Please help! 4 week old advised to top up with formula

[Manal92]

I'm really hoping someone can help or reassure me as I am feeling really low. This post is going to be really longwinded so I apologise in advance but I just want to give all the information for better understanding!

I'll start from the beginning - so my baby is currently 4 weeks old exactly. Thankfully I had an uneventful pregnancy and a natural birth but afterwards I had lost a lot of blood. I was admitted to hospital directly afterwards and was given a blood transfusion. 4 days later I was discharged (baby was healthy and born at 3.280kg with no issues) but whilst I was at hospital my milk supply seemed really low and baby was very fussy at night so one of the midwives advised me to give her one bottle of formula at night. This continued even after I left hospital, I would breastfeed her all day but at night give her one bottle of formula (60ml).

So at her first 5 day weigh in she had gained a bit of weight (3.410g) which the midwife was really surprised about. Then at her second weigh in at 9 days she gained weight again (3.480). When my baby was 13 days old I stopped formula cold turkey and was just breastfeeding (as that was always my intention from the start but due to difficulties at the hospital I couldn't). I felt that my milk supply was a lot better and my breastfeeding support worker advised me that it would continue to improve if I just constantly offered her the breast whenever she seemed hungry.

I saw the midwife again at 16 days who weighed her and found that she had lost a little. (3.400kg) I was so disappointed but she advised me to just continue with exclusive breastfeeding and to come back the next week for another weigh in. I went back the same time next week (when baby was 23 days) and the weight dropped again (3.345kg). I also told the midwife that baby was only pooing once every 6 to 7 days and considering this and the weight loss she advised me to take her into hospital.

Once I took her in the doctor had a look at her and took some obs, but straight away she said that I may have to top her up with formula :(. I was so upset at that point because I had really struggled through the breastfeeding and I thought that I had been doing well. The doctor saw my reaction and said that she wanted me to sit there and breastfeed her for 20 minutes then she was going to offer her formula. She said if she drank alot of the formula it meant that clearly she wasn't getting much out of me and that she needed to be topped up.

Which is what happened - baby drank about 30ml of formula straight after I had breastfed her. So after seeing that the doctor said that from then onwards after everytime I breastfeed her I should top up with 30ml of formula. I'd like to also add I kept asking her various questions about breastfeeding but she said she wasn't really an expert which really did confuse me as I wasn't sure if I should take her advice to begin with. She also made a horrible comment saying that my babys ribs were showing which just made me feel like I was starving her. Although deep down I really wanted to persevere with the breastfeeding I felt guilty if I didn't top up with formula as maybe I really didn't have enough milk.

So now really my question is will my milk supply be affected although I will always offer her breast before the formula? And for the last week I've been giving roughly 120ml of formula a day and I have another weigh in tomorrow to see how it's been going! Also do you think that I could ever go back to exclusively breastfeeding?

Any comments or advice will be so much appreciated and also I welcome any questions!

You were told to feed for 20min and then top up. How long would a feed be if you wanted for baby to come off?

Is she always taking the 30ml bottle? How often are you offering the bottle? Do you offer the breast after the bottle? Is she happy taking the bottle?

Your supply will likely be affected if you're giving her that much formula that often. It depends if she's taking the formula as extra or instead of breast milk though. But there are ways to improve it if you want to go back to just breast feeding, or you could maintain a lower level and intentionally combi feed.

If you want to breastfeed you need to be seeing someone who supports that. Don't be afraid to ask for a second or third opinion if your questions aren't answered or you don't feel like you're being good advice. You get to decide what is best for your child so don't be bullied into doing something you don't agree with (because that's what's happening if you're being made to feel guilty for doing your best). find a doctor who will help you come to a decision that you're comfortable with.

It does look like your baby is losing a bit of weight, but do also try to remember that 100g could be the difference between before/after a feed and wet/dry nappy.

And please keep asking on here if you want help/advice/support.

I didn't want to post a massive reply because that's probably not helpful, but there are plenty of us on here who have been where you are and want to help.

Oh goodness, you've been so poorly supported with a catalogue of bad advice from the very beginning. I'm so sorry
That evening bottle of formula will have almost certainly impacted on your supply early on and meant to breasts were going too long between feeds to go cold turkey and make enough milk to ebf.
The weight loss and lack of poo after stopping that evening bottle was a big concern, but at this point you should have been offered breastfeeding support, looking at increasing supply by pumping, increasing the number of feeds and topping up with expressed breastmilk. I honestly don't know where to begin with how wrong that hospital doctor was with everything they told you
Can you find some good breastfeeding support? A lactation consultant would work with you to turn this around with a pumping and feeding plan.
It will mean feeding off both breasts every 2-3 hours, pumping in between and gradually reducing the formula, replacing it with the expressed milk as you go.
Good luck - with the right support you can do this

BumbleBerries - Thank you so much for your response! Well normally when I'm just breastfeeding during the daytime baby will feed for 10-15 mins and then fall asleep. Most of the time I have to keep waking her and ill usually let her feed for 30 mins to 45 before letting her nod off.

Yep she always takes the bottle. However I haven't been following the doctors orders exactly because I'm using Hipp Organic which only gives measurements for as little as 60ml so I've been giving her 60ml twice a day - once in the morning and once at night. I always offer her breast after the bottle also as I find she can only really fall asleep on the breast.

When you say maintain a lower level - do you think I should be giving her a less quantity of formula or just left often in the day? And the day before she was weighed the second time she did a massive poo which made me wonder if it had an effect on the weight that day!

If I did want to continue mix feeding I wonder what the best way to go about it if I wanted to keep my supply but also top her up here and there.

Yes I'm being seen by a health visitor tomorrow for another weigh in so I will definitely ask her about these issues although as you said I should probably get in contact with an expert..

I'm just wondering if there's such a thing as a person just having a low milk supply and there not being any way to improve it, as when I was exclusively breastfeeding her for over a week she was constantly (and I mean constantly) on the boob throughout the day and night and she still managed to lose weight.

But you have been very helpful it's nice to know I'm not alone here, thank you

Chickchickadee555 -thank you also for your helpful response! wow it makes so much sense now, why my milk supply was so low to begin with. To be honest I did try to express milk at the start but I found that I really didn't have time and couldn't keep it up.

Sounds crazy but it feels like all i do is breastfeed and when I'm not doing that then I'm trying to nap. Also when baby is sleeping I can never really put her down as she wakes up straight away so i have to hold her or she won't sleep!

Yep my midwife gave me the contact details for breastfeeding support which have come to visit me once, but the lady just said to keep feeding her whenever she was hungry (which is all the time) and to try and express every 3 hours (which feels impossible to maintain)

Hi manal.

The best thing to do would to go along to your local breastfeeding support group if you have one? My town runs it at the local children’s centre. You could also contact your health visitor or midwife unit for some help.

It does sound like you were badly advised to top up with formula. As your baby may have been cluster feeding to build up your milk supply.

When my daughter was born I thought that I didn’t have enough milk as she seems to constantly be feeding so topped up with formula too and it took ages to get a supply. I did all the antenatal classes NCT etc. but no one really tells you about this! You just kind of expect to have loads of milk straight away but that’s just not always the case.

Do you have a breast pump? I would start expressing between feeds to build up your supply, then you can slowly start reducing the formula depending on how you get on.

Let her feed on you as much as possible even if it is just for comfort as this will also help build supply.

Good luck and well done for keeping going, breastfeeding is hard but I’m 10 weeks in now and it’s so worth it.

Also just to add, when I first tried to express hardly any milk came out! Now I can express a whole bottles worth and still have enough milk to feed the baby if she’s hungry. It’s hard work steralising everything etc. when you want to use that time to rest but it may be an option.

Can you speak to the breastfeeding support again? I think you need a better plan in place as it sounds like she's been a little vague.
Are you managing to express at all? Until you start doing so regularly, your supply will never catch up and - to be totally honest - may well start to decrease further.
How many breastfeeds in 24 hours would you say LO has? Do you use both breasts each time?
The other thing to bear in mind is that night time feeds are really important for establishing supply, so by giving a large bottle of formula overnight from the off, the breasts were being told that the milk wasn't needed and to slow down production.
Blood loss CAN cause issues with milk supply, but the fussing you describe may well have been normal and if there were issues with supply then these will have been exacerbated by introducing formula.
Truly, I'm so cross for you.

Can you hear the swallowing? (If you're not sure the answer is no) and can you feel the let down?

I don't have experience with combi feeding, but you have two options, either top up after each feed or have some set bottle feeds and breast feed the rest of the time. You are currently doing the second option and that is probably easier if you want to sustain it. Feeding on demand should keep your supply at the level that is demanded, so if you carry on like this you'd probably need to keep giving bottles but wouldn't need to increase the amount.
If you want to cut out the formula it might be better to spread it out across the day, ideally express after each lot of formula until you can replace it with ebm, then wean off the bottles. You can split a made bottle and store half in the fridge for a certain period of time as well. If you can't express after because you're feeding that's fine too, comfort feeding should do the same job. If you're reducing the formula then reduce the amount in each bottle slowly so your body can catch up. Importantly don't increase the formula, baby will have grown spurts and you will feel like you don't have enough milk, ride out a couple of days and the milk will come.

Some people have actual medical conditions which mean that they'll never produce enough milk, but that is very rare. 'Diagnosing' supply issues is the default position for poor weight gain, because the 'solution' is formula which almost always results in weight gain. Generally the low supply (If it exists) is due to low demand either through poor feeding (which imo should be diagnosed and if possible rectified) or through use of formula, and not because of an actual supply problem. Nothing you've said so far suggests to me (not a doctor) that you have supply issues that would stop you exclusively breastfeeding.

I had a similar situation. I felt terribly guilty that I somehow wasn’t feeding her properly. I went to endless bf workshops, had a volunteer come round to my house, all of it. Then a midwife told me I had to start giving her more formula because she was underweight, and it was a wake-up call. She said the baby wasn’t feeding properly - the fact she was falling asleep midway through a feed was that she was exhausted by trying to get milk.

So I upped the bottles for a while, still always offering a bf first. By 4-5 months she just started breastfeeding really well and I dropped all bottles except the bedtime one (and I only kept that one because I wanted my DH to do that feed sometimes). Looking back, I so wish I’d increased the bottles sooner.

So what I’m trying to say is, persevere with bf but don’t feel bad about formula, the most important thing is that your baby puts on weight. The bf will come good in the end.

Honey2018 - you are so right! I signed myself up for so many classes while I was pregnant but I never expected breastfeeding to be so challenging and was never really told about these kind of setbacks that could occur.

I was seen by the heath visitor today, and thankfully my baby put on 150g since the last weigh in . She did say the exact same thing as most of you guys, I should get a pump and try to express milk whenever I can to build up my supply. I've just ordered one on Amazon, and I'm going to see how it goes. If I can keep it up, I'll try an invest in a good quality pump. And the exact same thing happened to me when I first tried to express milk - a few dribbles came out and I was so disheartened I never really tried again. It is really hard work to sterilise etc but since I'm already doing that when I have to give her formula I think expressing won't really be any different!

Chickchickadee555 - you are totally right, hopefully my pump will arrive tomorrow (I chose next day delivery as I'm eager to get this started ASAP) and I will start expressing regularly to build my supply. I would say in 24 hours I probably breastfeed her around 9 or 10 times and I'll always offer her both breasts. In the evening time she can get very fussy so I'll keep alternating breasts as it seems to calm her down when I do so.

Ahh it's such a shame, I really wish I had posted on here right at the beginning but to be fair I had so many midwives around me at the hospital I really thought I was getting the best advice possible .

Not to worry though, I'm really eager to try and just fix this now, and you girls have really encouraged me! I still have the breastfeeding support contact details so I will call tomorrow to find out more about expressing and how I can wean her off the formula.

BumbleBerries - yes when I first put her on the breast I can hear constant swallowing but then it starts to get more infrequent and when I notice its stopped I'll try breast compressions. In terms of let down I'm not sure tbh, what does it feel like?

That's really helpful thanks, I think I will follow your advice regarding cutting out formula altogether, I will try to express enough so that I can replace it with breastmilk. My health visitor seemed to think that was the best option for me also.

I thought the same thing, when I was exclusively breastfeeding I felt that my supply had really increased hence why I was so upset when she had lost weight. I feel that when I was giving her formula in the beginning it impacted on my supply hence why I switched to just breastfeeding as I wanted to improve it.

Frenchsticker - what you said really made me think, when I was exclusively breastfeeding my baby would always fall asleep after feeding for 10/15 mins in the daytime and stupidly I would just let her sleep without thinking I needed to wake her. One midwife told me that she might have lost weight because she was only getting the foremilk and no hind milk because she wasn't breastfeeding for long enough.

That's really encouraging though, I was being really hard on myself for giving her formula and I felt like I wasn't doing the best thing for my baby by not exclusively breastfeeding but now I'm starting to accept the situation abit more. I will do my best to try and express so that my supply doesn't suffer and eventually try and replace the formula with breastmilk. If it doesn't work out for any reason then I wont feel bad for topping up here and there!

Out of curiosity what is the best formula for mix feeding? And also how long would you normally let baby breastfeed before you give her the formula directly afterwards?

Thanks everyone for all your responses I really didn't expect this many people to respond and to be so detailed, honestly it's been so helpful and really nice to know that there is support out there

It's good you've got a pump coming. You're unlikely to get a lot at first, and that's okay, it will build up. Little and often is key. It's okay to mix breast and formula in the bottle if you only have a little (but let the formula cool before adding the breast). The good thing about pumping is that if baby is healthy and term you don't have to steralise, just wash in hot soapy water.
I know I hated people telling me this but a good pump can make the world of difference and no amount of recommendations will help because it depends on your body, I went from 60ml in 1h30 in the hospital to 60ml in 20min at home, if it's not working and you can't afford to to try new ones beg and borrow - don't put yourself through what I did (and don't ever express for that long i was given really bad advice).

Don't worry about not feeling the let down, perfectly normal. for some women it's pop-gush for others it's a slow trickle. I was just checking that she was actually sucking milk out rather than just drinking the let down, saying you fed constantly made me wonder. It sounds like she is sucking at least a bit though with the gulping at the start which is a really good sign and shows that baby can feed. But if the breast compressions are helping a lot then this could be happening and it's worth looking into for example tounge tie, poor suck, or poor latch.

I never used formula but I'd stick to the normal kinds. I think the anti colic / anti reflux / comfort / hungry ones are generally thicker and you want it as close to your milk as possible. Obviously that doesn't apply if she has reflux etc. If people know better please correct me. Use teats with the slowest flow she'll accept so that bottles aren't easier than breast.

If it were me I'd g ive her side one until she was finished the side two until she was finished then bottle until she was finished, and repeat that sequence indefinitely. By finished i mean either fussing or asleep or refusing. If she was asleep but still hungry i found switching her over or sitting her up woke her enough. If it didn't i assumed she was finished finished and let her sleep. But that depends on how sleepy your baby is. But I definitely wouldn't take her off if she was awake and feeding that's just giving her formula when she is happy breastfeeding. And if she's taking plenty of the formula I'd be tempted to only offer it only once per feed, but repeating breasts as often as necessary.

And forget about the foremilk/hindmilk thing. I can explain it you want but long term it makes negligible difference.

And you have absolutely done the right thing giving formula. You have done what you felt was best for your baby based on the advice given every step of the way, and that makes it the right thing (even if it may have been poor advice).

BumbleBerries - yep I only managed to fit in one pumping session today and it was less than I expected to come out but I'll just keep going and hopefully it will improve. How often would you pump in a day to begin with? And at what times?

And when you say you don't have to sterilise the pump, do you just mean everytime you use it or do you still have to sterilise it once a day?

Also when you say asleep but still hungry how can you tell?

So if the foremilk thing isn't really true then how long would you say is a good time to feed for per breast?

Sorry for all the questions but once again thank you for the detailed advice you've been so helpful

Hi Manal,
If the plan is to get LO back to ebf then you will need to pump at least every time he has a top up. That's the only way you're going to be able to increase supply to meet demand.
Once a day isn't going to be anything like enough.
I'd also look to increase the number of direct breastfeeds - 9 is at the lower end of what we'd expect for this stage. Can you up this to 12?
Re sterilising - you don't need to sterilise a breastpump or bottles which have only come into contact with breastmilk. Breastmilk is anti-bacterial so hot soapy water is fine.
I disagree with pp advice to mix formula and breastmilk in the same bottle. Not only does this mean you'd have to sterilise the bottles but also, if LO doesn't take the full top up, that's a waste of hard fought for breastmilk

*she, sorry!

Have you heard of a Haaka or Nature Bond pump? It attaches to one side whilst you feed/pump from the other and will catch the let down on that side - if you are like me at this stage both sides will let down for every feed. It made all the difference to me on being able to express some - being/not being able to express doesn't translate to whether you can successfully BF by the way. I'm sorry you've had some poor advice from Drs and a huge well done for persevering.

I would follow your doctor's advice!

Is there a breastfeeding support group near you? Ideally you need one which has a professional, well-trained adviser, as some of the advice you've been given is confusing and contradictory.

With my first baby, I was told to top up after he lost too much weight and try expressing, and ended up paying a fortune to rent a breastpump via the NCT. Actually my dad paid, but it was a waste of his money. I never got very much milk via expressing. I gave up and felt terrible. But I had found someone who could give me much better advice, and worked with the health visitor team.

With my 2nd baby I did end up giving limited top ups, but I tried to get dp to give them as much as possible, and gave up the top ups when DS2 kept crying as I was washing up bottles. I did go through some spells of constant feeding and he never grew very fast but he did put on weight and in the end I breastfed him for a very long time, just a couple of feeds and then one at the end. He did have formula at his childminder during the day 4 days a week from 8.5 months but by then he wasn't exclusively breastfed anyway.

I believe expressing can be useful for some women, but I found that only directly feeding helped to get the supply right, and I only found out later that not expressing successfully doesn't always mean you can't directly feed.

Gosh Op you poor thing. I was forced to give formula top ups when we were taken back into hopsital after a week , I was so determined to bf and it took a while after a c/s for my milk to come In. The HV went into raptures when she saw my breast pump. I pumped for 10 mins after every feed to get my supply up and it worked so I ebf eventually.
Have you checked for tongue tie, top and bottom lip, to ensure latch is good?
Also second feeding long enough on one side to get the fattier hindmilk rather than just thirst quenching foremilk (we are amazing creatures to automatically dispense perfectly aren't we?)
Also re weight, on formula they do pile it on so I imagine a drop in gain is normal when formula is decreased and replaced by bf.
Well done you for sticking with it, I nearly bailed when DC was instantly pacified with formula and it took 2 minutes compared to ages bf with sore nipples etc, but once we were rocking, for me nothing came close to the bonding through just having to cuddle and provide and the hazy daze of the hormones

I've been thinking about you. I should have said this sooner but this takes time, and when it's you it can feel like forever.

In terms of pumping schedules the most important thing is that it works for you, if it's not sustainable then you won't be able to keep it up and it won't do much good. You do want to be doing the same thing every day, and give yourself a maximum time for pumping each try. Do you have a partner who can help with the baby while you express? If you do then express literally when your baby is having her bottle. Obviously that isn't going to work all the time though. Does baby nap not on You after a feed? if so that's a good time too. If you're trying to increase supply then you ideally want to be expressing either every feed or every 3hours. If you're trying to cut out bottles then whenever you give a bottle. If you're trying to cut out formula then whenever is convenient so long as you're consistent.

It's really hard to give good advice on this because we don't know why baby isn't drinking enough from you, and none of this is a quick fix. It actually really bugs me that there's no interest by professionals in identifying what issues actually are.

I washed in hot water once a day and kept the milky parts in the fridge the rest of the time (don't think that's really necessay), they didn't clean the hospital one more often than that so I assumed it was fine.

At that age you can't really tell if they're asleep hungry. If they're both hungry and tired something will win. telling us mostly instinct on your part. I personally found that if dd was full i could put her in her crib asleep after a feed, if she was hungry that would result in screaming within a couple of minutes. Your baby might be different though. I've also heard that asleep babies are more floppy if they're full than if they're hungry where they're more tense, clenched fists etc.

Feed for however long baby wants to. The milk coming out of you during a feed changes from foremilk to hindmilk, the milk you produce is just milk. So if baby only gets foremilk one feed the next feed will just be fattier. The fat sticks to the sides and is harder to get out, but it's not just going to sit there forever it'll be washed out with time.

I should say that I agree with not mixing the milk. I think I was saying if you've got too little to give in a bottle without baby taking too much air then it's an option. But it's really disheartening to waste milk, so don't if you can avoid it.

And whilst pp have said it better than me, pumping is totally optional. You can get back to exclusive breastfeeding without it if you want to, it's a good tool but just that and if it doesn't work for you don't let it get you down. Some women really struggle with it and that doesn't reflect on their ability to breastfeed, you'll find women who haven't managed to breastfeed but exclusively pump, and some who have easily breastfeed but can't get a drop expressing.

There are herbs you can take that will increase supply and be safe for baby, also she is falling asleep in the breast stroke her cheek or the palm of her hand to wake her up a little