Milk supply

[Lunalovegod]

Please bear with me as I'm not sure how to properly explain my concerns re my supply.

I've been combi-feeding since baby was 2 weeks old, he's now almost 10 weeks. I wanted and intended to ebf as I did with my first, but he wasn't putting on weight. It wasn't picked up until week 5 that he wasn't latching correctly, by which point he was probably taking more formula than breastmilk. Since then, I've worked on getting his latch right and breastfeed more often. I want to get him off formula if possible. I think it constipates him and when he does poo, roughly every 3 days atm, it's very watery with a green tinge.

My issue is that I've no idea if my supply is enough to ebf now. Due to combi-feeding from so early on, I presume he hasn't had the chance to build up my supply to his needs. However, the milk is there whenever he does feed. He probably has around 3 feeds a day from me, and around 3 feeds throughout the night, then will basically use me as a dummy until morning 🤣 then another feed before we get up. So the milk is there, however, I don't get engorged between feeds or 'missed' feeds when he has a bottle, which makes me think my supply must be low?

Most of the time he will fall asleep after a breastfeed and is content, very occasionally it seems like he's not satisfied until I give him a bottle. Does this indicate an issue?
However, this never happens at night. He sleeps well between feeds.

My health visitor is lovely but is telling me to keep up with the formula as he's putting weight on as he should be now. I just don't think she's considering that he may have been just fine if his latch was right from the start.

So, how do I begin to move back to ebf, without putting his weight gain at risk?
How do I know if my supply is enough, and how do I increase it if I need to?

Sorry if I've waffled on.

Very, very grateful for any advice.

Would also like to add that he must be getting what he needs throughout the night, as he is the HAPPIEST baby every morning (so many smiles😍🥰). So there's no way he's been going hungry all night. I'm just worried that my supply might not be enough for him thoughout the day. I'm so confused with it all

In my experience top up formula feeding decreases your breastmilk supply, the latest research which is actually a few years old now says that health visitor ,medical practitioners et cetera were using data on weight gain for babies solely based on formula for babies not breastfed babies. formula fed babies tend to gain more fat and weight than purely breastfed.
Maybe in your situation I would slowly reduce formula, and then work towards breastfed exclusively

I would make an appointment with a lactation consultant (IBCLC). You will need to increase your supply as every time your baby has taken formula, your body has received the signal that he didn't need milk at that time, so you haven't been making it (unless you've been pumping at that time).

Perhaps pick a formula feed at a time and offer the breast instead? This will signal to your body to produce the milk for that feed, should take a few days, then swap out another formula feed? If you are feeding a lot at night this is likely helping your supply as this is when the body produces the milk production hormone. I found my supply was lowest mid morning but not to the point of needing to top up.

It is possible to keep the level of formula the same over time and increase your breast milk supply instead of increasing the quanti morety of formula.

Best to speak to a breastfeeding counsellor (LLL / ABM / NCT).or pay for IBCLC

Express after every breast feed and add in a pump session
the more milk you use the more your body will make

@sorchanim I haven't been pumping, just the very odd occasion that I have become engorged. That's what I'm most confused about - the breastfeeds he has during the day are never at specific times, usually if we're out for a while and I don't have any bottles on me, or at home if I don't have one made up yet and he's too impatient to wait, but I always seem to have milk for him. Is it possible my supply is okay despite the formula feeding? Is it possible that, because I ebf for 18 months before, my body just knows what to do?

@Petrie999 I think that's what I'll do and see how it goes, thank you :) I've recently learnt that the body produces the hormone at night, makes me very glad that I've stuck to breastfeeding at night as this may have helped here.

How many bottle of formula he having?

Sounds like he is cluster feeding ober night which is normal, he is telling your body that tomorrow he will need more milk.

I would start with dropping a bottle for a week, and then next week after bottle. You may have to make sure you allow extra feeding time your body adjust to the change.

“Most of the time he will fall asleep after a breastfeed and is content, very occasionally it seems like he's not satisfied until I give him a bottle. Does this indicate an issue?”

When he’s unsettled do you switch sides and offer both boobs?

also, congratulations on turning this around, it can be really hard to phase out top ups and get a baby back to the boob

I don't usually but it did occur to me as I was writing that to do that, so I will from now on. I think I've just got used to him having formula so thought that's what he needed.

Thank you, I really appreciate that, it means a lot to me to be able to do this.

Tbh I'm not sure as I don't count, and there's no rigid schedule with his bottles as I will give random breastfeeds here and there instead, but around 4 bottles a day.

Yes that's absolutely possible- that milk making tissue has already been activated and will increase supply the more milk is removed. Advice from a pp to drop a formula feed each few days/ week is sound, and if baby looks for more after a breastfeed offer the other breast, you can switch back and forth as many times as you need to. You might get a few fussy evenings with baby permanently attached but your body will respond.

If you have any bf groups or specialist support available they would be able to help you. I'm sure they would be interested in your feedback too, sorry you haven't had the support you needed so far.

3 or 4 bottles a day really isn’t many. I would start limiting to 3 bottles for a week and then only 2 a week.

Do you want to be ebf? I had a baby who moved exclusively ff at 6 weeks and one who moved to ebf at 6 weeks. I always thought combi feeding at least one bottle every few days would be ideal in case you need to go to an appointment or even a social event (😱) and then some one else could look after baby. My Mum was very ill when my youngest was born.

It's not that many really, it was more but I've started breastfeeding more often recently. He only takes 2-3oz per feed every 2 hours, so really he's not having that much now that I think about it. I've been really worrying over how to stop the formula incase my breastmilk isn't enough, but breaking things down in this thread, I've realised he's actually having more breastmilk than formula anyway. I do want to ebf yes as I did with my first and I really wanted to do that again. Now that he's used to bottles I think he'd still always take one if I needed someone to look after him 🤞🏼

Thanks for everybody's advice in this thread, it's helped me to stop overthinking it and realise this can be done.

giving both boobs, and even going back to the first one after he’s had both, especially in the evening when he’s cluster feeding, will do great things for your milk supply.

also, bear in mind that milk drips/dribbles out of a tipped up bottle even if he’s not sucking for it, paced bottle feeding will help to make sure he’s not just drinking it because it’s pooling in his mouth. That way he’s only drinking the top ups if he actually needs it, can regulate his intake and won’t get overly full.

Offer baby the breast regularly, even if you need to top up with formula after he has taken as much as he can at the breast.

Do regular skin to skin time.

In a couple of weeks your baby is going to start getting really distracted during feeding (daytime at least) so try to find somewhere dark/ less stimulating, and quiet, and/or try a cover, to stop him getting distracted at the breast.

I would make an appointment with an IBCLC breastfeeding counsellor. I had a lot of local support from hospital, NCT, local groups, and health visitors so I didn't go to an IBCLC counsellor until 8 weeks. She was absolutely brilliant and I wish I had seen her sooner. We worked out a clear and precise plan for moving towards EBF (at this point I was doing a mix of breastfeeding, formula feeding, and expressing).