Combined Feeding - Breast and Bottle
In this article I’d like to look at both the benefits and some of the challenges that many face when combined feeding.
Combined feeding may not always be a choice. The most common reason is that baby is not receiving enough from the breast and therefore needs a complementary feed. There may be a combination of factors involved such as mothers supply hasn’t yet fully come in, she has a low supply, she has trouble attaching the baby or the baby has trouble attaching which could be due to very large, nipple trauma, flat or inverted nipples or baby being premature or having a poor suck. The three main reasons for the need of combined feeding besides a baby who is partially in the care of others, such as a baby in hospital care, which may prevent full breastfeeding are:
A hungry baby
One who does not receive enough from breastfeeding and whose mother is in the process of increasing her supply.
A mother who has a naturally low supply
She is unable to increase her supply or has a failure to thrive baby – a baby who is not putting on enough weight.
A mother choice
Mothers who have chosen or prefer to do both breast and bottle feeding, this incudes mothers who are returning to work. Many breastfeeding mothers are concerned about how much their baby is receiving from the breast especially in the early days when either their supply is low or the baby is sleepy when feeding. I am hoping the following information will help to reassure and assist you in knowing how to increase your supply to give you the confidence to know that your baby is receiving sufficient for their growth and development.
Building up your supply
For those who would like to exclusively breast feed you must work on building up your supple within the first few weeks. This means breastfeeding at every feed, not skipping a breastfeed or replacing it with a bottle feed for at least the first 6-8 weeks as it usually takes this long to established a good supply. This means putting your baby to the breast every 2-3 hours until your milk ‘comes in’. Your milk will usually ‘come in’ within the first 3-6 days. Once your milk ‘comes in’ you will not need to feed baby as frequently. Baby, if fed well, should be comfortably full and sleeping between feeds. Feeds should now be 3 ½ to 4 hrs. If you are feeding more frequently than this, either baby is not getting enough or needs to learn how to self settle. Feeding too frequently can cause an oversupply, mastitis and engorgement. Frequent feeds and cluster feeds can also result in an over feeding baby which in turn can cause bloating or reflux. Too frequent feeding or feeding baby to sleep may result in poor sleep routines and or an association with being breastfed to sleep.
If you feel baby is not getting enough at a feed and is still hungry and although your milk has come in it is still not enough to keep baby happy between feeds (that is baby comes off after a feed still hungry) you may need to increase your supply. (for more information on this topic see our article Is My Baby Getting Sufficient Breastmilk?) To increase your milk supply express immediately after every breastfeed on both breasts for 5-10 mins depending on how low your supply is. Some mothers with a very low supply find that natural remedies may assist in increasing their supply. Alternatively inquire with your doctor for drugs such as Motillium which will help increase the milk supply.
Top up feeds
During this time of increasing your supply you may need to introduce a top up or complementary bottle feed. This should be done directly after every feed if baby comes off the breast and is still hungry. If baby comes off the breast and is awake and content then she/he does not need a top up feed. It is imperative not to continue topping up after every breastfeed unless it is necessary and should not be continued over a long period of time otherwise your baby may more than likely begin to refuse the breast. (for more on this topic read our article: Breast refusal - a disturbing phenomena). During this time you must also work on increasing your supply). If your baby is unsettled having gone to sleep and then waking unsettled especially in the afternoons (during what is commonly called the witching/arsenic hour), I suggest you offer your baby a top up directly after this breastfeed and express for 5 mins on each side. Try to express immediately after the breast feed. If you are able to express 10 or more mls then I suspect it may not be a low supply. If your baby continues to wake up, after having this top up feed, there may be an underlying problem. For more information on this topic you may like to read our article on Irritable Baby Syndrome - colic/reflux. Top up feeds should always be straight after a breastfeed or within the hour of starting the breastfeed and not after baby has had a short nap or wakes after 45min this is a sleep cycle and baby needs to be resettled. If you have offered baby a top up feed after the breast feed and is settled this usually indicates that your supply may be low. It is preferable to top baby up with only a small amount say 30 -60mls otherwise you may be at the risk of overfeeding your baby. (a helpful article on Formula Feeding) A newborn can take up to 45 mins to feed nutritively, during the feed try to keep baby awake baby to encourage nutritive feeding.
In our next article we will look at some practical tips to increase your supply and problems to avoid when combined feeding.
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