Let's talk about Triple Feeding.
Triple feeding is when a Lactating parent breastfeeds, pumps, and bottle-feeds at every feeding. Does that sound exhausting? It is! It is necessary sometimes but it is something I recommend only when truly needed. And I always have a plan in place to stop triple feeding. There are very important points to keep in mind if you are on this care path.
First, let's review some reasons why this may have been recommended.
1. Excessive newborn weight loss
2. Jaundice
3. Baby is sleepy at the breast
4. Late pre-term challenges (babies born between 34-37 weeks)
5. Ineffective suck pattern at the breast
6. Difficulty latching
(This list is not exhaustive)
Time management is very important when Triple Feeding.
Newborns eat every 1-3 hours so Triple Feeding often can feel like parents have no break at all. I recommend keeping the whole cycle or process of the feeding to 40 minutes or less. This means, breastfeeding, pumping, and bottle-feeding all in 40 minutes. This becomes a challenge when the baby is improving and nursing more effectively and for longer. In this scenario, we don't limit their time on the breast. But if your baby is simply asleep despite adequate waking techniques, trying to wake them for an hour is counterproductive. Give the nursing a good attempt but if it's been 10 minutes, and your baby is still not latching well, you can move on to the bottle portion of the feeding. There will be many times to breastfeed in the future. Babies' reflexes to suckle and find the breast and latch are present for months.
Monitoring the duration of Triple Feeding is key.
This is a Short-Term Care Plan! I educate my clients that they can proceed with Triple feeding for 48-72 hours. At that point, a re-evaluation by your (IBCLC) Lactation Consultant is necessary. The goal of Triple Feeding is to build and maintain your milk supply while addressing your baby's latch issues and keeping the baby fed and energized to learn to nurse. Milk supply will increase over 3 days with adequate stimulation and the latching may have changed in that time. A Lactation Consultant (IBCLC) can re-assess your situation and recommend a more sustainable long-term plan based on your needs. It is not wrong to continue this method for longer than 3 days. But it is a lot of work. Working with a knowledgeable IBCLC who can support you throughout this process is essential.
Triple feeding has a place in reaching lactation goals but it can also be discouraging. It is recommended for a short-term period. During that time, you and your IBCLC will be finding the difficulty and taking actionable steps to improve that situation. As direct nursing improves, triple feeding gradually stops. You can modify this plan if it is clear that it will take longer than a few days to resolve breastfeeding issues. You may breastfeed and bottlefeed only for one session and skip the pump. (try to add that pump in later in your day if possible). You may bottle-feed and pump for some sessions and skip an at-breast feeding and resume at a later feeding. Enlisting partners to complete the bottle portion of the feeding is helpful. Family members can also clean pump parts and prepare bottles. Reaching out for help and support is necessary!Â
~Cathy Walker, MA, RN, IBCLC
Registered Nurse and Lactation Consultant
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