Combination Feeding - Breast, Expressed & Formula

Combination feeding tips and advice for moms.

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We talk about breastfeeding a lot here on Making of Mom, but what about moms who can’t or choose to feed their baby with pumped milk or formula? In this series on formula feeding, Emmy is going to talk us through a lot of things you need to know when choosing formula for your baby.

When it comes to breastfeeding vs formula feeding, you might think it’s one or the other. It’s not!

I struggled to breastfeed and ended up expressing for as long as I could before switching exclusively to formula. But, while I was able to express, I still ended up supplementing with formula.

Many people seem to think that you shouldn’t mix breastmilk and formula. This is a formula feeding myth.

I found that due to the pain of breastfeeding or expressing, I could only stand so much – and it was not enough to fill up my hungry boy. So, we ended up topping up the breastmilk I expressed with formula from the very beginning.

I wanted to share some thoughts with you on how you make the most of what you can manage to breastfeed or express for your baby and not worry about using formula at the same time!

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It doesn’t have to be an “either-or” situation

You don’t have to do only one thing when feeding your baby. If it is possible to breastfeed sometimes, express sometimes and formula feed at other times – wonderful! Make the most of that!

Depending on your location you might even have the option of a breastmilk donor. These days there are actually breastmilk banks. A properly set up milk bank has a screening process for all donors and will pasteurise the milk and supply it safely for your baby to drink. They are usually reserved for babies who are born premature or who have some illness, but you could inquire if you wanted to. You can find them here.

[You may know someone who may be willing to donate their milk towards it as well. A friend of mine had a party when she managed to reach 50 bottles of expressed milk which she had donated to the local breastmilk bank here. It was certainly an amazing feat!]

It is recommended to go through an official breastmilk bank to be sure that the milk is safe for your baby.

But if this is not an option, remember, formula is also safe for your baby!

How Does Mixed/Combination Feeding Work?

Basically, mixed feeding involves feeding baby both breast milk and formula (sometimes even at the same time using a supplemental nursing system (SNS)).

There are all kinds of scenarios that mixed feeding works for:

a working mom might breastfeed in the morning before work, leave formula with baby’s caregivers and breastfeed at night.
another mom might choose to exclusively pump and top up with formula if needed.
a mom might choose to breastfeed most of the time, but have her husband feed a bottle of formula at the middle of the night feed.
a mom with low supply might breastfeed or pump as much breast milk as possible and top up baby with formula at each feeding (or using an SNS). If you do believe you have a low supply, it’s best to speak with a lactation consultant to confirm that your supply is a problem as sometimes moms think their supply is low when it isn’t.
a mom who can’t breastfeed (due to pain, past trauma, baby’s inability to latch for example) might choose to pump as much milk as possible and top up baby with formula.
any other scenario or situation where mom has decided it’s the best option for her family.

Pumping Milk for Combination Feeding

If you aren’t able to breastfeed, but are able to pump, you can still provide your baby with your breast milk through pumping and bottle feeding.

This is a very comprehensive article on expressing, but it is very biased towards breastfeeding, so be warned!

When I felt like I’d failed as a mom because I couldn’t even manage to express, this information would have made me feel worse. But, I think it has wonderful images and descriptions of how to express manually, as well as information on amounts to feed your child.

It also has some more information about types of breast pumps and maximising yield by massaging your breasts as you pump. If I had had this information it may have helped me to express for a bit longer and to have tried it with my second child.

But as I have said before, my kids are healthy so I really cannot regret formula feeding them!

I want you to have the information you need to consider the options so that you can make a good decision for you and your family.

Essential Pumping Info that Makes ALL the Difference

One other reason I liked the article I suggested above is that it includes information that made the biggest difference of all to me.

Flange size.

Yes, ladies, there is another way for your breasts to be measured. Who knew?!?

“the standard size flange, which is measured from the diameter of the nipple, not breast cup size, is 24 mm, this size only fits 45% of all mothers”

I was issued with a larger than usual size flange from the hospital (thank goodness) so that I could actually express properly.

But, I would have had no idea why I was struggling so much with expressing if it had not been for a midwife in the hospital who noticed and asked a lactation consultant to come and see if I needed another size of flange. And, I would not have known where to find a new larger size if they had not helped me to do so either.

Essential Pumping Equipment

So on to the other equipment you may need to express. There are quite a few options.

The haakaa

For myself, I love options that are easy and don’t need anything extra to work, like power, if I happen to be out and about. If it is endorsed by Chrissy Teigen and John Legend as well as many other unnamed medical professionals, then it must be amazing 🙂

You can also use the haakaa while breastfeeding to catch leaks from the other breast – efficiency!

Medela Swing Single Electric Breast Pump

This is the breast pump that I wanted, but didn’t end up getting. I still think it is a good little machine, though if you intend to do a LOT of pumping, you’re better off getting a double (again, efficiency is key – though they are a little more pricey).

What I ended up doing was finding somewhere that I could hire the hospital grade breast pump like the Medela Symphony. Hospital grade breast pumps mean that the system is closed, meaning that milk particles cannot end up inside the pumping mechanisms. Most breast pumps are open system, which allows milk particles to become trapped inside the pump… this is why a breast pump you buy at your local store is considered single user only because of the risk of milk particles transferring into your pumped milk.

If you’re hiring a pump, you’ll also need a breast pump kit that fits the brand you’ve hired (double preferred).

A Manual Pump

For those times that I was away from home, I didn’t want to bother with batteries, so I liked this:

As you can see I was a Medela fan!

Having used it in the hospital it was easy for me to use at home as well… But for what it’s worth I also considered this one as well.

How Much Should You Feed Your Baby?

If you’re combining breast milk (whether breastfed or expressed) with formula, you might wonder how much your baby is actually getting and how much you need when formula feeding baby.

If you’re ‘topping up’ after a breast milk feed, prepare a single portion of formula and feed to baby.

If you’re feeding formula only, prepare a single portion of formula and feed to baby.

If baby seems to still be hungry, you can always prepare another portion of formula. It’s better to waste some formula than have baby going hungry.

Most Importantly

Regardless of what combination of feeding you use (even if that’s different from one day to the next), the main thing I would say is to be kind to yourself. Feeding your baby is one of the biggest jobs of the first year, and it can be tough.

Especially when they wake you again for the umpteenth zillionth time that night and you haven’t had even 2 hours of sleep in one sitting since you can’t remember when…!

But you and your baby will find your rhythm together and make it work.