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Tuesday, June 14, 2011

Combo Feeding: Poll, Caution, and Experiences

Last week I did a post on Combo Feeding . . . and I really loved and appreciated all the comments, so I wanted to re-post them here, along with other thoughts from Moms elsewhere. . . but first a couple other things.

One, a discussion about the results of the poll (please participate by leaving a comment on this post).

My thoughts are this . . . so far, with nearly 80 votes, it looks like 97% breastfeed their babies. That is pretty awesome. In my opinion, the most important thing is to try breastfeeding. Maybe it works, maybe it doesn't, maybe you love it, maybe you don't, but if you give it a try, that means at the very least, the baby has colostrum and you get the experience of nursing your baby.

And so 97% of people are already there . . . so the question isn't really to motivate people to breastfeed, the question is, how can we support women better so that they are more likely to continue breastfeeding after trying it out? I think this is a very critical question.

As I say on my breastfeeding page, the goal should be to get more women to give more breast milk for longer. Whether or not they also use formula or donor milk, pump and bottle feed, NIP (nurse in public) or not, breastfeed for one week or close to a decade, we need to support them--each other.

And what about our 3%? You know at the beginning of my pregnancy, I had a semi-heated argument with my now-friend Karen about whether women should feel like they HAVE to try it, whether they should feel guilty if they don't. At the time I insisted that yes, I thought that a Mom SHOULD feel guilty for not even attempting to give their kid the best. And Karen said I was being a Mommy-Judger.

I can see my point at the time still but at some point since I had James I came around to Karen's corner. It needs to be okay for a Mom to give all, some, or no breast milk. Every woman is different, every family is different, every situation is different, and best nutrition doesn't always equal best option.

Furthermore, over the last year I've become convinced that a lot of the time, a Mom will not breastfeed or stop breastfeeding, because of the guilt and other negative emotions that we have come to associate with the breastfeeding VERSUS formula feeding mentality . . .

As Karen says...
"I went and voted. When I transitioned James from breast to formula, I combo-fed for about a month. For some reason, that was really stressful for me. Every time I gave him a bottle, there was a little voice in my head that was like "you should be breastfeeding" but I hated BFing and wanted to stop. So then I started exclusively pumping, but was frustrated by how little I could produce."

So in my mind I have been convinced. The way to support women in feeding their babies is to support women in feeding their babies. Period.

Two, a word of caution and realism on combo feeding.

Unless the baby nurses the majority of the time, it may be difficult to maintain your supply on the long-term.

When I wrote the original post on combo feeding, I was looking at it as being beneficial in two ways:

1) Helping Moms who need to give the occasional formula or donor milk bottle feel acceptance with that very common situation and
2) Helping Moms who are about to give up nursing altogether and switch to formula and/or exclusively pumping a way to leave their hearts open to nursing part time for a little longer.

However, like I said before . . .

Unless the baby nurses the majority of the time, it may be difficult to maintain your supply on the long-term.

Now, the key word here is MAY. Many women are successful at exclusively pumping and bottle feeding on the long term. However, if you have a small baby who you start giving mostly formula to (especially through bottles), and only nurse once or twice a day, the odds are that your supply will diminish and eventually dry up with so little nursing. However, this could take a week, two weeks or longer, and in that time, it is very possible that the reason that caused you to start giving formula and/or pumping has changed (your nips are less sore, your mind is clearer, you've gotten some sleep, the baby's latch or milk transfer has improved, etc). At this point if you tried to go back to nursing more you might be totally successful.

The point here is that combo feeding with a MAJORITY of formula through bottles is a pretty temporary situation. Every woman is different, but I think most need to be expressing milk every 4-6 hours in order to maintain a supply on the long-term. So if you are doing less than that, it is going to slowly dry up--which might be exactly what you want, to wean a bit more gradually. I just wanted to make sure that people understood that unless the baby nurses the majority of the time, it may be difficult to maintain your supply on the long-term.

But in my option, if combo feeding extends your nursing relationship by even one day, one week, or one breastfeed, that is worth it!

And, last but far from least, here are some great thoughts on this topic from some fellow Moms (including comments on the previous post) . . .

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.

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.

Hilary says...
With my first, I pumped and I stopped pumping because I couldn't make 100% of her needs so I just stopped and went to formula. She did know how to latch on, so looking back I wish I would have kept nursing at least 1 or 2 times a day, maybe before bed and nap or something. But for some reason I didn't even consider it!

Samantha says...
I voted combination, since CP started out BF and then switched to FF. I really wish I'd had some kind of guidance on how to transition from EBF to part-time BFing. I would have LOVED to nurse in the morning before work and in the evening after work with formula in between, but somehow or another I messed up the transitioning process and ended up with no supply at all. We had such a great/easy BFing experience--CP latched right on after 24+ hrs of labor, 10+hrs with an epidural, and ultimately a C-section delivery, lol, literally 30 minutes after she was born, she was nursing while I was still in the recovery room from the surgery:) I couldn't find ANY help searching online, and the ped just said, "you should be able to transition to part-time BF just fine." I didn't think it would be a big deal, but literally after three days of being back at work, my supply was GONE.

Kim says...
I am now exclusively using formula, but I started with just BF, but had a horrible time. Dylan never latched well and he was juandice and he didn't gaine weight for the first month and I didn't produce a lot so we went to a combination. It was rough because I would BF, pump, and then supplement with formula. He would want to eat every two hours at first and it would take me an hour to 1 1/2 to feed him with that whole process so then neither of us were really sleeping. I eventually moved on my own to switch off BF and FF every other feeding. I still pumped after every nursing session. If I had to do it over again, I would have tried to continue the combination when I went back to work, but I was nervous about leaking since I am a pre-K teacher and did not want to explain that to any of the kids :)

Jennifer B. says...
I did combo as well. Although now he its just BF we had a rough start. Tongue tied which resulted in two clippings. But I just couldn't give up.

Jennifer W. says...
Combo only because my milk came in after six days and by day four the lc and midwife were panicking telling me maybe my milk never would come in, etc. We did some organic formula with a supplemental system for two days until I was sure my milk was in. Sad to find out recently that 4-6 days can be totally normal. :(

Karen E. says...
With DS1 I went straight to formula because I was honestly scared to BF. It seemed foreign, uncomfortable and it grossed me out, in all honesty. I don't think a woman in my family has breastfed in generations. Between DS1 and DS2, I did a lot of research and soul-searching and decided to try. I actually loved it and one of my greatest sources of guilt is that DS1 didn't get a drop of BM. Now that's he's 8 and sees CP being BF, he's asked a lot of questions about it and if he did it. Sadly, when he found out he didn't, he asked why. That was hard to explain and like I said, it makes me feel guilty.

Adrienne (yep me) says...
Karen, someone recently told me that when people feel guilt, they should usually feel anger. You should NOT fee guilty for a second, you are AWESOME to have changed so much from #1 to #2, I know how much work that takes and you should feel PRIDE, not guilt, for putting all that work in.
You should feel ANGRY that you didn't grow up watching people breastfeed and learning and being comfortable with it as nature intended. You should be angry that our society has gotten so far away from normal that it felt foreign to you.

We should be celebrating a Mom who continues to breastfeed while giving formula but I think a Mom in that situation is either pressured to stop breastfeeding altogether or made to feel guilty for using formula, when the reality is the a LOT of the benefit of breast milk/breastfeeding can be gotten through one or two feedings a day, even if you are using formula the rest of the time . . . I just wish women were more supported to do that.


Emmy said...

I wanted to comment on your last post but was out of town and I never went back to it. We had to supplement in the beginning (4 days old-10 days old, or so) because Juliet lost too much weight and was not getting enough from me. The ped. told me to supplement at 4 days old and call a LC since she had lost a pound. The LC was fantastic and had me feed her for 15 min. on one side, change her diaper to wake her up, feed on the other side, then pump for 10 minutes- every 2 hours during the day and 3 at night. Three feedings a day we were to give her an ounce of formula right after a feeding. If I had enough expressed milk, we gave that to her instead of the formula. After about a week of that, she was just about off of the formula, except for her last feeding before bed for a few days. We did get lucky that J had no problems going from bottle to breast. The LC told us the medela bottles were not good, and told us to get Dr. Browns, first years Breast Flow, or born free, as they had the slowest flow and were most like the real deal.

Then, my nips were really sore and damaged and I was dreading each feeding, so I made the LC come back to help me fix it. She was latching pretty well, but wouldn't open her mouth wide enough and I wasn't getting her on fast enough. The right side got better, but the left stayed bad, even with using different positions and letting it get a little sun. I had to get a nipple shield to use on the left side only. That allowed it to heal, and everything has been fine since! Although 2 weeks ago, the left got a little damaged again-- I think she had a bad latch at night, but two days using a soothies gel pad helped it heal right up!

And that's our BF story! It took hard work and determination, but we made it!!

Devin said...

The things I most liked and agreed with from this post:

"It needs to be okay for a Mom to give all, some, or no breast milk. Every woman is different, every family is different, every situation is different, and best nutrition doesn't always equal best option."

"The way to support women in feeding their babies is to support women in feeding their babies. Period."

justadrienne said...

I think the most important thing is to make sure women are given the correct info, not feel like X is the only option in any situation because Y or Z are great solutions too.

And then, yes, whatever they decide when they have the right tools and info in their hands we should support them.

I think sometimes it's hard though, when people have already decided to do one thing, then giving them information seems like a threat to their decision, even though you might have been TRYING to support them in feeding their baby by knowing that they have a lot of strategies they could try, KWIM?

justadrienne said...

Emmy, thanks for sharing your story!! I'm glad you had such a helpful LC, that is great!

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