Combined BF and FF - how does it work for others?

After trying hard to build up my milk supply so that I could exclusively BF, thinking we were doing well and then finding that Zac had actually lost weight, I am now reconciled to combined feeding. Hopefully when he starts solids we can cut out the formula, but he's only 8 weeks old, so that's a way off still!

However, the whole experience has left me feeling quite confused about how to tell when he's hungry and when he's just generally unhappy/tired/bored. So we have feeds that seem to stretch into eternity - we might have a really good BF (20-30 mins each side) and then a while of reasonably happy behaviour before he completely cracks it. Sometimes I think he's telling me he's hungry but he just yells at the breast and refuses to attach - of course, he will then guts down a bottle. He doesn't sleep much during the day - can be awake for up to five hours, by which stage of course he is completely beside himself (as am I). I don't live in an area where I can easily take him for walks, and the car is out of commission at the moment, so we're also a bit house-bound, which is definitely not helping...

Apart from help with understanding his cues, I was wondering how other people manage combined feeding. Do you feed on demand or have a bit of a routine in place? Do you find that you use more formula at certain times of the day? Do you top up each feed or just give a certain number of bottles a day?

I would really appreciate any pointers that people have - just as I think I have it worked out he goes and changes all the rules on me ;-)

Thanks in advance :-)

Im interested in this too as bub was put on formula due to weight loss but I still want to bf him.. Are u sure u have ur attatchment right? I've been told recently bub probably wasn't getting enough due to poor attatchment.. He would get on and suck for 20mins each side but still not appear full and this was because he wasn't getting enough milk but not because I didn't have enough milk if that makes sense.. Have u contacted the aba? They can be really helpful 1800 mum 2 mum they also might have some ideas for u on how to combine both and how to make sure bub is getting enough...

When DD lost weight we had to start topping her up with formula.

What I did was always offer her breast first, when ever she demanded then after a burp I would then offer a top up, it was usually about 60ml after each feed during the day, and the in the evening it was 120ml, as my milk was a lot less in the evening.

That we she still stiumlated the breast to encourage more milk supply and got all the BM she could get and the F was purely a filler/top up, sometimes she would only take 20ml other times the whole lot. It was very sporadic.

By the time she was 5 1/2 months she actually learnt to suck properly so it was painfree for me, and she also started to not need the F top ups. We dropped the top ups started with the morning feeds, and eventually the evening feeds, as my supply was better earlier in the day.

We eventually got rid of the tops up by about 6 1/2 months (I think!).

It is a bit of work with the bottles as well, but I found this worked the best for me and would continue to encourage the milk supply.

Wishing you the very best and I hope you can make the combo work for you.

Take care
xxoo

thanks Beema and Noni for your speedy replies!
we've been comping since birth - what with emergency c section, gestational diabetes, and breast reduction surgery, plus I think a general lack of education, it seems like I just may not be able to get as much milk as I would like. I have spent time with two excellent LCs (including Pink Mackay), and they agree that this may just be the way it is for us. Zac's attachment is excellent so that doesn't appear to be the problem.

I combine FF and BF for different reasons.
1. I enjoy the break
2. I am not an expresser - would rather be spending time with my 3 year old when my bubs is down for sleep, plsu I find expressing makes my nipples sore.
3. I am returning to photography sessions and will need to be away for the mid morning and mid afternoon feeds
4. I like having some freedom during the day ;)

So, I introduced 2 FF's a day - it works out to be every 2nd feed after the first big morning feed of the day - so around 10-11am and 2-3pm. I just make up the 150mls recommended on the tin and go from there. Sometimes he will drink it all, other times he will only take 80 - 100mls.

I breastfeed all top ups and every other feed - and because I get that break I enjoy BFing him a whole lot more.

I didn't introduce with with my 1st child until around the 3 month mark (Koby is 7 weeks).

By the time I introduced it with Paige it meant her day feeds were formula and her morning and night were BF's.

I know this is different as I am not topping him up with formula, but I thought it might help others.

I always introduce formula under the condition that emotionally I am ok if they wean from the breast altogether.

Cate, have you tried fenugreek or even motilium prescribed from your Dr? I had a c-sec and my milk took 5-6 days to come in and I started taking motilium in hospital on day 4. I also had GD and DS had to have some formula top ups in hospital due to me having very little to offer him and his low blood sugars. I was feeding him and topping him up with any EBM I had and then formula as well. After every feed I would express for 20 minutes to encourage supply. By the time we were home he was off the formula top ups and I was just topping him up on EBM if he was still wanting more. It worked, and we have been exclusively breastfeeding ever since.

A friend from mothers group had her bub 4 weeks early by emerg c/s and has been b/f and offering formula tops ups as well. She's been taking something else to help her, fenugreek I think. Now, at 4.5 months old she only has to offer a top up at night and her bub is thriving. It is a lot of hard work, and if you're feeding approx 3 hourly you feel like you are constantly b/f, topping up or expressing. I hope you can find the best balance for you and your bub. I second nonie's advice about calling the aba helpline. Maybe they will have some new suggestions for you?
Good Luck :)

I was taking 6 x Motilium a day, up to 8 x a day to boost my supply. Just recently weaned off it completely, but it worked well for me, and cut back the top ups a lot.

Cate, it sounds as though you have been down all the right roads to keep on breastfeeding your DS, that's fantastic! It is quite difficult when you realise that you won't be able to breastfeed exclusively, and that some top ups will be needed. And TBH, I found it even more difficult working out just WHEN my DS needed those top ups!!! But it does get easier over time, and although we never really cut out the comp feeds in the first 12 months, we did manage to breastfeed for over 2 years! So it can be done :D.

I would suggest getting in touch with one of your LCs again, and having a session with them where they can go through with you how to read Zac's signs, and how to know when it's appropriate to 'top up'. I think that will be the most helpful thing for you by far. You WILL work it out, but it will take a little information, and practice. I know I certainly found it quite hard, it was probably the most challenging thing I encountered in my first year of parenting.

As for HOW - I would definitely recommend feeding on demand, and topping up according to need. The more breastfeeds you offer, the better, for all sorts of reasons. Nipple confusion is a real possiblity, it sounds as though you may be experiencing some of this already. Try to make sure that the teats you use are as slow as you can find, and pace the bottle feeds out to mimic a breastfeed as much as possible. Also, have a chat to your LC about other methods of comp feeding that might be suitable in your situation. Try to BF before he gets really hungry, certainly before he's crying, and even while he's still waking up. If you haven't already, chat to your LC about taking some motilium to help your supply along while you're bfing. Given your history, it might be something that can keep things going well for you. And lastly, check out this website BFAR - Breastfeeding After Breast and Nipple Surgeries and see if there's anything helpful for you there, and check out the links to their sister site lowmilksupply.

I hope some of that helps you. Good luck on your journey, and remember that we're all here to support you :D

thanks ladies

I am on motillium which I think has definitely helped. Janie and Chrissy, thanks for sharing what you do - it's good to know that it can be done. I agree that knowing when to top up is hard!

I called on the ABA a lot in the very early days, and they were just magnificent, so I may well recontact to get some advice on the situation as it stands now. Although they haven't 'evangelised' in the past, I am always nervous about being judged/criticised for not exclusively BFing, however I feel very proud of the effort I have made (with a huge amount of support from DH) and comfortable with the reality that we will be combo feeders for the immediate future at least.

Zac is a generally happy, very healthy little boy, and I am pleased that he is getting at least some BM!

Oh Cate, you are doing such a wonderful job hun!!!! I certainly hope you feel comfortable to contact the ABA again - I would feel sure that no one there would judge you, it is so clear that you are giving your best to your little boy!!! Do you have a local ABA group that you have made contact with? If so, I would highly recommend going along to meet with other breastfeeding mothers, it's such a lovely community :).

You should feel so proud of yourself (and your DH) for putting in such a fantastic effort so far :D. And I'm sure you will continue to do so, with a little more support along the way. It just goes to show doesn't it, what a difference wonderful support makes to breastfeeding mothers.......

ETA Just saw that you are in Belgrave, so about 30 minutes from me!!! I'm pretty sure Belgrave is part of the Dandenong Ranges group if you're interested. You can get more info from the ABA website. I would be happy to meet up one day too if you're interested, in Olinda or somewhere :)

I did it much the same as Beema - only my stupid doctor at the time would not give me motillium (because its for nausea, not breast milk, grrrrrrr) and so my supply just went down with the less time. But always breast first and a 1 scoop top up afterwards. If they guts the 1 scoop then I would make them another one. I never overdid the formula comp but sadly never got decent supply.

When they are just fully fussy and you are missing the queues, especially if they have been fed not so long ago - try everything else before food. Check the nappy, check for wind, try some tummy to tummy time letting bub look up at your face, a bit of carrying around. I even got the pram in the house and sometimes I will put her in there and just roll it back and forth - usually she just drifts off to sleep with that. If he is still screaming despite all that, try feeding again. Usually with formula they don't scream again soon after unless a burble is stuck or something else is bugging them.

Hey Cate,
With regard to understanding babies cues - I found my local CYH (I think it might be MCHN where you are) had heaps of info regarding reading baby cues - I found this really helped me (as up to about 12 weeks I reckon I was missing some of Baileys and confusing tiredness for hunger etc)

Having said that - it really depends on the MCHN too, some of them are very helpful and some and just plain dumb

I do have some handouts I could scan and email you - just PM me if interested with your email addy

I have just started giving my 17 week old some FF as I just cant express anymore, I have enough to feed, but nothing 'extra'. As I am not always comfortable whipping out the boob, I prefer to FF when out unless at someones house etc. I have found that luckily he interchanges between both, but I was advised to use the NAN HA 1 Gold formula as its supposed to be easy to digest like breast milk and a good compliment to BF

HTH :)

Naomi