Switching from breastfeeding to combination feeding

[Fezzle]

I've been mostly exclusively breastfeeding for 5 weeks and want to switch to combination feeding- maybe about half and half. What's the best way to go about this so that I don't end up losing my supply but also don't get too engorged or risk mastitis? I saw on the NCT page it said to breastfeed and then top up with formula which will extend time between feeds and gradually lessen milk supply, but then on another site it said to replace a breastfeeding with formula gradually. I'm going to the baby clinic later and plan to ask someone there, but wanted to know if anyone had first hand experience with this transition.

 

[MindUtopia]

I think the advice would depend on if you plan to keep breastfeeding/combi feeding long-term or if you are planning to switch to formula full-time, but want to do it gradually. If you don't plan to stop BF entirely, I'd have a look at kellymom or la leche league to see what advice they give you on keeping your supply up and how to do it.

I can say from my own experience though that we started to combi feed at 6 weeks but totally from a bottle, with expressed milk and formula as needed. It's slightly different because I started to combi feed because of existing health issues of my own, so my supply was probably not great to begin with. But we took the route of breast milk first (if I had any, I started to express then, so was trying to get as much as I could but it wasn't always a full feed) and then topping up with formula if she was still hungry. I think honestly it's probably easier just to either BF or FF rather than to top up because then you only have to do one and not both. My daughter had no issues with formula and happily took it so we didn't need to do it gradually, but I was just trying to still get as much BM as I could in her.

But if you want to maintain your supply, you will also have to express at every feed that you offer formula. If you want to wait until later on, closer to 3-4 months, your supply will be more established and you probably won't have to, except for comfort. But if you don't want to stop BF altogether at this point, you'll need to express as often as she would feed anyway (either expressing while you give her a bottle or after if she falls asleep and you can put her down or get the pump on while holding her). This bit is really key. I personally was pumping 6 hours a day (30 minutes per side, 6 times a day), which sucks, and I would recommend a double pump if you want to go that route (which would make it about 20 minutes total per pump, as often as you give her a bottle and she doesn't have a feed from you). Even doing this, I lost all my supply within a month and had to switch totally to formula at 10 weeks.

So my advice would probably be, if you can manage to wait a bit longer, to wait until your supply is established, closer to 3 months before you start to combi feed if you plan to continue BF along with formula. It will save you a lot of extra effort with pumping, which is a lot of work, though not impossible. If you don't want to wait, just make sure you're pumping regularly whenever you don't feed her from the breast, both sides, at least 20 minutes. If you do plan to switch totally to formula and you aren't concerned about lowering your supply, I would just switch out a BF with a bottle of formula, starting slowly so you are comfortable, maybe once a day to begin with and see how it goes. You might end up keeping your supply up for quite awhile without much effort if you have a good supply anyway, or you might be like me and have it decrease pretty quickly. It really just depends what you're long term plans are.

 

[noon_child]

I didn't plan to combi feed, but due to my LOs weight I had to do formula top ups and I carried on with this for a good few months until I knew my LO was feeding well and Daddy continued to use formula during his (increasingly rare!) offers of help.

I think my advice would differ depending on your reasons for wanting to combi feed. For me and PP top ups after every feed were a pain in the bum but replacing a full feed with formula does increase your risk of mastitis and gives a stronger signal to your body to slow milk production (the fuller your breasts are the less milk you will make). What do you want to get out of combo-feeding? Maybe identifying that will help identify the right course of action for you.

 

[blueblue]

Slightly different but my LO wouldn't latch at first so I exclusively expressed from birth with supplements as my milk supply wasn't great, I was expressing every 3 hours until 8 weeks, then wound it down until 10 weeks (then breastfed at the day feeds before formula and eventually managed to drop some of the formula feeds) and still managed to have a milk supply. I'm not sure if this is the case for everyone but was told it takes 6/8 weeks to establish supply and have managed to keep the supply without expressing or bf at night from December til a few weeks ago.

So I would probably try and breastfeed at each feed for a few more weeks to get it established and cut back then, are you thinking of replacing the night feeds with formula?

 

[Fezzle]

It's been a combination of my health issues (though hopefully they are temporary) and her weight issues.

Me- About a week after my LO was born, I had a bladder infection turn into sepsis and was hospitalised for almost a week (but with her, and still breastfeeding). I have been loaded with antibiotics via IV in the hospital and then a week of oral antibiotics, but last week the infection came back with a high temperature, pulse and chills, though it seemed to just be in my system rather than a UTI now. I was hospitalised again but just for a night this time and am on oral antibiotics again now. All the antibiotics have given me thrush in my breasts now too which is also currently under treatment.

Her- a few days after she was born, she dropped so much weight we were hospitalised again where I was put on a schedule of bf every 3 hours, then top ups with expressed milk and formula. I had loads of breastfeeding help there, and we left doing well. She gained steadily and was back to her birth weight at 3 weeks, then gained again last week. Today I took her to get weighed because she looked skinner to us and she was back down to her birth weight and lost a good bit from last week.

In the past couple weeks, it feels like I've been feeding her constantly. She'll feed for usually over an hour, then want more soon after. It got worse in the past few days which was another reason we worried if she was getting enough milk even though she has enough wet nappies and poos. Clearly there's some issue if she's lost weight- we're going to see the Dr. I know there's no tie issues, or with latching as due to all our hospital stays we've been well examined!

Since I've been feeding so much, my husband hardly gets any time with her and when he does, she's been hungry and crying. My parents and MIL visited recently and also barely got to do anything but watch me feed her. I've had trouble sleeping, eating and getting any sort of activity since all I do is bf which probably isn't helping kick this infection, so I've been miserable. I tried expressing but there haven't been breaks to do unless I give up more sleep, and when I do pump it's not a great amount.

We had been sticking it out because people have said it gets easier at 6 weeks, or that it's just a growth spurt, or that some babies just take a long time, but now with her weight loss, we have to give her formula for now as recommended by the health visitor. I want to keep giving her a bit of breastmilk but I think we'll end up gradually switching to completely FF so if my milk dries up, I won't be disappointed- but want to dry it up in a safe and mostly painless way. We started formula this morning and she's been much happier today, and so have I. I've only done one am feed from both breasts and then pumped this evening, and haven't felt close to being engorged or even full in between.

 

[Fezzle]

Also- thanks for all the very informative replies!

 

[blueblue]

That's really tough, glad you are feeling better now and she's doing well with formula. Hope it's getting easier a few days on? Sometimes bf just doesn't work out and that's ok, you have to do what's right for you. I've found for me that for me, bf only works if I use formula too, otherwise she isn't getting enough and that's not good for anyone x

 

[Fezzle]

I ended up going completely to formula- I was expressing and getting hardly anything and it was too tricky trying to avoid engorgement. Tomorrow she'll get weighed again where we'll see if she's gained weight and is back on track, but she looks and feels heavier and seems so much happier (and I am happier too)! Thanks for all the advice and support!

 

[blueblue]

Glad you are all so much happier! If she feels heavier I'm sure she will have gained weight. Expressing is bad for engorgement, I found I got much more engorged when expressing than with bf. A friend said it's overstimulating and that a friend of hers ended up with mastitis because of it. x

 

[Fezzle]

Freya gained 1lb 4oz in her first week of formula! She's looking a lot plumper now and we're all doing well. I've completely stopped any expressing or feeding and my breasts are feeling much more normal now (though one leaked this morning for the first time!)

 

[blueblue]

It's great she's gaining so well! x

 

[Daddy2Maddie]

My daughter Madelyn was breastfed exclusively for about 4.5 weeks. The I thought it would be a good idea to have some formula on hand as a backup food supply, and also to be able to feed my daughter while my wife sleeps, if she hadn't pumped enough milk for a feeding.

The first time she took the bottle, she'd stop a lot and cry, but got used to it pretty quickly. We got a dr. brown's glass bottle, which is supposed to flow slower, but it still comes out faster than breast milk.

When I feed her the bottle, I either have her upright or on her side, and try to keep the bottle parralel to the ground so it doesn't come out too fast. It seems that having her on her back causes her to choke and cough.

Our lactation consultant also recommended this, so that the baby has to "work for the milk" like they do at the boob.

She's now over 6 weeks old, and the only issue we noticed is that she went almost 2 days with very little poop. Then today she suddenly let it all out. I'm not sure if that was from the formula, but we give her a max of 4 oz of formula per day.