being able to spread out my time evenly but I think every mother probably feels like that. A lot of people have reassured me that as the newborn cluster feeding days settle down things will improve as baby will be able to go longer between feeds and feed quicker so I won't always be attached to baby. I breast fed my first son until he was 2.5 years and so he understands that it's milk food for the baby because he remembers feeding himself and so he's pretty good at just letting me get on with it. Whenever the new baby cries my son will shout out at the op of his voice, "mommy, the baby needs feeding!!!"

All you can is what's best for your family and if that means giving formula alongside some breast feeds then so be it. Don't feel guilty about any decisions you make

You can maintain some formula alongside bf. The LC should help you make a plan. But first you have to protect your BF....and that does mean, in the short term, BF more.

Hope it all works out well

Hi everyone,

Thanks for all of your suggestions.

Just in case anyone searches for advice on something similar in the future I thought I would update...

I have seen a lactation consultant and the problem for us was caused by an undiagnosed posterior tongue tie limiting movement of the tongue and therefore limiting effective nursing.

Baby was spending ages on the boob but not really getting very much milk meaning she was less satisfied with the breastfeed and was getting tired and falling asleep / coming off early and not completing the feed. She was more satisfied with the bottle as the flow is faster and she could get a full feed from the bottle.

Hopefully the TT division will have solved it!

I have been advised that if I want to continue to combi feed, a formula fed baby would need 180ml per kg of their body weight per day so I can calculate her 100% needs based on that and then divide it by whatever % I want the formula to be, meaning my supply will increase along with her needs providing the formula stays at the same percentage.

Hopefully things will start to even out a bit over the next few days as I have been spending most of the day and night nursing and my poor nips could do with a bit of a break!

My advice to anyone having similar difficulties would be to contact a lactation consultant or breastfeeding counsellor as soon as you can... Had I not done so I probably would have ended up increasing the formula and eventually stopping breastfeeding altogether as my baby was crying constantly when not on the breast / after a formula feed.

Thanks again everyone and good luck to anyone who may be having a similar experience and may come accross this thread in the future.

Hi Luna;

I'm very late to the thread! I could have written this myself. I have the exact same issue, I was struggling breastfeeding my youngest (eldest is 2). Became unwell ended up in hospital and on antibiotics I couldn't breastfeed with. Then given more antibiotics that upset my little ones stomach, so we are currently on 4 bottles on ff a day and I breastfeed around those.
I just wanted to know what you ended up doing in the end? Did you manage to continue or did you go to ff.
I feel guilty for having less time for my eldest, and guilty for not doing the same for my youngest I did for my second. I combi fed her until 1yr old, but only did 2 bottles a day x