When to give up breastfeeding and go to formula?

[Frenchyfren]

My baby is 13 days old and was born 5 weeks early. He has been breastfeeding since day 1 (topped up with donor breast milk for the first 48 hours in hospital). I was then pumping and topping him up with 30-40ml of expressed milk after each feed on the breast.

I had a lactation consultant come on Monday who ruled out tongue tie etc. She helped with positioning for a better latch and for the first time I could hear him properly gulping the breast milk. She also advised me to do compressions when feeding to encourage him to take the milk. On Monday we had a great day feeding.

It’s gone downhill since then. Baby fed ok during the day yesterday and slept for 2-2.5 hour stretches in between. Last night was awful with him waking up every 45 mins or so for a feed, I couldn’t hear him gulping the milk so I suspect he wasn’t getting what he needed. He was then falling asleep on the breast and wouldn’t always rouse to go on the next breast and would therefore wake up again soon after for another feed.

I always said I didn’t want to sacrifice my mental health for breastfeeding which I know probably sounds selfish. But I don’t function well on broken sleep and I know that I will end up glued to the house making sure baby is feeding during the day if it continues this way.

I’d really appreciate some advice please!

Don't feel guilty for choosing to survive and finding a way to have energy. Having a newborn is hard. Breastfeeding is hard. No sleep is hard. So if there is a way to make life easier for you, you have every right to take it.

Personally, I find pumping extremely tiring so kudos for achieving this. Could you try combi-feeding and simply giving formula for top-ups whilst working on your latch (if you want to)? Baby is still super little and their mouths are tiny for feeding. I know everyone says don't combi feed until six weeks but I've found it fine and an absolute life saver in terms of giving me a break to actually sleep.

Ultimately, my view is that the best thing you can do is have the energy to care for your baby and feeding them in a way that works for you will help with this. Don't feel guilty and remember your hormones are wild at this point which will make things feel more intense regardless of the option you choose!

The early days bf are hard. Probably even more so with an early baby.
Frequent feeding is very normal as this helps establish supply. Even feeding with formula there will be many nights of broken sleep ahead.
It's a while since my baby was this little but being more alert at night isn't uncommon either.
They don't really know day/night for some time and mine was certainly quieter during the day before birth as my movements rocked her to sleep and then she woke up when I went to bed!
I don't think you're doing anything wrong, it's just early days with a little baby. Their tummies are small and they need to feed often.
If your latch is fine and you're getting a good number of wet nappies that's great - talk to your HV if you're worried.

Just something to think about too is that formula fed babies still wake up as often and breastfed babies. But then someone else can always feed while you catch some sleep. I'm a strong believer in do what's best for you and baby. If it's formula then crack on.
I combie fed my lot untill about 10 weeks then they preferred the boob.
Could be having a growth spurt too and cluster feeding it does get easier.

This. Frequent feeding is normal as baby is establishing the supply. Once you both get into a routine and a rhythm it's so much easier than formula feeding. Good luck!

Just to agree with the other poster - fed is best however you do it.
I definitely found it got much easier to bf once we got past about 6 weeks.

@Frenchyfren You've done amazingly well! And you will know when it's time to finish - and whatever works for mum is what's best for baby.

I was in a similar position - the thing that transformed feeding for me, was a nipple guard - baby was able to latch must easier. He fed for so long too it protected the nipples. Might be worth a try if you want to continue BUT - if you're ready to move to formula, definitely do it. How a baby is fed doesn't matter, it's that they are fed ❤️ x

It's the incredibly early days. Obviously if you want to move to formula then do- but what's happening sounds quite normal for a bf baby. If you do want to carry on for a while, I suggest not expressing-feeding is so much better at increasing supply and expressing is time consuming and (in my case, mood lowering). Try just feeding on demand and see what happens. It does settle into a more predictable pattern soon. Reassure yourself by getting him weighed and making sure he has plenty of wet nappies. Good luck!

Thanks everyone! The lactation consultant suggested pumping once in the morning and that’s it. I think I will continue to do that and see how we go. In hindsight I probably should have given him an expressed bottle during the night last night. I do wonder if me being so tired is affecting his positioning at night time and therefore he isn’t getting an effective latch 😢

I don't think there is necessarily anything 'wrong' here ; it is common for babies to feed very often .As long as there are wet and dirty nappies and baby is alert at times and growing your baby isn't suffering in any way.
At the same time your baby will come to no harm if you wean onto formula and bottles. Most babies are fed on formula in this country and thrive. It isn't a competition to see how much stress you can put yourself through although I do understand that there is a social pressure to do the perceived'best' thing for your baby. The secret is that there really isn't a perfect way to do things ( this applies to all sorts eg weaning, routines etc) just aim to muddle through. Your options are to give it one more day and see how you feel tomorrow or to start weaning. Whichever you choose will be fine .

It could just be cluster feeding rather than a latch issue. I agree with PPs that BF is really hard at first, but once you’re established it’s easier than prepping bottles in the night

Babies who are premature can struggle with feeding and it isn't always a linear journey. They often need extra (be that best compressions, fortifier or specialist prescribed formulas) support and switching to formula might not solve it all.

Thanks, I suppose it’s reassuring to hear that switching to formula isn’t going to resolve the ‘problem’. He is producing plenty of wet and dirty nappies and will be weighed tomorrow by the midwife.

Is it normal when cluster feeding at night to not have a very deep latch and not be gulping down milk? And also for him to be very sleepy and fall asleep after just a few minutes on the breast?

Hi Op, those early days are so tricky, there's nothing wrong with switching over to formula if that's what's needed for your wellbeing.

For what it's worth, I know they tell you how important it is to breastfeed at night but we have always given formula through the night and breastfed in the day. I did it for my sanity and with the knowledge that my supply could be impacted but it wasn't and I'm still breast
Feeding a year later.

Of course baby is so young so will still wake in the night I'm sure at least twice but it means you might get slightly longer stretches of sleep but also someone else can do the feed for you. I've never personally pumped as it's tiring enough feeding baby through the day when they are that age.

I truly believe that formula feeding at night is one of the main reasons that Ive been able to breastfeed all this time. I really struggle with lack of sleep so DH taking on some of the load has been great.

This isn't really advice as it's basically everything they tell you not to do (introduce bottle before 6 weeks and not breastfeed at night) but my own experience has been good. Combo feeding and formula feeding are great options and the most important thing is that baby has a happy mum.

Yes in my experience it's normal. We had to work really hard on the latch (we did have two TTs) and at night when you're both tired and it's darker then it is more difficult.

One thing I found helpful was learning about the stages of a feed - I was worried as my baby first did LOTS of very short feeds (20+ a day) and then moved to what I thought were very long feeds. I was constantly worried about her getting enough. My LC showed me the signs of let down/active feeding, which you already know (the sound of swallowing and the underside of the chin moving up and down), which is then followed by light 'butterfly' suckling where they are still getting a little milk but also stimulating your supply. For my baby this then often transitioned into sleeping while doing the occasional suckle - my LC called it 'dreaming of suckling' and baby would have done this all night if she could. It is about soothing and comfort and stimulating more supply as well as the actual milk. I realised I sometimes missed the signs of the active feeding which could be quite short at the start which is when I worried she wasn't swallowing. I think with every new feed there will be a new letdown but it might not be very much if it wasn't long since the last feed and she's half asleep. We also did a weighted feed which reassured me milk was going in.

My LC's advice turned out to be really good - only if you want to continue BF - which is have a baby moon where you just stay in bed and do lots of skin to skin, put baby to breast whenever they want it, no supplementing, and try and stop worrying. But much easier to say looking back!

They don't! 😂. They really don't. Formula fed babies sleep like a dream. Nobody is brave enough to say it out loud and if they did, more people would feel more confident to release themselves from breastfeeding hell.

Cluster feeding is totally normal. DD2 took about 4 weeks to get a proper latch (and needed a tongue tie cut after first lactation consultant said she didn't have one) then something just clicked and she got it

Keep going OP it gets easier (and don't feel guilty for using formula if that's what you want to do)

Do your best, ( as I'm sure you are)
If BF doesn't work out, its no biggie.

Take Care.

It sounds completely normal to me.

It’s really difficult to see this when you’re in the thick of it, but bf will get easier and easier every single time you do it - the baby gets more efficient, you find the latch easier, your let down comes quicker, your supply is established, their tummies grow. There is a major improvement at 6 weeks and then again at 12 weeks. Once you’re past the cluster feeding stage it is so quick, so easy, so convenient. You can do this!

But that's normal. Your babies only job is to get your supply established, were not cows, we only produce a tablespoon at so at first.. Breastfeeding is how I got into console gaming. Theres only so much you can do when pinned under a baby. As long as you're getting alert time and lots of wet nappies then it's going well.

Formula feeding is to fill them up only. Breastfeeding isn't. It has other functions.

However, you can stop whenever you want. There's no rule.

Babies also suckle for comfort. Whilst this is on one level a nice thing to be able to offer your child it can make you sore if feeding isn't well established yet. The lack of gulping suggests this might be the case. You can gently break the latch, use your finger, don't pull baby away as this will hurt you too. Maybe switch breasts if he's been on the same one long enough.
This is tricky to judge with your first baby - nipple shields might be worth a try if you get sore. Although soreness is more likely with a latch in the wrong place and it sounds like yours is fine.

Would you consider combi feeding? Was a life saver for me and meant baby had breastmilk for 17 months which wouldn't have been the case with ebf. Also meant husband could help and do a bit too

I don't agree with this. I know babies who were FF from birth and awful sleepers, and babies like mine who were mostly breastfed and pretty good sleepers. Also i have experience of switching to exclusively formula earlier (12 weeks) and later (10 months). Neither time did my children's sleeping patterns change at all. Also both my babies were combi fed from being 2 weeks old and they didn't sleep longer stretches after bottles of formula or expressed milk compared to being fed on the breast.

I just wanted to add to the advice above - I also had struggles withy baby falling asleep on the boob at night and so not taking both sides. I did find doing compressions continuously at every feed to be very effective (eventually I no longer needed to do this but whilst she was very little it helped her to take a better feed), but also did find cool flannels and stripping her down to a nappy before starting a feed worked to some degree in keeping her awake enough to feed on both sides.

You are doing a fabulous job, so hope you feel proud of yourself as it's not easy!

which I know probably sounds selfish

It absolutely doesn't.

However - if you want to breastfeed and you had a great day with it on Monday, it might be worth carrying on a little bit more to see how you go if you want to.
13 days is still tiny so having ups and downs with feeding and sleep is totally normal.

It’s very easy when established- I never used formula- too much like hard work!

Sounds like you are doing well, OP.

Formula can never replicate breast milk, hence they have to call it “Formula “

Getting the right support initially is really important.
I’d have quit had a lovely older nurse not helped ( Decades of experience while I was a blubbering mess)😬🙂