Combined breast and bottle feeding

[oversomerainbow]

Hi all. Awaiting arrival of DD and have questions about combined feeding! I've read everything I can get my hands on but I've read conflicting advice about this in particular.

I'm hoping to breastfeed the majority of the time, but I also want to pump and bottle feed sometimes. I have an electric pump and have been able to express some colostrum by hand already. I would be ok with topping up with formula if necessary but would ideally like to avoid this if possible.

This is the general advice I've been able to find:

• Don't bottle feed at all during the first couple of weeks to avoid nipple confusion
• Pump from the other breast while baby is feeding during the first couple of weeks, as baby won't need both breasts
• Introduce a daily bottle of breast milk around 4 weeks
• Keep pumping daily to ensure supply stays up

Do you agree/disagree with the points above? Is there anything I'm missing? I'm also reading opposite advice about the bedtime feed - some sources say make sure to breastfeed as baby's sucking will ensure supply stays up, but others have suggested this should be your bottle feed?

Can anyone share their experiences and advice? Thank you!

Not advice but this is what has worked for me. Since three weeks baby has had a bottle of expressed milk most days. Originally in the evening as part of his night time cluster feed so I could eat dinner with two hands. Then from about six weeks it's just been at a random time of day when I'm out getting some exercise/baby free time. He's never shown any nipple confusion and we've just used bog standard tommee tippee bottles. I have yet to master pumping and feeding at the same time so I tend to do it in the evening after he's asleep.

The bits you’ve put down are more or less the advice I saw and followed and I’m still feeding my 2 year old.

I was probably a bit slacker on the feeding a bottle per day, but did try to pump once a day (it was invaluable for if I was having a chunk of time away from baby as they fed a lot until 9 months).

I also wouldn’t pump during the first 3/4 weeks - it takes some time for your supply to establish and you don’t want to send your boobs into hyper over production as you’ll end up with constantly hard boobs and in wet patches through the night 😂 you can capture your letdown from the other boob whilst feeding on the other though?

And buy a pumping bra for hands free, nothing easier than being able to eat or do basic stuff while pumping, your free time is so precious. Good luck!

Thank you both!

@T0rt0ise Was the evening bottle feed his last one before going down for the night, and then did you breastfeed during the night?

@coffeeorwine How long would you wait between pumping and feeding? And do I need a manual pump for let down or will my electric one do?

Sorry. So many questions!

No, not his last one as I breast feed as part of his bedtime routine, just a random point in the evening whilst I was eating dinner.

• Don't bottle feed at all during the first six weeks to avoid nipple confusion. Agree
• Pump from the other breast while baby is feeding during the first couple of weeks, as baby won't need both breasts Disagree
• Introduce a daily bottle of breast milk around 4 weeks Doesnt matter
• Keep pumping daily to ensure supply stays up Depends

So, there is no point pumping now before the baby has arrived. Your body won’t produce milk until a few days after birth.
You do want to exclusively breastfeed for the first six weeks to establish both the breastfeeding and your supply (assuming here you can). Breastfeeding has a learning curve, both you and baby have to learn how to do it. It’s also best to feed the baby from both breasts otherwise you will end up with lopsided breasts- one will be at least a cup size bigger than the other. In addition, I personally found it more relaxing to not do both at once. It was much easier for me to nurse the baby, put them down to sleep and then pump for 10-15mins from both breasts at once. I had a dual hospital grade pump.
Anytime after six weeks you can introduce bottles of expressed breast milk. You can introduce one bottle day all the way up to feeding 100% by bottle. It’s whatever amount fits your needs/lifestyle. As a tip though, make sure you are not in the room when the baby first learns the bottle. This is for your partner to do because most babies prefer breast to bottle and will refuse the bottle so long as they know a breast is in the room and available.
As far as pumping goes, it’s a 1:1 ratio, for every bottle you feed the baby you need to do one pumping session. If you are exclusively breastfeeding say over a weekend because not at work or for a week while on holiday, you don’t need to also pump.

Am only expecting baby number one so haven't done this but a friend did combined feeding. Evening and morning milk contains different things so if you're pumping and storing/freezing, make a note so that you can feed evening milk in the evening, and day in the daytime.

I used to pump after the morning feed about 2 hours after, my supply was always pretty heavy in the morning, I think it really depends on you though and your supply will be there regardless of time of day I just found it was quicker first thing.

In terms of pumps I had a hakaa (sp?) type one that suckered onto my boob while feeding, and an electric for proper pumping.

Agree with what plan said on feeding too - much easier for partner to learn and baby too when you’re not present.

Don't bottle feed at all during the first six weeks to avoid nipple confusion.

I don’t agree with this. From experience, a bottle should be introduced early so you don’t end up with a bottle refuser.
I’ve never known any baby to have nipple confusion. I have however known MANY bottle refusers. And it’s grim! Mums getting so stressed that they can’t ever leave the baby for more than an hour or 2.

Great post. I’m also planning on doing combination feeding. I’m planning on using a bottle for the evening feed from day one so I’m glad to hear that @TwighlighPeace

My son had to be combi fed from around 9days old due to weight loss.
Not ideal, and I get it did impact my supply. But that could have also been because I had a PPH.
Despite a slow start, I was able to feed him for 10 months. After that he seemed to lose interest!
Good luck. You’ll do great xxx

You can get a bottle by a brand called medela which has a special teat unlike any other. It’s long & very flexible & kind of stretches to completely mimic the breast. It’s been designed for breast fed babies that refuse a regular bottle. I’ve found it amazing, didn’t have any “confusion” with my first & will be doing the same with my second.

I used to give my first a bottle of formula as a dream feed to try & keep her fuller longer after about 6 weeks of no sleep....didn’t work Haha.

I think a lot of it is trial & error. Do what feels right, see how baby responds & adjust accordingly. Try not to worry too much about guidelines etc.

Nipple confusion doesn’t necessarily happen, I had to top-up feed DS from about five days old due to lack of weight gain and since then we have kept on one bottle a day, either formula or EBM, and he has had no issues. Like @TwilightPeace says you don’t want to end up where they have never encountered a bottle and won’t take it.

Same with using the breast pump, I started using it five days in even though all advice says to wait. I queried this with the midwife and she said to express after feeding for 20 mins (5 each side, then repeat). It was hard work but easy enough to get used to.

I try to express milk as regularly as I can now, but if we get out of a rhythm then I just express for 10 mins each time after I breastfeed & my supply comes back up then. Agree with buying a Haakaa pump too, takes the effort out of it.

Good luck!

Bottle refusers are not that common. Mine tried to refuse the bottle, but when they got hungry enough, they took to it. You just might have to stay away for more than an measly hour or two when first getting them trained to it!

I have seen nipple confusion though. It is real. Babies unable to suck hard enough to breast feed because bottles are easier. Babies choking because they suck too hard on a bottle and get more milk than they can swallow.

Honestly i think if you go into it thinking you will combi feed, its not gonna work.

Is there a reason you dont wanna full time breastfeed?

You can pump and get an oversupply in the first 2 months but after that it is such a gruelling procedure.

We express so we can have free time/dad csect n bond etc but really you will end up painfully full in the breast or needing to express during this 'free time' to fix tomorrows bottle and so on.

I think go into it mind wide open, catch your excess let down with a hakka & freeze it for a few months but in the nicest way if you go into breastfeeding with the intention of topping up then it wont work for you.

I dont care which one you do and ive formula fed, breast fed full time and combi fed and combi was the hardest one to do.

Good luck & any amount or length of breastmilk is better than nothing!

You will find your way regardless

*dad can bond

For myself, I did not have the choice to breastfeed full time.
I expressed because I had to go back to work FT at 11wks post birth.
So it was either do all day bottle fed and nights/weekends breast fed or do formula. I made the first option work for all four DCs. I agree it wasn’t easy, but it’s feasible and I don’t regret it one bit.

Bottle refusal is more likely than nipple confusion. I tried a bottle at 4 weeks she reluctantly took the first one and never again since, it doesn’t matter how hungry she is, she doesn’t understand how to feed from a bottle, she pushes it out with her tongue and gags, same with a dummy! I wish I’d offer a bottle earlier but didn’t want to give formula, if you’re happy to give formula, then maybe offer a bottle occasionally within the first few weeks and manually pump during that feed to remove the milk she would be having during a breastfeed, in effect not adding any extra pumping to create an over supply, you’ll build up a nice stash in your fridge and then can gradually swap the formula for EBF in and bottle

EMB*

My experience is I have never been able to pump enough to make it worth the effort. If I do express I just use a manual pump. We had to give a bottle of formula as well as breast from day 3 due to issues with supply. Baby has not ended up with nipple confusion. In the early days he sometimes struggled to get the hang of latching on but he'd get there.

I echo what pp have said, I think bottle refusal is much, much more likely than nipple confusion. I introduced a bottle of f a day with dd when she was a couple of weeks old, at first it was a small amount and she only took a little bit but she built up over a week or so. For the first 6 months she had it when we went to bed, dp gave her it so I could get an early night. At 6 months she had a proper bedtime so we switched the ff to then. I breastfeeding fed her all of the rest of the time apart from the very occasional bottle.

Great thread, I had been thinking about combi feeding too.

If I'm being honest I found pumping such a chore and I did less and less as time went on. You spend so long feeding... When you have moment to yourself you might not want to pump. It used to take me 20 mins with a full boob to fill a bottle. I just got sick of doing this.

You might be different to me - my experience only.

But just see how you go... Don't over plan it

I'm currently combi feeding my 12 week old with expressed breast milk. I introduced a bottle around 3 or 4 days old when he had jaundice (this was actually formula at the time As my supply hadn't fully come in). Never had any issues with nipple confusion.
I expressed after each feed, slowly building up my supply. I had a bit of over supply in the first few weeks and quite sore boobs but I don't think this is any different to a mum who isn't expressing. From what I've heard, massive leaky boobs are common in the first few weeks whatever you do!

My DD1 was also on the boob and bottle from birth after spending a couple of weeks in NICU. Again, no problems there.

The relief at being able to pass your baby to someone else for a bottle whilst you go for a bath or pop out is immeasurable in those first weeks. I think a lot of mum's would do better at breastfeeding if they expressed earlier and got baby used to the bottle too. It's relentless at first so any break you can get is needed.

Just express every time your baby has a bottle to keep your supply up. Can sometimes feel like a faff but you don't necessarily have to do it at the same time. My LO has a bottle from DH at bedtime whilst I bath toddler DC1 and get her into bed. I sometimes don't express til 2hrs later.

Thanks everyone for your experiences, it's really helpful.

I think I am trying to over plan and I will just need to see what works for baby, but I'm not really one for winging things so I think that's why I'm struggling with the conflicting advice!

@Danni91 The reason is because I will need to go to work and I also run a business, and I've heard the stories like PP have said above about babies refusing a bottle unless it's introduced early. So I'd like to get her used to it so that she's not suddenly going from breast to bottle when I go back to work.

DS was born a week ago and the first two days he wasn't feeding at all. I was told not to bottle feed as he's more likely to become lazy and not take to the breast. I was given cups and formula. Midwife came for a visit and said the complete opposite. I shouldn't give him cups and should express my milk into a bottle and give him a little bit (I've been doing roughly 10 seconds) on the bottle then straight to breast and it's working so well. He now has very foamy poos because I mixed formula with breast milk. My advise would be if you can, stick with just the breast if you can and do not top up with formula.
If you want to bottle feed or need to, then express yours into it. It's made for them! Good luck with everything l 😊