Mixed breastfeeding is one that combines breast milk and artificial milk. The WHO recommends exclusive breastfeeding for the first six months of the baby’s life but sometimes it is not possible.
Although studies indicate that most women want to breastfeed their babies, breastfeeding rates decline over time. According to UNICEF data, only two out of every five children are exclusively breastfed for six months.
Mixed breastfeeding: decision or “obligation”?
Some mothers choose to mix breastfeeding because they want someone else to be able to bottle feed the baby and they can rest. In these cases, I always recommend keeping breastfeeding feeds at night, since prolactin, a fundamental hormone for the production of breast milk, has its highest secretion at night; night feedings are essential to guarantee the production of breast milk.
I have also known cases of mothers who want to do mixed breastfeeding because that is how they know what their children eat when they take a bottle. Although any maternal decision is totally respectable, knowing how much our baby takes is totally unnecessary, since there are indirect measures that indicate whether our baby is taking enough milk.
With some frequency, mixed breastfeeding begins when the mother goes to work. Unfortunately, maternity leave of 16 weeks makes it difficult in most cases to maintain exclusive breastfeeding during the first six months of the baby’s life. Some mothers cannot express breast milk, or not in sufficient quantity, and decide to switch to mixed breastfeeding: when the mother is at home she will breastfeed the baby and when she is working they will give her formula.
However, in most cases, mixed breastfeeding is “mandatory” when a health professional recommends supplements because the mother does not produce enough milk and / or the baby does not express all the milk he needs and does not gain weight normally. The supplements can be made from breast milk (it is a myth that formula milk feeds more), in which case we would not be facing mixed lactation, or artificial formula.
The failure of mixed breastfeeding
On many occasions, breastfeeding fails and turns into artificial feeding. This can be for a number of different reasons (or a combination of several).
- The cause that led to mixed breastfeeding is not solved. In this case, we are talking about those “forced” mixed breastfeeding, in which a health professional guides supplements because the baby is not eating enough. This may be because the mother is not making enough milk and / or the baby is not able to get all he needs. Most of us women are perfectly capable of producing all the breast milk that our baby needs; cases of primary hypogalactia are rare, but when there is a need for mixed breastfeeding, it must be ruled out. Secondary hypogalactiae (the mother is capable of producing milk, but is producing less than she should for some reason) are more frequent and may be due to poor latching, inadequate technique (for example, very rigid schedules …). It can also happen that the baby has difficulty expressing all the milk he needs: short sublingual frenulum, hypotonia, retrognathia … Many of these problems have a solution, but if we do not act on them, the production and / or extraction of breast milk will continue being low. This will lead in many cases to progressively increasing the amount of formula and breastfeeding will become almost exclusively artificial.
- More milk comes out of the bottle faster. Bottle feeding is totally different from breastfeeding. When babies suckle, they express small amounts of milk at a time. Even around three months they have to be suckling for a couple of seconds until the milk begins to flow (three-month crisis). Instead, large amounts of milk come out of the bottle in a short time. This can make some babies impatient with the breast and end up preferring the bottle.
- Nipple-nipple confusion. The way you suck from the breast is totally different from the way you suck from the bottle. In the first case, the baby must place the tongue under the nipple and areola, make a good seal with the lips and perform peristaltic movements with the tongue to pump the milk. In the case of the bottle, on the other hand, the suction is different and the milk comes out more easily. Although it does not happen in all cases, some babies may become confused, and try to suck at the breast as they would the bottle; with the consequent anger because the milk, like this, is not going to come out.
How to Achieve Successful Breastfeeding
We have just looked at the main reasons that lead to failure of mixed breastfeeding, so now let’s see what we need to do to make breastfeeding a success.
- Solve possible problems that do not allow exclusive breastfeeding. In the event that we have to give supplements because our baby is not growing properly, it is essential that, although we give them to ensure their correct growth, we identify possible problems and work to solve them. Except for primary hypogalactia (rare), most other problems can be resolved. It is essential to ensure that the technique is adequate (breastfeeding on demand, whenever the baby wants and for as long as he wants) and that the latch is good. It is also important that a professional trained in breastfeeding explore our baby to detect possible problems: short sublingual frenulum, hypotonia … Sometimes varying posture helps, since babies latch on and express milk better in some than in others
- Offer the breast first . With few exceptions, the ideal is that we always offer the breast first. The baby will be hungry and will suck vigorously. Later we will offer the supplement without forcing, since babies perfectly regulate their sensations of hunger and satiety and may not want to finish it all. After the supplement we can offer the breast again. We know that the breast is not only nutrition but also comfort, affection, bond. Plus, you will have an “extra” boost to increase your breast milk production.
- Finding the right supplementation method . Supplements do not have to always be offered in a bottle. There are many other methods that may be more suitable. For example, in very young babies who drink small amounts, we can offer them milk with a finger and a syringe (a method called ” finger feeding “). They can also drink milk in a glass (there are even some designed for this purpose). In those babies who latch on well to the breast but do not drink enough milk, we can use a relactator. Finally, in the case of deciding on the bottle, I recommend using the Kassig technique.
Can you return to exclusive breastfeeding if we have started mixed breastfeeding?
Yes, absolutely yes. In fact, when mixed breastfeeding is because we have been prescribed supplements because the baby was not growing enough, the objective should be to achieve exclusive breastfeeding again. To do this, we must solve the problem that led us to mixed breastfeeding : poor attachment of the baby to the breast, poor breastfeeding patterns, difficulties for the baby to express milk …
Mixed breastfeeding and return to work
This is a particular case of mixed breastfeeding so it is worth dedicating a differentiated section to it. Mixed breastfeeding in this case generally begins after four months.
At these ages, breastfeeding is already perfectly established so it will be very rare for there to be nipple-nipple confusion or for babies to end up preferring the bottle; rather the other way around, it is probably difficult for them to take a bottle.
Many moms ask if their milk supply will be decreased; it is highly unlikely, since breastfeeding is more than established at these ages and most of the milk is produced during feeding. If you do not express milk during the working day, it is likely that you will notice a very full breast the first days, then it will normalize. The chest is able to adapt to the demand perfectly.
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