Combine feeding

Why do some people combine breast/chest and bottle-feeding?

There are lots of practical, physical or emotional reasons why you may choose to combine breast or chest feeding with bottle-feeding. For example, you may:

• find it difficult to breastfeed exclusively
• have to leave your baby, and need someone else to feed them while you are away
• want to share feeds with your partner
• prefer to give your baby expressed breastmilk from a bottle
• want to start breastfeeding after you have been bottle feeding.

The main thing is that you are happy about how you feed your baby. If you are struggling and getting stressed or anxious about it, talk to your midwife, or health visitor. They can give you advice and support, as well as telling you about local breastfeeding drop-ins, cafes and centres. You can also find details of local support on the NHS website.

When can I start combination feeding?

It is generally a good idea to wait until breastfeeding is well established. This usually takes roughly 6–8 weeks after birth, but it can be different for everyone.

Some parents will want to try combination feeding from birth. This is safe to do, but you may find it more of a challenge to establish breastfeeding if your baby is also bottle-fed.

Feeding from a bottle is different from feeding from the breast. Some babies may prefer one to the other or find it hard to switch between the 2. Your midwife or health visitor can help by showing you good feeding positions and ways to attach your baby to your breast.

Talk to your midwife or health visitor if you are worried about your baby’s weight and wellbeing. They are there to guide you. They will help you make a feeding plan to support your breastfeeding and make sure your baby is getting enough milk.  

Bear in mind that the growth rates in your baby's red book (personal child health record) are just a guide. Babies grow at different rates, and most catch up well.

I wanted to breastfeed exclusively, but because my baby was being tube-fed in intensive care this wasn’t possible. Once he was back on the ward with me, I started breastfeeding and used formula milk as a top-up. I found it much easier to breastfeed during the night. It was more relaxed, there was no waiting around for the bottle to be warmed and my baby fed quicker, was much happier and went back to sleep a lot faster.

Amy

Combining with expressed breast milk

Some people decide to try breastfeeding combined with expressed milk feeds.  

The amount of milk you express may vary depending on how you are feeling and whether you are using a hand pump or an electric pump. You may need to give your baby more expressed breast milk than you can express in a single session.

The time of day you express matters too. Hormones have a different effect on breast milk in the daytime and at night. Between 2am and 5am, the hormone prolactin boosts your milk supply, so some people find it easier and quicker to express milk early in the morning.

Your breast milk also contains more melatonin (a sleep-inducing hormone) in the evening and at night. Babies do not produce their own melatonin, so giving your baby breast milk for their evening or night-time feed can help them to settle to sleep.

Keep in mind that it is important to feed or express from each breast. If you do not then there is a chance that one breast may become engorged. This can lead to problems, such as mastitis.  

How often should I express milk?

Your breasts make milk to demand. Once breastfeeding is going well, you will only need to express as much as your baby needs. For example, if you plan to give your baby 2 bottles of expressed milk a day alongside breastfeeding, then you may only need to express twice. Although, you may need to express for longer to get the amount of milk that your baby needs. 

Do not worry if you find that your supply has increased too much. You can just slowly reduce the amount you express until your supply settles.

How should I introduce formula feeds alongside breastfeeding?

If you want to combine breastfeeding with bottle-fed infant formula, here are some tips.

• Use first infant formula – your baby does not need any other type.  
• Introduce combination feeding slowly to give your body time to reduce how much milk it makes. This will also give your baby time to adjust to formula milk.
• If you are going back to work then start combination feeding a few weeks before you’re due back.
• if your baby is 6 months old or more, and can drink milk from a cup, you may not need to introduce a bottle at all.  

Will I produce less breast milk if I introduce formula?

Introducing formula is likely to reduce the amount of breast milk you make because your body makes milk on demand. Replacing breastfeeds with formula feeds, will tell your body to produce less milk.

To keep your breast milk supply going, breastfeed your baby often, or express often between formula feeds.

My baby was breastfed from birth, but my nipples became really sore and I couldn’t bear to have him near them. I offered him a bottle and fully expected him to be bottle-fed from then on. A few days later I just decided to try breastfeeding again, and he latched straight away. From then on, I would offer him breast first, then top him up with a bottle of formula. This lasted until he was around 16 weeks old when he just lost interest in the breast altogether and I could not get him to latch. I’m glad we managed to get this far.

Katie  

How do I introduce bottle-feeding to my baby?

Babies use a different sucking action when drinking from a bottle. So, it may take a while for a breastfed baby to get used to it. Here are some tips:

Give your baby their first few bottles when they are happy and relaxed rather than when they are very hungry.

Ask someone else to give them the first few feeds so that your baby is not near you and cannot smell your breast milk.

Try different positions for breastfeeding and bottle-feeding.

Paced feeding

Try paced feeding. This is way of giving your baby more control over feeds.

Babies usually take small amounts of milk and stop for a rest, and then take more. You can help them to "pace" their feeds so that it mimics the way they would breastfeed.

Never force your baby to finish a feed as this will be distressing and can mean your baby is overfed.

Will bottle-feeding stop me bonding with my baby? 

Some people may worry that they will lose their bond with their baby if they bottle-feed. Try not to get too anxious about this. You can still grow a strong emotional bond with your baby while giving them a bottle. During feeds, keep eye contact with your baby, feed them skin-to-skin, chat softly to them and watch out for signals or cues of how they are feeling.

This is called responsive feeding. It means every feed can be a special time for you and your baby. It also helps your baby to stay settled and comfy while feeding.

If I am also breastfeeding, how much formula milk should I give my baby? 

The best guide is your baby and their feeding cues. Your baby’s needs will change daily, and as they grow, so they will let you know how much they need.

Is it normal to have mixed feelings about combination feeding? 

It is completely natural to have conflicting feelings. Some parents may feel guilty or sad about combination feeding their baby, especially if they had planned to breastfeed exclusively.

Do not be hard on yourself. Every parent and baby is different; there are many reasons why combination feeding may be the best thing for both of you.  

If you still have any worries or concerns, talk to your midwife or health visitor. There are also more breastfeeding information and support services available.  

My baby refuses my breast now they are bottle feeding. What can I do? 

Combination feeding takes practice. Some babies will adapt more quickly than others. However you decide to feed your baby having some skin-to-skin time during feeding can help.

Practising responsive bottle-feeding will also help to make sure that your baby is not taking a lot of formula milk too quickly.

It may help to settle your baby back on your chest if you:

• try to stay calm and relaxed as you encourage your baby to breastfeed
• breastfeed your baby when they are very drowsy, to tap into their natural drive to feed
• try different breastfeeding positions.

Can I stop combination feeding and go back to breastfeeding exclusively?

Yes. You can return to exclusive breastfeeding if you have been combination feeding. It is even possible to get your breastmilk going again after stopping breastfeeding.

It is best to do this slowly, to allow your body time to increase your milk supply. Always offer your breast first, for each feed, and slowly reduce the amount of formula you give your baby.

It is also a good idea to have lots of skin-to-skin time and cuddles with your baby. This will help to boost your milk supply, as well as encouraging your baby to feed from your breast.

It may also help to choose a time when your baby is relaxed, alert and not too hungry.

You may need to increase your breast milk supply by expressing after a breastfeed. The more you express the more milk you will produce. This should ease the transition back to exclusive breastfeeding.

Some babies may find it hard to go back to breastfeeding after they have got used to the bottle. Ask your midwife, health visitor or other local breastfeeding support network for help, if you need it. 

Breast awareness 

Your breasts change a lot during and after pregnancy, so it’s important to check them regularly and be aware of any unusual changes. This is called ‘breast awareness’. Breast awareness is important because some breast changes might be a sign of breast cancer. 

In collaboration with Tommy's, CoppaFeel! has produced a new resource especially for women and pregnant people about natural breast changes during and after pregnancy, tips on how to check your breasts and what to do if you notice any changes. Find out more about your breasts during and after pregnancy.