Did your baby receive supplemental bottles of expressed milk or formula as a newborn? Not what you had planned? Is combination feeding becoming a nightmare? Don’t panic! All is not lost.

This story is familiar to many mums. You planned to breastfeed. You wanted to. But your baby doesn’t behave like your antenatal class doll at all!! You never envisaged that feeding would be this complicated, emotional or stressful. Take a deep breath, get a cup of tea, pass the baby to someone else or snuggle him on your shoulder, and read on.

According to the Academy of Breastfeeding Medicine, there are many good reasons why formula (or expressed breast milk in a bottle) may have been necessary for you and your newborn. These include significant jaundice, dehydration, low blood sugar, excessive weight loss and other problems. However, many disillusioned mothers turn to a bottle because, despite the media hype and posters about breastfeeding everywhere, they have been given outdated and old-fashioned advice about breastfeeding, which means their experience doesn’t live up to the dreamy image in the posters and leaflets. However it happened, many mothers in this situation wonder how and if things can ever get back on track. See my earlier blog on infant behaviour for more information.

The good news is that at least 98% of women are perfectly capable of achieving a full milk supply if given the correct information. The reason most women give up breastfeeding is due to a perceived (not real and lasting) milk insufficiency. This is unlikely to be true in most cases. If you have been giving your baby additional formula your breasts may not have got the correct messages about how much milk to make for your baby, but with a little time, effort, patience, and perhaps some additional expertise, you can turn this situation around, get your body making enough milk, and coax your little one back to the breast.

Ultimately, the primary goal is to feed the baby! Secondly, you will need to preserve or perhaps increase your milk supply, and thirdly, you may need to get over a bit of breast refusal, flow or nipple confusion, to coax your baby back to the breast.

If you are unable to exclusively breastfeed and have to supplement, the first choice is with your own expressed breast milk. If this is not available, you may need to use formula. Either way, to preserve your milk supply, you’ll need to express if your baby is reluctant to feed. I cannot stress enough, especially in the first few days, that if you are struggling to get your baby to attach to the breast, if she refuses to breastfeed, or you need to supplement, you will have to protect your milk supply by expressing – by hand before your milk comes in, and then later on by using a pump if you prefer. Remember that hand expressing is often more effective than using a pump with small quantities and it is worth trying some hand expressing in addition to using the pump – here’s an amazing video of hand expressing: https://vimeo.com/65196007

Oh expressing……. The number of mums who nearly come to blows with their pump, chucking it across the room in fury! Here’s a 2 minute lesson in expressing:

(By the way – I have pumped in most places you can think of – service stations, restaurants, clinics, hospitals, neonatal units, the car, and even Hampton Court Place. I’ve come to learn quite a lot about pumping form a personal point of view as well as professional!)

  1. First of all – pumping is not easy for everyone. You simply don’t love the pump the way you love your baby, so your hormones don’t always work the way they do when you breastfeed. Pumping output should NEVER be used as an indicator of your overall supply. I often tell my clients that breasts are a little bit like stroppy teenage girls. If you are sad, stressed, cold, grumpy, inhibited or in pain, they just wont let down milk very well – they go into their room, slam the door, turn their music on really loud, and ignore their mum. So, you have to condition the pumping response. Get into a habit of doing the same things in the same order, so your body comes to expect what to do. Try gentle breast massage, warm cloths, have your baby nearby, listen to music or distract and relax yourself somehow. And for goodness sake don’t watch the pump – you know what they say about watched pots not boiling…… Same with your boobs.
  2. Use the best pump you can lay your hands on – preferably a hospital grade pump. You can hire these in the community from the NCT
  3. Pump 8-12 times in 24 hours (this is as often as a normal newborn feeds). And try a technique known as hands on pumping – here’s a video: http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
  4. Include at least one expressing session between 2-6am (eek – really??? Yep, unfortunately, this is when your prolactin levels are highest, and is absolutely critical for maintaining your supply).
  5. You can cluster pump if it’s more convenient – pump more often when it suits you, and then less frequently another time. Just try to make sure the longest gap between pumps is no more than 4 hours if you can. Double pumping gets the job done in half the time and is usually more effective if you can manage it.
  6. Pump until the milk stops dripping or becomes very slow.
  7. Don’t worry too much about how much milk you pump – remember that this is partly about stimulating your breasts into action! Don’t get despondent.
  8. Ultimately – you will find the pumping schedule that works best for you. Some mothers find it better in the morning, others prefer to pump juts for 4-5 minutes after most feeds, whilst others like a technique called power pumping where you pump for 2-3 minutes every hour for several hours in a row. Please know that there are no rules! Just let it fit in with your day. Be flexible and it will work out.

Also remember that your body cannot instantly ramp up your milk production rate. You are an extremely efficient machine and your body will not produce milk that hasn’t been required, just in case. So it will take a few days of consistently trying some strategies to improve milk supply before you notice things happening. Don’t panic! In a few days you should start seeing an improvement in milk production.

I often recommend setting a time limit on any strategy – try reviewing the situation in a week or two and see where you are. Nobody can keep up these strategies forever – and you don’t have to! Most women find that they like the idea of giving it a really good go for 2 weeks, and then seeing where they are at the end of that time. If its going well, you might want to do a bit longer, and if very little has changed, then it might be time to change strategy or seek some additional help.

You may also like to try a herbal or food supplement to kick start your milk production. I love Diana West and Lisa Marasco’s book – The breastfeeding mother’s guide to making more milk. It’s a comprehensive and pretty exhaustive guide to explaining why you may have low milk supply and how to increase it. There is a brilliant table at the back with several herbal, drug and food substances to increase milk supply.

To get your baby back on your breast and away from the bottles (whether they contain formula or all that lovely expressed milk you’ve lovingly pumped) try the following:

  • Lots of skin to skin
  • Having a bath with your baby – make sure it’s not too hot and get Dad (or someone else you don’t mind seeing you in your birthday suit) to pass the baby to you, and take him from you when you’re finished.
  • Making sure the positioning is absolutely right (get help with this if you’re not sure, or if you experience pain).
  • Allow your baby to self-attach if they can. Babies are clever little people and are born with the ability to get up and on to the breast all by themselves if we let them – have a go! Start by being quite reclined so your baby can dig his feet in and balance better
  • Staying calm and breathing deeply. Babies sense your stress levels and can pick up tension which rattles them.
  • Try feeding your baby just as he’s waking up, or after about 50% of their bottle – hungry babies are less patient with trying something new! If he’s not ravenous he is more likely to accept the breast. Christina Smillie IBCLC has written a brilliant article called Finish At The Breast – google it – it’s wonderful!

After all that time of knowing exactly how much milk your baby is getting, it can be unnerving not being able to monitor their intake precisely. But again, stay calm, and trust your baby. Monitor their dirty and wet nappies, and listen and look at your baby for signs that they are drinking milk well. It is not enough for your little one to simply have your breast in their mouth. You need to watch for rhythmic suckling and wide jaw movements. Listen for little swallows (they sound a bit like a sigh).

And remember, there is plenty of support out there if you look for it. Try breastfeeding drop-ins, baby cafés, the NCT or other helplines, or look up a local International Board Certified Lactation Consultant (IBCLC). You can find your nearest IBCLC by going on to www.lcgb.org/ and using the find a lactation consultant feature. I cannot stress enough that if you are not finding the help you need, keep asking until you find someone who is skilled enough to help you – weaning from formula is often a complex and emotional process – you’re going to need support! Surround yourself with positive people – not doubters!

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How long the process of getting back to breastfeeding takes depends on how long you have been having trouble, how old your baby is, what the primary reason for your troubles is, and how much formula they have been having. I can’t promise you that you will be able to eliminate all bottles, or how much you will increase your supply, but it is likely that you will certainly see some improvement. Keep a diary so you can see how far you’ve come – this is enormously encouraging on your darkest days!

Please now that any breastmilk your baby receives is a minor miracle! Every drop is precious, so celebrate what you can do, don’t focus on what you can’t do. My thought to end on – there is more to motherhood than milk!

Lyndsey Hookway is a paediatric nurse, health visitor, IBCLC, holistic sleep coach, PhD researcher, international speaker and author of 3 books. Lyndsey is also the Co-founder and Clinical Director of the Holistic Sleep Coaching Program, co-founder of the Thought Rebellion, and founder of the Breastfeeding the Brave project. Check Lyndsey’s speaker bio and talk brochure, as well as book her to speak at your event by visiting this page. All Lyndsey’s books, digital guides, courses and webinars can be purchased here, and you can also sign up for her free monthly newsletter here.