Combi/ supplemental feeding

[jwake]

Hello, I'm at a bit of a loss about how to continue so would appreciate any words of advice/ encouragement.
My son is four weeks old and we have been supplemental feeding since week one, when we were readmitted into hospital following weight loss as a result of a tongue tie. Even though that was snipped on day 9, my milk supply has been low ever since.
I am breastfeeding for every feed but it's v rarely enough so having to follow with a bottle of formula. I'm also pumping four or five times a day (and get around 30 mls per time). I feel like I'm stuck in this cycle of endless breast and bottle feeding all day and night and don't seem to be making any progress with upping my supply. It's been devastating to be unable to exclusively breastfeed and I'm trying everything in order to do so (have a lactation consultant, hospital grade pump, supplements, specific diet, drinking loads of water).
Has anyone been in a similar situation and managed to succeed in moving onto full breastfeeding? I wonder if I need to accept my fate and that combi feeding will just be how I have to do things.
Any advice thankfully received.

There are lots of things you can do. If you use social media then Lucy Rundell is a good person to follow. He recent book "Mixed Up" is on mixed feeding and covers a lot of things like making is sustainable for you and increasing your supply to decrease top ups.

When you breastfeed and baby comes off, if they are then showing more cues what are you doing at the moment? Putting back to the same breast? The other breast? Or giving a bottle?

Does baby fall asleep on the breast? In which case breast compressions may help to get them feeding a little longer.

Also how often are you expressing? Have you tried cluster pumping/power pumping?

The feed, pump, feed cycle is really stressful and time consuming. I'm not surprised you are finding it tough. It may help at this stage to consolidate your top ups into 2 or 3 "full" feeds and put baby to the breast in-between. You may find this helps you feel like you have more time to focus and take stock. You could then work on gradually reducing the volumes of the bottles and increasing breast once you feel ready to do so.

Thanks for the reply and book recommendation. He rarely comes off the breast of his own accord, I move him from one to the other until it's clear there is absolutely no active feeding happening. Sometimes that can be 20 mins, other times 45. Either way, he is still always hungry afterwards and is asking for more. Sometimes this means 40mls formula, other times a full 120mls so it would be hard to take those away entirely and consolidate because he would be v distressed and hungry. This is why its easy to become disheartened that my milk will never be enough. That being said it is still lovely to have that bonding time together when we feed and I feel lucky to have that. I just don't feel like I'm making a huge amount of progress in the last couple of weeks despite putting so many hours of work in.
He is gaining weight well (not too much) so clearly he's getting what he needs and that's the main thing. I just worry that my supply has reached its limit and I will be doing this endless feed cycle from now on.

Hi OP - I was in a similar situation also due to tongue tie and the only thing that worked for me (and it did really work) was taking domperidone. It's slightly controversial as it's not licensed for that purpose in the UK due to some risk of side effects but my GP was happy to prescribe - suggest you do some research and see if you're happy to try it or not. Like you, I was told to pump etc to up supply but found this didn't work at all - I later learned that if demand isn't high enough in a crucial early period it will be very difficult to increase your supply sufficiently through demand alone. The other thing I would say (though I'm sure you know this) is that feeding is just one part of parenting and exclusive breastfeeding is not the be all and end all. It took a good 10 weeks before breastfeeding was working properly for me and I do feel like I missed out on a lot in that time. If I have another I'm setting myself a deadline of six weeks to get it working in a way that I'm happy with long-term or switch approach (which wouldn't necessarily mean giving up entirely, but would definitely involve giving up pumping!).

OK, I think the breast compressions would be a useful thing to add to your toolkit to encourage more active feeding at the breast and it sounds as though you are already switch nursing which is great.

You are doing a marvelous job. Even if lots of calories are coming from formula right now you are still giving all that fabulous immune support via breast, be bloody proud of it.

As the previous poster mentioned if it seems that things have stalled a bit and that despite effective feeding and pumping including power pumping you are not seeing an increase in supply then domperidone is an option to discuss with your GP. By increase in supply we don't only mean what you express but also things like do you breasts feel full at all, are they softer after a feed etc.

OP, I know you've said you want to exclusively breastfeed, but I just wanted to say, for me combi-feeding was the best of both worlds. It came about in a similar way to you - DD had a tongue tie & my milk was delayed, so combi-fed to get calories in but even once the tongue tie was sorted & my milk was in, we continued with combi-feeding as it meant I could breastfeed on the go but also let someone else feed her when needed. It really helped with sleep training too, & get her out of the feed-to-sleep cycle.
When DS came along we did combi-feeding from the outset as it had worked so well.
Just to give you the positives of combi-feeding.

Thank you all for advice, and yes good to note that Combi feeding doesn't always have to be a bad thing. In the last 48 hours I have discovered that he loves to feed lying down in bed (his neck and shoulders are tense from forceps delivery) and it has improved our situation no end. Yesterday we reduced our formula feeding by two thirds which was a huge step forward. But realise it's often one step forward two steps back with these things