Single formula feed a day...?

[ginnybag]

I'm hoping for some help and advice here because I'm in a bit of a pickle.

My DD is 16 weeks old and, so far, has been exclusively breastfed, either directly or expressed.

For a number of reasons, I had to return to work when she was eight weeks old. I've been expressing every day since to make up her feeds for her whilst she's with her childminder and this has worked fine till now...

However, my childminder said this morning that she doesn't think the two six ounce feeds she's being given are enough anymore. DD is finishing each bottle and still not satisfied - Can I give her more milk in each feed please?

My honest answer is no. It's heartbreaking to say it, but I'm not convinced that I can. I've been struggling for the past couple of weeks to get the six ounce feeds off - I don't think I have a hope in heck of getting seven. Nor do I have the opportunity, really. It's a small office and I'm very busy - I'd certainly have to pump three times a day, rather than the two I've been doing - and that's just not going to be allowed.

So my question is this - how much risk am I taking introducing a single formula feed a day? What are the risks - because I've heard all sorts of horror stories. And what would be the best way to do it? As a top-up after each feed? As a single feed whilst she's with the minder, so one expressed, one formula?

Help!

I don't think what you're proposing deserves any sort of horror stories - what have you heard?

Predominant breastfeeding - which is the techical definition of what you would be doing - differs very little in terms of health outcomes from exclusive breastfeeding, and the precise difference is only really guessable. The later you give formula (ie the older the baby) and the smaller the amount, the more 'predominant' the breastfeeding is.

The vast majority of babies aged 16 weeks in the UK have had some formula already.
(Obviously if your baby is allergic or has some other medical reason why she should avoid anything other than breastmilk you'd want to take that into account - I'm sort of assuming this doesn't apply).

Having said that, your employers have to permit you to express at work and to supply the facilities for doing this safely,and if this is important to you, they are not doing you a favour, but fulfilling their legal duty.

An alternative would be to express once more at home in the evenings.

A further alternative would be to ask your CM to give small amounts of water - your daughter can make up for the milk she needs when she is with you (this would not be suitable for a younger baby, but at 16 weeks there's no reason to be too precious about it).

If you do give formula, then discussing the timetabling of this with the CM is best - most babies would not manage more than 6 oz per feed, whatever it is, so I would guess that a top up is not the best idea, but she might have some guidance on this.

The horror stories are my own fault, I suspect. I am, by training, a scientist, so with things like this I tend to look up journal studies - only to come across a report that suggests combination feeding may actually be worse than full formula feeding because of the growth factors in the breast milk sensitising the gut surface to the proteins in the formula and possibly exacerbating the chance of an allergy.

DH was lactose sensitive as a child and was on soy milk and I had horrendous ear trouble so EBF really wasn't much a of a difficult decision to make in the first place and I've been setting myself little goals all the way along.

I'm being a precious first-timer I suspect... My head is saying there's no reaosn not to, my heart says another.

"Tis true that mixed feeding appears worse for HIV-AIDS transmission than either soley bf or solely ff, ginnybag. Is that the same mechanism, I wonder, as outlined in the report you read?

I think the link between exclusive bf for 6 mths and allergy protection is very thin, speculative, and to me, not convincing...I think the evidence is stronger for lesser times, though.

Your heart is a good thing to follow, though - what about the other suggestions I made for not using formula? Is it really impossible for your work to obey the law on this (I sympathise with you being a pioneer or lone voice on this - which is why all work places should have a bf policy, IMO).

It really would be difficult. It's an office building rented to various clients so there's not really anywhere proper for me to express, unless my colleagues are out. Asking them to leave the office for an hour to an hour and a half each day (which is roughly what it would take me to express 14ozs) is not really viable.

The law is one thing - physical layout of the building is another, unfortunately!

I could try to express again when I get home, but I'm not sure if this would do much good. Baba doesn't give me much down time between feeds in the evenings. I'd have to wit for her to go to sleep and then express - DH would be thrilled. He's already grumbling that by the time lo is asleep, so am I! (I tell him to stuff off, generally.)

Would asking the CM to move the feeds earlier make any difference, do you think? Current pattern is 8am from me, 12 and 4 expressed, 6pm from me, 8pm (bed time) 2am ish dreamfeed.

The space between the night feeds (8-2-8) had led me to think we had this cracked and were in quite a nice rountine. She's taking two 6ozs expressed and four other 'both side' fifteen minute feeds a day and gaining weight nicely.

I really am hoping to hold out a little longer, at least. I'd like her past her thrid set of jabs and well past the 17 week marker, by preference, which was my latest goal.

Have you chatted to your cm in depth about this? What cues is she picking up on that lead her to believe your baby wants more? From my experience, 6oz is a rather large amount of ebm for a baby to take, even at four months. Most babies fed expressed milk that I know in my circle rarely ever take more than 4-5oz. I'd try and probe a bit more tbh - could your daughter manage on the 6oz feeds, and can the cm to try with an ounce of water as a drink rather than using formula? Although one extra ounce each time is presumably easier to try and pump than 6 for a whole feed. But if you could get another short pumping session in in the day, even if it's only very short, just for the extra ounce that might help. But in all honesty, two ounces of formula a day at this stage is not going to compromise your supply, and it wont actually harm your daughter I feel.