There are many reasons why it may be necessary or desirable to combine nursing and bottle-feeding. The bottle may contain formula or breast milk. In the first three weeks this combination poses unique challenges but is very feasible if done with direction and care. If the baby is receiving additional supplementation after nursing or instead of an at-breast feeding, the milk supply may decrease if pumping is not initiated at the same time. It is therefore recommended that a woman pump her breasts any time the baby receives a supplement, even if she has recently breast fed. This holds true in the first three weeks after delivery to ensure an adequate milk supply. The recommendations change later on. Many women will report that they had a low milk supply with their first child. During our conversation, they relate that the they needed to supplement their first baby for some reason and they did not pump or did not pump enough. This is a very common reason to have a decreased milk supply. This person will most likely go on to produce an adequate supply with their subsequent children as long as they follow the pumping regimen if needed. These suggestions can be very overwhelming especially early on when parents are already exhausted. I always stress that the pumping is short term. When an adequate milk supply is apparent, pumping may be gradually lessened. Many parents are faced with a medical recommendation to supplement their baby and this can cause concern about a disruption in the breastfeeding experience. It is possible to preserve the breastfeeding relationship in these circumstances.