Breastfeeding and Formula at the Same Time

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Formula and breastfeeding at the same time

May 2013

I am trying to understand all of my options for infant feeding. I could write a book about my reasons, but basically I hated breastfeeding my first despite doing it until 16 months, and I had painful difficulties (thrush, plugged ducts, pumping hurt). I want to have another child but at this point I'm thinking I'll just go straight to formula. Breast is best, and that's why I suffered like hell the first time around, so I'm not feeling totally happy with this either/or option. What I'm wondering is whether it's possible to do both, and I'm not finding a lot of information, so I'm looking for first-hand accounts. I want to offer formula right away at birth to avoid the jaundice issues that my first had, but I also want to offer the breast for the colostrum. I'd like to be able to alternate between the two, and use formula for night feeds. However, if I got thrush again I'd probably give up, so I'm wondering if this is all worth it if I only breastfeed for a month or something. Anyone out there try to use both? Did it work? Tips for success? I imagine that nipple confusion and milk supply would be the main obstacles I'd have to manage, so how can I do that and make it work? Or should I just plan on formula now? To clarify, I'm only looking for advice from people who've tried what I'm talking about and have first-hand experience with it. Thanks! want to understand my options

I combined formula and breast-feeding for all 3 of my kids from pretty much the first week of their lives - it can be done! And I know there's a lot of pressure to breastfeed around here, but don't feel guilty - if you're happy and relaxed, your baby will be happier, too, regardless of what he's eating. I didn't have a real strategy for it - I usually offered the breast first when I was around, but my husband often gave them formula at night or when he was out and about with them, and I sometimes did a bottle in public for the convenience. And my supply was always pretty low (partly because I wasn't exclusively breastfeeding, but partly that's just the way I am), so we supplemented with formula when I was tapped out, too. The kids are in grade school now and all healthy, smart and strong. I'd say try breastfeeding, but don't stress if it doesn't work out or you need to supplement or go to all formula. Practical Mama

I did ''mixed method'' feeding with our second after breastfeeding nightmares with our first (despite paying through the nose for various breastfeeding consultants, none of whom seemed to care that I had a jaundiced baby and red-hot, sore, cracked, infected skin that lasted more than a month). I was determined not to repeat that experience or spend any more money on completely useless advice. I still wanted to breastfeed and held out hope that the second time would be easier, but I came up with my own game plan so I would not find myself in the same excruciatingly painful/frustrated place. I started breastfeeding right after delivery, using nipple shields with lanolin (which I brought with me to the hospital) from the get-go. When I got too sore (about 24 hours in), I introduced a bottle. I brought my own supply of formula, water, sterilized bottles, and nipples to the hospital, enough to last a 48 hour hospital stay. From that point on, I alternated breast and bottle feedings and kep t up that pattern until my supply diminished (6 or 7 weeks in). When my milk came in I also pumped to help establish supply. Most importantly, I stuck to my guns despite much judging from hospital staff, the Dr's office, and freaky people in cafes and restaurants and their unhelpful comments about bottle feeding. The baby had no issues with nipple confusion - just quickly learned what he had to do and fell into a nice rhythm of breastfeedings with Mama and bottles with Papa, his big sister, and grandparents. And the money I did not spend on unhelpful breastfeeding consultants covered a family weekend away when we all felt together enough to travel. I Did It My Way (and Saved My Sanity and Pocketbook)

Hello! I hear you about the breast feeding! I had twins, and I was unable to nurse exclusively. And, my kids were not great at latching. After lots of lactation consultants (who I felt pressure from and who did not seem to have a good solution for me) I did what felt right and supplemented with formula. After trying lots of things, here's what worked for me. I stopped latching the kids and exclusively pumped. Luckily, I had a really good pump (best Medela pump at the time) and had 2 attachments so I could pump both breasts at once. Then I bottle fed. At first I would alternate feedings--one was exclusively breast milk, next was formula. I made sure the final feeding before bedtime was formula because it seemed like they slept better. Later, I mixed 1/2 breast milk and 1/2 formula and that worked too. You have to make sure you are pumping on a very regular basis And in the middle of the night too! Oh, I should say that I latched them for 2 weeks first. Also, in my research, I discovere d that most health benefits for mom and babe are achieved if you breast feed for three months, so I set that as my goal, and managed to keep on for four. I got a lot of pressure (they would have called it support, but frankly it was negative and wracked me with guilt--so it was pressure) to exclusively breast feed, but my solution was best for me and my kids and everyone turned out just fine. Oh--and my kids had jaundice too. Formula is fine

I'm 'mixed feeding' right now. I didn't plan on it. During pregnancy I naively assumed that breastfeeding would be straightforward, even blissful. I will not dwell on our problems (tongue-tie, flat nipples, low milk production were the main issues), but after months of struggling, we have reached a compromise that I can accept: I always breastfeed at night and in the early morning when my milk production is high. I will offer my breast in the first instance during the day, but my daughter will often refuse to drink or 'comfort nurse' for long periods. When this happens, I offer her a 'top up', first of expressed milk and then formula. She rarely drinks more than 100 ml at a time, and often takes much less. Feeding her the expressed milk works very well and this approach minimises wastage. I express 2-4 times a day. 10 pm, midnight, 8am and 3-5pm is our usual schedule, if you can call it a schedule. We rent a hospital grade pump (Medela Symphony), which I wholeheartedly endorse. At nea rly 5 months my milk production is finally increasing and I estimate that my baby gets about 1/2-2/3 of her milk through this method. We do cycle through a lot of bottles and expression paraphernalia during the day, but I am grateful that I can continue giving my daughter breast milk. We have been lucky that nipple confusion has not been an issue for us. I would also recommend the book ''Making More Milk'' by Diana West. This helped me increase my production, especially during the worst periods of the tongue-tie situation. I am interested in hearing about the experiences of others who have gone this route. Wishing you the best of luck. anon

I went into having a baby expecting to nurse 100% but a couple of days after my daughter was born she developed jaundice and the doctors insisted on supplementing with formula because the jaundice kept getting worse. To get rid of the jaundice, I alternated feedings - one by breast, one formula by bottle. After the jaundice went away, we gave her less formula but still generally gave her about 1-2 feedings a day of formula. I wound up nursing for about a year with this kind of pattern. And it proved to be a great thing. Thankfully, we never experienced a problem with her preferring one over the other or having ''nipple confusion'' or anything like that. And it was a blessing to have the occasional break from breast feeding or pumping. Obviously you'll get some people saying that is horrible, you should breast feed for years, etc, etc. But you need to do what's right for you. Our baby was (and 3 years later still is) happy, healthy, thriving, smart, ''normal'', etc. I have no guilt about my approach and if I have a second I would do the same thing, even if the child didn't have jaundice. Kim

I fed my daughter with both breast and bottle from day one and had no problems. Generally at night or whenever i was home i would put her on the breast but if we were out i took a bottle. The only downside was getting sore swollen breasts and needing to express if she had missed a feed. I just bottled the expressed milk and put it in the fridge to use later. The only thing i would say to be aware of are any scare tactics you may come across in the first few days after the birth. My doctor instructed the nurses to give my daughter a top up bottle if she needed it (she was in the nursey at hospital while i recovered from a c-section). A couple of the nurses and the lactation consultant gave me scary stories about my milk drying up etc, which caused me great deal of distress. Didnt happen of course, but it's a standard line you might hear. After 8 months she was off the breast altogether is going great. Good luck! EricaN

I did this. But you CANNOT give formula immediately if you want to establish your milk supply and avoid nipple confusion. Many of my friends tried this and ended up with not enough milk. On the advice of my doctor, I waited 6 weeks before introducing a bottle and it worked perfectly. I had a good milk supply and baby didn't reject the bottle. One thing to think about though is what formula you use- I ordered mine from Europe because in the US the main brands are loaded with corn syrup and sugar! Incredible that babies are exposed to junk so early, but they are. Have a look online, otherwise here is a good article: http://www.naturalnews.com/033926_infant_formula_corn_syrup.html This of course is pretty expensive, so do take into account how much money breastfeeding saves. Anyway, good luck! It is very possible that breastfeeding may be easier for you second time round! Cmom

As you said, breast is best but so is your sanity! You can most definitely do both. You'll need to focus on breastfeeding the first couple weeks to ensure your supply and perhaps alternate feedings from then on. Every situation is different so I'd highly advise seeking lactation support when your potential child comes along. In that same vein, this next baby might be an entirely new breastfeeding experience for you - it may be easier than the first time. Just keep an open mind about it. And kudos to you for going 16mo despite the difficulties. HH

Hi, first off, I want to give you some encouragement regarding your decision. The Bay is such a pro-breast feeding area, that even moms who have struggled and tried for weeks or months with a baby who isn't gaining weight feel a lot of guilt about supplementing with formula. You know yourself and your body, and it makes sense to want to give the best to your baby (breast milk) while also being able to enjoy being a mom and know that he/she is growing healthily (with supplementation). To avoid nipple confusion, try and SNS system for the first month or so. The baby latches to your nipple, but then gets supplementation when you run out. You can give your baby your colostrum/breast milk and formula this way. My LO hasn't had a problem with nipple confusion, but we didn't use a bottle until she was 4 weeks (this is earlier than typically recommended), then just EBF again until 8 weeks when we started using it regularly. She loves the bonding from breast feeding so much, she still prefers it unless she is really hungry and I am already empty. This may also be due to the fact that prior to introducing the bottle, we spent a LOT of time doing skin-to-skin, and nursing almost hourly to try and reconnect after some time apart at birth and shortly after due to health complications for both of us. I don't know if it'll be the same for your LO. Also, for a while, only my partner fed her from the bottle. This was in hopes that she associates my smell with breastfeeding only. I don't know if it helped, but it can't hurt. I also have a really hard time pumping, so anything from a bottle is usually formula, though we were getting donor milk for a while. That is a good option to look into, though your baby won't be getting as much of the benefit as if he/she were getting your breast milk. A word of warning though, doing both will not necessarily save you from some of the troubles you had before. Although I haven't had thrush, I do feel like I get clogged ducts fairly often, and just got over mastitis last week. Also, from speaking with other moms, it seems like many who start off wanting to do both end up eventually giving up on breast feeding before 6 months and go to 100% formula. It might be that part of my ''success'' at doing both is that I am still very committed to breast feeding and get a little sad anytime she takes more in formula than her typical daily amount. anon

Hi there, I did both with my son and it worked out just fine. My son was 7 weeks premature, so getting any milk was super hard, and my milk supply never got full speed. I do think offer some breast milk if you can, as I believe it does help with health and immunity. But we switched back and forth depending on my production and it was no problem. Stephanie

You may want to read this article that just came out in the Chronicle: http://bit.ly/ZU76Um It talks about mixing breast milk with formula. Andi

Hi. I can't say it will work for you but I did breast and bottle with my son and it was never an issue. I started giving him water in the hospital because he was slightly dehydrated (Nurse's advice) and kept up with it at home. I had a lot of pain nursing so I alternated with bottles and he never seemed confused by it. I liked it as well because (as a single mom) it was really nice when someone could take him for a bit and give him a bottle. I guess the caveat might be that my son was a spectacular eater so maybe I could have tried anything and it would have worked . I say try it and see what happens. Been there, done that with success

Yes, it's definitely possible to do both. So many things make it seem like it's all or nothing with breastfeeding or formula. But, if your inclination is to do formula, then having some breastfeeding in there is definitely better than just the formula. And, yes, even if it's just for a month of breastmilk, it can make a difference in terms of gaining some of the benefits of breastmilk (immune system, etc.). Nipple confusion is actually much less of an issue than was previously thought. One of the biggest issues you'll face is that if you're formula feeding half of the time, you may encounter supply issues because of not doing ''enough'' breastfeeding to keeping the supply going. This is more of a problem for some people than others. Pumping could help with that (if you're so inclined). When my babies (twins) were very young, I supplemented with small amounts of formula, then I exclusively pumped for a few months, then I did a combination of pumped milk and formula, and finally at 6 months I transitioned to formula only. It probably didn't sit well with the breastfeeding police, but it's what worked best for my family. Good luck! --glad to be done with that phase

We introduced formula at about 10 days old and continued to breastfeed and offer a daily formula bottle until age 15 months. No nipple confusion. So I wouldn't worry about that aspect of it. Breastfeeding your second baby could be entirely different from breastfeeding your first, so it's definitely worth a serious good-faith effort (without pre-committing to formula). My good friend was not able to breastfeed her firstborn at all, instead pumping exclusively for a year (Wonder Woman!), but with her second baby, had no BFing difficulties at all. BFing mom x3 (with a little formula in the mix)

Hi. I've done exactly what you're asking. With baby#1, I had to be dragged into the ''combined formula/breastfeeding'' thing kicking and screaming. I had a low milk supply and nothing worked. The advice of lactation consultants was turning me into a crazy person and finally a visiting nurse (assigned to us because my baby was losing WAY too much weight) had a ''come to Jesus'' moment with me when my son was 2 1/2 weeks old. She shook me out of my stupor and reminded me that formula is not poison and that my child NEEDED to be fed. From then on, we switched easily between breast and bottle. With baby #2, there was no way I was taking the highway to crazy town again. She got her first formula within a day or two of coming home. She too switched easily between formula and breast. What worked for us was to breastfeed first, then give formula last for the first few weeks. So she had to do the harder work first, got as much breastmilk as I could give and then topped her off with some formu la. But after a few weeks, I was able to sometimes just give a bottle with formula without nursing first. And that was certainly handy in the middle of the night, since Dad could feed her. I combo nursed/formula-fed baby #1 until I went back to work when he was 4 months old -- pumping was not worth it for my tiny milk supply. With baby #2, I think the lower-stress start actually made us a better nursing pair. I nursed her (with formula mixed in) until she was 6 months old. After I went back to work, we kept nursing morning and night, but I didn't pump during the day -- she just got bottles with formula all day long. It worked like a charm. Your situation could be different, but I see no reason not to try the combination of nursing and formula and see if you hit on a balance that works. In all likelihood, breastfeeding will be easier the 2nd time around. You'll be more relaxed and prepared and you'll probably make more milk and with fewer complications. Worst case scenario, you can always quit nursing and give formula. But if you want him/her to have a little breast milk mixed in there, you can definitely do both. Just don't let anyone give you a hard time about giving formula -- one of the hardest things about formula feeding is being judged by others. Develop a thick skin, know that you are doing the best you can, and if you end up exclusively formula-feeding, that's going to be just fine. If you've never read it, this article by Hanna Rosin, made me feel better about our situation: http:/ /www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/307311/. Anyway, good luck with baby #2. Maybe you'll be pleasantly surprised and find that breastfeeding doesn't have to be tortuous after all. And maybe the combo approach will be perfect for you both! Combo Mom

After MUCH struggling to breastfeed with my first child (breast reduction = low supply, nipple confusion, very small baby, pumping round the clock), I gave up about 2 months in and happily (and somewhat guiltily) gave formula after that. With my second, I decided no guilt. If she wanted formula, I'd give it to her. My supply was still low, so we did supplement with formula until she was about 5 months when my supply caught up and I was able to (almost) exclusively breastfeed. I refused to pump and refused to feel guilty about whatever happened. So, here's what I did. Breastfed first, then gave the baby whatever formula she wanted in an extremely low flow bottle (we used the Medela newborn bottles). She never had nipple confusion (unlike my first) and even took a pacifier and still happily breastfed. We nursed for each feeding when she was a newborn and then when my supply was regulated (maybe three months in?) I gave her formula when I went out, so she usually got one bottle a day of formula at different times. I think the key is waiting to do this step until your supply is regulated, but if you don’t care how much breastmilk she’s getting, just that she’s getting some, I think it doesn’t matter when you give formula. Your supply will decrease depending on when the baby feeds so if you always give a bottle a night, you’ll have little milk then, but be fine for day feeds. I think the key is to not stress, give the breast until you get overwhelmed and exasperated OR the baby wants more, then give formula. I was glad I got to breastfeed the second even though, like you, I never loved breastfeeding. And she nursed until close to 2. Never would have thought it was possible. Did It

Firstly, congratulations on your second! I anticipate you will get lots of advice about sticking with breastfeeding, using lactation consultants, etc. etc. But I want to chime in with: give what you can, take what you need. It is totally okay for you to ask for formula while you're in the hospital and practice breastfeeding at your own comfort and pace. I both breastfed and supplemented with formula. My little guy needed to gain weight, and it took over 7 days for my milk to come in. So, okay, I cried and cried, but I fed him formula. And then I combo breast and formula fed for several months until giving up breast altogether. My reasons are my own and I own them. The fact is you need to do what works for you and keeps you sane for your family. People will say that formula is just a bunch of chemicals and BM is pure - but guess what, it's not really that pure with all of the environmental pollutants we've been ingesting our whole lives. I had a similar problem in that I couldn't find much out there re: researching formula feeding. But there's a great place of essays called Fierce Formula Feeders that I stumbled upon when I just kept googling over and over ''is it okay to formula feed my baby?''. The answer is yes. Formula is a-ok

I know you only wanted advice from those who combo fed (and I'm sure you will get plenty as it's very common), but I wanted to let you know that I had a terrible time breastfeeding my first child, and the second time around it was so much easier. With my first, I now know he had an undiagnosed tongue tie that resulted in repeated bouts of thrush, painful nipples, slow weight gain, fussy nursing behavior and more. With my second, I found a doctor who knew about tongue ties, and she clipped my daughter's tongue tie. We had thrush also, but this time it actually went away. I used a very strong probiotic, along with gentian violet, and it never came back. She also was a bit slow to gain weight, but everything else was so much easier. I would encourage you to find a professional who knows what different types of tongue ties are (posterior and anterior), and can do laser surgery and teaches tongue exercises to make sure it doesn't grow back (which it can). This doesn't just affect nursing, it can affect speech later on. See: http://www.bestforbabes.org/booby-trap-docs-who-wont-snip-tongue-tie-thousands-of-breastfeeding-moms-babies-suffer http://www.sfotomed.com/conditions-tongue-tie-ent-bay-area-ca.html second time mom

I formula fed and pumped breastmilk for each of my kids' first few weeks. After that I switched exclusive formula feeding. I won't get into why I couldn't nurse - I don't enjoy discussing my nipples in public, but of course that's never stopped a million nosy strangers from asking me about them. But I digress. I pumped the first time because I was affected by all the scary stuff people repeat to you about how much better breastmilk is, but I gave up, as exclusively pumping was just too much of a burden for me at a time that was otherwise incredibly taxing (I'm sure you remember). Since that experience I researched the issue and found the claims about the benefits of breastmilk range from highly exaggerated to complete BS. The difference between the two, when it is supported by solid scientific data (which is rare) amount to a small difference in outcomes that can be greatly overshadowed by other things you can do to benefit your kid - reading books, sending them to preschool, making sure they eat vegetables, etc. If you want to learn about this yourself, google ''The Case Against Breastfeeding'' by Hannah Rosin. Despite its unfortunate name, it's not actually an argument AGAINST breastfeeding as it is a well-researched and realistic counterargument to the scare tactics used by many brea stfeeding advocates. After reading that article and confirming much of the research presented in it myself, I happily chose to formula feed my second child. One thing I did learn in my research though - there is one benefit of breastmilk that I am convinced might make it worth while: the baby's gut flora (the importance of which science is only just beginning to grok) is set by the mother's milk at the start. This is why I still pumped for a few weeks the second time around. Forumla is very advanced these days and makes an excellent substitute for breastmilk, but it can't replicate the beneficial bacteria a baby needs to start out on the right foot. Once the flora is established, I don't think it matters quite so much what you do. So, my advice would be to pump or nurse in the beginning and as soon as you are over it, get yourself a Subscribe & Save for account for formula on Amazon and don't look back. And, once I had them on forumla, I thought it was wonderful. It's much easier to get a break, they sleep great and the night feeding can be more egalitarian, you don't have to whip your boob out in public EVER, and my kids didn't suffer from any stomach issues, allergies, low IQ (my three year old can read already) or excessive clinginess. Good luck!!

Im sorry to hear about your struggles to BF your first. I also had horrible troubles and had to give up after 6 weeks due to health issues on my end. Before I got pregnant with #2, I decided that I was not going to get myself emotionally caught up in the ''breast is best'' dogma and if bfing went well, Id do that, otherwise Id do formula and not look back. Well, fast forward to now. I am currently pumping because my 7 week old LOVES to breastfeed but due to issues with his anatomy (not tongue tie, already got that fixed) he can not effectively get the milk out of the boob. So, in my case, the pump is more effective than the baby...Unfortunately, he wont take a bottle from me most of the time. So, my days are spent either nursing for hours on end or struggling with the bottle if Im not with a friend who can give him one. This, plus pumping to keep my supply up, is very hard with a 2 year old in the mix (for example, she is currently on hunger strike and will only drink milk, from a bottle due to the situation.) Even with all this, he is still not gaining enough weight. What Im trying to say is doing both is really hard for the two reasons that you state. If your child is born and breastfeeding seems daunting, go straight to formula. IMHO, I dont think it is worth it for you or your baby to go through many months of something you really feel is unpleasant or stressful and I do think you will find the combo has problems of its own. Best of luck in your choice! At least with pumping I get to write email!

I only just saw an article about managing this duo in the NYTimes and wrote it down to post it to you and now i can't find it. Do look around as I saw it after I read your post on 5/15. Good Luck!

I know that you asked for first person stories, but I'd like to add some second person experience since I've worked with so many nursing moms.

First, every baby is different! So your first time experience may not matter. Second babies benefit from mom's milk coming in sooner, and every baby latches on differently. You can put your baby at breast when she's first born and see--her mouth to nipple contact will help you let down your milk (and your uterus to contact). She has a couple of days for you both to decide how things are going!

Second, the nutritional and immunological benefits of breastfeeding for a full term baby from a well nourished mom with good home hygiene are not as significant as with the general population. Hand washing and minimizing exposure to adults and children outside the home are just as important.

Last, your milk supply overall will be better if you nurse exclusively for the first week, because early nursing does affect how much milk your breasts can store. So why not evaluate day by day? And then week by week? ''Nipple confusion'' is rare, and I've seen it mostly in hungry babies who are so exhausted that they prefer the ease of a bottle. Once they stop being hungry they usually go back to breast.

Feeding time should be relaxed and easy, not stressful for you or your baby! sign me as non perfectionist nurse practitioner

Just from experience of many years ago, i want to let you know that it can be done! I did both with my second child - formula and breast - and it worked just fine. When I wanted to give her the breast I did, when I wanted the break or needed to sleep she got the bottle. No nipple confusion, no preference for either bottle or breast. I would say towards the end of my time breastfeeding her (6 months) she weighed 20 lbs (!) so no problems with weight gain. With my first child, he couldn't latch and I tried in vain to get him to nurse only to see him drop weight which was just awful. He was exclusively formula fed.

Fast forward 10 years or so and both are happy, healthy, 95% height percentile, and doing great in school, athletics, etc. I fretted so much about the decision to give formula and what a waste of energy that was. If I could go back I wouldn't change a thing. Breastfeeding was a lovely experience (for a short time anyway!) but getting some sleep and sharing the responsibilities made me a saner, calmer mother as well as encouraged more equal co-parenting. Your children will thrive regardless because you are a caring mother who will ensure their health and happiness. Breast vs. formula is a really small part of that in the grand scheme of things. Do what your heart tells you

Breastfeeding/formula combo advice needed

October 2012

Are there any mothers out there like me?

My baby didn't latch on until 6 weeks! Her mouth was especially small and finally ''grew'' into the ability to breastfeed. I pumped and tore my hair out and broke down crying up until 6 weeks when I finally said enough. Then, she latched on!

So now we're confused. Formula feeding was simple and scheduled. We knew how much to give her, and when. Breastfeeding is different and I think I'm only giving her an average of 2 oz per feed.

With formula, we used to feed every 3 hours. We try to keep to that, but often she is hungry every 2 hours or sooner. Beauty is, she sleeps through the night, almost 10 hours at 14 weeks now. However, that doesn't help my milk supply!

Currently I am breastfeeding then supplementing with formula almost every feed except the early morning when supply is more and the last feed before bed.

Wondering if anyone has experience/advice for me?
Still learning

Congrats on having your baby latch on! That's great news. I've been exclusively breastfeeding so I don't have personal experience combining the two. However, my now almost 6 month old also eats about every 2 hrs during the day and sleeps about 10 hrs straight at night. Breastmilk is made for easy digestion (formula tries, but it's just not quite there). In other words, your baby digests breastmilk faster and more easily than formula so often will be hungry more often. If you're getting 2oz every feed you might not need to add formula anymore. But every baby is different. Mainly, make sure she's gaining weight, doesn't act starved and check in with a lactation consultant to be sure. Good luck, sounds like you're doing a great job. L

Have you talked to a lactation consultant at all? There are lots of good recs on BPN.I don't know much about formula feeding (my little one was a bottle hater) but in my experience breastfed babies nurse very frequently --- the breastmilk is digested faster than formula. My son nursed about every 1-2 hours round the clock for the first few months!

If your baby sleeps through the night, you might want to add a pumping session late at night or even wake up and pump if your supply is an issue. As rough as all the night waking was, I think that the night nursing was what kept my supply going for so long.

Also you can't rely on pump output to measure how much baby is getting. Have you tried weighing her before and after nursing? That's a better indicator. Good luck and good job sticking with nursing even after difficult first weeks! another mama

I had a similar problem since my twins were premature. My daughter's mouth was literally too small at first to breast feed. At 14 weeks, I would still expect most babies to eat about 6 times per day. Since she is sleeping 10 hours at night, it sounds like you are pretty normal.

In my situation, I ended up using a combination of:

1)Size extra small nipple shields - these were the only thing she could get her mouth around. There were not fun for me, but they did help until she was bigger

2)Combining breastfeeding and pumping. If you are really committed to continuing breastfeeding and really aren't producing enough, pumping (I used a hospital grade pump) will help increase your supply. Again, this totally sucks and isn't fun. I also took tons of fenugreek and Motherlove More Milk Plus supplements. All of this seemed to help increase my supply until I stopped breastfeeding. another mom

That's the thing about breastfeeding - you don't really know how much your daughter is getting so assuming she is getting about 2 ounces could be wrong. The only way to know if your baby is getting enough breastmilk is to count wet diapers, whether she seems satiated after feedings, and tracking her growth when you visit the pediatrician. Formula feeding is a whole different ball game and it sounds like now that you've gotten into that groove, you are accustomed to the ''number of ounces'' and ''hours between feedings'' when really what's best for a breastfed baby is to feed on demand, not looking at the clock or measuring bottles. Go with the flow....

I'm especially concerned that your newborn is ''sleeping through the night'' 10 hours at such a young age. If she's primarily breast feeding now, I'd be concerned that she is ''fasting'' for such a long time. It is such a common misconception that babies sleep through the night as soon as possible for our convenience.

My advice - check for 8-10 wet/soiled diapers per day. This is the best sign that your baby is thriving - not number of ounces per feeding, hours between feeds, or number of hours of sleep through the night. Breastfeeding Bliss

I had a similar experience with my now two years old. I had a very difficult delivery and I after that I was not able to walk or sit for a long period of time. My daugther had a jaundice so we had to be at the hospital for the first 10 days of her life. The nurses were pressuring me to breastfeed her and as much as I wanted, I was not mentally and physically able. I began to pump my milk (To their horror!). I kept continuing this for 5 months. After that I had to go back to work. I even had the time to freeze some milk so she could still have breastmilk until she was 6 months!

I will tell the truth it was not easy. Because you have the double work to do. What I did is each time she needed to be fed, I fed her with breastmilk already pumped that was in the fridge. After she was fed, I pump my milk for the next feed. You have to pump your milk very often (every two hours until your production increase) and for at least 20 minutes per breast. If you want to increase your production you can get special yeast pills at the pharmacy or talk to your doctor: there is a pill for this.

I will do the same for my other kids! Even though it was so difficult! When I didn't have enough milk she had formula. Not a big drama. Don't feel guilty about that! She had almost 1/2 to 3/4 of her feeds per day from breastmilk.

Don't let the other mom tell you what's best for you! Been there

It might be a good idea to focus on getting the most breastmilk possible into her feedings, even if you have to do it from a bottle. To do that, you'll have to pump.

I had twin preemies and, although they ''got'' latching just after their due date, they were so used to drinking from a bottle at the hospital (they were there for almost three months) that they NEVER got used to nursing as a food supply. It was more of a soothing thing for them to fall asleep to or just to snuggle with me. But, I was determined to give them milk so I pumped religiously. They had only breastmilk from a bottle for the first four months of their lives, and then my supply couldn't keep up with their growing appetites. So, we split their bottles 50/50 breastmilk and formula.

To get my supply up as high as possible and keep it there, I pumped on a very strict schedule. After delivery, I pumped every three hours, day and night. After doing this for about 6 weeks I could drop a night pump. Eventually I got into a routine of pumping every 5 hours or so, except at night. I kept it up until my boys were 15 months old (or a year adjusted age). You might want to get up at night to pump for a few weeks - this will help your supply definitely. The more you pump, the more your body will know it needs to make more!

You could try preparing a bottle of formula, breastfeeding her, then pumping while you are giving her formula. One of the best ways to trigger your body to make more milk is to pump for a period of time (which in your case would actually be nursing), take a 10 minute break, then pumping for 20 more minutes. This mimics what a baby might do when it's growing and has a bigger appetite. It might take 4 or 5 days of this, but it should work to increase your supply. Also you can get Fenugreek at Whole Foods. Take enough of that until your pee smells like a Christmas Tree (crazy, I know, but it really works!). You can also visit kellymom.com for more advice on pumping and supply management.

The best thing you can do for yourself if you decide to go this route is to get a pumping bra!!! It looks crazy to put it on, but it's a lifesaver, trust me! You can pump hands free! I could feed my babies, work on the computer, read, doze, even drive (haha), all while pumping. They sell them at a baby store in Lafayette (and probably other places too).

Good luck! Proud Ex-Pumping Mama

Emotional support for supplementing with formula

April 2003

I have 4.5 month old daughter and a serious milk supply problem. After months of exclusive breastfeeding, and constant stress about having enough milk, nursing 15 times a day, etc., I have begun supplementing with formula (around 12 ounces/day). The problem is that I am very committed to breastfeeding, maybe overly so. I was very determined to get to six months exclusive, and continue nursing for at least a year without ever using formula. The fact that I can't feed my daughter myself is tearing me up. I really believed that every woman could exclusively breastfeed if she tried hard enough. Every couple of days I get so upset about it that I stop being functional. Has anyone been in a similar situation? What did you do in order to deal with it? Are there support groups, counselors, or any other strategies that could help me deal with this issue? In my head I know that I'm being the best mom I can be by supplementing, but it still feels terrible. (I am not looking for advice about how to increase my milk supply or to just stick with exclusive breastfeeding -- believe me, I've tried it all and my daughter was starving and miserable.) Thanks so much for your help. Tamar

I'm sure you will get a lot of responses to this email, because every woman who tries to breastfeed but can't goes through similar doubts and pain. I experienced much the same trouble you did. My milk supply just quit after about four and a half months. The decision to stop trying was complicated by people with helpful advice about what I could do to bring the milk back. I tried everything -- drove myself crazy -- and ended up blaming myself for my ''failure.'' I was absolutely committed to breastfeeding and thought it was the best thing for my baby, and it killed me that I couldn't do it. An added problem was the pressure in the Berkeley community to breastfeed. Everytime I pulled out a bottle in front of a roomful of breastfeeding moms, I felt shame -- it was all I could do to not fall all over myself explaining about how hard I had tried. Now that my daughter is a year old, however, I have a slightly different perspective, which is that I lost the forest for the trees in my obsession with trying to breastfeed. What I really wanted was to bond with my child and make her as healthy as possible. Breastfeeding is a good way to do it, but it is not the only way. Focus on your goals and how you can accomplish them without breastfeeding. And remember that you have given your child a wonderful start on life by breastfeeding for as long as you did. That's not ending, it's just changing. The longer your child is on formula, and the more you see your child thrive in your love and care despite the lack of breastmilk, the more comfortable you will feel. Trust me. My daughter is healthy and happy and absolutely bonded to me. That's my solace -- and when you see your baby grow wonderful and strong -- it will be your solace, too. Good luck.

I really feel for you and wish I had some wonderful response that would see you through this. All I can offer is that you are not alone, and I congratulate you for sticking it out as long as you have, trying all you could, and making the choice you knew was best for your baby even though it is really hard on you emotionally.

THE MOST DIFFICULT thing for me emotionally after giving birth was the discovery that I was not producing enough milk. Like you, I had felt, if one was really committed to breast feeding, it would work. I worked with a lactation consultant. I pumped and nursed round the clock. I ingested fenugreek and Brewer's yeast, tinctures, mother's milk tea, tons of water and even a prescription drug--Domperidome--which was the only thing that actually had a notable positive impact. Still, I didn't have enough milk. Most people seemed not to understand the emotional impact of the situation--particularly people without children or those in other parts of the country. They thought they were being supportive when they said positive things about formula (like ''I was formula fed and I'm fine.'') and thought I'd feel better if I just let go of all the hoops I was jumping through trying to produce enough milk. Then on the other side were all the people who didn't understand all I had tried and thought that if I only did X I was sure to have enough milk.

My husband tried really hard to be supportive, but realized that he couldn't really empathize in the same way as another mother. He encouraged me to join a mom's group, which I did (in fact I joined two). I can't explain why, but even though none of the others in the group were going through what I was, and we didn't even discus it that much, it somehow helped. I think it was in part because it also coincided with me getting out more and being more active in other ways. I think part of why the issue of producing enough loomed so big in the beginning was because producing enough milk and caring for my babies was basically the focus of all my time and energy. Being active, doing things I enjoyed, socializing with other moms and babies, and occasionally meeting people who had gone through the ordeal of not producing enough, helped move the issue into a less central role in my life. I also found it a big relief to hear other people had been through similar things.

One woman told me her lactation consultant had told her ''formula isn't the antiChrist'' and that that had helped her ''give herself permission'' to feel O.K. about using it. I was also inspired by a woman who told me she pumped until her child was 6 months old as well as using formula because the baby had never learned to latch on and the mom didn't have enough milk. I was ready to give up pumping at 2 weeks, but kept telling myself ''one more day'' until I too made it to 6 months.

As time went on, I started to feel like there were some benefits to doing both breast milk and formula. My babies still got enough breast milk that I'm sure it helped their immunities (no colds or any kind of bug until 8 months). I developed innovative ways of feeding them while doing post-partum exercise (choosing bottle or breast depending what was easiest to do while doing a particular exercise). I didn't have to be the one to get up for night feedings, and I think it may have helped them sleep through the night more easily. I was free to go out for more that a couple hours at a time without my babies. As they got older, I could do things while my babies held their own bottles. Not that any of that changes the impact of feeling like your body can't do what you feel like it should, but for me, it was part of the process of growing comfortable with formula being part of our lives.

I wish you well, and hope you won't be too hard on yourself. Julie

Please, please forgive yourself for not living up to your own expectations! I had EXACTLY the same situation, and similarly felt like a failure. But having been through it, I promise you, supplementing can be the best possible decision you could make for both your baby's health and your own sanity. Remember, the goal is to have a healthy baby and a healthy mother, and you know already that strict breast feeding was not producing those results. By breastfeeding when you can, you are still giving your baby some of the benifits of breast milk, and by supplementing you are releasing her from the stress and misery of constant hunger.

I agree, there is very little support for doing a hybrid system. I think this is a shame, as it can be such a lifesaver for all concerned. I got my greatest support from my family, who could all see how much healthier and happier we all were. The subject also came up recently at our playgroup, where another mother was feeling defensive about not breastfeeding exclusively. She was relieve to hear how many other women had also experienced difficulty with breastfeeding, and had ended up compromising. So it's not as unheard of as everyone pretends.

Think of it this way - life is a series of compromises, and parenting is filled to the brim with them. This is just the first of many you will make! Congratulations, you have successfully solved a serious problem - one that you never expected to encounter. Celebrate that, and please stop beating up on yourself! emma

I read your post, and it almost made me cry - I was certainly there with my first child. I finally started giving her formula at 2 1/2 months, and it was SUCH a relief that she started to gain weight and seem so much happier! I know all the routines about increasing your milk supply, etc., as you said you know as well.

My advice to you is to try and let it go. I had a wonderful lactation consultant at Kaiser (Joanne Jasson) who said ''Rule number one is: feed your baby.'' And this is from a woman who also believes in exclusive breastfeeding as do most lactation consultants.

Try to be happy that your baby is getting enough nutrients now that s/he is getting some formula. Give her/him as much breast milk as you can and have, and be assured that anything is better than nothing. Give yourself a big pat on the back for how hard you tried. Know that you are not alone. This issue is not worth having post-partum depression over. Also, dad can help feed now that baby is not breast only, and that is nice for him.

My first child nursed for 16 months, taking both bottle and breast, and I had to wean her to get pregnant with number 2, otherwise we'd be nursing now! Number 2 weaned himself at one year. I tell you that so you know that giving your baby formula does not mean that s/he will stop nursing.

I hope other moms who are in your situation currently will respond to you so you can share your stories. I'm sure there are plenty out there. Been there

You have my full sympathy. I was in a similar situation but my daughter just didn't like to breastfeed. We made it about 3 months before she just REFUSED to nurse. I, too, thought breastfeeding should have been the most natural thing in the world and was very hard on myself for not being able to have a successful nursing relationship with her. Please just forgive yourself for something you have no control over. It's more important that you both are happy. I pumped for 4 additional months and when my milk supply started decreasing, I tried everything and went as far as attempting to make my own formula from a natural foods cookbook. I finally accepted the fact that I couldn't nurse her the way I intended and relaxed a bit. It was a difficult time and it was hard to let it go but I felt so much better when I came to terms with the formula. I think my daughter was better off having a happy mom rather than crying and being as stressed out as I was. Linnea

I don't know of any face-to-face support groups for bottlefeeding per se, but just wanted to let you know that you are not alone in being unable to exclusively breastfeed your baby (I cannot do it at all). I understand the guilt, but it's so unnecessary (I keep telling myself). And you, in fact, did get to breastfeed at least some, which is great. I know there are some mom's groups out there who are more connected to near-militant Breast is Best philosophies around feeding babies, but there are also lots of groups that understand that different things work for different moms and babies. You might try checking out general mom's support groups (there used to be some, anyway) organized from Waddle and Swaddle. Linda, the woman who owns Waddle and Swaddle (and the doula for all of my children...soon to be three) is down to earth and compassionate and realistic, and might know who to hook you up with, to assuage some of your fears and guilt around bottlefeeding. Good luck, and please be gentle with yourself. Donna

You ARE being a great mom and I hope you can stop beating yourself up over this. My kids are now 14 and 11 (sweet, strong healthy, smart boys!), and they were both 10 pound babies at birth and intensely hungry. I supplemented both of them with forumula to no ill effects. They got all the benefits of breast feeding, and no problems from the formula. Plus, it was wonderful to have my husband be able to feed them and share the sleep deprivation! I found our pediatrican VERY supportive. Perhaps yours would be? Trust me, in the long run, you and your baby will be fine. I think your baby needs a less stressed, well rested, confident mom too. Imagine if for some reason you simply could not breast feed, would you be any less a loving mother to your child? Certainly not. Take care and believe in your decisions. Enjoy your baby and this special time without stress you do not need. Been There

My perspective on this is slightly different than some others, but might be of interest to you. I adopted my little boy when he was just 30 hours old, and he went on formula right away. Many well intentioned, but uninformed people commented on his use of a bottle (especially in Berkeley.) I felt badly for a long time, and actually tried to lactate before I realized that I was making myself crazy, and that what should have been an enjoyable time with my son was instead, a source of stress.

Now although I wish I could have breast fed, I have seen that formula worked just fine for him. My son who was just over 6.5 pounds at birth quickly caught up in birth weight and is now a thriving 10 month old, 21 pound boy who is almost 2.5 feet tall...so clearly formula has provided what he needs to grow and thrive! He is already into quite advanced baby food, and appears to be working himself right out of the bottle stage on his own. I bring this up just to give you a context, that might help you think about what your childs future might look like.

In addition, I absolutely adore the fact that he looks right into my eyes when I feed him his bottle, and latches on to my finger to guide the bottle. His Dad loves that he can share in the feeding, and my nights have been pretty stress free, relatively speaking, since we share feeding.

Finally, he has only had one cold so far, and he is happy all the time. So, although I have worried about the fact that I could not provide him an immunity help, he seems to be doing just fine without it.

Hope this helps. Rockridge mom

How 'bout this. Since your daughter is 4.5 mos old, why not think of the formula as a ''solid''. You can still consider yourself a breastfeeding mom who exlusively bfed for 4.5 mos. anon

1999

With my first daughter I supplemented with formula after about 5 months--around the time she started eating solid foods. If you do this earlier you may need to be consistent about which feedings are formula and which are breastmilk otherwise you may have problems with a diminishing milk supply or with engorgement.

I found the evening feedings were the best time to supplement since that was when my milk supply was lowest. Also, when I introduced the sippy cup I used formula not breastmilk. It all depends on what you are doing--working part time, full time or not at all as to how much flexibility you have around which feedings to cut out.

As to which formula is best, I'm not sure but I've heard there are some questions about the way soy is produced--ie genetic engineering. Also, I've heard that something in soy mimics estrogen which is why they recommend it for menopausal women. I'm not sure they know what effect this might have on infants. I would be very interested to hear from someone who knows more about this or knows where to find out about it.