Far too often parents are sent home from the hospital on a triple feeding (nursing then pumping then bottle feeding) schedule with no further guidance or alternatives. When babies don’t have adequate output or weight gain or a parent’s milk hasn’t “come in” yet, a well meaning hospital staff or other lactation consultant will tell a parent to start a triple feeding schedule. It’s an aggressive feeding strategy that often ends up with parents being completely exhausted and feeling defeated. Triple feeding around the clock is, generally speaking, very unsustainable. All in, the feeding process can take upwards of 1-1.5 hours, just to turn around and feed again 30-90 minutes later. At Feed Well, we prioritize parental mental health and sustainable feeding plans for our families. Today we’ll discuss why someone would need to triple feed and what alternatives are available.
While these alternatives don’t replace the need for supplementing with additional breastmilk or formula, hopefully they will make supplementing and increasing your supply more sustainable. Of course, it’s important to see an International Board Certified Lactation Consultant to come up with a personal plan for your family. One of our Columbia, MD lactation consultants would be happy to see you in person or virtually. The great thing about finding alternatives is that you can mix and match what works best for your family at that time. Many families end up using a combination of the alternatives throughout the day.
Parallel pumping, or pumping while you breast/chestfeed, is often the most efficient alternative to triple feeding but also the most cumbersome. In this method, I generally recommend using a great pumping bra or a pump cup that can go in your bra. If you are using a traditional pump, I recommend putting baby in the football position to keep their cute feet away from the flange, tubing and bottle. If you are using a pump cup you can put them into a cradle position just fine. Once baby is nursing and you have your pump going, start the timer and feed/pump for about 30 minutes. Once baby is done, you can use the milk you pumped, and any additional breastmilk or formula needed, immediately to feed your baby in a bottle. If you have a partner who can feed the bottle, this will take some of the strain off of you. All in, hopefully you’re done in 30-45 minutes or so.
Other considerations: If your baby is not transferring well, or your baby is too sleepy to sustain about 30 minutes of nursing, conclude feeding at the breast/chest after 10-15 minutes and pump both sides for the remainder of the 30 minutes.
Be sure to switch sides at each feeding so baby gets equal “playing time” on both sides, so to speak.
At breast/chest supplementer
Using a thin tube that is attached to a bottle of supplemental milk, you gently put the tube in the corner of babies mouth. This allows them to get milk from both the breast/chest and their supplemental milk at the same time. If you are triple feeding because you are trying to increase your supply, this can reduce the need to pump after a feeding, if baby is able to transfer milk well. This is a valid choice for any family who wants to keep baby at the breast/chest for 100% of their feedings. If you are already using a nipple shield, you can consider a device called the Neotech Bridge which has the tubing attached directly to the nipple shield.
If baby is not transferring well, there is still a need to pump after a feeding to initiate or maintain your supply.
I certainly don’t want this to come across as a suggestion to exclusively pump (though that is a totally valid choice!) but I do encourage families who are on a triple feeding plan to consider adding in pumping only sessions over night if that aligns with their goals. Generally speaking, pumping for 20 minutes then bottle feeding is much faster than any of the alternatives. Ideally, a partner would be able to feed the bottle at the same time as the pumping session.
Many people mix and match the alternatives to create a schedule that works well for their families. In full transparency, all of the options are tough but our goal is to make it more sustainable until you hopefully reach a point where you can stop the supplementing/pumping.
As always, flange sizing is imperative as is using lubrication. Using the correct size can increase both comfort and output while lubrication can reduce friction and increase comfort. We are happy to help you size your flanges virtually or in person at our Columbia, MD location. In addition to double checking your flanges, it’s important to bottle feed in a way that fosters a healthy combo feeding relationship. We encourage elevated side-lying positioning and a good bottle fit for your baby (if you aren’t sure, consider the Dr. Brown with level T nipple or Pigeon SS nipple)
Remember to always follow the supplementation amount and guidance from your baby’s care team. If you would like more support on your journey, please don’t hesitate to reach out to us. We’d love to work with you!