Triple Feeding
Let’s have a conversation about Triple Feeding. Triple feeding is when the parent breastfeeds, bottle-feeds, and completes a pump session all in one feeding event. Does that sound exhausting? It is! Especially if you are doing this with no guidance from an IBCLC (International Board Certified Lactation Consultant). Sometimes a temporary course of Triple Feeding that is managed well can be helpful in reaching your breastfeeding goals. It is only recommended when it is truly needed to preserve the breastfeeding relationship.
Why would Triple Feeding be recommended? When your baby is not Effectively removing milk from your breast on a regular basis, we usually consider Triple Feeding as an option. Common reasons that babies have trouble with milk removal are:
Baby is sleepy or less effective at the breast
2. Baby is preterm or a late preterm baby
3. Baby is jaundiced
4. Ineffective suckling pattern at the breast
5. Painful latch or not maintaining latch
If your baby is not getting all the milk they need from your breast by nursing well, your breasts are Missing the message to make enough milk. This leads to a low milk supply. If your baby is not given extra milk from another method, they will not gain weight appropriately leading to even more issues with nursing.
Milk supply is really driven by Supply & Demand. Your baby drives the supply by ‘demanding’ the correct amount of milk when they nurse. This is where the pumping comes in. Your pump takes the place of the baby to build and maintain your milk supply until your baby can take over. (It’s critical to have an effective pump and the correct flange size. This is a topic for another blog post!)
Most of the time when we meet a family who is Triple Feeding, they describe a long process of breast/bottle/pump that usually takes about 80-90 minutes. This leaves everyone, including the baby, exhausted with only maybe an hour to rest before it all starts again. After a thorough lactation assessment, we recommend nursing for as long as the baby is Actively suckling (this is often 5 min or so for many babies with challenges). It's great if the lactating parent can hand the baby over to a helper (a partner maybe) for the bottle session. This should take about 5 minutes per ounce. (if not, this can be maximized by your visit with a lactation consultant experienced with bottle skills). You can then pump for 15 minutes. So in this scenario, we have reduced the feeding cycle time to 25-30 minutes altogether as the bottle can happen while the pumping is in progress.
As your baby starts to become more vigorous, more efficient, or gets back to comfortable latching, your baby will nurse for longer than 5 minutes. But this will mean they are now removing more milk. This will gradually lead to fewer bottles and less pumping!
It’s important to realize that you and your lactation consultant are also simultaneously working on improving at-breast feeding to solve the underlying issue. You are building and maintaining your milk supply throughout this process to facilitate an easier transition to the breast when ready.
If Triple Feeding has been recommended for your family, we recommend trying it for 72 hours. After that time frame, it is a good idea to check in with your Lactation Consultant to see if changes can be made. This is never meant to be a long-term way to feed your baby. For those who find that they need or want to continue this a bit longer, you can consider dropping a nursing session once or twice a day and pump and bottle feed at those sessions. Maybe let your partner handle a whole feeding in this way to get some much-needed rest. In scenarios where Triple Feeding lasts more than 72 hr, adjustments can be made to make it more sustainable.
It’s important to understand that Triple Feeding does not mean the end of your breastfeeding journey. It is only a small part that can be a springboard to success with the right guidance.
We always recommend working with an IBCLC if you are Triple Feeding. We are trained to help your family understand it, manage it and get back to your feeding goals! It's essential to work with an IBCLC to identify the causes of any challenges, address them, and safely transition the baby to the breast if that is the goal. At Gaea Breastfeeding Center, Cathy Walker and Carrie Dean are committed to supporting you in your feeding journey!
~Cathy Walker, MA, RN, IBCLC
January, 2023