How to combine breastfeeding and bottle feeding

Alison Lee of Guelph, Ont., felt like a failure when her midwife weighed her three-day-old son Dexter: He had lost 13 percent of his birth weight, despite frequent nursing. The midwife handed Lee some pre-mixed formula and told her to start supplementing with formula immediately. “I felt like there was no choice but to give him the formula, and I was disappointed that she didn’t try to help me with breastfeeding,” Lee says.

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Lee’s story is familiar to many new moms. In Canada, a majority of mothers plan to breastfeed, but about half end up supplementing within days of giving birth. Sometimes, according to Diana West, author of The Breastfeeding Mother’s Guide to Making More Milk, that’s because normal newborn behaviours are misunderstood. For example, you might think you don’t have enough milk if your baby nurses four times an hour without realizing it’s very common for new babies. On the other hand, says West, supplementing with formula can be life-saving in certain situations; some women may not be producing enough milk and some babies don’t extract the milk that’s there. Usually these challenges can be resolved, but until they are, a baby may need extra nourishment.

The decision can be heart-wrenching, as Emily Warren of Logy Bay, Nfld., remembers. “When I asked my husband to go out and get formula for our son Quinton, I broke down crying,” she says, even though she’d been struggling with sore nipples and a decreasing milk supply, and knew supplementing would help both of them. Her fears: Milk production would stop altogether and Quinton would feel disconnected from her. Neither happened, and at nine months old, Quinton still breastfeeds and has one bottle of formula a day.

Kate Pearson’s son Gavin was not gaining well at three weeks old despite very frequent feedings. “I tried taking herbs to promote lactation, nursing more often and pumping, but nothing was working. I felt like I was starving him,” says the Whitby, Ont., mom. Pearson was advised by her doctor to supplement three times a day as well as breastfeed on demand. She kept this schedule until Gavin was about seven months old. By then he was able to stop the formula when he was getting more calories from solid foods, while continuing to breastfeed.

Supplementing with formula can put breastfeeding at risk, but it doesn’t have to. Here's how to combine breastfeeding and bottle feeding:

* Supplementing at the breast by using a tube that is inserted into your baby’s mouth while he breastfeeds means the breasts get the “make more milk” message even as the baby gets formula, and he associates the breast with food.

* If you’re using a bottle to supplement, West recommends giving it first and then finishing the feeding at the breast. It seems counterintuitive, but because your baby feels satisfied when he’s at the breast, he can enjoy nursing more. Breastfeed first and he may begin to prefer the bottle because he associates it with that full, happy feeling.

* Consider pumping regularly, which can increase your milk supply significantly.

* Talk to a health professional and expect some trial and error in determining the amount of supplement to use. West suggests a lactation consultant or La Leche League leader may be the best choice to support you through the process.

As for Lee, the medication domperidone boosted her milk supply, and she also discovered Dexter had tongue-tie, which a doctor released to help him nurse. But she needed to supplement until he was four months old. “Seeing my milk increase enough that I didn’t need supplements was amazing,” Lee says.

Expert tip: Babies suck differently on a bottle than the breast, and some will not latch as well at the breast if they’ve had bottles (this is called nipple confusion). This risk decreases if breastfeeding is well established before a bottle is introduced.

A version of this article appeared in our July 2014 issue with the headline “Breast + Bottle,” p. 50.

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