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Combination feeding: mixing breast and bottle feeding

Combination feeding: mixing breast and bottle feeding

After successfully breastfeeding my first four children, my fifth baby threw a curveball my way by entering the world five weeks early. In the neonatal intensive, she struggled to breastfeed and while I spent hours trying to get her to nurse, it soon became apparent that she preferred the bottle. 

I knew that giving her breastmilk was important to me as a mum—and supply was not an issue for me—so I soon entered a world that I had really heard nothing about before: combination feeding. For around six months of my daughter’s life, I was able to pump exclusively breast milk for her (with a few nursing sessions sprinkled in). Then, sometime after she turned six months, I did a combination of breast milk and formula. Combination feeding truly was the best of both worlds for me and I am so grateful that I was able to have access to both the convenience of formula and breast milk, even when she lacked the skills to physically nurse. 

More and more parents are realising that, like so many things in life, feeding their babies doesn’t have to be all or nothing. Combination feeding lets parents combine feeding types–formula in a bottle and either pumped milk in a bottle or directly from the breast—to find a flow that works best for them. (Pun intended.) Read on to learn more about combination feeding, how it can work together, suggestions for making it work, and tips from real parents who have combo fed. 

What is combination feeding? 

Combination feeding is a parent combining breastfeeding and bottle feeding in order to feed their baby, explains Deedee Franke, a nurse and lactation consultant at Mercy Medical Center in Baltimore. This includes primarily feeding directly from the breast, then supplementing with formula or expressing breast milk and feeding your baby both pumped milk and formula. Or all three combined! 

With more resources and technology to help parents feed their babies (for instance, I only made it through getting my baby breast milk thanks to my Elvie pump!), you might think that combination feeding is a relatively new phenomenon. But Franke says you’d be surprised—she’s actually witnessed it for as long as she’s been a nurse: 41 years! 

Why combine breastfeeding and bottle feeding? 

There are many benefits to combining breastfeeding and bottle feeding that range from a low supply to medical issues that prevent exclusive breast feeding to mental health reasons. Some of the benefits of combination feeding include: 

  1. Someone else other than the breastfeeding parent being able to feed the baby

  2. Convenience of bottle feeding for things like work, public events, or travel

  3. Breast milk supply issues

  4. Medical reasons for the parent or baby

  5. Parent or baby preference

  6. May support mental health

In my situation, for example, there were several reasons that spurred on my decision to combo feed. For starters, because my baby was born prematurely, she lacked the ability to breastfeed. As a result, we had to bottle feed her right from the start and she developed a preference for the bottle instead of nursing. 

Secondly, I have had severe, recurrent mastitis through all of my breastfeeding journeys that damaged my milk ducts—I also happen to have extremely thick breast milk (the hospital nurses passed bottles of my colostrum and milk around because they said they’d never even seen anything like it, which made me feel both strangely proud but also very much like a dairy cow). That means that cutting down how often I breastfed and pumped helped reduce my supply to a much more manageable amount so I didn’t continue to get mastitis. It allowed me to keep giving my baby breast milk without it physically harming myself. And I’m not alone—here are some other reasons other parents decided to try combination feeding. 

Medical reasons 

Mastitis was a catalyst into combination feeding for mom of twin boys, Cheryl from Michigan. Her doctor prescribed a strong antibiotic to treat her breast infection, which has an unclear safety profile for breastfeeding. To stay on the safe side, Cheryl chose to split feeding her twins into a 3:1 ratio of three formula bottles for every one breast milk bottle. 

She also chose to pump, since tandem feeding didn’t exactly work out, and introduced bottles when the twins were five days old. The way she works it out is simple: every time her boys take a bottle, she pumps. And when they’re done feeding, she also pumps. “The natural letdown from their cries and the feeling of fullness are what have me pumping,” she says. She adds that she wasn’t given clear guidance on what kind of pumping/feeding schedule would be best, so she worked it out on her own and also joined a support group online. “I am part of a C-section and a breastfeeding group on Facebook that gave great tips/tricks and reassurance that I’m not failing my babies,” she notes. 

Mental health reasons

Hannah, a stay at home mom of two boys from Jacksonville, chose to combo feed her second child for a variety of reasons, including to support her mental health. “I chose to combo feed in the beginning because it seemed most doable at the time,” she explains. “I knew I wanted my youngest son to have breastmilk and exclusively pumping took too much of my time with my eldest. Exclusively breastfeeding was hard work. Trying to manage the pain it caused in my boobs with how little he drank wouldn’t have worked so I also pumped and gave him a bottle too. But if you pump too much, you’ll produce too much milk so it took a long time to try and get a groove. I had always wanted to breastfeed and I knew this was the only way I’d be successful at it, and it worked! He has a bottle now only if I’m not around but for the first five months, it was half, bottle half breast.”

She also added that having her husband be able to feed their baby was a huge factor. “I needed my husband to also feed him a bottle for my own mental health,” she explains. “Taking a bit of that load off my plate helped tremendously take the pressure off of me. As the mom, the grunt of the work seems to always fall on us (hormones from giving birth, the pain from giving birth, the breastfeeding) so they did not help with my mental state at all and made it much worse when they were around.” 

Fortunately, her husband was extremely supportive of her decision, another factor that supported her mental health. “My mental health was a little rocky already because of the loss of a family member less than a month before I had my son, so the stress of breastfeeding without his help would have been intense,” she says. 

No real reason needed, thanks very much

Lauren, a parent and consultant, from Boise, explains that she chose to combo feed when her baby was six weeks old because she knew she would be heading back to work and so she could have a break from breastfeeding around the clock. She explains that she waited until her breast milk supply was firmly established before she introduced a bottle. 

“I was told it would help prevent nipple confusion and then began [combo feeding] when I had some supply stored so that I could have a break from constantly being latched onto,” she explains. “Then it became necessary when I went back to work when my baby was 16 weeks.” 

Lauren notes that she had a lot of people who encouraged her to just pump, but she says “they didn’t realise how much work goes into pumping.” So to make it work for her, she chose to breastfeed from the breast for all feeds outside of her working hours, then bottle feed for the hours she’d be gone working so her baby would be on the same schedule. After her baby was 6 weeks old, she split feeds between 50% breastfeeding at the breast and 50% pumped breast milk in a bottle. 

When to start combination feeding? 

If you plan on feeding your baby from the breast, it is recommended that you establish a solid breastfeeding supply first, before introducing a bottle or formula. Franke cautions that if you plan on breastfeeding at all, it’s incredibly important to ensure you and your baby have that part down before you introduce a bottle or formula. 

“I want to stress the importance the the first two to three months are important for a [parent] establishing a good breastfeeding relationship with the baby and building a good breastmilk supply before introducing in any formula supplementation because it started too early without prior guidance, it can quickly negatively affect mom ability to produce an adequate breast milk supply,” she says. 

That being said, the timeline for introducing a bottle also depends on your reason, says Franke. Always talk to your own baby’s doctor, but in general, you can use this as a timeline: 

- No medical reason: wait two-four weeks before introducing a bottle

- Medical reasons (such as the baby not gaining weight): introduce before two-four weeks as needed 

It’s also helpful to keep in mind that every baby and situation is different. For instance, due to her having preeclampsia and having to be readmitted to the hospital after her son was born, Hannah wasn’t even able to breastfeed for the first two weeks of her son’s life—and yet went to successfully combo feed with 100% breast milk. “My son had zero issues adjusting and still doesn’t mind either,” she notes. “That was a huge relief.” 

Combination feeding with only breast milk 

Hannah combo fed with only breast milk, which meant she fed directly from the breast and also from the bottle with pumped breastmilk. There is no one-size-fits-all with combo feeding, which is part of the beauty, but it also means that as a parent doing it for the first time, it’s largely up to you to figure out a schedule and what works best for you and your family.

For Hannah, she decided to only do bottles at night so she could get the maximum amount of rest and allow her husband to bottle feed the baby at night. Her rough schedule boiled down to:

- Bottles at night

- Breastfeed in the morning and pump the other breast–“I ended up with mastitis a few times, so I was super diligent about relief for both breasts,” she adds. “I did not mess around, that was so painful.”

- Breastfeed and pump through the day

All in all, her baby received two to three bottles a day, including night feeds, and breastfed about four times. 

Combination feeding with formula and breastfeeding

Emily, a mother of two and teacher from western Massachusetts, notes that she chose to combo feed because her newborns struggled to take adequate milk from the breast and wasn't gaining weight sufficiently. She ended up doing a combination of breast milk from the breast, breast milk from the bottle, and formula for each child that looked roughly like: first child: 10% breast milk in a bottle, 5% nursing at the breast, 85% formula and second child: 50% breastmilk in a bottle, 15% nursing at the breast, 25% formula. 

She explains that for her first child, she had limited information and high hopes for breastfeeding and when exclusive nursing didn’t work, she got some impressions from others that thought she simply wasn’t “putting in enough effort” to make breastfeeding work. With her second child, however, her eyes had been opened to the benefits of combo feeding.

“My first child taught me the benefits of using formula in addition to pumping and therefore I was much more open to it for my second,” Emily says. “I also discovered that combo feeding is much more common than I had previously realised.”

Combination feeding schedule 

Your baby’s exact feeding schedule will depend on how exactly you are doing combination feeding and what your goals are. Ideally, you’ll adjust so you’re able to nurse, pump, or feed all around the same times every day—that’s because your body will get used to producing breast milk at the same time every day and if you miss a feeding or a pumping, you will risk getting mastitis. 

For Lauren, her goal was to have her baby take bottles while she was at work, and nurse when she wasn’t, so her schedule was simple:

- Bottles during work hours

- Nurse all other times 

She and her partner also found it helpful to label the bottles she pumped with the day and time and freeze anything unused. 

My combination feeding schedule looked different as my baby aged. In the beginning, to get my supply established and build up milk, I pumped every two hours. Over time, I adjusted my pumping sessions so I was pumping roughly five times a day. 

Once I ran out of my breast milk supply surplus around the time my daughter was six months old, I did a combination of breast milk and formula for every bottle until she turned 12 months old. I mixed half the bottle with milk, then followed the instructions for formula for the rest. However, you could also choose the opposite: full formula bottles only and full breastmilk bottles only. 

Tips for combination feeding

Our combination feeding parents recommended a few tips for making combo feeding work: 

- Wearable pumps are key. For myself, the Elvie was a game-changer. 

- Massage as needed. To ward off mastitis and clogged ducts, Hannah also found a breast massager helpful. 

- Get your partner on board with cleaning parts. Lauren notes that a supportive partner that helps clean/organise pumping is crucial. And I’d have to agree—my husband helped me by devising a schedule, washing parts, and setting timers through the night when I needed to pump. 

- Stick to a schedule. “Getting on a schedule was vital otherwise I would get a clogged duct or mastitis,” notes Lauren. 

And perhaps most important: make combo feeding your own. The beauty of it is you get to choose. If pumping once a day works for you, do it. If you only want to nurse at bedtime, make it happen. Combination feeding is whatever you want it to be. 

Restarting combination feeding 

If you have stopped breastfeeding and hope to reintroduce the breast along with bottle feeding, or in some cases, if you want to introduce breastfeeding for the first time along bottle feeding (for instance, in cases of adoption), Franke says that it may be possible in some cases. 

“It is possible to establish a milk supply but it will take some work,” she explains. “ A lot depends on how long it has been since the baby’s birth.” 

She recommends working with a professional board certified lactation consultant for best practices for re-lactation initiation. Every situation will be different and it’s best to work with a professional who can help guide you through your own. 

Where to get help and support 

If you’re interested in combination feeding or need support in your combination feeding journey, it may help to check out some resources such as:

Your delivery hospital. They may be able to connect you to a lactation consultant that can help.

Lactation Consultants of Great Britain. Plug in your location to get connected.  

Your doctor or your baby’s doctor. “Combination feeding for a baby and new family is very personal so I would stress getting some guidance from the baby’s healthcare professional and/or a lactation consultant,” says Franke. 

And last but not least, Lauren gives this advice: “Read all the instructions, label everything, and take a deep breath.” You’ve got this!