Mixing breastmilk and formula

As you sat cradling your bump while pregnant, you may have spent time thinking about how soon you’d be sitting there cradling your newborn instead, holding him close for a beautiful breastfeed. But now that your baby’s on the scene, this picture may not be panning out just as you’d hoped.

While the message that ‘breast is best’ is pretty loud and clear, the truth is not all mums are able to exclusively breastfeed their littlies for the first six months as the guidelines recommend. Despite your own breast intentions, there are many reasons you may find yourself looking outside of the breastmilk zone to maintain your sanity, as well as your baby’s wellbeing. In this case, combining both breastmilk and formula feeds – known as complementary or ‘comp’ feeding – may be the way to go.

Choice of breastmilk or formula

Lots of mums comp feed (at one month of age, over 10 per cent of babies are receiving both breastmilk and formula), but the reasons for doing so are wide-ranging, explains Sydney-based midwife Cathy Shortt. “There are a variety of reasons why a mother might decide to undertake complementary feeding. When it comes to medical reasons, these might include a pre-term or small-for-date bub, a baby with jaundice or low blood sugars, or an unwell mother.”

Obstacles to do with your breasts, including low milk supply or other difficulties feeding, are another reason comp feeding may emerge as an appealing option. Here, formula feeds are used to ‘top up’ bub after he’s taken what he can of breastmilk. Rather than abandoning breastfeeding altogether, many mums use this option to ensure their babies thrive.

Sometimes the reasons for comp feeding may not be medical, but personal. You may be returning to paid work and unable to offer bub the breast for periods during the day, for example. “It can be a worrying time for mums to return to work when they’re still breastfeeding,” acknowledges Yvette Sheehy, from Lactation Consultants of Australia and New Zealand. Knowing that your bub is still getting some amount of breastmilk through comp feeding can help put you at ease with the transition.

Making breastfeeding and formula work

If you’re set on keeping up breastfeeding, you may be worrying if those complementary formula (or even expressed milk) bottle-feeds could ultimately mean problems with offering the boob. Rest assured, Yvette says, many mums out there are successfully combing two different types of feeding and you can too!

So where to begin? If it’s troubles with breastfeeding that have you wanting to comp feed, first and foremost chat to your early childhood health nurse or a lactation consultant. “It’s best to start offering any complementary feeds only after you’ve had an assessment of your breastfeeding,” advises Yvette.

Cathy adds that if possible, it’s best to wait until breastfeeding is established before introducing comp feeding in order to reduce the chances of nipple confusion, which is when a bub becomes reluctant to breastfeed and prefers a bottle instead.

Think about it: milk from a bottle flows into your littlie’s mouth at a continuous, relatively fast rate, and he only has to play a passive role to feed. When he breastfeeds, though, he has to put in a bit more effort in order to stimulate a let-down. Your bub’s a very smart cookie, so it won’t take him long to figure out that it’s easier to drink milk from a bottle. This may see him more fussier at the breast or refusing to breastfeed altogether. “This can leave mums feeling worried and rejected,” acknowledges breastfeeding counsellor Renee Kam, from the Australian Breastfeeding Association (ABA).

If you do use a bottle for bub’s comp feeds, she says it’s often suggested you choose one with a wide-necked, slow-flow teat to help limit bottle-preference hurdles. But to really boost your chances of comp feeding success, there are alternative options to using a bottle.

“Instead of a bottle, your healthcare provider may show you how to use a spoon, cup or syringe to introduce the comp feed,” Cathy says. If it will be you offering bub his formula feeds, in some situations you may also be shown how to use a feeding tube or ‘supply line’. With this feeding method, a tiny tube feeding your littlie his formula is taped to your nipple so that he still has the experience of sucking at the breast in order to have his meal.

Another key to successful comp feeding, when using it as a top-up method, is to always offer the breast before the formula, letting your baby have as much breastmilk as he can get before he has his formula. The amount of top-up given will depend on your baby’s needs, Cathy advises.

Breastmilk supply and demand

Whether you’ve turned to comp feeding because your breastmilk supply is low or you’re using formula so bub can be fed when you’re not there, it’s important to do what you can to maintain your milk.

“Your breasts work on a supply and demand basis,” Renee explains. The more milk that’s removed from them, the more they’ll continue to make. If bub is feeding from your breasts less, then, you may find your supply dwindling and maintaining breastfeeding can become harder. If you’re away from bub, missing breastfeeds can also be pretty uncomfortable! At first your breasts will likely become painfully full and blocked ducts and mastitis may rear their heads.

Expressing regularly is a good way to help maintain your supply and avoid problems with breast engorgement. You can also store this express milk to feed to bub later, in place of formula. The ABA advises that breastmilk freshly expressed into a closed container can be stored in the fridge at 4ºC or lower for three to five days, or in the freezer for up to three months.

The ABA also suggests the following techniques to encourage a milk let-down when expressing:

• Try to relax. Express in a quiet, warm area away from distractions, pop on some relaxing music if it helps and breathe slowly and deeply.

• Use gentle massage to stimulate your breasts, which can help trigger a let-down.

• Think about your baby. Look at a photo or even listen to her babble if you can (if she’s in daycare or at home with a carer, a quick phone call can take care of this).

Relax, mummy

A final word of advice. If you find yourself anxious about introducing formula, ease up on the guilt! “Whatever breastmilk your baby receives is still valuable to him,” Renee notes, adding that as long as you’ve had the right information and support in making the decision to comp feed, you’re doing okay.

“As mothers, we do what we feel is in the best interests of our children. Remember that you’ve done the very best for your child.”