When I was pregnant with my twins, I resolved to nurse them exclusively no matter what. I knew about breast milk's many health and developmental benefits, so I did everything possible to ensure my success. I reached out to mothers of multiples, found a great lactation consultant, and even bought a special pillow designed to help me feed both babies at once. Then Thomas and Elisabeth were born... and reality intervened. Because they each had difficulty latching on and I didn't make enough milk to feed them both, my infants wound up getting a combination of breast milk and formula.
In those first few weeks, I was disappointed in myself. But then I learned that many pediatricians and nursing experts support the practice of combination feeding. "You should feel good about whatever nursing you can do, because every little bit makes a difference for your baby," says Freda Rosenfeld, a certified lactation consultant in Brooklyn, New York. Formula contains all the nutrients your baby needs, and introducing it -- whether during the first few weeks or a few months later -- doesn't necessarily signal that your nursing days are coming to a close anytime soon. Combination feeding makes particular sense in these three scenarios.
In general, the more you breastfeed, the more milk you'll produce. But if you get off to a relatively rocky start with nursing -- whether it's because you and your baby are separated in the hospital for longer than normal, your child isn't latching on well, or another reason -- establishing an adequate milk supply can be a big challenge. Even when everything goes right, some women don't make enough to meet their baby's needs. This is most common among moms who have multiples, those who have had breast-reduction surgery, and possibly women who give birth later in life. "In my experience, the older a woman is when she has a baby, the more likely she is to have milk-supply problems," says Rosenfeld. Experts aren't certain why, though they suspect it may be because a woman's body becomes less efficient over time at producing breast milk.
If your baby repeatedly seems hungry after you breastfeed him, you may have a low milk supply. Talk to your pediatrician about having your infant weighed before and after a feeding to see how much milk he received, suggests Sheela Geraghty, M.D., medical director for Cincinnati Children's Center for Breastfeeding Medicine. She may recommend that you pump your breasts in addition to breastfeeding to increase your supply and that you top off the meal with some extra pumped milk or give your child a supplement of formula for a short period of time.
Helpful hints: Nursing is more effective at stimulating your milk production than pumping, so it's important to keep it up even if it's a struggle. While some women who have sore nipples may decide to pump exclusively for a while, this strategy could cause your supply to dwindle further.
If you need to supplement your infant's diet with pumped breast milk and formula, they may be mixed together safely in the same bottle. Dr. Geraghty recommends that you prepare several smaller bottles (about 2 ounces each) in case your child doesn't finish. Once a baby sucks on a bottle, the remaining contents should be discarded. As you initiate bottle-feeding, begin with the smallest nipple size, since a slow-flow one most closely mimics your own body. Many moms of twins find that it works best to nurse only one baby at each feeding and bottle-feed the other, alternating so that each child gets to nurse at every other feed.
It's no surprise that moms often decide to wean when they go back to work. Pumping at the office can be stressful (not to mention a logistical challenge), and even if you build up a freezer full of milk during maternity leave, the stash will start to dwindle quickly. However, there is another option: Have your baby drink formula during the day but continue nursing before you leave for work and after you return home. This will allow your baby to still benefit from breastfeeding, and you'll both enjoy the quiet bonding time. Within a week or two, your body will adapt to produce milk when your baby needs it -- peaking in the early morning and at night and lessening during the day.
Helpful hints: A few weeks before your maternity leave ends, start pumping once or twice during the day and give your baby a bottle instead of nursing him. This will help your midday supply start to diminish, so that you can avoid becoming engorged on the job. "If you're in pain at work, use your hand or a manual pump to gently express a little milk in the ladies' room, which will take the pressure off," says Martha Snyder, M.D., assistant professor of pediatrics at Duke University School of Medicine, in Durham, North Carolina. When you're not at work, try to nurse your baby for all other feedings to maintain your supply.
Many new mothers adjust very well to the frequent sleep interruptions that are virtually inevitable when it comes to breastfeeding an infant. But for some women, getting at least one extended block of shut-eye at night can mean the difference between being happy and functional and feeling out of sorts and overwhelmed. "Breastfeeding is very hard work, and we see a lot of depression in women who are having problems dealing with it," says Dr. Snyder. If you know that adequate sleep is important for your mental health, try asking your spouse to give your baby a bottle of formula at one of the nighttime meals. This will provide the restful break you need while giving him a bonding opportunity with your baby. An added bonus: Your child may sleep a bit longer than usual, since formula takes a bit longer to digest than breast milk and stays in her stomach longer.
Helpful hints: Have your partner take over the late-evening feeding (generally around 11 p.m.) so that you can fall into bed at, say, 9 o'clock and enjoy an uninterrupted stretch of sleep until the middle of the night without having to ask him to wake up. Or, if you operate better on a later schedule, have him give your baby a bottle at 3 a.m. so you can rest from, say, 11:30 p.m. till the early morning. You might wake up engorged and uncomfortable the first few times, but your body will adjust quickly to the reduced demand.
Originally published in the August 2011 issue of Parents magazine.