Can I ask you combi/mixed feeding routine?

[Richtea67]

Hi, DD2 is almost 3 weeks old and and since 1 week old we have been combi feeding, due to her tounge tie, jaundice, my late and low supply. All this resulted in 13% weight loss, which we were readmitted to hospital for. Since coming home we have been breastfeeding (offering both breasts), then topping up with either expressed breast milk or formula, then I have been pumping to help increase my supply (every 3 hourly). It's all been quite demanding, and I think we are at the stage when I am accepting that we will probably not get back to her being ebf, but that combi feeding could work well for us, and she would at least get some breast milk over a longer period of time (hopefully). We have had great support from a lactation consultant. Based on their advice we are trialing a supplementary nursing system instead of bottles for top ups. I'm so far finding this an incredible faff, but persisting....

Thankfully DD has put on a good amount of weight in the last 2 weeks. We are currently feeding on demand (2-4 hourly), and not in a set routine with feeds. Our current breastfeed, top up feed then pump routine takes ages and is not a long term solution. I would like to know how combination feeding has worked for others- how your feeding routine has developed when things did become a bit more routine and what has worked well?

Thank you so much in advance for your replies and sharing experiences.

bump

I had exactly the same situation with DD. Breastfeed, top up and pump (with reflux) was awful and I stopped breastfeeding at 5 weeks because I just wasn’t enjoying it. From my experience, I would pick one or two feeds to give a bottle, perhaps the evening one - one when your partner is around to give the bottle if you need a break. I would then stop trying to top up on the other ones and keep breastfeeding the rest of the time. I would make sure you breastfeed overnight and don’t replace those with bottles.

It’s easier said than done. The HV gave us the green light to do this at about week 3. DD never had a great latch but it was very hot and miss by this point. I was too anxious about weight gain though. I didn’t want to go back to hospital and after having the midwife/HV over repeatedly for the first 3 weeks weighing her, I’d already felt like I’d failed so I couldn’t give up the top ups. Plus she was crying because she was hungry and it was horrible to hear her cry and know the bottle was a simple solution to it. So if you can’t drop the top ups, you’re not alone, and it’s ok to formula feed. I knew it was time to stop breastfeeding on Boxing Day, I didn’t breastfeed on Christmas Day because I just didn’t want to do the whole routine and then on Boxing Day a black cloud came over me as I was about to breastfeed again.

Hello I mixed fed all of my three my last needed to be readmitted to hospital with jaundice also. I would basically offer breast then top up with formula starting at about 2oz then went from there once weaning they got food breast and bottle. By 18 months all formula stopped but I carried on breastfeeding my youngest is almost 3 and still breastfeeding morning afternoon nap and bed time 😊.

Mixed feeding doesn't have to stop you breastfeeding all together good luck

Also forgot to add I never expressed milk we just went with formula and breast. Daddy got lots of time with the babies this way also ☺️

I never really made enough milk for my children so combi fed. DD from 6 weeks and DS from 2.
I usually BF and DH would bottle feed, but often I'd top up as they could feed for ages from me and never really were sated, and would hoover down extra offerings from the bottled formula. It worked for us and my DH really bonded with them too which was important for us all too. Good luck and don't stress, they're feeding and gaining weight and you're all happy that's all you can ask

I really struggled in the beginning with my DD and put a lot of pressure on myself to BF exclusively but she lost weight and never slept. We gave her one formula feed at bedtime and the rest were breastfeeds. Some nights she'd get an extra bottle overnight if she wouldn't settle from my milk. Took the pressure off me feeling like I had to only sustain her with my milk. She's 13 months old now, gets a bedtime bottle of cows milk and breastfed morning and naps.

D's is twelve weeks, but premature. We've had a really hard time with breastfeeding. What works for us now, and what I am ok with, is fifteen to twenty minute breastfeed followed by formula top up. I pump once in the morning and add whatever I get to the formula. I have lots of milk in the morning as I miss two feeds overnight (not recommended for supply but I was told to do so by psychiatrist in mb unit.) D's feeds every three to four hours.

Thank you everyone for helpful replies. it's really helpful to envisage how this could work for us in the longer term. And also that it's OK if it doesn't work out and we have to go 100% ff. Can i ask, did anyone have issues with 'nipple confusion' and baby refusing breast due to preference for the easier flow of the bottle? On the advice of our lactation consultant we are trying a SNS instead of bottle for top ups....but so far it seems a massive faff and not a practical solution.

Hi @Richtea67 I have a 3 and 1/2 month old and I’m combination feeding since 3 months as my supply dropped and the pump doesn’t work for me. My lactation consultant gave me the following schedule:

11.30pm/12 midnight ish: formula feed
Nighttime feeds - breast feed
Morning feed 9am ish - formula feed
Next few feeds - breastfeed
6pm ish feed - formula feed
9pm feed - breastfeed

So formula feed at key times and let’s me have more of a gap for my supply to build up for the breastfeeds. At the minute I find I’m doing the above but usually need a formula top up in mid afternoon so out of 8 feeds I tend to do 3 formula, 4 breast, 1 breast and bottle top up.

For how much formula to give she told me to look at formula for Babies age divide by 8 feeds so for example at my babies age if exclusively formula she should be on 5 feeds of 200ml so 1,000ml in total - over 8 feeds that’s 125ml per feed.

@Richtea67 also no nipple confusion at all - I use MAM bottles which are meant to be close to the shape of the breast. Before starting this schedule we had been giving baby 30ml in a bottle so we had an option of bottle so no nipple confusion since birth - she easily goes from breast to bottle for top up feed too.

What you are describing is called triple feeding. I did it for 8 weeks and it seriously destroyed my mental health. A lot of specialists don't recommend it anymore due to the toll it can take on the mother.

If your coping and have a lot of support, then keep it up and we'll done you.

But also give yourself permission to stop if it is too much.

You need to rest, recover and enjoy your baby.

It sounds like you're doing a good job OP. Can I ask, are you time limiting how long you breastfeed for before the formula top-up? I had to pump after feeds at 3-ish weeks as baby wasn't gaining weight because she'd settled into a routine of cluster feeding but not really taking enough milk. I limited the feeds to 20mins per side and then gave her the top-up expressed milk, then pumped. It did take ages and didn't stop her wanting to be on my boob all of the time though 🤨. If it's taking ages because the baby likes to be latched on, that got better for us around 6-8 weeks so you could give it another few weeks. Mine does still want to latch on for longer periods now and then for comfort, even at 12 weeks old.

I had exactly the same scenario as you, OP! (DD in NICU then SCBU and i have PCOS all of which totally wrecked my supply). Well done on triple feeding this far. You are doing an amazing job!

I basically dropped the pumping at 12 weeks but kept offering each breast at every feed and topping up with formula. I did that for another 12 weeks to take us to 6months. But I'd say my mental health would have been much better if I'd dropped the pumping earlier. Can you keep pumping until 6 weeks at least? If not, then its fine, but I think i read that 6weeks is a good amount of time to get bfing settled. I also bought a perfect prep machine so preparing the formula was easier and quicker.

At 6months, i started slowly winding down the bfing dropping one feed per day each week. By 9months, she was just having a morning bf. I picked a day (mothers day!) to be the last bf then switched her onto formula. Dh brought me croissants and prosecco in bed after I'd done that last feed.

I did bottles from the start - we tried tommee tippee but DD couldnt get on with them. Nuk worked for us. Ive also heard good recommendations about Mam. No bottle / nipple confusion here but i was very consistent about always offering breast for at least 30mins first (20mins one side, 10mins the other, alternating which side first).

I basically took it week by week and gave myself mini deadlines eg. Ill just go to the end of the week etc then see how I feel.

Hope your LO is recovering and remember to take care of yourself as well!

I had a similar journey to yours OP.
Nothing to add to pp except to ask if you're using a hospital grade pump?

If not already then I fully recommend hiring one (Medela deliver them and you pay on a monthly rolling basis, send back at any time). They made a massive difference to time spent pumping! Also I used a pumping bra to do both sides at once. Felt like a cow being milked but it was much more time efficient.

I second this. I did it with my twins (born early, reflux, tongue tie which meant that for the first six weeks or so I was doing the routine of bf, pump, bottle feed at every feed) and it was very very hard. My advice would be:
go easy on yourself. You are clearly doing an amazing job but having a new baby is hard enough, particularly one where feeding is not straightforward. Try to find a route that allows you a break too, esp as you already have another kid.
If you are finding the SNS difficult/stressful ditch it. I never used one (tho lactation consultants also advised it) because the thought of trying to master that as well as everything else made me want to weep. Like another poster, I recommend MAM bottles- I’ve used them for all my children and never had an issue with nipple confusion (the issue with my twins was getting them to bf effectively at all due to tt, not confusion with a bottle).
has the tongue tie been fixed/is it preventing DD from taking milk from the breast? If she can bf a bit, then see if you can reduce some of the pumping, for your sanity- eg pick a few feeds to pump after and not after others and use formula for the rest.
in terms of what I did: my twins had 100% and 80% tt respectively. Once that was fixed (at just under six weeks) I got them back feeding properly on the breast using nipple shields (for what felt like months) and then eventually removing them. I still gave them top ups after every feed (mostly because they were twins so only got one boob each) but massively reduced the amount of pumping I did so the top ups were whatever EBM I had and then formula. For the night feeds I did bottles with formula so someone else could feed them. I bf them until 7 months. So it is possible (but - esp with the twin factor it was basically a full time job and I wish that I had given myself an easier time). the key is to find what’s manageable and sustainable for you- whatever that is and realise that whatever way you feed, you’re doing a fantastic job. Good luck.

Thank you for your replies all. It is really useful to have examples of how combi feeding worked, as well as the advice of the lactation consultant. DD has had tt divided but not sure it has made a difference yet- this was a week ago. We're still using nipple shields and she is having none of it when I take them off!

@Ivyonafence I completely agree....8 weeks must have been so tough, no wonder your mental health suffered. Certainly in hospital there was little regard for the practicalities of this regime, or impact on my emotional and physical wellbeing. I very much felt abandoned in a side room with a pump for 4 days, and little practical help. My husband tried to help but was busy looking after the other DC. The nurses would pop in to do DD obs, and check what time I fed, and how much top up she'd had. The community services have been a bit more practical in helping me find a way forward. I also have a history of PND and PTSD from a MC at 20 weeks last year, so have been very fragile with all of this. I'd never heard of the definition of 'triple feeding', but that certainly feels like a good description.

@CycleGirl20 I was initially advised to limit feeds to 30mins on one breast, then pump from the other and alternate breasts at the next feeding. This advice has changed to offering both breasts, not time limiting but being led by how well DD is feeding, then pumping from both....this is actually taking more time, but somehow feels more relaxed. I'm not sure about the logic behind the change of advice in all honesty.

@Xanthe123 wow doing this with twins...I can't imagine. I think I have been doing something like your routine recently, in that I am not pumping as often, but always offering breast first. And I have started to wait before offering a top up, although she is still not back to her birth weight so I feel somewhat reluctant to do this. We also have the Mam bottles and they seem pretty good and hopefully she won't get too confused. I'm starting to think the SNS was a waste of money! It does feel like something extra to fit in when there is not much capacity for anything else in the day.

Thank you all, I can now see a way forward with this. And if at the end of the day DD ends up being ff, then I know that she will thrive on that also 😊xxx

@PumpkinPicker83 , no I just have the single electric medula swing....nobody has mentioned to me having a hospital grade pump...thank you I'll look into it. And the bras sound good too. Many thanks x

I breastfed in the day and then gave her a bottle about 5pm so I could have a break and a bath on my own. Eventually we increased to 2 bottles, then 3, until she was just on formula by 1yo. Once she turned 1 we dropped the formula as well and she had cows milk as well as solids.

I did the night time and morning feeds as breastfeeds (11pm, 4am and 7am) and the daytime feeds (11am, 3pm, 7pm) as bottle (formula). Meant that DH could do the bottle feeds too and we shared the 7pm bedtime feed between us, which was nice. Milk supply adjusted fine and it worked really well for us.

Also, there were no nipple confusion issues at all. We used Tommee Tippee bottles. Worked great, possibly because they have such a wide top they might have felt similar.

No nipple confusion and we used all different sorts of bottles before settling on the Mam ones. I did what you are doing for 5 months and it was too much. I wish I had stopped sooner. The pumping (with hospital grade pump) was the killer. I felt like I never got a break and was starting to resent my little one, it just felt like a chore. Switched to just formula and breast, so they got the benefit of both and I felt so much freer!!! I would definitely do the same with the next one (minus the pumping!!).

The feed, top up, pump routine was sending me west. Mine had reflux, tongue AND lip tie and I had low supply. I was so unhappy but kept going - I don’t know how. In the end I was prescribed domperidone instead which worked wonders and right now I’m breastfeeding her to sleep the night before her first birthday.

I was on the increasing maternal supply pathway which involved feeding and pumping every two hours 🤯

Oh I also did what a pap said - gave up with the pumping, accepted my supply was as good as it was getting, and topped up with formula. Life changing, honestly.