Breast and bottle: combination feeding without the guilt

Funke had a plan. She would breastfeed exclusively for six months, just as her sister had. Then her son arrived early, was slow to gain weight, and on day five a kind midwife suggested topping up with formula after some feeds. Funke cried in the car park. A week later her son was gaining well, she was sleeping a little more, and she was still breastfeeding for most of the day. Months later she said the hardest part had not been the bottles. It had been the guilt.

Funke's story is a composite of many mums' experiences, and perhaps it sounds a little like yours. Combination feeding, giving both breast milk and formula, is a common and practical choice. Here is how to do it well, and how to put the guilt down.

Why mums combination feed

• A baby needs extra milk while gaining weight, often suggested by a midwife or doctor.
• Returning to work or study makes regular expressing difficult.
• A mum's health, previous breast surgery or low supply makes exclusive breastfeeding hard.
• Sharing night feeds helps everyone get more sleep.
• Breastfeeding is painful, stressful or simply not working, and some formula keeps feeding going.
• It just suits the family.

Every one of these is a good reason. You do not need to justify your choice to anyone.

Getting started gently

• Talk it through. A midwife, health visitor or lactation consultant can help you plan which feeds to replace and how, especially if you want to protect your milk supply.
• Introduce changes gradually. Replacing one feed at a time, a few days apart, is gentler for your breasts and your baby, and makes engorgement or mastitis less likely.
• Keep favourite breastfeeds. Many mums keep the first morning feed or the bedtime feed as breastfeeds, because they are cosy and often when supply feels good.
• Try paced bottle feeding. Hold your baby fairly upright, keep the bottle more horizontal, and let her pause. This helps her control the flow and stay comfortable switching between breast and bottle.
• Watch your breasts. If they feel very full when you skip a feed, express a little for comfort. Look out for hard, red or hot areas.

Formula safety basics

• Use a first infant formula unless your doctor advises otherwise.
• Follow the instructions on the pack exactly. Never add extra powder or extra water.
• Clean and sterilise bottles and teats.
• Make up feeds fresh and throw away any milk left after a feed.
• Never prop a bottle or leave your baby alone while feeding.

Putting the guilt down

Feeding guilt can be loud. It might sound like a relative's comment, a post online, or a voice in your head saying you didn't try hard enough. Here is what is true: every feed you give your baby, from breast or bottle, of breast milk or formula, is an act of love. Your baby needs to be fed and to be held by a mum who is coping. Fed is best, and you, cared for, are part of what is best.

If guilt or sadness about feeding feels heavy, or if it is part of a wider low mood, talk to your midwife, health visitor or doctor. Grief over a feeding plan that changed is real and deserves gentleness, not shame.

Sung over, not graded

The LORD thy God in the midst of thee is mighty; he will save, he will rejoice over thee with joy; he will rest in his love, he will joy over thee with singing. (Zephaniah 3:17, KJV)

God is not standing over your kitchen counter with a clipboard. He is in the midst of you, rejoicing over you. Picture that as you mix a bottle at three in the morning or offer the breast once more: the Lord singing over you, not grading you.

A prayer for peace about feeding

Lord, take the guilt I have carried about how I feed my baby. Thank you for breast milk, for formula, for bottles and for the people who help. Let me hear your song over me louder than any criticism, and help me simply enjoy my child. Amen.