Having to top up with formula - can you combine

[Mickj]

Had little baby Finn 3 weeks ago at home under water after a calm pregnancy and an 8 hour delivery which couldn't have gone better. I was so keen to keep Finn calm and happy but the breastfeeding has been such a problem. At first, incorrect positioning made the nipples bleed and feeding was usually done in tears. Had some great help from an NCT cousellor and thought it was all sorted, with a little pain but nothing like as bad as it had been. But the nipples got infected which resulted in me taking antibiotics and live yoghurt to try and stem possible thrush. Two days ago after what we thought had been a good week, the midwife weighed Finn and instead of a weight gain he had lost weight. I have felt like such a failure and that I have let the little fella down so soon. We were told that we would have to supplement with formula after every feed which we have done and the weight is creeping up. But does anyone know if you can realistically combine the two - Finn is already getting a bit lazy and getting latched on is continuing to be stressful for both of us. I have tried so hard, but there is so much conflicting advice where do you turn?? The feelings of guilt are stopping me enjoying my first baby.

Why don't you go back to your NCT counsellor? She can probably try to walk you through what you can do to reduce the botttles (if that's what you'd like).
Combining at THAT age is quite tricky...
Good luck !

Why did you take anti-bitoics ? That's what leads to thrush.... did you have mastitis?

I need to go to bed so can't wait for your reply.... (I am a BF counsellor BTW)... I don't understand soimething....
She was weighed 2 days ago and had lost weight.... now she is weighed 2 days later and has gained weight.
Was the scale used 2 days ago the same as the scale used before ? It is well known that results can be skewed.
If ypur DS is properly latched on and fed every 2h1/2 or 3h... and he poos and wees a lot (if it comes in it comes out).... he really should be fine. Topping up at every feed seem quite drastic to me.... MWs and HVs are (I am sorry) not the best qualified to help... we hear time and time again how their advice/knowledge is poor... if you have a MW/HV who truly knows what they are talking about then fabulous.... but it seems to me (from what you wrote) that topping up after every feed is NOT a brilliant idea... How much do you topup with and did that increase the time between feeds ? If so this will affect your supply.
Hence my initial suggestion that you contact your NCT counsellor.... I am sure she'll be happy to help as she has before.

Sorry I realise I say he/she in my post... very tired, long day.... I know it's a he !

I have posted my experience of mixed-feeding before and can confidently say that it can be done. I offered DD the breast at every feed and then gave her a bottle after (sometimes expressed and sometimes formula). It is hard work though and I didn't particularly enjoy it as, like you, I felt guilty. After 6 months she was completely breast fed and continued until she was 2 years old. Was your baby's weight loss very large? It can be a worry but after my first I learnt that many BF babies don't regain birthweight until about 4 weeks old - this alleviated my worries with my subsequent two children who I managed to BF totally.
See a counsellor again for more advice but don't let it get in the way of enjoying your baby's early weeks and months.

We are feeding every 3 hours and 4 overnight. We have been told to top up with 60ml of formula after every feed. Finn was not upp to his birth weight (3.4 kg) Lost a little and was at 3.22. Two days ago he was weighed and it came in at 3.20. After 2 days of topping up he is now 3.36 and we have been told to continue. Was prescribed the antibiotics by the doctor after examination of nipples which are v cracked and bleeding. Hope all this makes sense!

Midwives/health visitors can get you extremely wound up about weight gain and loss. With my second I had a wonderful pair who judged my daughter's health on how she appeared rather than recording every 25g loss or gain. If only they could all be so supportive.

Do remember that your breast milk is also contributing to his weight gain. The amount of formula you are giving him is actually very small and the initial weight loss could simply have been because he'd wet himself before being weighed. Did your antibiotics upset his stomach at all as that could have been a contributing factor? Prior to topping up did he seem content after a breast feed? Have you thought about expressing to top up? It sounds as though you are on the right track with the feeding and maybe your technique just needs a little tweaking. You have to do what makes you happy of course .

So he has lost 200gr in 3 weeks... that's 7oz.... that's not a big deal ! That's 6% of birthweight.
Also I am concerned that we are "judging" this little fellow's weight over 20gr (less than 1 ounce)...
2oz/60ml is a BIG top up IMO...
I would love to hear what Tiktok thinks of the preventive measure of AB for cracked nipples.... I would have thought that would INCREASE the risks of thrush....

From what you post I would urge you to speak to a lactation consultant (often available in hospitals) or a BF counsellor..... seems like you are falling for the "fear tactics".... it's quite normal you would but I would hate it for you to look back on this and realise you were scared into bottles....

Some AB also affect milk supply....
Good stuff/advice yoyo....

You can combine - I did with ds from 2w as a result of him dropping from 8lb10 birthweight to 7lb7. I gave him a bottle every four hours, but preceded it with a breastfeed (about 45-60m on the boobs each time). He never showed any nipple/bottle confusion or preference. I wonder whether that was because we used Avent teats and made sure that his mouth gaped wide around the base of the teat to try and mimic a natural breastfeeding position.

Ds fell in with the 4-hour schedule very comfortably, but I was miserable about bottling. At about 6w I decided to try and boost my breastmilk and had several long talks with NCT BFCs. I started by dropping the first bottle of the day and feeding on demand until he was looking for food at intervals shorter than 2h. Within a month he dropped the middle of the night feed completely (though he had to be woken for a dream-feed before I went to bed myself to maintain that), and went from 6 bottles a day to 2.5 bottles.

I can't recommend the NCT BFCs highly enough - I cried on their shoulders often enough! - so please do talk to them again, as often as you like, even if there's nothing 'new', just for some moral support. Anyway, if the latching isn't quite working then you could probably do with some more help fromt hem.

If Finn is well, why don't you try dropping an early bottle? Mornings are good because that is when you tend to have the most milk at this stage. Drink plenty, rest plenty, get plenty of skin-to-skin cuddling with your little one. Try feeding lying down on your side in bed, with you well-propped-up by cushions behind your back and under your neck.

Whatever has happened, you haven't failed him. Babies gain differently and feed differently (my ds was such a gentle feeder, yet I ended up mix-feeding him, whereas dd was an absolute ruffian, yet I managed to boob her and continued for nearly 2 years) and you are in no way 'to blame' for the difficulties you've encountered.

Mickj, I am off to bed, but have just seen this....so many questions and will write more tomorrow!

I too share pupuce's question of the accuracy of the weighing.

I disagree with one poster who says 60 ml top ups at every feed is not much - it amounts to quite an impact on the amount of stimulation your breasts are getting and it is likely to undermine your breastfeeding long term....however, none of this is irreversible, and yes, do call your NCT bfc again.

I will post more tomorrow! I can understand you feel bad about this, but with more info, you may think differently :)

My DS1 took four weeks to get back to his birth weight, and never really gained quickly (always 2-4 oz/week). But he was reasonably content, and pooing and weeing, so I stuck with it. He's three now, and still fairly slim, but absolutely fine.

If you're unhappy supplementing, seeing a BF counsellor is a good idea. Health visitors and midwives (and GPs!) aren't great on the subject of breastfeeding.

If the problem is supply, rather than latch or nipple pain, a nice trick to boost supply is to have a babymoon - go to bed with the baby, and just rest and feed together for the day.

Mickj, back again with more time :)

The frequency with which you're feeding means you are probably only feding 6-7 times in 24 hours. For many women, this isn't enough at the beginning to establish and maintain a good milk supply, and the cracked nipples makes me think the baby was not positioned in a way to feed effectively, too.

The best way to improve weight gain for anyone - not just babies! - is to eat often. With breastfeeding, this also stimulates a good supply. Milk supply is driven by the frequency of effective feeds.

Ask your midwife about feeding Finn more often - lots of skin to skin contact, co-bathing, co-sleeping, not waiting until he cries to feed, and responding to feeding cues promptly will almost certainly increase his 'visits' to the breast. If she feels he still needs supplementing, discuss reducing the freq and amount of supps. 60 mls at every feed is a lot, believe me, and it is likely to be reducing his feeds.

It is not normal for him to be still losing weight at 3 weeks. An initial weight loss is normal, but babies should not continue to lose after the first days (though they may gain slowly). You'd need to be looking for frequent, soft yellow poo after about day 5 as a sign all is well - did this/does this happen?

I'd also wonder about how he was weighed. If he was naked on electronic scales then you can have some confidence in the reading. If the midwife used 'hammock' scales or if the baby was in a nappy, then there is no way anyone should make a clinical decision based on that reading.

I hope you'll post again, with more info....and I really hope you can find someone to listen to you properly, and who understands how difficult and stressful it can be to be in your situation :(

I've been thinking about this a lot today and realised that you can sometimes be given too much info (and contradictory info too). Really think each baby (and mum) is an individual case and whilst we can generalise without seeing you or your baby feeding it is impossible to give advice which is specific to you. Really think you should see someone in person if possible (are you near Oxford as the JR used to have a breastfeeding clinic run by Chloe Fisher?). I spent a lot of time there with DD1 and did find it helpful.
I wouldn't get too stressed about the poo (I did thanks to my brother-in-law producing a leaflet with helpful photographs(!)). All mine have been different - every other day, after every feed - I even know of someone who's baby went every 3 days (we all knew about it when she did though!).

Hope things are starting to work out for you and that you are getting plenty of support.

yoyo, infrequent and unpredicatble poo is fine after the first weeks....but not necessarily before then. It can be a sign to check for effective intake.

Tiktok - do you not think though that there is a tendency to start looking at everything when feeding is not going as you would like? I remember smelling my daughter's breath, looking at her poo, weighing her before and after a breast feed... It all gets so stressful and I do think it makes enjoying your baby very difficult. I don't want to counter anything you say (I write from experience and interest but not from a professional standpoint) but it does worry me when first-time parents find that the issue of feeding hinders the enjoyment of their baby. This was certainly the case with my first and it is only since having my others that I realise what I missed and how difficult it all was. I remember greeting visitors with the words "I have to express milk now if you don't mind" and then hooking myself up to a double pump!!

I agree, yoyo - parents often look at everything and anything when they are worried about feeding. I'm not suggesting looking at everything and anything. I'm suggesting something easy, factual, non-interventionist and evidence-based. Weighing before and after a feed is none of those things :)

Thank you all for the advice - you have taken away those feelings of isolation - and some sound advice too from people who seem to be very experienced. had a good day today without the usual anxiety and fear of all the pain. I have been expressing before each feed which has been going quite well and topping up and Finn seems much happier. It was terrible watching him getting upset and then falling to pieces myself while we tried to feed. There have been no tears today and I have started to enjoy my baby which was impossible before. I think the strain on my husband was apparent too and he has been so supportive. But ultimately, this problem can consume you and for the moment all is so much better. i will continue to express until the nipples have healed a little and the advice about skin to skin is great. But seeing Finn today, looking at the Christmas lights, full and contented the worried look on his face gone was priceless. It was probably the first time the three if us just enjoyed the day together, Christmas shopping in Brent Cross with a happy little fella looking around at everything from the comfort of his pram!

Aah, Mickj, sounds wonderful . I'm so glad you've had a good day. You're right, it can be very stressful, both for you and for your partner, and a good day is a good thing to have in your memory 'bank'.

Glad you've had a good day Mickj. Had a similar thing with ds losing weight in his 4th week. we topped up as well. all incredibly worrying and stressful but it sounds like he and you are doing well. i also had my mum and mum-in-law at each shoulder telling me that unless he was gaining 100g a week without fail something was very wrong. aaaaaaaghh!! killer death rays!! i think without that i might have stuck to my guns, or breasts. had a go at relactating (reducing bottles) and that definitely helped me bf for longer, so if you can bear to give it a go, you may find it helpful. La Leche actually helped me more than NCT - it's all individual.

can i just say that i am a total fan of the Chloe Fisher/Sally Inch clinic at Oxford's JR, but they also use weighing before and after a feed sometimes. i was surprised to see this as i always thought it was this that caused my mum to give up bf at about 3 wks. but maybe it reassures some mums that something's going in.

acnebride - I have no problem with 'test weighing' as it's called, when carried out by experienced people who know what they are doing and can set whatever result they get into a context, and can offer support through the crisis.

If it's done by 'amateurs' then it's bad news!

hello

i breastfed dd every 2 hours for a couple of months and her weight gain was slow and steady. sometimes she fed all evening, im glad i didnt ask my hv then. i just spoke to th enct councellors who helped me through those first excruciating nipple bleeding weeks, well two weeks to be exact, they were so helpful and i remember crying to them saying i must be doing it wrong because of the pain and that she neber seemed filled up but it does take awhile for your supply to match their needs. I would rec any mum to speak to b/f councellors and stick at the feeding for a few months then if you are still worried try topping up. I was not aware of "topping up" when i was going through it all which im glad of as i probably would of jumped at it... I know how hard it can be and worrying, becoming a mother makes you face all these options and feelings of guilt but dont worry as we are all in the same boat

:)

Sorry should say bf for 8 months but every two hours up to 2 months

thanks acnebride- you are so right- putting things into perspective and not feeling such a failure anymore. Finn is so much happier and the irony is that my breasts are expressing nicely and he is still getting quite a good supply. I think it is the first time I have relaxed and so the milk letdown is much better. But for all new mums, its good to know that you are not alone and not a failure - and there is life after all those tears and heartache. Mumsnet chatters - thanks again and much lovexxxx