WBW2018: My Unexpected Journey in Combination Feeding

Mother Sider Jenny was determined to breastfeed. As we’re all aware, parenting is a total rollercoaster and things don’t always happen in the ways we expect. This posts highlights the lack of support women sometimes receive in protecting their ongoing breastfeeding journey when their babies require supplementation. Rory is approaching his first birthday and this post has been written over the past seven months.

Over to Jenny…

‘I am mama to Rory, who is nearly five months old.  He’s such a little sweetie, a real chatterbox at five in the morning (yawn) and we have been breastfeeding since birth.  However our feeding journey has been as far removed as possible to how I imagined it would be. When I became pregnant I knew two things: I was having a baby and I wanted to breastfeed, preferably to a year and beyond if that is what my baby wanted.  I had watched many friends go through very difficult breastfeeding journeys that included lactose intolerance, tongue tie and cracked, sore nipples. I read ‘Baby Led Breastfeeding’ by Gill Rapley so I was prepared to feed on demand and understood that I might be feeding for hours at a time. I was prepared for cluster feeding, that breastfed babies often need to be fed more than formula fed babies and that I might be up all night.  I knew that latch could be an issue and that breastfeeding might be painful at first but that it would get easier and Lansinoh cream would be my saviour. I was prepared to cut out dairy if need be. I knew it might be hard but it was a journey I was determined to go on. I started leaking at 22 weeks pregnant so I assumed I would have lots of milk and I even syringed some colostrum to take to the hospital.

What I had not bargained on was low supply.

I believe the reasons for my low supply were a catalogue of events that started in the hospital. I developed pre-eclampsia at 38 weeks so was induced. Although my birth was almost the opposite of what I had planned, I actually had a really good time.  Rory was born at 8.54pm and we had a lovely few hours together in a darkened room, just myself, my husband Mike, and our baby. I breastfed Rory and it felt OK. Strange and new but, OK.  However, Rory had low blood sugar. Nothing major but they wanted to get it up to normal levels before we went home. I needed to stay in hospital anyway because my blood pressure was still high, so it was suggested that we give him formula to get his blood sugar levels up.

If I had known how formula could affect supply I would have discussed how we might be able to get his sugar levels up through breastfeeding. No one mentioned that formula might affect my supply if I wanted to breastfeed and there was no mention of pumping to keep my supply up.  But we went with it and, after four days, his blood sugar was up, my blood pressure went down and we were allowed home. My milk came in at about day four and I was leaking all over the place. No one had checked for tongue tie at this point. Those first few days are pretty hazy but I do remember working very hard on my latch, watching hundreds of YouTube videos and, by the Sunday at around 5pm I remember shouting to Mike, “I think I’ve got it!” as it didn’t hurt so much anymore.  At the midwife visits, Rory had lost a bit of weight and then gained some so I thought all was fine. However, at two weeks, the health visitor came. I had been feeding constantly so assumed he would have put on lots of weight. When she weighed him and he hadn’t put on any at all, I felt the bottom fall out of my world. I was confused as to how this had happened, I fed him all the time and he slept and his nappy output seemed good. We were required to take him to be weighed with a midwife four days later.  Again, he hadn’t put on any weight.

As you can imagine, I felt increasingly distressed. I don’t think this helped my supply. I was told to try and pump eight times a day and cup feed any expressed milk I had pumped. Just “pump”. No plan, no real support on what that would look like and I got home and had a tiny meltdown. I got a hand pump but didn’t really enjoy using it so ended up hand expressing most of the time. I never got up to the pumping eight times a day as I found it exhausting and stressful and I thought it would be better to just keep feeding R as much as possible.  But again the midwife came and he had lost weight. We were admitted to hospital for tests to see if there was anything underlying. There wasn’t but we were told to top up with formula. There was more of a plan here but, again, I was told to pump eight times a day and there was still no support in terms of how to go about this. At this point, I also paid to have a lactation consultant come over to give me advice. She diagnosed tongue tie which not one midwife had mentioned. He was referred as urgent case so, in the same week, he had that procedure done and we started topping up with formula.  I pumped when I could.

Two weeks after the tongue tie procedure, we decided that we would like to try and phase out the formula. He had put on weight so we thought that we could give it a try as we felt strongly about exclusively breastfeeding (EBF). We dropped one formula top up every four days and, again, I tried to pump when I could. The health visitor I spoke to said we could drop all the top ups in a week but we decided that would be too sudden. We decided to weigh him ourselves once a week to check how it was going. However, his weight started to become static again and I knew something was not right. It all came to a head at my eight week postpartum check when I broke down in front of the doctor and asked her to weigh him and he had lost quite a lot of weight over a weekend.  He was now way down the weight chart and she wanted to admit him to hospital. The consultant on the phone said he wanted us to try feeding him formula before they admitted him. My husband and I felt pretty devastated but went home and fed him as much formula as he wanted. I thought that would be the end of my breastfeeding journey. However that was not the case at all.

There isn’t a huge amount of advice out there on combination feeding so I have basically made it up as I have gone along and taken advice from friends who have gone the same route.  Different people choose to combination feed for many different reasons and so I made my own way with it. Although I know I will never be able to get back to EBF, I am still breastfeeding through the day and night. I worked hard to keep up the supply I did have; it has meant that there is always milk for Rory, day or night, and I use it for so many reasons. Our current pattern is breastfeed before each bottle and he sometimes refuses bottles at night but will happily breastfeed. It is much easier breastfeeding at night rather than having to get up and make bottles. We co-sleep so sometimes he sleeps next to me, my boob is out and he can just feed when he wants. It is lovely to nurse him when he is feeling overwhelmed or tired or just wants a cuddle. Lots of people have said to me I could get him on a schedule now that he is bottle fed but, to be honest, I find it easier not to, just to take his cues and then we can be more spontaneous throughout the day.  Sometimes I know he just wants a snack so he can snack on me. If we are out and I don’t have a bottle to hand again he can have a quick snack from me until we get home. He has had a couple of colds recently and, when he is feeling really under the weather, he often refuses bottles but will happily breastfeed, so I know that he is not dehydrated and it obviously makes him feel better.

I am absolutely thrilled that we are still breastfeeding at five months because at that eight week check up I thought that was the end. I don’t know how long we will go on for. I go back to work part time in a month, so I obviously won’t be able to breastfeed during the day on the days I am at work but we shall see. I think my body, and Rory, will adapt again and we’ll just take it as it comes. Combination feeding has worked well for us and I am grateful for each day he still wants to breastfeed. It also has many advantages.  I have been able to go out quite a bit and leave Rory with my husband and not have to express to get enough milk for him. I found expressing extremely stressful so I am glad I don’t have to. I don’t believe partners can only bond with your baby through feeding but it is nice that Mike gets to feed him sometimes. You have to be quite organised when you bottle feed which we had to learn quite quickly in the early days but we’ve got it sussed now. I know some people are confused why I am still breastfeeding when I could just formula feed but it is something I feel very strongly about and want to breastfeed for as long as I can. I also get odd looks when I breastfeed but then get a bottle out afterwards but I’m not bothered; it’s working for us. I personally found myself under way more pressure to formula feed than breastfeed. Every time someone has said to me “oh there is so much pressure on women to breastfeed” I recount the many many times I have been told, “Oh, just give him a bottle” or, “He needs ‘proper’ milk”. The Milk Meg is an amazing blog and she posts the most fantastic quotes on Facebook which I have found invaluable at 3am to bolster my confidence to keep going. She has posted many articles about low supply and, although a lot of those are about getting back to EBF, I have still found many an encouraging phrase in her articles that remind me I am still breastfeeding which is what I wanted to achieve.

Do I feel guilty about what happened?  Sometimes.
Do I wish I had done some things differently? Maybe.
Do I wish there was a lot more support and advice out there to ensure things like this didn’t happen? Absolutely.

In the course of Rory’s first eight weeks I saw lactation consultants three times and a woman from La Leche League very kindly came to my house to watch me feed.  I never had cracked or bleeding nipples, even with his tongue tie. I didn’t have the “usual” problems people have with breastfeeding but the lack of support was maddening. Breastfeeding rates are so, so low in the UK but, if there was better support in place, I am sure they would rise.  If formula was not the go to solution for health professionals then supplies would not be compromised. Formula is what helped my baby become well again but I worked so hard to EBF and was still unable to. My husband was, and still is, incredibly supportive and I know he found this journey as traumatic as I did.  But I am still breastfeeding and will continue to do so for as long as I can.

Update: Rory is now nearly a year old.  We managed to breastfeed for seven months.  My return to work reduced my supply massively and he started to sleep for longer periods at night.  He also started to develop bottle preference so I made peace with stopping.  It was a very gradual process but I did manage to take a photo of one of the last times I fed him to sleep, I love that picture.  Hindsight is a wonderful thing and I can now pinpoint how our issues occurred and how my breastfeeding journey was not protected by any health professional I saw: 

No one at the hospital mentioned that giving him formula for the first few days would affect my supply so catastrophically.
Not one midwife checked for tongue tie or mentioned this could be a problem.
Not one midwife or lactation consultant worked with my to increase my supply or give me an idea of how to solve the problem.  
Nobody mentioned supplemental nursing systems (SNS)

The answer was always formula. My issue is certainly not parents using formula, my issue is the complete lack of support in continuing or improving breastfeeding journeys for women who are experiencing difficulties and want to continue. My husband is extremely angry at how our journey panned out and has written to our local MP several times. My close friend just had a baby who had one of the worst tongue ties the consultant had ever seen.  It took them over a week to refer him to the consultant and her breastfeeding journey was cut very short because of this. She still feels guilty but this is not her fault, it is the system that does not support breastfeeding. We are hoping to have another child in the near future, we are much more informed, much more prepared and ready to take on the and take on the establishment’s unwillingness to support breastfeeding.’

Jenny, writing for The Mother Side xx

Useful articles to read before supplementing:
– www.themilkmeg.com/4-common-myths-around-supplementing-breastfed-baby/
– www.laleche.org.uk/my-baby-needs-more-milk/
– www.breastfeedingtoday-llli.org/at-breast-supplementing/
– www.kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/
– www.facebook.com/DrJackNewman/posts/i-am-constantly-surprised-that/221424024675318/
– www.canadianbreastfeedingfoundation.org/basics/weight_loss.shtml

Useful articles if you think you may have low supply:
– www.emmapickettbreastfeedingsupport.com/twitter-and-blog/low-milk-supply-101
– www.emmapickettbreastfeedingsupport.com/twitter-and-blog/the-dangerous-game-of-the-feeding-interval-obsession

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