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Thread: Advice for early combo feeding and avoiding nipple confusion

  1. #1
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    Default Advice for early combo feeding and avoiding nipple confusion

    Because of my work schedule, my husband and I want to start combo feeding our new baby as early as possible. I will breastfeed exclusively for about 2 weeks, but after that we will need to supplement with formula (I will not be pumping).

    My question is, what steps can we take to minimize the risk of nipple confusion? Are there particular bottles that can help maintain combo feeding without the baby learning to prefer the bottle? Any other advice?

    Also, could we start combo feeding from the very beginning (after the colostrum stage)? It's very important to us that both parents be involved in feeding. Has anyone done this successfully?

  2. #2
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    Default Re: Advice for early combo feeding and avoiding nipple confu

    Welcome to the forum and congratulations on the baby to come!

    Ways to minimize nipple confusion:
    - Nurse exclusively for as long as possible- so no bottles or pacifiers for as long as possible! The more practice your baby gets at the breast, the more likely she will be to be a proficient and avid nurser, and the less likely she will be to turn down the breast in order to get a bottle or pacifier. Consequently, I would strongly recommend against beginning combo feeding from the very beginning. It's not that combo feeding is guaranteed to cause nipple confusion- far from it! But the longer you can avoid it, the less risk there is. Also, the colostrum stage does not end when mom's milk comes in (usually 2-5 days after birth). Colostrum is actually present in the milk for the first few weeks of breastfeeding- you will see that your milk is creamy white for the first few weeks, and turns more bluish/watery-looking thereafter.
    - Check out the YouTube videos of paced feeding. Paced feeding is a better way to bottle feed- it helps minimize overfeeding, it helps the baby recognize her own satiety cues- in general, it's more like breastfeeding.
    - Though bottles are often marketed as being like the breast, there is to my knowledge no evidence that any type of bottle is more breast-like or more likely to prevent nipple confusion. One thing that does seem to help is to use a newborn nipple for the entirety of the first year. "Stage" nipples are made for formula-fed babies, in order to get them to chug down large bottles quickly. Breastfed babies generally do much better when the flow of the bottle is more like that of the breast. So go ahead and buy some "similar to the breast" bottles and nipples- they can't hurt and may help! Just don't expect them to combat nipple confusion all by themselves.
    - Make sure that you use appropriate amounts of formula. Breastfed babies typically take small feedings and compensate for the size of the average feeding by nursing frequently. You want to keep the formula bottles small- 2 oz is plenty!- and frequent if you are planning to try to mimic the way breastfed babies feed.

    Are you 100% sure that pumping will be impossible for you? If you feel comfortable doing so, you might want to post your job description on the forum. Sometimes there's a mom with a similar job who can suggest pumping hacks that might make it possible for you to pump at work- for example, we had one thread where nurses and doctors ended up swapping all these great tips on how to pump in a busy hospital setting! Commuting moms are always swapping tips on pumping in the car. Also, are you going to be unable to get pump breaks at all when at work? I'm a little concerned that you might get back to work and then suddenly get engorged or uncomfortable, in which case having a pump and the opportunity to use it may be vital for you!

    Finally, how eager is your husband to feed the baby? Sometimes dads get into the mindset that this is the ONLY way to bond with a baby, but it's really not. We might be able to suggest some alternatives that would leave you free to nurse without feeling pressure from your husband, because he feels like it's "his turn".
    Last edited by @llli*mommal; February 19th, 2016 at 08:08 PM.

  3. #3
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    Default Re: Advice for early combo feeding and avoiding nipple confu

    I agree with mommal. Also, since your baby has not been born yet(?) and presumably you have a little time, my best suggestion is to get a copy of The Womanly Art of Breastfeeding (8th edition) and read up on the biological facts about all aspects of breastfeeding- milk production, the impact of supplemental feedings (any feeding not at the breast), how separations from baby might be handled with as little impact as possible, etc. You do not have to take all the suggestions in the book, or adopt it's point of view, but it will give you a better all around grounding in the facts than any other single source.

    Once you are versed in the biological realities, you can make your infant feeding plans as you see fit, with a better understanding of how those choices may or may not impact breastfeeding. (Milk production, your own health, and baby being willing and able to nurse at the breast.) No one can tell you that "combo feeding" or not pumping at work will or will not "work," as it depends so much on individual factors and also what your personal goals are. But overall, speaking generally, the more often/longer baby can nurse at the breast, the fewer unnecessary supplements (feedings not at the breast) that occur, and the longer biologically normal frequency of milk removal from the breasts occurs, the longer an individual baby might breastfeed.

  4. #4
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    Default Re: Advice for early combo feeding and avoiding nipple confu

    Thanks for the advice, ladies.

    To answer some of your questions, I am really sure that pumping will not work for me because of the nature of my job. I'm a trial lawyer, and I can't make a judge and jury wait for me while I pause the trial every couple of hours to pump. So once I'm back at work, it's going to have to be formula. I just want to make sure that my baby gets some breastmilk while I'm on maternity leave, and the transition goes as smoothly as possible. Unless I can continue breastfeeding a little bit, but not so much that I can't get through the day without pumping?

    Any suggestions on brands of bottles or formula that would make it easier?

  5. #5
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    Default Re: Advice for early combo feeding and avoiding nipple confu

    Any suggestions on brands of bottles or formula that would make it easier?
    No brand of bottles have been proven any better than any other bottles as far as preventing nipple confusion, despite the claims of manufacturers of being "more like the breast." So that is entirely your choice. I would suggest start with simple, inexpensive bottles and nipples that are somewhat interchangeable, so you can try a few different combos, rather than expensive 'bottle systems" that claim to reduce milk flow. Avoiding nipple confusion is not really so much about fast or slow flow, but more about helping baby control the flow as a baby does naturally at the breast. Who ever gives the bottle can help baby control the flow using paced bottle feeding positioning and technique. It does seem to help to use a newborn or even preemie nipple for a newborn, this seems to help the caregiver keep the flow gradual as they help baby control the flow. Here is more info on paced feeding: http://www.llli.org/docs/00000000000...astfedbaby.pdf and https://www.youtube.com/watch?v=UH4T70OSzGs and here with a real newborn: https://www.youtube.com/watch?v=ykdFuEOIdeE Yes the baby is crying, they do that. The LC explains the ways of paced feeding nicely so listen for that.

    I would also suggest, choose bottles that are size 4 ounces or smaller, because normal feedings in the newborn stage are 1-3 ounces and lighter bottles are usually easier to handle and position correctly for the normal length of a feeding, which would be about 20 minutes or more in the newborn stage. Your hand could get tired propping up an 8 ounce bottle, even if it is half empty.

    There is also no type of formula that would make transitioning from formula to breastmilk "easier." Formula is formula. Buy a reliable brand you trust to follow safe manufacturing processes. Don't get fooled into switching brands due to normal newborn issues- Allergies have specific symptoms and general fussiness, gassiness, spitting up etc. are all entirely normal and not typically signs of allergies in either breastfed or formula fed infants.

    To try to make "some" milk but not "too much" milk - this might be tricky, (Not saying not possible, just tricky) and is why I suggested the book but very basically, the less milk you take out of the breasts, and with the less frequency, the more your body will get the message to reduce milk production. (or rather, the less likely your body will get the message to have a normal production in the first place.) But the fact is, some moms make way more milk than others, and will do so even if they are actively trying to reduce their production.

    So I would strongly suggest that if you are going to be separated from your baby for any periods longer than 2-4 hours in the early weeks, have some back up plan for milk removal when you are away from baby. Not frequent enough milk removal potentially creates a situation where the lactating mom may become painfully engorged, start getting plugs, or even become ill with mastitis, which usually makes you feel like you have been hit with a very bad flu. It is not the end of the world, but certainly something you would want to avoid. The chances of this being an issue are increased the younger baby is. So even if you are not keeping the milk you express, expressing it over your workday at least a bit is pretty important, at least until your milk production reduces to the point you will not need to do that anymore.

    Most moms who pump at work do so on some type of schedule, not whenever they may feel like it. Trials do not go on for the entire day with no break. You might not be able to pump as often would be optimal on trial days, but that does not mean you could not pump at all. Finding a place to pump in the courthouse might be a challenge, it depends on the facility, and you could ask around about that. You might even check what the law is in your state as well as Federal law as far as pumping accommodations go, however they might not apply to you or might apply at your firm or offices but not when you are in court.

    Even on short breaks, maybe you could quickly hand express, and that could be done in a restroom. Of course, so can pumping, in a pinch. If pumping is not for you, it is not for you and that is fine, but again, having a thorough understanding of what is going to happen on a biological level once your baby is born might help you figure out how to best make things work for your circumstances. I would again strongly suggest the Womanly Art, for the reasons I stated above. If you are looking for something online, www.kellymom.com has some articles where she explains the biology of milk production in detail and also what is normal and expected in the early weeks of parenting a newborn baby. Of course she is going to be speaking from the point of view of what is needed to increase the chances of normal milk production, but that does not stop you from using that information and applying it to what you are wanting to do in your situation.
    Last edited by @llli*maddieb; February 20th, 2016 at 03:11 PM.

  6. #6
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    Default Re: Advice for early combo feeding and avoiding nipple confu

    So I would strongly suggest that if you are going to be separated from your baby for any periods longer than 2-4 hours in the early weeks, have some back up plan for milk removal when you are away from baby. Not frequent enough milk removal potentially creates a situation where the lactating mom may become painfully engorged, start getting plugs, or even become ill with mastitis, which usually makes you feel like you have been hit with a very bad flu. It is not the end of the world, but certainly something you would want to avoid. The chances of this being an issue are increased the younger baby is. So even if you are not keeping the milk you express, expressing it over your workday at least a bit is pretty important, at least until your milk production reduces to the point you will not need to do that anymore.
    You know what is probably worse than having to leave the courtroom for 20 minutes to express if you get overful? Missing a day of work because you didn't get a chance to relieve the fullness and ended up with mastitis and had to run to see the doctor. I'm not saying that will happen- just that it could and it would be pretty rotten.

    I assume that the court does have 10-20 minute breaks every few hours, so that people can pee and have lunch and stuff? If so, pumping or expressing may be a workable option for you. The breaks don't have to be regular in order for them to be effective. When people recommend pumping every X number of hours, they are usually aiming for a pump frequency that will maximize milk production. But that isn't the ONLY goal that people can aim for. You can also aim for a pump frequency that maintains some milk production and minimizes the likelihood of you getting engorged or uncomfortable. Pumping when possible, as opposed to pumping every X number of hours, would be a way to achieve that goal.

    Do you have a pump? MaddieB and I are definitely not trying to talk you out of combo feeding! We just don't want you to suddenly need a pump and not have one. Now is the time to get one- it's better to have the pump and not use it than to need it and not have it!

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