Supplementary formula feeding at 2 weeks - should I express as well to keep milk supply up? No joy with electric pump.

[m27]

Midwife was concerned that DD losing weight at 2 weeks so has suggested formula feeding twice a day. We've been doing this for three days and its going well - she's lapping up the formula like its going out of fashion and also breastfeeding throughout the day.

But, I don't want to lose / decrease my milk supply so do I have to express at the times when my husband is giving the formula feed (7pm and 11pm)?

I've tried using the Medela mini electric pump and I can't seem to get more than 40ml out after a good 40 minutes pumping, and sometimes only 20ml. I hate using it and find it really painful. I know I have more milk than is coming out with the pump as I can express more by hand.

Any advice on using pump or even if I have to use it would be much appreciated.

AFAIK, you should express as much as possible, or in fact, stop topping up and feed your baby as often as she wants to.

formula will interfere with establishing your milk supply especially in teh early days, your baby needs to go to the breast as often as possible to make sure that your supply reaches her demands... and also more prolactin is produced at night, so not feeding all night might not be a good thing.

also, expressing is not a good indication of milk supply, as the pump is not as efficient at extracting milk from teh breast as a newborn.

www.kellymom.com is great for breastfeeding info

replacing a breastfeed with a formula feed will decrease your supply.
as camilla says, the best thing you can do is feed baby more often, this will help her weight gain, and increase your supply

Stop the supplementing - this will be decreasing your supply as your breasts will think dd wants less milk.
How much weight has she lost - is it more than 10% of her birthweight?
You can try expressing as well as feeding her to increase your supply.
It might be worth trying a different pump - my boobs were rubbish on elec pumps and I could only express with an Avent hand pump. A friend coudn't get on with any pumps but could hand express no problem.
If you want more info la lache league or ABM (asoc of bfing mums) can help too
(Although the best source is usually MN!)

howbreastfeedingworks.com a mumnsetter's blog with fab advice and the numbers for the free breastfeeding helplines

Hi M7

That is quite a lot of formula for your DD to have at such a young age and yes, it is likely to have an effect on your supply.

Did your midwife give you any indication why your DD would be losing weight by breastfeeding alone? Did she watch your DD feed? Did she refer you to a BF counsellor?

If you want to carry on BF then pumping and giving formula is not the answer. You need to make sure that your DD is getting to the breast milk and then feed. I would contact one of the BF helplines and talk to someone who actually knows something about breastfeeding (which it doesn't sound like your midwife does TBH).

Congrats on your DD by the way

Hi M7 - just wondered how you were getting on today? Hope dd is feeding better and sorry you have a mw that is not as clued up on bfing as she could be

m27 - there are indeed some situations where a baby needs to be supplemented with formula milk, and maybe yours is one of them.

OTOH, maybe your midwife is not as supportive of your bf as she should be - certainly, to tell you to supplement with formula milk twice a day and not emphasise that you must express in order to protect your milk supply (and to produce a supplement of expressed breastmilk instead of formula) makes me wonder how good she is at her job

If your baby has formula at 7 pm and 11 pm, and you don't express at those times, your milk will decrease quite rapidly...that makes a massive long gap between breastfeeds, and long gaps mean milk supply dwindles.

Can you ask the midwife about preserving your milk supply, and how long she thinks supplementing will be necessary?

Hi m27,
I have been in a similar situation. its great that you are home and able to ask for help over tinternet as i was in hosp and kept getting rubbish info/no info. i had to start supplementing at 2 weeks as LO had become too weak to suck properly without some extra calories+fluids, and I too could not pump enough for his needs.

lo now 5 weeks but i can tell you weaning off the formula has been a nightmare as my supply had tanked. so think carefully about how necessary the formula topups are. for me they were essential but you may want to take a 2nd opinion. ?baby cafe near you etc.

being able to express 20-40ml is completely normal. when i started i could only express 15ml or so. pumping is a learnt skill. the secret is getting a good let down - for which you have to be very calm and relaxed and think soppy thoughts about baby!

anyway it doesnt matter too much if you can only express 20ml, IMO it is more important to express frequently. But if electric pumping is painful why do it??? (it will give you sore nipples, and the pain/negative feelings will be interfering with the amount of milk you can get out by pumping) use the vacuum on its lowest setting or hand-express instead. i am using medela swing and find it to be comfortable only on lowest settings.

GOOD LUCK and don't give up!

Thanks to everyone for the advice.

DD is doing much better - she's gone from 3.1kg to 3.4kg since Friday so is finally above her birth weight. Today's midwife (different one each time!) has now said to phase formula out, which I will as long as her weight gain remains good. I've also been breastfeeding before giving formula rather than expressing so she's been taking less formula anyway. Also planning to see local breastfeeding counsellor this week to get this finally cracked.

Fantastic news M - well done!!
Hope dd continues to pile it on and you can both relax and enjoy her

Starlight - that's a really good question and one I've been thinking about a lot. I think its because I believed the Baby Whisperer book when it said that newborns only need feeding every 2.5-3 hours and so when Arielle was very sleepy in her first 10 days or so, I let her sleep 3 hours between feeds.

Now she's more awake, she's demanding to be fed every 1.5-2 hours so I think she's now getting much more breastmilk and I'm weaning her off formula. She's now just having a top up after one evening feed of about 40-50ml. If her weight is up on Saturday, we'll cut this down to nothing over the next week.

Very nervous about the Saturday's weighing, but fingers crossed for my beauty putting on the pounds.

Btw - no, the midwife didn't offer any reasons.