Supplementing with Formula

[amandabea]

Hi - my DD is 15 weeks old and has been gaining weight very well. I am breastfeeding and pumping, but I can't ever seem to pump enough and have just blown through my frozen milk supply. She goes to daycare everyday and goes through 16-24 ounces depending on how long she's there/away from me. I've spoken to her ped about beginning to supplement with formula, but am wondering what the implications are...and I have a ton of what may seem to be stupid questions, but I just don't know...

Will one bottle of formula quickly turn into two or three? Will my milk supply continue to decline to the point that I dry up? I'm still planning to BF whenever I'm with her, so I know that will help, but I'm to the point that it seems like she's never fully satisfied at the breast.

Is there anything I can do to bring back what I seem to have lost since returning to work? Initially I was able to pump 7-10 ounces total every session (about every 3 hours), now it's down to 3-4 ounces (total from both breasts). I started taking the More Milk drops, but I can't tell if that's working or not.

Should I have daycare give her all the EBM bottles first and then formula as a last resort? That could mean she won't need to BF when I pick her up. Or should I have them feed her the formula prior to the last EBM bottle so I potentially have that for the next day?

Can I use the same bottles for formula and EBM?

thanks!

[ajmom]

BFing can pumping can be very confusing and stressful! Good for you for wanting to make it work!! I'll try to answer some of your questions...

>I've
>spoken to her ped about beginning to supplement with formula,
>but am wondering what the implications are...

If by "implications" you mean negative associations with formula, you can be sure you will find some the more you ask and do research. However, formula is the only option for tons of babies whose mothers either can't or choose not to BF. Ultimately, I don't know that BF or FF makes a huge difference. I work in an elementary school and no one is asking whether students were BF or FF as babies. No one asks me if I was BF or FF as a baby. In the long run, a well-fed baby is a healthy baby.

>Will one bottle of formula quickly turn into two or three?

If you are still pumping as regularly as you can and if you are still BFing her when you are with her, you should be fine. Your baby will eat what she needs when she isn't with you. Your body will adjust accordingly. Unfortunately, a pump is not as effiecient as a baby at expressing the milk, so you will begin to pump less, but I also don't think you should judge how much you are pumping with how much your baby eats while BFing b/c the 2 things are not the same. Your baby is probably getting more than you think when you nurse.

>Will my milk supply continue to decline to the point that I
>dry up? I'm still planning to BF whenever I'm with her, so I
>know that will help, but I'm to the point that it seems like
>she's never fully satisfied at the breast.

Maybe I already answered this... keep BFing her as much as she wants when you are together and keep pumping regularly.

>Is there anything I can do to bring back what I seem to have
>lost since returning to work? Initially I was able to pump
>7-10 ounces total every session (about every 3 hours), now
>it's down to 3-4 ounces (total from both breasts). I started
>taking the More Milk drops, but I can't tell if that's working
>or not.

I think I answered this one too. A pump won't express as much as real BFing and your body will adjust. You can try taking fenugreek capsules and eating oatmeal. Be sure you are getting plenty to eat and drink lots of water b/c nutrition and water are extremely important in keeping your supply up.

>Should I have daycare give her all the EBM bottles first and
>then formula as a last resort? That could mean she won't need
>to BF when I pick her up. Or should I have them feed her the
>formula prior to the last EBM bottle so I potentially have
>that for the next day?

I'm not sure I understand this question... If she gets the EBM then the formula, why would she not need to nurse when you pick her up as opposed to giving the formula and saving the EBM?? I can tell you how I do it, though... The bottles DD recieves while I'm at work are the EBM from the previous day, then formula only if needed. But she stays with DH during the day (he's self-employed) and he knows to try to hold off as long as he can if she gets hungry during the time I'm on my way home. If she needs more to eat, he goes with the formula. Either way, I'll bet your DD would be ready to nurse within an hour or so of you picking her up, if for no other reason than to reconnect and bond with you after being apart from you for the day. At least that has always seemed to be the case with my children when I worked.

You can also try pumping while your home in the evenings and on the weekends. You can try pumping an hour or so after nursing, but you might not get alot. However, the ounces do add up and you might not have to do formula at all if you don't want to. It takes more time than I have, though.

GOod luck with it all! It can seem overwhelming, but you can make it work!

[o_mom]

Have you tried replacing some of the pump parts? I know the Medela pumps have the little white membranes that need replaces quite frequently. Someone else may know what other parts could potentially wear out.

[Bean606]

I was in a similar position, although my DS didn't start day care until 6 months, and then only 3 days a week. He was EBF before then, but was not gaining weight all that well. If your DD is gaining weight well, are you sure she isn't satisfied at the breast?
As for day care, I am only able to pump enough for 2 out of the three bottles he gets there, so he gets one bottle of formula every other day, and the rest of the time he is BF and has been eating some solids since about 6 months. I did everything I could to boost supply -- fenugreek, oatmeal, extra pumping, etc., but it wasn't enough AND DS wasn't gaining well, so we had to go the formula route. I was committed to not going more than that 1 bottle every other day, and would sneak in extra pumping whenever I could at work, and always pumped before bed and after DS nursed first thing in the morning. It is time consuming, but worth it! I would definitely tell the day care to use BM and then formula only as a last resort, and ask them, if at all possible, to hold off feeding DD in the hour or so before you pick her up, so that you can nurse her as soon as you get her. Also, once DS started solids, I would ask them to feed the solids first and then the bottle for the meal where he got formula, and the other times I ask them to feed the EBM bottle first and then the solids, so I know he is getting as much EBM as possible. I mark the bottles - Breakfast, Lunch and Snack, so they know which one to give when. You can use the same brand of bottles for formula and EBM, but I would avoid mixing the two in the same bottle if you can.

[Momof3Labs]

Yes, definitely. Also, how often do you pump during the day? At 15 weeks, 3 times is probably the right answer if you work a 8-5 type schedule. When you pump, start out using the fastest speed and lowest suction. When you start to get a letdown, switch to the slowest speed and the highest suction that is comfortable for you. When the letdown ends, switch back to fast speed and low suction. And so on.

Have you considered adding a pumping session first thing in the AM or late at night (heck, or both)? I found that to be tremendously productive, especially after a few days, when my body adjusted to the additional demand!

[jgriffin]

Not stupid questions at all! I would recommend joining the Yahoo group PumpMoms; I got a lot of useful advice and cheering there when I pumped for E. I found I was most productive in the morning, so I would dream-feed E on one side when I first woke up, then pump off the other side before heading to work. Each subsequent pumping throughout the day was less productive (I did 3 at work). I also tried to pump before going to bed, even if it meant only getting an ounce or two. Like the PPs said, every ounce counts!

I tried a few methods for keeping my supply up, although in the end we wound up supplementing with formula until E stopped nursing. Eat lots of oatmeal, stay hydrated, try fenugreek and blessed thistle and mother's milk tea.

For supplementing, I mixed the ebm and formula, because at least initially that's the only way E would take the formula. I think we had 3 bottles a day for daycare, the first 2 would generally be straight ebm and the last was a mix. But I would definitely use the formula last, and not try to save a bottle of ebm for the next day.

GL, and keep asking questions as they arise!

Jen

[pb&j]

If you're using a PIS or PISA, make sure to replace the white membranes regularly (like every month or two).

The only way I was able to pump enough for DS was to have an extra pump session each night after he went to bed but before I did. It was a major chore, but those 4 or so ounces I got each night made the difference between having a stash and having to start giving formula.


-Ry,
mom to Max the one year old
and my girl in heaven

http://www.windsorpeak.com/dc/user_files/37124.gif

[JoyNChrist]

Another thing to remember is not to freak out too much about giving the baby formula. My supply has only just now caught up to DS's appetite, so we've been giving him formula here and there since he was two weeks old. At first, I was so committed to not starting the formula - I thought it would hinder breastfeeding, and I almost thought it was bad for my baby. But then our pediatrician gently reminded me that formula isn't BAD. No, it isn't as good for the baby as breastmilk, but there's absolutely nothing wrong with it. Many, many babies grow up having nothing but formula (including, probably, most of us) and they're perfectly happy, healthy children. You're not going to hurt your baby by giving her formula. The most important thing is that she's getting enough to eat, no matter how you have to do it.

Just something to remember...supplementing was really hard for me at first. :-)

[luvsviola]

I found that when DD wakes up at 4 am, she will eat one side and go back to sleep if I rock her long enough and leave her attached to that side. I can usually get 3-4 oz. out of the other side. That is enough when added to what I get at work to keep us going. You might add an extra pump after the baby goes to bed and one after baby wakes up in the night. It sucked when I added it in the beginning, but now I'm so used to it it doesn't faze me any more. I just set the pump up at night so its ready to go at 4 am and do 10 minutes with my eyes closed, and then I can fall back asleep.

Also--I pump right before I leave work. I don't really need to except that I need the milk. So I pump and then it is about an hour by the time I pick her up and get home. So there is milk for her to eat, but I got the benefit of an extra pump in. I get about 4 oz. per pump session at work.

Also--(Sorry, keeping thinking of things)--I got a water bottle with a thick straw and drink 32 oz. of water before lunch and 32 oz after lunch. I just carry the bottle around and sip on it when I'm bored. If you have a big straw, its amazing how fast you drink it. But out of a Nalgene bottle, I have to choke it down. So you might try getting more water too.

Good luck!

[amandabea]

thank you all so much for the great advice and support. I feel like I've been pumping non stop this week, but I think it's working. Only had to supplement one bottle every two days!
Happy Mother's Day to you all!