How to combine breastfeeding and bottle-feeding

When “Breast Is Best!” is displayed on the walls of every maternity ward and walk-in clinic, not to mention libraries and bus shelters, it’s easy to understand why some moms might feel guilty about wanting to add bottle-feeding to the mix. But Amy Peterson, a lactation consultant and co-author of Balancing Breast and Bottle: Reaching Your Breastfeeding Goals, says combining breastfeeding with bottle-feeding—using formula, expressed milk or both—is a choice that works for many. Whether your partner is hankering to give a bottle, your return to work is imminent or you just need some time for yourself, here’s how to make combination feeding work for you.

Time it right Peterson says milk supply takes a good four to six weeks to regulate. She recommends introducing a bottle at around three to four weeks, when breastfeeding is established and “babies are still willing to suck on any­­thing.” Wait too long, and he may decide he’s a boob man and refuse the bottle.

Build your tool box Nipples, bottles and pumps, oh my! A good combination feeding strategy requires all of the above. To ease the transition from breast to bottle, you might consider a bottle that purports to mimic breastfeeding. As far as feeding technique goes, “Make sure the tip of the nipple reaches far back into the baby’s mouth,” says Peterson, “and your baby’s lips rest on the base, as opposed to sucking on the nipple like a straw.” If you know you’ll be away from your baby regularly but want to keep up your supply, invest in a double electric breast pump to express milk during those missed sessions. Supplementing with formula or just giving the odd bottle here and there? A simple manual pump will do.

Pace yourself, kid “Breastfed babies are like college students during frosh week—they can chug a bottle,” says Meggie Ross, a public health nurse and certified lactation consultant in Penticton, BC. To emulate breastfeeding and avoid overfeeding, Ross recommends pausing frequently and holding the bottle horizontally to decelerate the flow. Start with a bottle with a slower-flow nipple.

Eliminate feedings It can take up to a week for your body to adjust to one missed feed. So if you’re replacing regular feeds, do it gradually (for example, one per week) to avoid engorgement or, worse, mastitis. How will eliminating one or two feeds affect your overall supply? “Our bodies are amazing,” says Peterson. “They’ll down-regulate for that time and keep up supply for the rest of the time.” Still, you know your body. If you feel your supply is decreasing too much, pump during at least one of your missed sessions and breastfeed as much as possible when you’re with your baby.

The time of day can matter  Most lactating women feel fuller in the morning because supply is typically highest during that time. And while it’s true your body should adjust to any missed feedings, Ross suggests keeping the morning feed or pumping at that time instead. “Otherwise, your breasts will be uncomfortable,” she says. Because it may be five hours (or more) since your last feed, you need to be careful not to signal the feedback mechanism to the brain to slow down supply.

A word on formula If you decide to use some formula, go for one that’s iron-fortified. Powdered formula isn’t sterile, so if your baby is very young, choose formula that’s “ready-to-feed” or comes in a liquid concentrate. Speak with your paediatrician to determine the right formula for you.

A version of this article appeared in our May 2016 issue with the headline “Boob + Bottle: Best of Both Worlds,” p. 57.