Combining breast and bottle - when to express?

[WIPsMom]

Hi,
I'm brand new here and expecting my first child.

I would like to combine breastfeeding and bottlefeeding earlier (in the first month) than later to avoid potential refusal problems when I head back to work and would like to use one bottle of formula daily (at evening or dreamfeed?) but have been told I should at least start with bottled breastmilk then introduce formula.   

Has anyone done something like this? How exactly was the routine?  Did you offer formula or breastmilk?  If breastmlik, could you explain the pumping routine as I'm confused about pumping timing: if I would like to give a bottle of breastmilk in the evening, when should I actually pump the milk to be used (I would be renting an electric pump)?  In the morning and then put it in the fridge?   For example, I don't understand, if baby is breastfed on one side then when would I pump and on which breast (I assume the other full breast).  And then which breast would I feed baby on at the next feed?

Sorry to sound so "dumb".  Thanks SO MUCH for any tips and advice.

Hope you can help this novice ;-)

Thanks so much!

[Shdef]

My breastfeeding councillor suggested to express after each feed. It will take a few days for it to work but there are two good side-effects. If the baby has a growth spurt and needs more milk each feed your supply has already caught up because due to the pumping you always produce more than needed. And there is a good supply of milk in fridge and freezer. You can mix the milk in one bottle if the expressing isn't more than 4 hours apart from each other (says the neonatal intensive care unit).

Good luck!

[Mamastalawatt]

  Thanks for asking this question - I was just about to post a very similar one myself!

My son is 11 weeks old today and is almost exclusively breastfed apart from a very small feed of formula last thing at night so his Daddy can feed him - it also gives me a chance to rest and for my milk supply to replenish a bit better ready for the night feeds.

I'm not too confident at expressing any more, since I have had worries over my supply that have put me off.  So my question is, if I express after every feed, will that affect my supply for the next feed or will it actually trigger an increase in it?  I am just about on 3-hourly feeds and at the moment I am feeding from both sides during a feed.  Last night I am sure that I ran dry and he was still hungry, but I think that might have been to do with not drinking as much water as I should.

I want to start building up a stock of frozen formula, and also replace the evening bottle with expressed breastmilk.

Good luck with your new baby when he/she arrives and hope you manage to breastfeed and express well - it's hard work to begin with, but so rewarding and so worth it when you've settled into it.

Mama
xxxx

[WIPsMom]

Thanks Scott's_Maw for the suggestion.  Can you clarify what you mean by after each feed?  That is, did you feed baby on one breast and then when he/she was done just pump the rest out?  Or did you feed baby on one breast and pump the other breast?  I know I'm asking for really specific details here but for a novice these sometimes "obvious" things just aren't so obvious.

Thanks so much!

[WIPsMom]

Mamastalawatt - just wondering - have you been giving the bottle of formula since birth?  Or did you start after a few weeks of ONLY breastfeeding?  I've heard so many different things - some say don't start until 3 weeks, some say go ahead a start from week 1 with one bottle a day.

Thanks so much ;-)

[Mamastalawatt]

No, I just started with the bottle about 3 weeks ago - I went through a nightmare couple of weeks with more than one issue (my son was born with severe tongue-tie and once it was treated my supply couldn't match his new increased demand, I went through a patch of extreme exhaustion and Daddy told me he was feeling a bit left out, etc) so a nightly bottle seemed to be right for us.  If I have a particularly good supply at night, I do sometimes skip the bottle to avoid becoming too engorged, but we try to keep it in the routine.

My midwife told me that it was OK to start introducing bottles at 3 weeks if you had really established breastfeeding well.

Good luck! HTH

[daisymelan]

I just wanted to add for whoever asked.....  if you pump after a feed, it will not diminish your supply for your next feed, it will increase your overall supply. 

Also, I would wait 3 weeks, as previously mentioned, to ensure your supply is well established.

[KellyC]

Hi

I could never express very well - I always expected that when I expressed it would come flowing out and I'd have a full bottle that DH could give at bedtime and was so disappointed with the half oz or so I could actually achieve!

Two things worked for me.  Once DS was eating less during the night and my breasts were full in the morning I could feed him from one side whilst expressing from the other and get a full bottle in the time he took to feed.  It had to be the first feed of the day and was occassionally at around 5am!  The second thing was missing a feed completely (again, once feeding is well established).  I feel I really missed out on a trick here as I could have put together all those half ounces to make a full bottle to allow me to miss a feed.  Instead of feeding I would express and very easily achieve a full bottle as my body was used to producing the milk at that time.

Mama - it's possible that your LO is going through his 12 week growth spurt.  I have in the past followed Tracy's adviced and expressed one hour after each feed (even if it hasn't resulted in much).  If DS was still hungry after his next feed I'd top him up with what I'd expressed earlier.  After 3 days your supply should have increased enough to deal with his new requirements.  If you want your supply to increase then giving formula could hinder this as the way to do it is to feed (or express) more to let your body know that more is needed.

Kelly x

[Shdef]

I think the SCBU was just a bit more hygenic than we would be at home. They were also handling very small babies and babies with infections and complications so that rule might not ally at home... I just know that 4 hours is definately safe, 24 hours might be too, I don't know.

[Mamastalawatt]

Hi

I just want to say thank you so much for your replies to this - I know it wasn't initially my post, but it has been so useful.  I have looked everywhere for really concise, thorough information on expressing (when I first did it, I would do it in the very early hours and get 5ozs but when my son's tongue-tie, growth spurt etc all came in one go, I totally lost confidence in how I was affecting my supply).

This has been the most useful, helpful information I have had in a loooooong time 

Thank you for being here!

Mama
xxxx

[jbepko]

I started banking my EBM around week 2 or 3 so I would have enough "frozen stash" and at 7.5mo- the stash is still plentiful. I headed back to work full-time at 8 weeks (usually separated from LO by 11.5 hours). I started by pumping approx one hour after the morning nursing and then a few days later added a second session and then a few days later a third session. I continued until I was pumping approx 5 times a day. I did create an oversupply, but I also went back to work at 8 weeks with nearly 700 oz of frozen gold! I was able to maintain his need iwth 2 pumping sessions at work and 2 at home (dropped to one around 3 months) and daily weekend pumping sessions. I only pump in evening 3-4 times a week now. The huge stash has really given me a sense of security. It was a lot of work in those early weeks- I felt like I was always nursing or pumping- but it was well worth it. I've never had a low supply issue and he's never needed formula and there's always "extra".

[WIPsMom]

Thanks so much everyone for the detailed information.  It's so helpful to get some really specific "routines" for expressing.  I think I understand now - I can actually pump "anytime" and even pump from the same breast just fed on or the other one and it won't mean that at the next feeding I have no milk... it will actually increase the milk supply right?

I'd really like my husband to be doing the evening feeds - 7pm and dreamfeed from bottle (but we'll start slow with just dreamfeed) starting at 3 weeks so I knew I had to introduce the bottle and pumped breastmilk.

So I guess if I start by pumping in the morning (then also later including evening when dad is giving from bottle) and gathering enough EBM to store there will be enough for each day.  After a few months I will probably move to formula but wanted to at least give my future little boy a good start in life with breastmilk.

Does this sound about right?

Thanks again!

[KellyC]

Yup, sounds great.  I'm sure you'll find what works best for you.

Jeni - you're amazing to put in such hard work to give your LO breastmilk, I'm in awe!

I was never able to freeze breastmilk and give it to Zander.  He went through a phase of refusing bottles of EBM even though I knew he didn't have a problem with bottles and I realised after a while that he wouldn't take breastmilk which had been frozen.  I looked into it and there's something in breastmilk (called lipades or something, can't remember exactly) and if there's too much (I think - memory is failing!) it can make frozen breastmilk taste soapy!  Kellymom which is a pretty definitive breastfeeding website now advises breastmilk can be kept in the refridgerator for 8 days so we've always got by!

Kelly x

[Shdef]

Stacy...

Most dont advise that you offer frozen milk that is too old. not because it goes bad, but because it changes.  Your breast milk changes to meet the needs of your baby, what you  produce at one month of age isnt the same as 12 months of age.  I havent found an answer to how old is too old though!  I have a 4-6 week rule in my house. 

Kinda throws the stock pile idea out the window, im kinda thinking you would still be ok though if your choice was old breast milk or formula, i bet  most would agree to the breast milk, especially if it wasnt every feeding.

Every few weeks the baby becomes unhappy with the breastmilk and screams and fusses about, sometimes arches his back. The breasts respond to that and the milk becomes thicker and more nutritionally effective. So the answer would be after each of these wee problems the milk that is in the freezer isn't efficient anymore. But small amounts can be kept and used for nappy rash and blocked nose, even as a bath. I've never done that but this is what the lactation councillor told me

[KellyC]

Lol DS had an eye infection recently and had to put up with me putting breastmilk in his eye to make it better - it worked!

Kelly x

[daisymelan]

Lol DS had an eye infection recently and had to put up with me putting breastmilk in his eye to make it better - it worked!

But small amounts can be kept and used for nappy rash and blocked nose, even as a bath. I've never done that but this is what the lactation councillor told me

Thank you for sharing both of those ideas.  I had no idea!