Why We Went From Breastfeeding to Combo Feeding

On February 5, 2023 at 7:31am, we welcomed baby Jack David into the world. We were elated and also extremely sleep deprived as I had started my induction three days prior, and had essentially been awake the entire time through a variety of medical interventions to bring him earthside.

That whole time I was so focused on getting him out of my body safely that I didn’t even think about the feeding journey that was going to begin seconds after he arrived (surely he could wait to eat until after I had my long awaited Italian sub to start breastfeeding!... JKJK). While he was full term, he was just 6 lbs 3 oz and considered small for gestational age (SGA). While there was never any medical reason determined for his size, we were aware that he was hanging out on the edge of the growth curve.

Luckily, he latched and breastfed immediately in the delivery room, but after that initial feeding he struggled to re-latch for the rest of that first day of life. At our hospital, it was protocol to test SGA babies’ blood sugars to make sure they didn’t dip too low. To get him by that first day, a lactation consultant taught me how to hand express colostrum and spoon feed it to him, to make sure his blood sugar remained stable and he was getting adequate nutrients. With his energy up, he finally latched again that next morning, and was attached to my boobs for what felt like non-stop for an entire month.

While I did my best to exclusively breastfeed that first month, I felt so insanely sleep deprived we decided to introduce a bottle with a mix of pumped milk and formula around day 10. We did this about 1x/day for the remainder of that first month because it always seemed to ensure getting a decent stretch of sleep (decent as in like, three hours) for us all. The only exception was one day where I was sick with a stomach bug. I was vomiting for about 24 hours and felt too weak to even hold him. That day I pumped and he got all bottles, again a blend of formula and breastmilk (in hindsight, I think this stomach bug affected our BF journey more than I realized at the time). 

Come his one month appointment, he only gained about 8 ounces (½ lb) and fell completely off of the growth charts. I was stunned. How? It felt like he was ALWAYS feeding, spending hours upon hours a day attached to my boobs. Plus, supplementing a bit with a bottle!

Needless to say, I panicked. I felt like my desire to exclusively breastfeed my baby was clouding my ability to see that he wasn’t even growing. Luckily our pediatrician helped me snap out of my self pity party and helped us devise a plan. She suggested exclusively pumping and bottle feeding him for 1-2 days just to see if this was a metabolic issue (ie he was getting enough food but still not gaining) or if it was simply a matter that he wasn’t getting enough calories.

I pumped and supplemented with formula and had him latch whenever he rooted. In three days he gained another 8 ounces. Phew. I was very relieved but also felt terrible. Those two days he didn’t cry once. He slept 2-3 hour stretches all day and night. He was so content because he was finally satisfied. It was so hard to see that in hindsight he was becoming extra fussy and not getting enough sleep because he was hungry for so long. 

I was relieved he took so well to the bottle and seemed to be getting back on track, but I didn’t want to give up breastfeeding just yet. We met with the lactation consultant and our pediatrician’s office to help determine what was going on. She did an assessment on Jack, asked me a bunch of questions about my pregnancy, birth experience, and medical history (which can affect milk supply), and then she watched Jack latch and we did a weighted feed where he was weighed before and after breastfeeding. She did note that he seemed to tire easily on the breast which caused his latch to become more shallow the longer he hung out there. Her assessment was that, paired with an undersupply of breast milk resulted in him only being able to transfer a little over an ounce at every feed, making it really difficult for him to get the calories he needed to grow. 

She helped me a bit with his latch and positioning to help him remain more alert while feeding. In terms of my undersupply, it wasn’t clear if that was something that had been there all along, or a result of him not transferring enough milk. We assumed a combination of both. Plus, my supply likely took an extra hit when I had the stomach bug a few weeks prior.

Side note: I am providing a lot of these details because I know that a lot of people have experienced slowed growth in that first month for a variety of reasons. A lot of babies don’t track perfectly on their growth curve when they are exclusively breastfed as it takes some time for supply to establish and baby to build strength with sucking and swallowing. But knowing that he was so small to begin with and not tracking on the growth curve at all, I didn’t feel comfortable waiting any longer to help him catch up. 

After our assessment, the CLC suggested to “triple feed” him until our next meeting (10 days away) and then reassess. Triple feeding is where you breastfeed, pump, and then bottle feed what you got from the pump. We also added in some formula for this as well because of my under supply. I felt great that we had a plan to help me continue breastfeeding while ensuring that he got the calories he needed. But by day 4, I found myself googling “how to triple feed without going crazy.” And I am not joking.

To those who do this on the regular, I salute you. But I found myself falling into a deep depression. Everytime I had to put my baby in the bouncer or the swing so I could hook myself up to a pump for 20 minutes, I wanted to cry. All I wanted to do was snuggle with him all day long and I felt like I was trying so hard to make breastfeeding work in the name of “bonding” but found myself apart from my baby more than if I just gave him a bottle of formula for every feeding. On top of that, feeding a newborn is round the clock. It’s all day and all night and it feels like there are never any breaks. And when you add in a bottle and pumping it feels like the second you are done, you have to start again. Those 10 days felt like one very long day that never ended. 

I was both anxious and depressed and felt like I had very few people to turn to for support. I had a few well meaning people telling me I was being too hard on myself and needed to take the pressure off, and others who encouraged me to keep at it, try supplements, keep going. I felt like there were very few resources available for coming out the other side of something like this. It seemed like those in a similar situation who made breastfeeding work did so by absolutely killing themselves (triple feeding for months on end, or adhering to an extremely strict pumping schedule on top of nursing) and experimenting with various supplements and products to boost milk supply. 

Perhaps this is not the case for everyone, but it seemed to be the road we were going down and I knew I *could* do it, but I wasn’t sure if I wanted to. I finally broke down crying at my six week postpartum appointment when my midwife asked how things were going. I told her what was going on and she was so kind and asked “what do you want to do?” and “what feels manageable for you?” 

I said I wanted to breastfeed but at this moment in time, doing what it takes to exclusively breastfeed does not feel manageable for me. Worse, it feels like the pursuit is putting my own ego above the wellbeing of my baby. Because in the past 10 days he was growing, sleeping well, and incredibly happy. And I was miserable because I felt like I was missing out on all of the little milestones.

At that point I decided I would stop pumping and just breastfeed and supplement with a bottle of formula, but after a few days of that, it didn’t seem to be working out how I intended. Jack still wasn’t getting enough from the breast (we did another weighted feed) and would kind of lose interest in the bottle after breastfeeding. I felt like I was pathologizing every feeding and I felt like I just needed some reassurance that he was getting enough from me.

Later that week I was talking to a good friend of mine and she told me about another friend who had a similar experience and she had decided what was manageable for her was pumping 4x/day, getting whatever amount she got from that, and then supplementing with formula. I don’t know why but this advice really felt helpful to me. 

I never had any intention on exclusively pumping. In fact, I said if it came down to that I would just switch to formula. But, since he was still nursing occasionally, I wanted to continue pumping to keep my supply at a level where he could nurse if he wanted to or it made sense. 

At that point I started pumping 4x/day for about 20 minutes (sometimes more, sometimes less), and once my supply regulated (nearly doubled from where it was prior!), I was making enough for him to have about 50% breastmilk and 50% formula. Plus, he would nurse in the middle of the night or before naps for a “snack” feeding or some comfort to help getting back to sleep. 

While pumping didn’t feel like a walk in the park, I felt like taking the pressure off to produce a full supply made it much more manageable. Plus, Jack just did so well with the bottle and he was really thriving. He was self regulating, eating as much or as little as he wanted. He wasn’t nearly as fussy as he was that first month. He was sleeping well. And he was tracking well on his growth curve, even bumping up a bit at his 4 month appointment. Our pediatrician even said “I’m so glad you’re able to feed him like a MOM and not like a DIETITIAN now” - meaning she was glad we got to a place of “flow” with feeding, and not feeling the need to track every ounce he ate. PLUS I got to spend my time being WITH him instead of worrying about every little drop of breast milk I was producing. 

This didn’t come without some grief of course. Honestly, I had to work really hard to keep my eye on Jack and drown out some of the chatter from mom groups and social media. I felt so much judgment from every angle. I was taking the easy way out. I was trying too hard. I was not trying hard enough. 

I had a few moments where I considered giving it another go as I saw my supply increase. I thought I could give up pumping and breastfeed while supplementing with a bottle, but Jack really didn’t seem consistently interested in breastfeeding, so it seemed like an unreliable pursuit at best. Finally around 4ish months I decided it was time to stop fighting what was working and really settled into bottle feeding him and only nursing overnight when necessary (for whatever reason he nursed totally normally overnight). 

I had a goal to get to 6 months of this and then decide if I wanted to keep pumping or if I wanted to switch exclusively to formula. And as his desire to nurse naturally decreased, I made the decision to start weaning. The bonus of having an under supply is that weaning is not too bad! There was no big last nursing session and my pumping sessions just got spaced out a little more day by day. Now, I’m going days between sessions, and I’m thinking I might actually be done (?). TBD. 

As of today Jack is drinking 100% Bobbie formula (affiliate link). I love that it’s an organic formula, and satisfies both FDA standards and EU standards for DHA and iron. I also love that they have a subscription service, and help you determine how many cans of formula you’ll need each month if you’re combo feeding or 100% formula feeding.

It’s not the feeding journey I intended but it’s been so incredibly fulfilling to see the bond we’ve created just by being together. The way he engages with me, smiles at me, rests his little head on my chest. It’s just the best. 

Sometimes I think about what I would do if we ever had another baby. Or how I might have done things differently if I could go back in time. I know I would have started working with a CLC right away* to help guide our journey a bit, but I also think next time around I won’t hesitate to add in formula if needed.

I’m curious to hear from you… what was the most unexpected part of your feeding journey - breast/chestfeeding or otherwise? Let me know in the comments!

*I actually had a consult with Kristen Allen, The Lactation Mentor, but ultimately decided I was OK with bottle feeding at that point. But would 100% work with her if we ever do this again!