Practical Tips to Combined Feeding
Continuing on from my last article on Combined Feeding – Breast and Bottle, I’d like to take a look at some practical tips and some of the problems that can occur and steps to help avoid them.
There are several practical things that you can do to help increase your supply which I would like to cover. The most important of these is expressing.
Practical tips to increasing your supply
Wherever possible the complementary or top up feed should be EBM (Expressed Breast Milk). As previously mentioned, to increase your supply, the best time to express is immediately after a breastfeed. If you have a low supply you will usually not be able to express any milk after a breast feed except possibly in the morning when your supply is at its greatest. Expressing to increase your supply is not to acquire milk it is to stimulate the breast to make more milk. Any breast milk from these expressing can be given as a top up feed when needed. One thing to remember is that typically what you have expressed does not indicate how much milk baby receives at a feed as your baby is more efficient at extracting milk than manually expressing or machine expressing.
Sleep and Rest
When trying to increase your supply you must make an effort to express after every feed. I understand that it is difficult when there are other demands on motherhood but if you are going to miss a session I suggest it is during the night so that you can catch up on your precious sleep. Sleep and appropriate rest is very important to help increase your supply. An afternoon rest helps to increase your evening supply so try to make time to rest early afternoon. Try to rest or sleep when baby sleeps.
Diet and Hydration
Eating a healthy diet and not skipping meals or just snacking on convenient foods is very important to the quality of your breast milk. If you skimp and eat poorly your body will leach the goodness it needs from other supplies, such as your bones, so that your milk contains what is necessary for your growing baby. This is often why mothers have poor teeth, brittle bones, hair and nails calcium is redirected to the breastmilk instead of where it is needed in your body. Include in this is to keep hydrated. The best way to do this is to drinking sufficient water. I suggest taking other drinks in moderation such as fruit juices, carbonated drinks, tea or coffee.
Exercise is good but when breastfeeding too much exercise or over strenuous exercise is often detrimental to your milk supply as the energy that goes into producing milk is now used in exercise. This is also why rest is very important for milk production. Once the supply is established light exercise can be resumed.
Stress at this time is often difficult to avoid. Mothers may be under stress from sleep deprivation, an unsettled baby, worry if they have enough milk, if they are doing the right thing and trying to live up to the demands of being a mother and wife. If you do have a challenging baby it is not a failure to ask for help of family, friends or professionals. Don’t hesitate to ask for help if you need it.
Problems to avoid with combined feeding
One of our aims with combined feeding is to encourage baby to be able to take both the breast and the bottle till the breast feeding is sufficient. Another is to have a baby who will happily swap from breast to bottle without refusing one or the other. To achieve both these aims we must also be aware of some of the problems that may occur. While working towards increasing your supply and topping up your baby so that they are not hungry there is a possibility of breast refusal. Baby needs a supplementary feed but you also need baby to feed from the breast to help increase your supply. Offering a bottle after every breast feed can have disastrous results. Babies who are continually topped up after a breastfeed typically choose the easiest option – the bottle and begin to refuse the breast. This is where things can become a little difficult.
It is not always easy to avoid breast refusal when you have a hungry or low weight baby who needs a supplementary feed. It is suggested instead of topping up your baby after every breastfeed feed your baby 3 hourly or for the morning feeds to encourage baby to suckle at the breast and increase you supply through stimulation and in the afternoons evenings to top baby up after the breastfeed and feed 4 hourly so that both baby and mum are able to rest. During the night, when mum is better rested and her supply is at its greatest, only breastfeed. Limiting the use of the bottle will encourage your baby to look for his/her feed from the breast instead of wait for the bottle.
Another reason baby may prefer the bottle is because there is less effort needed; it takes 20 mins instead of 45 mins slog at the breast. They, as we do, look for the easier option.
If your baby needs quite a large top up then I suggest you look into using a Medela SNS or supply line which will encourage baby to stay on the breast while sucking the supplementary feed from a tiny tube attached to the nipple.
(for more on on breast refusal please read our article: Breast refusal - a disturbing phenomena).
Bottle refusal usually occurs due to infrequent or lack of experience with a bottle. If a baby is not offered a bottle on a frequent basis from birth they can often refuse a bottle feed from the age of 6weeks and older this can be very inconvenient for mothers who are planning to return to work or those who need to return to hospital. My suggestion is to keep up the bottle feeds even if they are only periodic such as twice or three times a week. This will help to avoid this problem.
Combined Feeding Plan
My suggestion is to continue combined feeding once your supply has been established to enable you to have a break and for fathers to become part of the feeding-bonding process. To enable this I suggest that the last feed at night (ie the 10pm feed) becomes dad’s bottle feed. This can be done through offering EBM. Mum can express one hour before this last feed is due. At this time express and try to empty both breasts (or enough for a full feed – babies weight in kg x 150 divided by 6 feeds = the amount in kg needed per bottle) If you cannot express enough for a full feed then I suggest you expressed in the morning after the first breastfeed and saved this to top up your evening bottle. This bottle feed can be done every night or a couple of nights a week and will allow mum to get to bed early and for dad’s to have a one on one time with baby. If done regularly and kept up it will help baby to be able to happily swap between bottle and breast and should help avoid bottle refusal.
Combined breast and bottle feeding is not only for those who are looking to increase their milk supply, it is recommended to introduce a regular bottle from birth to encourage baby to be able to adapt to both the breast and the bottle. Having a baby who will happily swap from breast to bottle will enable mums to have a break and an opportunity for fathers to get involved in the feeding. I would suggest that a sipper cup be introduced between 4-6 months so that bottles can be totally replaced by 12 months. This will help prevent other problems that often occur with bottles.
Other breastfeeding related articles
• Is My Baby Getting Sufficient Breastmilk? • At What Age Should You Introduce a Bottle? • Breast refusal - a disturbing phenomena • Mastitis a - common breastfeeding fear • Feeding and Speech Development
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