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Combi Feeding

by Joelle Moore • 09 May, 2021
This is something I get asked about a lot both on social media, and at work. It seems like something there aren't a huge amount of resources for but loads of people are able to combi feed successfully.

(Please note that this blog fully recognises that expressing breastmilk is breastfeeding, however I have seperated the terms for the sake of clarity)

Combi feeding is usually a term used for combining some breastfeeding with some formula feeds in between. It can also be used to mean some expressed breast milk and direct breastfeeding or formula feeding.

Risks of combi feeding (mixing breastfeeding and bottle feeding) :
- your baby can develop a preference for the bottle teat due to it being easier for them to remove milk from a bottle than a breast
- your baby's stomach can be stretched by a larger volume of milk from a bottle, thus making them more likely to be dissatisfied at the breast
- the introduction of formula milk can result in lower milk production from your breast. If baby develops a preference for the bottle they may not breastfeed as much and your supply may begin to reduce

Benefits of combi feeding :
- your partner/friend/family member can share the load of feeds
- it can be a good opportunity for the baby's non-birthing parent to bond with them
- it can give a breastfeeding parent time to sleep between feeds
- for some people it can enable them to continue breastfeeding through other problems - e.g. nipple trauma, tongue tie or low supply


How to balance the risks and benefits of combi feeding :

In an ideal world, try to establish breastfeeding prior to introducing a bottle , however babies can learn to do both, so don't panic if baby has a bottle for the first few days of life. You may find it harder to convince them to breastfeed exclusively but babies get a lot more from breastfeeding than just milk so they may bottle feed when they're hungry and breastfeed to sleep, for comfort or when they are unwell

If you decide to combi feed, don't feel like you have to have an even 50/50 split of breast and bottle feeding, you may give 1 bottle a day and the rest breastfeed, you may give 5 bottles a day and 1 breastfeed.

There are no set rules about how to balance formula with breastfeeding, for some people it is essential to feed baby with both expressed breastmilk or formula for at least some feeds in the first few days of life, sometimes all three! There are a huge number of complications which can impact feeding, from very serious emergencies to nipple trauma. I believe a much bigger barrier to successful breastfeeding is stress and fear about giving bottle feeds.
Breastfeeding :
If you are 100% set on ensuring your baby exclusively drinks breastmilk from a combination of direct breastfeeding and bottle feeding, it is important to pump whenever baby feeds from a bottle. This can be adjusted to suit you though, for example if you are planning to use combi feeding to allow you to have a longer sleep, there is no point waking yourself up evey two hours to pump if that is what baby is doing. My advice would be to pump while someone else bottle feeds your baby, then store your pumped milk in the fridge and allow yourself a minimum of 4 hours to sleep. To establish this you will need a small supply of milk (one feed's worth) in the fridge so that you are always one feed ahead. To start this, pump after you have fed baby and use a suction pump on the opposite breast each time your baby is feeding over a 24 hour period. This will enable you to build up at least one feed's worth of milk (you may not know how much milk your baby is taking if you have only breastfed them until now so you will need to use baby's hungry and full cues to get an idea of this), you can combine the milk from several pumping sessions within a 24 hour period to use for one feed.

If you begin pumping breastmilk before 6 weeks postnatal you are at a slightly increased risk of having an oversupply; however, this may be what you want if you are planning to form a freezer stash of breastmilk. Having an oversupply can be an indirect cause of mastitis, so for all breastfeeding people, ensure you check your breast for lumps daily, massage them when you are feeding or pumping, if they do not soften keep a close eye on them for signs of infection; if at any point you feel very unwell, have sore breasts or generally feel that you may have an infection it is important to speak to your GP immediately.


Mixing formula and breastmilk :
In order to ensure your breastmilk supply continues you should try to put baby to the breast as often as possible. If you are unable to do this for any reason you should try to pump when baby is feeding. Remember that if you are unable to breastfeed your child, even if this was your initial goal, it does not mean you have failed in any way. There are options for using donor milk and formula milk will sustain and support your child's growth, you do not need to feel guilty about this.

The addition of formula can harm breastfeeding if the baby is allowed to take huge amounts of formula at each feed as this will stretch their stomach and they will not feel satisfied by the volume of breastmilk they are receiving. In order to avoid this do not let your baby have an excessive amount of formula, for example, the 70ml starter pack bottles are not a recommended feed size for a newborn, I would expect a baby of 7 days old to be on around 70mls of formula. For the first 24 hours they should not be drinking more than 15 mls per feed as their stomach volume is only 5mls! It is not uncommon for new parents to say their baby just kept drinking, this is because sucking is a reflex for babies, not because they recognised that they were still hungry.

In some cases parents will wish to give their baby a small amount of formula to wake their baby if there are concerns about baby's blood sugar levels. This can work well, and can also be done with expressed breastmilk. In order to do this successfully the breastfeeding parent should first attempt to breastfeed, if the baby is continually falling asleep and the healthcare professionals taking care of you both are becoming concerned, it can be helpful to give baby a small cup or syringe feed of 5ml to wake them up enough to have the energy to latch.

If you begin combination feeding from day one, I would recommend trying to give a breastfeed before giving formula as this will encourage baby to establish their latch and is less likely to cause nipple trauma through teat confusion. Some babies are very adaptable and will take to both very easily, others will struggle to do both, in this case, if breastfeeding is very important to you, try to prioritise breastfeeding for a few days or weeks and then introduce bottles.


Combi feeding is very individual and for this reason, blanket "rules" such as "don't introduce a bottle or pump until 6 weeks" can be quite unhelpful. You and your baby are unique and need to be listened to and supported, I really hope this information was helpful to you! Please reach out via email, DM or my contact form if you need support.


Happy feeding!

Joelle xx

Birth Trauma

by Joelle Moore • 20 Apr, 2021

*Trigger warning*

This post contains discussion and information about birth trauma, this may be distressing for some people so please read on only if you feel comfortable to do so.

 

Birth trauma is PTSD (post-traumatic stress disorder) and can manifest in different ways for different people. Birth trauma can form alongside postnatal depression which can be extremely difficult for birthing people and their families. Sometimes it can also lead into hypervigilance, this is where you feel the need to be constantly watching your baby. Birth trauma can affect anyone. Birthing people as well as their partners can experience it. It can affect those who have emergencies during birth as well as those who have a “textbook” birth. Signs and symptoms of birth trauma can appear immediately after birth or several weeks later, in some cases it can even emerge when you start to plan for your next baby. They include flashbacks, panic attacks, being unable to sleep and feeling triggered when you look at your baby, think about the birth or hospital, or when you return to where you gave birth. Birth trauma can be caused by many things, it isn’t always the emergency itself which causes trauma, it can be the way those caring for you made you feel, for example if you didn’t feel listened to or if those caring for you didn’t explain what was happening and why those decisions were made. For some people birth trauma is experienced due to the care they received following birth.

 

Birth trauma may be reduced when birthing people and their birth partners engage with antenatal education and have talked through how they will navigate decisions within the birth space, including how the birth partner will advocate for them when they are in the throes of labour or postnatally when they are at their most vulnerable. However, in most cases, birth trauma happens as a result of a combination of factors out of the birthing person or their birth partner’s control. It is important to be aware of the signs and symptoms of birth trauma and reach out for support if you feel like this is something you are experiencing. Your midwife normally takes care of you for between 10 and 28 days after birth, after this your health visitor takes over, you can speak to your midwife, health visitor or GP if you think you are experiencing birth trauma.

 

It is important to be aware that some health care professionals do not have vast experience with birth trauma and it can be misdiagnosed as postnatal depression. If you feel that the person you have reached out to about your experiences has not given you enough support, it is really important to ask someone else, this is something your birth partner can support you with.

 

People who see the same midwife throughout their pregnancy, birth and postnatally may be less likely to experience birth trauma. An emergency situation can incredibly frightening for the birthing person and their partner, there may be times you fear for your own, your baby’s or your partner’s life. This typically isn’t what people expect for their child’s birth, it can be shocking and confusing, especially if things happen quickly. When you know and trust the midwife who is caring for you, you may feel less frightened as you know you will be supported and even if things happen quickly you can talk to them afterwards and know that you will be supported. When seeing lots of unfamiliar faces, it can make a situation feel more intimidating and it is not uncommon for this to be a factor in birth trauma.

 

Birth trauma isn’t always linked to emergencies in birth, it can also affect people when the treatment they received has left them feeling confused, not listened to or has not been the experience they had hoped for. It is not uncommon for people to feel birth disappointment if their birth did not go to plan, and due to the unpredictable nature of birth it is not uncommon for this to happen either.

 

While you are pregnant it is important to think through your birth plan, consider how labour may feel and know what the signs are that your labour is progressing well. Birth and labour pain is different to any other sensation you have experienced before and it is important to have confidence that some pain is normal and a sign that labour is progressing well.

 

The Birth Trauma Association supports people who are experiencing birth trauma, and there is ongoing support for professionals about how to support birthing people during emergencies so that they trust those caring for them and the situation is explained. Birth workers play an enormous role in preventing birth trauma, and while it is true that we cannot eliminate emergencies and completely take away peoples suffering, we can make people heard, ensure that birthing people and their partners are at the forefront of decision making and shown respect within the birth space at all times.

 

If you have had a baby and think you may be suffering from birth trauma you may benefit from speaking to the hospital where you gave birth about having a debrief, however if this does not feel like the right option for you can contact the Birth Trauma Association for more information and support, PANDAS foundation who support people suffering with postnatal depression, you can also speak to your GP about a referral to Mind charity, perinatal mental health (who support pregnant people during pregnancy and for a year following birth) or talking therapies. You can also make a self-referral for mental health support if you feel that you need it. Remember you are never alone, there are always people who have experienced what you are going through and who have come out the other side.

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