Breastfeed, pump, top-up. Tips for “Triple feeding” and how to eventually stop.

“Your baby is losing weight so you need to do the following: breastfeed, pump and then top your baby up with that pumped milk.”   This is the most common advice women received when their baby is not gaining enough weight. It’s called “triple feeding” …sounds fun doesn’t it?!     NOT.

There are many challenges that go along with this advice:

1. Many women find this schedule of feeding is literally impossible to do…unless they didn’t have to care for a baby (and possibly other children), eat, sleep, shower, or do anything at all. Ever.
2. So often this advice is given without any investigation into WHY the baby needs supplementing. Make sure your health care provider is helping you figure out WHY your baby is’t gaining well. It could be that your body is not able to make enough no matter what you do, it could be your baby is not able to efficiently and effectively remove the milk, or it could be a combination of both.
3. The woman is not given any other alternative to this plan. It’s given as black and white information and instruction without explaining what to do if it’s not working (mother is getting little to no milk when pumping) or if the woman is finding it impossible to fit this into her day. If we’re not asking women how they feel about this advice and whether or not they are able to (or even want to) do this then how it this advice helpful? I had a woman once come and see me who had twin babies, three other children and a husband who worked 3 weeks away and one week home. This advice was given to her without any conversation as to whether or not she could actually realistically DO THIS. And not surprisingly, she couldn’t!
4. For some women triple feeding can be really effective and just a temporary thing that needs to be done. However for others, it might not do anything at all to help  supply or baby’s weight gain. If you continue to only pump 5-10 mls total every pump after doing frequent pumping over a week…then this is obviously not the answer for you! Time for a different plan.

So when is it appropriate?

After a thorough history gathering from a woman, there are some occasions where I will suggest triple feeding. I would suggest pumping, breastfeeding then topping up if a woman a) has a baby who is not breastfeeding effectively and/or efficiently and not draining the breast well or b) a woman who’s struggling to get her baby to feed frequently enough and needs more stimulation and milk removal to make more milk. AND I would be forming a short term and long term plan for her. AND I would make sure that the woman is OK with the plan (even if just trying this for 4 days) before we go ahead with it. AND I would also make sure to investigate WHY her baby was not gaining enough (Problems with mother’s production, baby’s removal of milk or both?)

Are there other things you can try though?

YES!…if your baby is feeding well and removing the milk well (and you’re not in pain), then what makes MUCH MORE SENSE (and is much more effective for many women) than triple feeding is “switch feeding”. Here’s how to do this. Breastfeeding for 3 minutes is a guideline. You might want to stay on one side for 2 minutes or 4 minutes! What’s most important is that you’re able to switch back and forth during the feed so that you’re on each side at least 3-4 times. This way it ensures heaps of stimulation and milk removal from both sides, at every breastfeed. In the night you might be too tired or half asleep to do this. That’s OK! Just try to do this for as many breastfeeding sessions as possible during the 24 hour period.

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If switch nursing is not improving things or you still have to supplement while doing it, you can supplement using a supplemental nursing system (also called an SNS or supply line). This allows the baby to breastfeed while also getting the supplement AT THE SAME TIME! It’s a clever little contraption that works well for many women. It saves time as you do not have to top up after the breastfeed. It all happens at the breast while the baby is feeding so helps prevent bottle preference too. Here is a photo of what it looks like. This mother made her own supply line, however you can buy them already made.

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Homemade supply line.

How to do triple feeding as effectively as possible…

1. Do “hands on pumping” and make sure you get a hospital grade pump or very high quality double, electric pump as this will save you a lot of time. Many women find a double electric pump is more effective than a single hand pump. CLICK HERE for information and my video on pumping more milk.
2. Pump about 20-30 minutes after the breastfeed has finished. IF you have enough time in between feeds to wait a bit. If not, then a pump straight after the breastfeed might work best for you.
3. It’s all about frequent draining of your breasts. The ideal pumping schedule for this would be a pump after every breastfeed day and night. If your baby does not breastfeed at least every 3-4 hours overnight, then it’s important to pump if you cannot wake the baby to breastfeed. This is because the longer your breasts stay full, the more your milk production slows down. So the important thing is that you are draining your breasts by breastfeeding or pumping as frequently as possible. BUT…
4. Do not stress yourself out trying to fit into a hard core pumping schedule! If you cannot pump after every breastfeed then try to pump after as many as you can. Yes, doing it frequently is important, however so is your sanity. It has to be working for you to be sustainable.
5. Take it in short goals. Give yourself a goal of 4 days of doing triple feeding and then re-assess where you’re at, how your supply is doing, how your baby is doing and what your plan should be moving forward. Ongoing help from an IBCLC (International Board Certified Lactation Consultant) is crucial so you can continue to get support and change your plan if needed.

There are two possible options on the outcome of triple feeding:

1. It doesn’t help and you will need to continue to triple feed for an extended period of time (or the whole time you breastfeed), or form an alternative plan. An alternative plan could be breastfeeding while also supplementing with formula and completely stop pumping, or only pumping occasionally and using expressed milk when you have it while using formula as well. Some women will choose to use donor breastmilk instead of their own milk so they can stop pumping but continue to supplement with donor milk and breastfeed. For more info on donor breastmilk head here.

OR

1. It works and you only have to triple feed for a short period of time and then start to wean off of the pumping and supplementing as your supply increases and you can start to exclusively breastfeed. It’s important to slowly drop the supplements over time as your supply increases.

In either case, it’s important to have ongoing, follow up care from your IBCLC or health care provider to make sure the amount of supplement you’re using is appropriate, and that you have a plan to wean from supplements if you start to see improvements with the amount of milk you’re making or the amount your baby is getting.

Remember, if the underlying issue as to why you have to triple feed is because your baby is not effectively and efficiently remove the milk, then make sure you have someone helping you figure out WHY that is and how to fix it. If the underlying issue is because of something going on with you (hormonal reasons, insufficient glandular tissue, etc) then make sure you are receiving help from someone so you can either a) Fix it if possible or b) Find out what your options are on long term supplementing so you find a plan that works for you and your family.

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