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Tuesday, June 7, 2011

Combo Feeding: The Overlooked Option (Part 1)

In gathering info for this post, I got so much interesting feedback and thoughts from other Moms that I decided to make this a two-parter, so here is part one!

So I'm in a lot of online Mom groups and even in talking to Moms in person, the question is always: "Are you breastfeeding or formula feeding?"

I am guessing that even if your baby is now primarily eating breast milk, formula, or food, that at one point, they may very well have had some of the other. (Please participate in the poll if you haven't already, results will be discussed in Part 2).

Does a Mom who breast feeds for one week before deciding to stop "fail to breastfeed"? I don't think so! Any amount of breast feeding is wonderful, and the colostrum of the first week is the most important thing for the baby to get. In fact, that first week is the most critical week to breastfeed ever! The Mom succeeded in breastfeeding her baby during the most important time for the baby.

On the other hand, what about a Mom who breastfeeds for two months and then learns her baby isn't gaining because of a bad latch or because of low milk production. There are ways to fix these problems without using formula, but many Moms might feel more comfortable supplementing during this time--either on the short term or permanently, or even switching altogether to formula. Does THIS Mom "fail to breastfeed"? Again, I think not . . .

I think Combo feeding (feeding some combination of breast milk and formula) is not only one of the most common feeding methods, but one that also is under considered and under discussed.

There are many situations in which a Mom might feel like she needs to switch to formula:
-Low supply
-Going back to work
-Bad Latch
-Pain During Feeding
-Lack of Support
-Baby Blues or PPD

However, in all of these cases, combo feeding should at least be considered, but often I think it is overlooked.

Low Supply*:
Mom can breastfeed for every feed (or as many as she feels comfortable with), and the supplement afterward with formula or donor milk if the baby still seems hungry. Another option is to use a Supplemental Nursing System to feed supplemented formula or donor milk AT the breast.

*true low supply is very rare and should be diagnosed by a Lactational Consultant or, ideally, two seperate ones, before deciding that supplementation or switching to formula is necessary

Going Back to Work:
This is an IDEAL situation for combo feeding. If you do not want to pump while you are at work, you can wean your body from producing milk during the day. HOWEVER, in the evening/night/morning when you are at home with your baby, you can still breastfeed during the time you are together. When you are at work, a care provider can feed formula or donor milk with a bottle.

Bad Latch:
A bad latch can be painful and can make it hard for the baby to remove enough milk from the breast. This can be improved with the help of lactation consultants, but it can also be heartbreaking and physically painful until the problem is fixed, and sometimes it can't always be. Moms in this situation can consider pumping and supplementing their own milk, or supplementing formula or donor milk.

If your problem is not pain but only weight gain, using a supplemental nursing system to supplement pumped milk, formula, or donor milk is ideal. You can do this for as many feeds as you need to in order to help the baby gain.

Pain During Nursing: If you are experiencing pain during nursing, because of a bad latch or other reasons, definitely talk to a Lactation Consultant or a doctor to look for thrush, bad latch, tongue tie, or other reasons for the pain.

Some pain during nursing is "normal" but bleeding nipples, or nipples that start to hurt again after feeling better, are a sign that something is wrong.

For someone that is about to stop breastfeeding because the pain is too bad, consider either pumping and bottle feeding, or combo feeding. Even if the pain is AWFUL, could you stand it ONCE a day (while you work on latch and search for solutions)? Twice? Weaning is also painful, so weaning slowly by allowing the baby to still nurse once, two, three times a day might actually make things less painful for you. For the other feedings, you can use pumped milk, donor milk, or formula. If the baby is still getting SOME breast milk, that is awesome!

Also, if you continue to nurse for some feedings, you might find that the pain improves, and that you are actually able to go back to nursing more later!

Lack of Support for Nursing:
Maybe your partner is not supportive, or your parents or inlaws, and you feel so uncomfortable about it that you are considering switching to formula.

Consider combo feeding! If you are EVER alone with the baby during the day or night, that can be your special time to nurse. Your family doesn't even have to know about it if you don't want them to. Nursing is a personal thing between you and your baby, no matter when, where, or how you do it. But if you feel as if you aren't able to nurse your baby all of the time, that is okay.

As long as you nurse your baby every day, even if it's only a few times, your baby will still get a ton of benefit.

Baby Blues or PPD: Sometimes in the immediate post-partum period, nursing can be too overwhelming. And, in fact, the hormones associated with depression, if high enough, can actually PREVENT the letdown reflex. Meaning that your milk will not come out. So when people say that they can't nurse for this reason, it's actually one of the "best" excuses--in that it's no joke. People don't realize how hormones can have a physical effect on your body . . .

Firstly, there are anti-depressants and anti-anxiety meds that are safe to take while breastfeeding. Secondly, therapy is proven to be (nearly) as effective on the short term and even more effective on the long term for depression so that shouldn't be overlooked either.

But if you feel like you can't continue breastfeeding for another day, don't! It's okay to give donor milk or formula. However, after giving donor milk or formula for a few feeds, when your breasts start to get heavy, ask yourself if you've got one more feed in you. And see how you feel nursing for that one session. And then when your breasts start to feel heavy again, ask yourself the same question. And sometimes the answer will be no, but maybe sometimes it will be yes. If you are able to keep nursing for one or two feedings per day, your baby will get all the immune properties and wonderful benefits! Furthermore, breastfeeding produces hormones that actually help relax you and fight depression!

But sometimes the answer is no every time because you really need to stop for whatever reason. That is okay, formula and donor milk are both great feeding options even if you are not able to continue any amount of breastfeeding

One final thing to consider in any of these cases . . . until your baby is four months old, your body/breasts/baby remain "flexible".

That is, even a Mom who has been exclusively feeding formula out of a bottle from one to four months post-partum has the ability to go back to breastfeeding. It is hard and you might need to continue supplementing, but it's possible to breastfeed again and some people can actually get back to doing it exclusively.

And actually it is possible to re-lactate and nurse again regardless of the age of your baby/child, as in the case with breastfeeding an adopted baby.

So mothers of the world, take control of your feeding options. Figure out what is going to work for you and realize there are a million different options. It's not just breastfeeding or formula out of a bottle, it's a combo feeding world out there--there is donor milk, pumped milk; organic formula based on soy, cow, goat, amino acids; feeding from a bottle, breast, spoon, dropper, cup, from a supplemental nursing system . . . AND you can always decide to change what you've been doing and do something new.

Be successful at breast feeding by defining what success looks like to you, and when challenged, don't overlook the wonderful world of Combo feeding!


Alyssa said...

Love this!!! I've never thought BF'ing was an all-or-nothing thing. I figured, as long as I could give Evan SOME breastmilk (even when it was down to 1-2 times a day), it's worth it.

Grace said...

I have a friend who combo fed for a really long time, and it worked great for their family, she actually continued to nurse her little boy well into toddler-hood, and I know she was really glad that she never switched all the way to formula.

While I think combo feeding is an awesome option when necessary(for whatever reason) If you primarily want to breastfeed, it's typically best not to supplement very much in those first few months when you're establishing breastfeeding.

Great post!

Aletta said...

Good post! Patrick only had formula from 10-12 months when I stopped pumping "extra" and decided he could just get forumla if he was a little extra hungry at daycare or if we were leaving him with a sitter. Next time, I think I'd relax and start using formula in this way around 7 or 8 months, once the baby's eating a good amount of solids.

I spent so much time stressing about pumping enough milk to make sure he never had to have formula. In retrospect, I feel like I was trying too hard to live up to other people's standard of being a "perfect" mother.

EricaG said...

This is such an important message, Adrienne. TOO many moms think breastfeeding is all or nothing. Then, when trouble comes along, they stop breastfeeding instead of getting support and/or considering a combo deal. Due to insufficient glandular tissue, I cannot create a full supply. With baby #1, I supplemented but really beat myself up. With baby #2, I was introduced to the Supplemental Nursing System (SNS). This was wonderful because I could supplement with formula, but feeding still happened AT the breast. A win-win for us! I'm so thankful that you are giving such great information on this topic.

justadrienne said...

Thanks so much for all your thoughts and experiences, guys!

Liz said...

Thanks so much for this, Adrienne. I've finally quit kicking myself for having to use some formula, but it's taken me awhile to get there. I also refuse to use bottles in public, but that's more for a lactivist post. :)

Combo feeding is hard, but it's worth it. When Peter grabs my hair and rubs it on his face while we're nursing, I remember why I have no intention of weaning anytime in the near future.

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