Mixed feeding - advice needed on making it work

[HolidaysQueen]

My DS is 9 weeks old tomorrow. He is currently breastfed apart from one bottle of formula at night (11pmish). We started that at 2 weeks old, because of concerns about my supply (severe anaemia) which were making me very upset, and it has worked well for us.

I still have worries about my supply (e.g. if I miss a feed due to being out, I never ever come home with sore boobs and I only get slightly uncomfortable boobs if he has had EBM for some reason and it is 9 hours or more since I've fed) and by evening I do not feel I have anything left for him. He feeds constantly for an hour (just breaking off to be winded) before his bath and then for an hour afterwards. Tonight he would not settle even after that and my boobs were so sore that we gave him formula and he took another 4oz. I felt crap, because it just seems to say that 2 hours of feeding barely gave him anything

Mentally I am finding this really really hard to deal with. I love our breastfeed in the morning which goes brilliantly and I want to continue that beyond weaning etc. if I possibly can, but by 6pm he is so much less happy, never satisfied and my boobs just feel pulled to bits. I also find it way too intense being physically attached to him for that long and I find I upset very easily in the evening because of it.

So I am thinking about dropping the post-bath feed and making it formula so that he gets a good feed before he goes down.

What are the potential implications for my other breastfeeds if I do this? I would still like to give him the pre-bath feed so really it would only be stopping feeding him an hour or so earlier than I normally do. How do I make sure I maintain my supply for all the other feeds? I am concerned about quickly going down a slippery slope towards full formula feeding, but I feel that if I don't do something soon then I might just snap and go fully formula anyway, so this may save breastfeeding for us.

FWIW, we have been checked by a BFC for latch and positioning and she said these were great, so we have worked out how to bf, and I have tried things like extra rest and good diet to keep my supply up, but the problem seems to be a severe lack of milk come the evening.

I mix fed with success.I started like you with the 11pm feed,for different reasons,my DD2 would only go 2 hours between feeds,by having FF at 11pm she would go until 2am or 3am. Then, to make her go from 3am until 6 or 7am, I introduced another one.I was happy to continue with BF during the day.Eventually when she was 5 months I introduced an Early evening FF. By 6-7 mths I was only BF'ing in the morning.This was my last one which I was reluctant to give up,but eventually did by the time she was 7.5 mths.

I'm sure the BF'ing experts will be along to help you,just wanted to say it didnt "ruin" my supply.I still had as much as DD2 required.BF in the evening is notoriously "less rich" and not so satisfying as you are at your lowest ebb,but there are ways around this,as the experts will explain I'm sure.

Babies are often fussy in the evenings - cluster feeding normal.

How you deal with this is the issue though - it is intense feeding a baby frequently.

How do you know he's not getting anything? Breastfeeding's not solely about food for babies - he's enjoying being near you.

He is likely to have taken the formula because it was there, not necessarily because he was hungry - Mears always says it's like making room for cheesecake after a big dinner

My baby is fussy and feeds alot in the evenings, for at least an hour before her big sleep. She enjoys the closeness and i bet your baby does too.

i have both FF and BF but not together so cannot really help, but i just wanted you to know my baby feeds alot in the evenings too, as do at least 2 of my friend's babies.

i guess the thing is that it seems most of the time that he doesn't actually enjoy being with me for those feeds, and that is why it upsets me. he fusses, cries, gets upset, drops on and off etc. and then after a while drops his latch and just sucks furiously so my nipples hurt. this week he has even started biting down with his gums which is so painful the couple of times he has taken a bottle at those feeds from his dad it has gone much smoother and he seems much happier (dad makes sure to give him a big cuddle afterwards)

tonight it wasn't just frequent feeding, it was continuous feeding. he was latched on for 2 hours with only a 30 min break between for his bath. i know i should have probably just stopped it but he seemed so dissatisfied that i wanted to keep him on in the hope he would get some food and settle.

in an ideal world i'd love to express so he could get breastmilk at least but it is a struggle to get more than 4oz out of my breasts even in the morning, so that would never be enough, and i am trying to keep that in the freezer for times when i am away from him.

i really want to keep the other feeds going, and i've been thinking about dropping this feed for a few weeks - it's just that tonight's experience made me decide to ask the questions about it. i am determined to get to 10 weeks (one more week) before i decide, and hopefully then i'll feel okay with continuing through our holiday which will take us to 12 weeks/3 months, but i wanted to get what info i could on mixed feeding now so i do the right things rather than the wrong things to preserve our other breastfeeds as i think it's a real possibility that i'll need to do this.

thanks for your thoughts - keep them coming!

Holidays, I think I would tend to take your assessment of a supply issue seriously - while it is of course true that babies cluster feed in the evening and will take formula just because it's there, you have enough clues in your history that there is a supply issue....but the good news is this is likely to be reversible

If you do what you suggest - drop the post-bath feed in favour of formula - there is a real risk that a potential supply issue becomes an actual one.

If he occasionally goes 9 hrs without feeding directly from you as well as the routine bottle at 11 pm, then it's just not good for your supply...and the way to address the issue is to feed more often not less often....how you work that out in practical terms is up to you (dropping the formula at 11pm, fitting in more breastfeeds, offering two or three or more breasts when you can) and you may not need to maintain what you do forever (eg you could go back to the 11 pm bottle which you say you feel has worked well).

Hope this helps.

Thanks tiktok He's such a happy little boy but he didn't get back to birthweight until 4 weeks and he is only averaging a 4oz per week gain at the moment which i guess is slightly lower than average so it really feels like bf is not optimal at the moment and it is upsetting.

Does expressing between breastfeeds help with supply as well, even if not as efficient as a baby? I used up my paltry freezer supply last Monday when I was away from him during the day so want to build that back up and it takes a couple of days for me to get enough for one feed anyway so i could be pumping quite often to do that! If I time that between feeds would that help with supply? Also does it matter when i do it or is it best to pump in the evenings to encourage more supply at that time of day?

Expressing between feeds does improve your supply, Holidays, and just do it when you can. Removal of milk drives supply - the precise timing does not matter.

While you are retrieving your supply, you need to know that spending long periods without feeding or expressing won't help - but you knew that

tiktok - i try to express if i have been away from him long enough to miss a feed so that my body 'remembers' it needs to make that milk, although that's only been 3 or 4 times since he was born. i'll give the expressing between feeds a go - i need to up my freezer supply anyway so hopefully can kill two birds with one stone! when i did have enough in the freezer i was expressing a bit each day so that his bottle at night was at least part ebm and i'd like to continue that.

out of interest, if i express regularly does that make it more likely that i will get more out when i express? i was getting maybe 3-4oz then for various reasons didn't do it for a week and it took a few days before i could get more than 1oz out.

Holidays, people's experiences and 'productiveness' when expressing is hugely variable. You will hear people say that babies get out more than pumps do - and this is untrue as a generalisation. An efficiently feeding baby may well be better than a pump, or the person operating the pump, but that's not always the case. In addition, the baby can stop because of being 'full' while the pump can carry on - so you might get more out with the pump than the baby.

What is true is that the amount you get when expressing is never a guide to how much the baby gets at any one time - the baby might get more, or less.

When expressing is efficient (whether by hand or by pump) it can reflect the amount made, though - and getting more out with the pump may be a sign you are making more and/or a sign you are getting better with the pump.

thanks tiktok and everyone else!

god, this breastfeeding thing is so hard mentally - much more so than physically - and that is what nobody prepares you for as prenatal stuff is all about the mechanics of latch, positioning, engorgement etc. i think taking a knock to your confidence in the early days (slow to gain back birthweight plus worries over anaemia, in my case) makes it very hard to ever feel comfortable that the baby is getting what he needs. i'm not sure i'll ever feel confident that it is working iyswim, but at least with all the great people on MN i feel like i can get the info i need to do my damnedest to make it work. i'm still not planning to do anything on the second bottle until 10 weeks - will re-evaluate after this week - and still want to try to get to 3 months at least. i'll try the expressing and see how that goes, and i'm not away from the baby now for at least the next 2-3 weeks so there won't be any missed feeds confusing things.

Holidays - I had the exact same issues with my DS (now 20 weeks). I started an evening ff at 8 weeks although I did express whilst DH gave him the feed. However, I found myself supplementing more with ff as the weeks went on (DS also very fussy in the evenings and would feed from 5-10pm with only a break for a bath). I got to around 14 weeks and found that DS was only getting a b-feed in the morning and I was happy to continue with that. Unfortunately, DS started to refuse b-feeding and now we are totally ff. I'm not sure whether he just got so used to the bottle or whether my supply dwindled away to nothing but I wish I had not supplemented so many feeds. I did try to increase my supply but 3 hourly expressing was very time consuming and wasn't working for us. i was upset at the time but we're happy now. With my next DC I will be so much more informed re: breast feeding and will accept that DC's will feed when they want even hourly or for several hours at a time. I think if you accept that, then BF can be much easier. Just wanted to share my experience with you and good luck in whatever you decide

Goodness this post could have been from me; except I'm one behind; exclusively BFing at the moment and thinking about going to one FF - prob at the 10:30pm slot - to make it a bit easier on my breasts.

A question about expressing between feeds: at the moment I'm expressing twice a day; first thing in the morning and then again in the evening, and I get just about enough for 2 feeds; which he has at his 10:30pm and middle of the night feeds. The evening expressing takes forever, but I do it then because he sleeps 7-10:30pm and if I do it when his sleeps are any shorter I'm worried he'll need food before my boobs have replenished.

How do you time expressing between feeds so this doesn't happen?

HQ, you're not alone, it is really hard, both physically and mentally - more so mentally I think. I so want to make it work but it's such a struggle. I actually find the feeds he has through a bottle with EBM so much more rewarding than him at my breast; we have lovely close time. If I could fit in expressing for all his feeds I'd be sorely tempted but there's just no way...

HQ, I think you are doing really well to breastfeed at all! I fed all my children by expressing then bottle feeding them EBM. I'm sure the large electric pump (with variable suction) helped, and I expressed 4-6times a day. I hired the pump from the local NCT or La Leche League. Just wondered whether it may be worth you investigating too....one of my friends used one for expressing later in the day when she had less milk. Good luck!

I had exactly the same problem with DS from about 3 weeks to 3 months - he just seemed to constantly cry from about 6pm to 10pm - feeding on and off - only feeding for 5 minutes then falling asleep for about 15 minutes and then back on again, etc it was a complete nightmare and I felt like giving up everyday - I did supplement with formula occasionally - though never more than once a week and eventually after about 3 months it did sort it self out. i also expressed quite a bit during this period as well between feeds as I was so paranoid about my supply. I mainly breastfed DS until he was 7 months and then due to work i had to introduce 2 bottles during the day. I still bf in the morning and night now, he is now 10 months though my supply is noticeably reduced now. I would try and wait a bit longer to do the mix-feeding thing, I know that every night seems like an eternity but it really does get easier - though DS still does not manage to sleep through the night yet - but that's another set of issues! You've done so well to get this far and it would be a shame to jeopardise your future breastfeeding.

I mixed fed from 6 weeks, also dropped the 6pm feed for formula as was finding the cluster feeding too much as was also older ds1 tea and bath time.

Ds2 slepth through from 5 wks so i was not bf from about 3pm until 6am ish. Supply good for the other feeds, kept this up no probs until 5 months and only stopped cos i wanted to. I also ff when out but made sure this wasnt too often and seemed ok.

Thanks so much for sharing your advice and experiences. It is really really helping!

I think two small victories yesterday have helped - he fed continuously for 2 hours again and then cried for an hour while dad and i alternated cuddles and ate dinner. I then offered him the breast again rather than bottle (nothing sterilised!) and he had 10 mins and fell fast asleep! As it was 9pm we decided to leave him rather than do ff dreamfeed and he woke at 1am so I breastfed him then. So not only did he go to sleep (eventually!) solely on breastmilk but he was excl breastfed yesterday for the first time since he was 2 weeks old

Small victories are often enough to keep you going a bit longer, aren't they? We'll definitely go to 10 weeks as we are now and then see how things have gone. My thoughts at the moment are that until my supply issues are rectified I think I'm going to try not to add in an extra ff because I'd love to get into the same position as jimmyjammys where he can still have a couple of bfs from me after he starts solids. I may swap the ff to be at 7 and bf at 11 some days to see if that makes a difference to how I feel. SO I'm going to up the expressing to try and get the supply more stable.

Casserole - I'm a bit hit and miss as to be honest it depends when I have a free moment. I try to express in the morning on the basis that my supply seems to be good then and I figure it can bounce back quickly. Most mornings I don't do it until he is down for his nap which is about 60-90 mins before he wants a feed again. The other day I finished only 10 mins before he demanded food but it didn't seem to stop him feeding well - he lasted another 2.5 to 3 hours as usual. I tend to find that I get most of my milk out at the start and then it really slows down - so I can get maybe 2-3oz out in 15 mins and then it might take another half hour to get another oz so I usually just don't bother with that extra half hour. No idea if that is normal pattern or length of time for expressing but that is what happens with me.

I expressed for my twin boys for the first three months.

For the first two months they were getting around 70% of their daily volume from EBM. So basically I expressed enough milk for one and a half babies!

I expressed for four sessions a day. The first around 7.30am, then 11am, 4pm and 10pm. The first session was the most plentiful and the late afternoon the least.

I had no problem with not expressing at all at night - though I was sometimes uncomfortably full when I woke up.

I used a hospital grade pump that I hired and was able to do other stuff when expressing (eg eating, internet shopping, email etc, reading baby books and mumsnet - or just holding a baby oe even feeding one baby with a bottle). You can sort of balance the pump in the cup of your bra when you have a vacumn leaving your hands free.

I think the key to expressing is to go on for a few minutes after you have "dried up". I think this encouraged my milk supply.

This worked out really well for me. The kids were getting breast milk, other people could feed them (my DH and mother both loved being able to feed them), I was able to sleep all though the night on the nights we had a night nurse. We were able to establish a good routine early on. And I did not have a baby permanently attached to me.

I could have gone on at this rate for longer but decided I needed to stop expressing by three months as we were going to Hungary for the weekend to see DH relatives and I did not want to take pump with me so I decided to start winding slowly down during month three. I also wanted to stop for other reasons.

I know people have successfully breatfeed twins - but I knew that I did not have the commitment to do this. Reading all the issues that mums get trying to feed one baby on mumsnet just confirmed this for me.

I think that sometimes the bottle and breat feeding section of munset is too dogmatic - one way or the other. There is a third way which is never discussed and I think that this limits womens choice and forces women to go down the formula route as they cannot live up to the exclusive breastmilk for 6 months path.

Just wanted to agree with upping the expressing as a way to increase your supply - I even used to take the pump in the car with me (if I was a passenger lol) as it could all be done quite discreetly (obv hand pump not elec!!!). Then I found if I'd been feeding for ages in the evening and baby still fussing, could be given a top up of EBM by dh... or whenever (middle of the night by dh so you have a good supply in the morning? )

really pleased you had a good day! good luck!

Holidays - when I expressed, I got most of my milk in the morning and this is, I'm sure, normal. It is true, as Sullwah says to keep expressing for approx five mins after milk stops flowing in order to stimulate more. I also found it was good to express whilst feeding although this takes an electric pump and a good sense of balance! Next time i will also get a better pump for more frequent pumping to enable me to get a better supply in the freezer - i always felt like I was playing catch -up! Hindsight is a fantastic thing but it sounds like you are doing a grand job - just take it one day at a time

Thanks for the tips on expressing! DS sleeping now (just had his first jabs and the crying zonked him out!) so off to do it now. HQ xx