Combination feeding your baby – providing baby their milk from both the breast and a bottle – has to be one of my the topics that I am most passionate about as The Parent and Baby Coach. I believe that it is a topic that is often missed, or misinformed, and I hope to clear up some of those misconceptions in this blog post.
I truly believe that for many people combination feeding can save a breastfeeding journey and increase the length of a breastfeeding journey.
Why combination feeding?
For me, I truly believe that combination feeding can be the best tool to prolong your breastfeeding journey. When Mums struggle to want to continue breastfeeding, perhaps have low supply, maybe find it difficult or aren’t enjoying their breastfeeding journey, they quite often feel that they have to choose between breast or bottle, but the reality is that you can do both. It’s not spoken about much and it’s sometimes believed that a baby will prefer bottle over the breast if you offer both but, for so many women I’ve worked with, combination feeding actually helps breastfeeding go on for longer. If you give a bottle from early on, I actually think your chance of breastfeeding for longer is higher, in my opinion.
Giving your baby the breast AND the bottle
Giving your baby milk through two different outlets can be in any ratio that suits you; it doesn’t have to be 50/50. However you choose to use a ratio for feeding, it is still classed as combination feeding.
The main reasons that might encourage you to consider combination feeding
- Your baby will get used to the bottle really early: I work with a lot of families who come to me with a 12 – 16 week old and the baby is refusing the bottle. Often this is because they haven’t had a regular bottle since they were born. You can try a bottle from very early on but if they haven’t had one you might find it difficult later on.
- Dad can help: not being able to help out with breastfeeding is really difficult for a number of men, so by Dad giving a bottle from early on it can really help with bonding and feeling part of the routine. It also gives Mum a rest for that one feed a day from early on and it really helps the entire family.
- To be able to know that your baby is full: for those of you who struggle with breastfeeding – which is a lot of people – because you don’t know how much baby is having, and it can be very stressful with weight issues, the idea that we can give baby a bottle now and then it can be very reassuring for them. It also means that baby won’t have to go through cluster feeding in the evening, because you’ve given them a bottle and you know that they are full.
- There have been some breastfeeding issues: if it isn’t going as well as you thought or hoped, you might want to combi feed. If there are any latch or tongue tie issues, I’d always recommend that you fix them and seek support. But, say if you didn’t want to cut a tongue tie and introduce a couple of bottles to make it easier, then you could combi feed for that reason. I always recommend seeking 1-1 support for any potential issue that could hamper breastfeeding early on, so do seek that support from a professional as it really can save your breastfeeding journey.
- If you combination feed, I genuinely think that you will breastfeed for longer. There are some women who have an amazing journey for years of breastfeeding but I see many women who find it difficult or they get to the stage when they feel tied to baby because they won’t take a bottle for childcare or when Mum goes back to work and so on. By combination feeding, you allow Mum to breastfeed for longer whilst having flexibility to suit the whole family’s schedule.
Possible drawbacks of combination feeding
The first thing people think of with both is that it can be a lot of faff! Hands down, it is more faffing but equally more faffing means more freedom! There is more washing up and sterilising with combination feeding, but it means you have more freedom in other ways, when you have both options.
The biggest risk that is spoken about with combi feeding is that your baby might get nipple confusion. This is because the suck is very different for the jaw and mouth; so the idea is your baby won’t breastfeed effectively. However, here’s the catch, I personally believe that as long as breastfeeding is going well (that’s the key point here), then you know the baby has a deep latch and is pulling milk from the breast, then there’s no reason the baby would get confused. If you start with one bottle a day and the rest from the breast and, once you are confident that breastfeeding is going well and that baby is drawing the majority of their milk from the breast, then you have the flexibility to introduce more bottles because – by this point – baby won’t get confused. Having successfully done it myself and with hundreds of clients, I don’t believe in nipple confusion. If baby prefers the bottle it’s often because breastfeeding wasn’t going well.
A lot of women are scared of combination feeding because they’re told baby won’t like both. Again, I disagree. It’s all about having a healthy ratio and you have to make the decision that’s best for you. One bottle a day from the neworn days means it’s so unlikely that baby will prefer the bottle and then you can add in more as they grow. If you do this, you won’t see breast refusal. I think parents are scared of introducing a bottle and this can be why you need the 1-1 help.
How to start combination feeding
If you’ve done antenatal classes you’ll know that the general guidance is not to introduce a bottle until 6 weeks. I would suggest that’s blanket guidance and you can give one sooner if you want to. The issue with breastfeeding is that it’s difficult but if it’s not done in the right way it should not be an issue. The main thing to think about at 2, 4, 6 weeks (or later) is that you still need to maintain supply and demand. I’m a huge believer in Dad giving a bottle in the evening when Mum’s milk supply is lower, from week 2. At this stage you need to pump milk to keep as expressed milk for the bottle.
Whilst Daddy’s giving the bottle, you need to pump.
In those early stages you can’t confuse your supply so you need to pump – a double pump is a great investment! You want to keep your supply up and then you have the milk ready for tomorrow’s bottle and create a lovely pattern. This means you’re ahead of yourself and you could also top it up with extra pumping in the daytime. Don’t go and start pumping too much in the early days as your supply will get confused and you may get mastitis. If you want more 1-1 support, do get in touch for personal advice.
With this 1 bottle a day from the early weeks onwards, there’s a technique you can use called Paced Feeding. It means holding the bottle horizontal to the floor so rather than tip the bottle up the teat is not completely full, ideally this slows down the baby’s pace of feeding so they suck for 30 seconds or so and then you tip the bottle down – to try and simulate breastfeeding. It’s stop-start and so the idea is it stops them guzzling milk from the bottle so they won’t overfeed. This can increase their air intake which is fine if they wind easily but if not, it might make them a bit uncomfortable. You could also stop every 20-30mls to wind them and then see if they want any more again. This is a way to ensure they don’t prefer the bottle to the breast.
The beauty of combination feeding is, once a baby gets older, you can introduce another bottle when you’re ready to have a bit of time to yourself, perhaps you don’t want to breastfeed when out and about; once your milk regulates at around 12 weeks or so you will have more options. Just remember that breastfeeding works on a supply and demand basis in the early days, so keep pumping to replace any feed that you give from the bottle.
When it comes to adding in formula I would suggest that you keep an eye on baby for any reactions, around their poo, a rash, tummy pain and their sleep can be affected. It’s important to keep an eye on them at this stage so you might want to try different brands. You may also notice a baby may not like the taste so it’s fine to combine it with expressed breast milk. It’s important to remember that most babies will be absolutely fine but do keep an eye on them just in case.
Balancing bottles and breastfeeding early on can be complicated so do get the right help 1-1 if you need it. You can find out about my breastfeeding support package here.
Notes on formula in the very early days
With both of my boys I experienced something that I hadn’t seen before. Both births were very different but neither of them would latch. They didn’t know what they were doing and wouldn’t open their mouths to feed! All I was told was “keep trying”, which I did. But I also acknowledged I needed to recover from the birth, especially the first time, so I gave a little bit of formula in those early days until my milk came in and I had my energy back. Just because you give formula in the first few days, it doesn’t mean you won’t be able to breastfeed, because you absolutely can. Both of my boys went on to be exclusively breastfed for months. I wish more Mothers were told not to be fearful to give a bit of formula so that Mum can rest. I felt ignored in the hospital when they saw formula on the side of the bed; but I knew if I pumped and hand-expressed my milk would come in. Having this confidence helped me but I felt the midwives did give up on me because they assumed I wasn’t trying breastfeeding. It’s so important to keep putting the work in for breastfeeding but a couple of those mini formula bottles with ready-sterilised teats does not make you a failure or that breastfeeding won’t happen for you. Keep stimulating your breasts to get your milk in but use formula, if you need to, in the short term to help.