Why I wrote this guide to triple feeding
So what exactly is triple feeding, why might someone need to do it, and how do you know if it’s right for you? I’ll answer all those questions below, plus provide 10 tips for surviving it.
But as you’re reading, keep in mind this is no joke. It’s hard and stressful, requiring a whole team of support to do it successfully. It can sometimes feel like a technique medical professionals use to torture new mothers. But when used correctly, it can be an effective (although challenging) way to support the breastfeeding relationship.
When my own daughter was born, it took us some time to work out her latch. While we were getting our issues worked out, I utilized triple feeding to kickstart and maintain my breastmilk supply. In some ways I was lucky because I was familiar with triple feeding. I was able to work with my lactation consultant set up a regimen that worked for us. But WOW! Even with knowledge and good support (thanks mom and hubby!) it was still draining.
As a pediatrician I would never take the step to recommend triple feeding to a newborn patient’s mother without a lot of thought and consideration. It’s tough! I’ve been on both sides, both as a physician supporting mamas through triple feeding as well as a mama who spent several days triple feeding myself. Seeing both sides has given me a window into many of the challenges of triple feeding as well as the must know tips and tricks. In this guide, I’ll share the knowledge I’ve gained. I hope you find it helpful!
What is triple feeding and why do mamas do it?
Put simply, triple feeding is when a lactating mother breastfeeds, pumps and then bottle feeds all in one feeding.
May be needed to boost or maintain breastmilk supply
Triple feeding is a technique mamas use to boost or maintain their breastmilk supply until they are able to exclusively breastfeed their babies. As I discussed in my ultimate guide to breastfeeding(link), your breasts produce milk on a supply and demand basis. Thus, if your baby is not able to effectively “demand” enough milk to make an adequate supply of milk, pumping provides that extra “demand” telling your body to MAKE MORE MILK! The first several days and weeks are a very important time to establish your supply. All too often, I’ve seen mothers who found it difficult or impossible to effectively establish an adequate breastmilk supply with breastfeeding alone. Triple feeding can help to ensure that your supply is established even if there are issues. It effectively “buys you time” to correct or work through early breastfeeding challenges.
Ensures baby gets the benefits of breastfeeding from day 1
Triple feeding is a way for your baby to get constant practice and all the benefits of establishing that breastfeeding bond from day #1. Babies are champs and it is possible to introduce the breast to a baby up to 6 weeks of life (and sometimes later!), but ideally you want to begin breastfeeding as early as possible. Extracting milk from your breast is WAY more difficult than taking from a bottle. Unfortunately, if a mama transitions to exclusive pumping, the baby may develop a preference for the “easier” work of taking from a bottle. Putting the baby to your breast first ensures that your baby gains the practice and experience of breastfeeding, but limits the time on breast
Reduces or eliminates the need for formula
In addition to helping your body to produce more milk while continuing to give your baby practice at the breast, triple feeding also has the benefit of helping to limit (or completely eliminate) the need to formula supplement when supply is a concern. With triple feeding, instead of feeding your baby formula, you are able to supplement feedings with the breastmilk you pumped.
What does a triple feeding schedule look like?
Every triple feeding plan needs to be customized to the needs of each mama and baby. But here’s a general outline for what I often recommend for patients and what you might expect:
|1. Breastfeed baby||• Place baby to breast with goal of 10 minutes per breast.
• If concerns about latch problems or ineffective suckling, feeds are often limited to 10 minutes per side.
|2. Pump||• Generally recommended to limit sessions to 15-20 minutes.
• Utilize manual compression techniques and different pumping modes to enhance supply.
|3. Feed expressed breast milk||• Either pumped milk from this feeding, or from previous feeding.
• Can be via bottle (make sure it’s a slow flow nipple!), syringe, tube, cup or spoon.
• Great job for significant other, family member, etc.
|3. Repeat||• Restart the whole process in 3 hours!|
Why might a mama need to triple feed?
While triple feeding is often recommended for issues relating to low milk supply, here are two instances where I’ve seen triple feeding offer the most benefit:
Mama’s breasts aren’t getting the signal to make adequate amounts of milk
Without adequate stimulation or demand on the breast, the breasts don’t respond with increasing supply as needed. There are many causes for this, some of the most common: sleepy baby, latching problems, prematurity, insufficient milk transfer, lack of sustained suckling or oral anomalies.
Delayed onset of full milk production
It can take several days for a mama’s milk to “come in.” During that time, many babies have the reserves to wait (these babies do not need triple feeding). But…some babies who have experienced medical issues such as jaundice, excessive weight loss, or poor weight gain need nutrition sooner. These babies need more milk than what mama is producing. Triple feeding is often used to boost mama’s production rather than relying on formula to make up the need until mama’s milk comes in.
How to know if triple feeding is right for you
The decision to embark upon a triple feeding regimen shouldn’t be taken lightly or alone. Thinking things through honestly with yourself as well as discussing with your support team is critical to ensuring success (and sanity!). I won’t lie to you. Every time I have had to recommend triple feeding to a new mama, I would die a little inside. It’s not because the technique is technically difficult or risky. But dang I’d be lying to you if I didn’t tell you that it isn’t exhausting and emotionally trying.
Questions to ask before triple feeding
These are the questions I would ask and topics I would cover before sending any mama out with a plan for triple feeding.
Do you have a health care partner (such as your OB, pediatrician, midwife, or lactation consultant) who is well versed in diagnosing and treating breastfeeding issues and is able and available to adequately support you?
First, triple feeding isn’t the solution to all issues. Unfortunately, it often is recommended even when other (often simpler) solutions may be more better. Second, triple feeding is complicated and needs to be very customized when used. I can’t tell you the number of mamas who are given a one size fits
all *none* plan, or instructions without any wiggle room, real follow up plan, or direction on when to stop.
Do you, mama, have adequate support at home so you can properly focus on triple feeding?
Is there someone (or ideally somebodies) who can take care of all the other *stuff* so your only job is breastfeeding and pumping for your baby?
Is there a history of postpartum depression, anxiety or other mental health concerns that the added stress and sleep deprivation of triple feeding could worsen?
This isn’t to say that mamas with a history of these issues can’t triple feed. But if you have a history of these issues, you should have an honest discussion with your team to determine if the risk is worth it. You should also ensure that there are adequate check-ins and accommodations in the plan to protect your mental health.
Do you have the necessary equipment to support triple feeding?
You will need a high-quality breast pump (ideally hospital grade and electric). It is also important that you receive instructions on how to properly use the pump. In particular, you will need ensure you know how to properly measure yourself so that the pump flanges are correctly sized.
Does your triple feeding plan allow you to take care of yourself?
Your triple feeding plan should allow enough time for adequate sleep, nutrition and self care. The plan also should be flexible to take into account unexpected challenges. Remember, you can’t take care of and nourish your baby without first taking care of yourself. If the plan does not allow that, you are almost certainly being set up to fail. Make sure that you are honest with yourself and others about how much you can reasonably do. Take that into account when you make your plan. Everyone’s individual circumstances are unique. There is no one sized plan, so don’t be afraid to speak up if it seems like too much.
Does your triple feeding plan have definite goals and an end point?
Triple feeding is a temporary measure and the goal is to wean you as quickly as possible to full feedings at the breast. Have you discussed how to wean from triple feeding and when to stop? How do you determine if this strategy is not working? Do you have follow up with your medical team within 1-2 days? Make sure all these questions are answered before you start.
10 must know tips for surviving triple feeding from a pediatrician mom who has seen it from both sides
Okay, so you have your team in place. You have your pump ready. You’ve decided you’re going to DO THIS! Now how can you maximize your chances of success? These tips below are in my experience (as both a physician and a mama who triple fed herself) the important things to know to maximize your chances of success while triple feeding.
1. Remember, triple feeding is a TEMPORARY solution
You should be working closely with your physician or lactation consultant. You should checking in frequently to ensure everything is on track. I also recommend that most moms don’t plan to triple feed for more then 48-72 hours. Of course, many moms do elect to continue longer, but after 48-72 hours it is important to reassess and make sure your plan is still t he right one.
2. Even Superwoman would struggle with triple feeding
Breastfeeding WITHOUT pumping is a full time, exhausting job. Add in pumping and bottle feeding, cleaning and preparing bottles, along with all of the other baby and household care duties. You’ve just been handed an almost impossible task.
Triple feeding supercharges the “it takes a village” idea to a whole new level. Having a newborn is tough. Breastfeeding is tough. You’ve just given birth. You are probably still recovering physically from a vaginal birth or the major surgery of a C-section. You’re sleep deprived, mentally and physically exhausted. Adding anything else to this is really a superhuman ask. All new moms need help. Triple feeding moms need EXTRA help.
Be kind to yourself and don’t expect that you can do it all alone. I fully recognize that not everyone has the optimal support system. But PLEASE don’t turn down help or feel like you shouldn’t ask those around you for help. It’s generally not recommended that you start triple feeding without a support system in place within your home, it’s THAT HARD.
Ideally your ONLY job in the timeframe that you are triple feeding should be to nurse the baby and pump. Of course, you CAN do more if you feel up to it, but nursing and pumping should be all you and others expect from you right now. Poopy diaper, not you! Washing pump parts, not you! Bottle feeding, not you! Laundry, cooking, cleaning, entertaining guests, no way!
3. Ensure you are getting adequate fluids and nutrition
It’s easy to be too exhausted or even forget to eat and drink, but it’s super important to make sure you’re not letting this slip!
DRINK! DRINK! DRINK! I can’t stress how important staying hydrated is. A good rule of thumb is to drink an 8 oz glass of water every time you breast feed. You need to keep your own body hydrated. Remember, you will eventually be pumping out 28+ oz of breastmilk per day. You will need to continually replenish that fluid you’re giving to your baby.
Similarly, don’t forget to EAT! EAT! EAT! When you’re breastfeeding you’re nourishing the growth and development of an whole new little human. That takes tons of calories and nutrients. Those calories don’t just appear from thin air. You can’t give your baby what you don’t give yourself. So feed yourself mama!
4. Limit the amount of time you’re spending on breastfeeding and pumping
Newborns generally feed every 1-3 hours. A normal newborn generally shouldn’t go longer than 3 hours from the start of one feeding to the start of the next until good weight gain has been established. Clarify with your physician or lactation consultant how often you should be putting your baby to breast and how often you should be pumping. For example, if you are planning to pump after EVERY feeding but baby’s going to breast every hour, well, that’s just not humanly possible.
In my experience, I always tried to limit the pumping to no more than every 3 hours even if baby went to the breast more frequently. Generally, the maximum number of recommended “triple feeding sessions” in a 24 hour period is 8. More times to breast may be encouraged as desired, if it seems to be beneficial for baby and mama.
5. Make sure you’ve optimized your pumping
Get the best breast pump you can, ideally hospital grade and electric. Measure those nipples, after plumped from pumping, to ensure that your flanges are the right size! And if you’ve pumped with previous pregnancies, measure again. Your nipples change with each pregnancy. Thus, the size you needed before might very well be different this time around. Your pump should come with instructions on how to measure for a proper fit. Be sure you familiarize yourself with how your pump works.
When using your pump, try various techniques and modes. Some women have great luck staying on one setting. Others need to constantly be going between letdown mode, pumping mode, and varying levels of suction. Pumping shouldn’t be painful! More suction doesn’t necessarily mean more milk. Too much force or time on the pump can lead to issues with tissue damage and engorgement later on. Make sure you’re setting reasonable limits.
6. If you’re offering a bottle, make sure you’re offering breast first and using a slow flow nipple
Newborns are smart little creatures. Extracting milk from a bottle is much easier than taking from a bottle. Most newborns will choose the easy way out if given the opportunity. This is why we want you to put baby to breast BEFORE offering the bottle. It’s a hard sell to convince a bottle fed baby with a full tummy to undergo the work of breastfeeding. If they’re hungry, and the breast is what’s on offer first…well, they’re no dummies. They can recognize a good thing right in front of them!
Use a slow flow nipple AFTER breastfeeding. This will give your newborn the practice and comfort of going to breast, but also help to offset some of the ease of using the bottle. The idea is to prevent your baby from developing a preference for the bottle over breast. One caveat to this may be the excessively hungry frustrated baby who needs *just a tipple* of milk or formula before going to breast. Getting rid of your baby’s “hanger” may help to give him just enough patience and energy to take the time to latch effectively and settle in for a good breastfeeding session.
7. Don’t be surprised if you need to limit the amount of time your baby spends at the breast
The ideal is to make sure the baby is getting adequate time and practice at the breast without wearing baby and mama out or causing nipple trauma from ineffective time spent breastfeeding. The optimal time your baby should spend latching on when triple feeding is incredibly variable. It depends greatly on the effectiveness of the latch, concurrent medical issues with your baby, any preexisting nipple trauma, and the reason for triple feeding. This time will be determined by your medical team. It can also vary with (hopefully) improvement in any underlying issues.
8. Have a triple feeding off ramp
In the ideal world, your pumping boosts your supply, your baby starts effectively latching and emptying your breasts, and you no longer need to pump. You will need to know when you’re producing enough milk and when your baby is satisfied with feeds. You will also need to know when and how to back off from the pumping regimen. Remember, this is only meant to be a temporary measure.
It may not be necessary to wait until your next visit with your health care team to wean off of triple feeding. In fact, the goal should be to transition away ASAP. So be sure you have a plan in place. If things are going great, you should confidently move away from triple feeding. Looking back on my experience, I had a good plan, but no good offramp. I ended up dealing with engorgement issues because I didn’t take the off ramp soon enough. Don’t be me!
9. Have contingency plans
Best laid plans…yup, if you haven’t learned by now the one guarantee in parenting is that NOTHING ever goes exactly by plan. In my own experience, when I was triple feeding there were definitely times when I skipped a pumping session and even *eek!* gave my baby some formula. But it was all ok. I couldn’t keep up the around the clock regimen. Nobody should expect you to either, mama!
There will be times when you’re too tired to pump, or too sore to put your baby to breast. You may be making more milk than your baby wants, or less than your baby needs. Make sure you’ve talked through different scenarios. You should have a plan when things aren’t going according to plan. At the end of the day, it’s about keeping your baby fed and your sanity intact. Please don’t feel that you need to stick to a rigid, inflexible plan. Make sure you take into account real life!
10. Know when to give up, back off, or change course
The hard reality is that not all mamas and babies will be able to breastfeed 100%. If the triple feeding isn’t getting you to your goals after 3 days, there is a high probability that you will need a course correction or entire overhaul of your plan. Be ready to think through and discuss all the options to choose the right course for you and your baby.
You may need adjustments to the plan, or you may need to think about alternatives. Some mamas switch to exclusive pumping, opt to entirely formula feed, or seek out donor breast milk (DBM). Some find that what works for them is a combination of nursing and pumping, nursing and formula/DBM, or expressed breastmilk and formula/DBM. There are almost as many options as there are mamas and babies.
The reality is, as long as you’re choosing the right strategy for you and your baby, IT WILL BE OK! Know that just by being a mama, you’re a Rockstar. You can’t do what your body can’t do. Never forget that you’re exactly the mama your baby wants and needs, no matter how she gets her food.