Triple Feeding: what you need to know
It's almost routinely suggested by midwives and child health nurses if a baby isn't gaining weight according to their expectations or even appears to have lost weight beyond that normally expected in the first week of life. Yet what is commonly known as Triple Feeding can lead to women completely giving up on breastfeeding, deciding to exclusively pump their milk or to mixed feed with infant formula until they cease all breastmilk feeding weeks or months later.
What is Triple Feeding?
After putting the baby to both breasts, parents offer expressed breastmilk by bottle and then turn to a breast pump to remove more milk, which will be used to supplement a later breastfeed. A baby might be on a pattern of feeding around two hourly and taking about 40 minutes to feed. They are then offered whatever expressed breastmilk collected earlier, followed by donor milk or infant formula if they do not seem satisfied. Often another caregiver will give this supplement by cup or bottle but those who are alone will need to do this themselves. Plus nappy changing and setting the baby to sleep - maybe 30 minutes all up. Then she will turn to the breast pump, which she will sit connected to for perhaps another 30 - 40 minutes if they only have a single pump option. If they are lucky, there might be time to go to the toilet and grab a quick drink and snack before the baby wakes to start the cycle over.
What is the goal of Triple Feeding?
Triple Feeding is intended as an interim measure while breastfeeding problems are identified and overcome. These include:
Attachment problems which are not yet resolved and need further assessment and investigation.
Milk supply problems which need to be identified and solutions have time to take affect
When is Triple Feeding usually recommended?
Because of the timing of hospital discharge coinciding with the typical newborn weight loss and preceding the mother’s milk “coming in” fully, it is frequently put in place as the mother-infant dyad prepare to be at home and will have a period between midwifery supervision and child health nurse visits. Paediatricians, General Practitioners (GPs) and child health nurses might also recommend it.
How long is Triple Feeding practiced?
Because it is so time-demanding, Triple Feeding is a very short-term tool to be used alongside actively resolving the issues leading to the baby’s potential low intake at the breast. At most, it is sustainable for weeks but many families find it overwhelming within days. The negative outcome will usually be to reduce or stop pumping breastmilk, skip breastfeeds and offering formula instead or - cease all efforts to increase breastmilk intake and transition to fully formula feeding.
Are there ways to make Triple Feeding less demanding?
The most important thing a Triple Feeding mother needs is support. Somebody with her to help with practical tasks like cleaning the feeding and expressing equipment, providing food and drinks to the mother while she feeds and pumps and being a positive emotional support person. Negative friends or family members can damage the mother’s motivation and confidence so screening visitors, phone calls and even social media viewing is important. Supportive family and friends can prepare meals and snacks, do shopping, laundry and other domestic tasks and reassure the mother.
Efficient and effective pumping are key to successfully increasing milk supply with this method. A hospital-grade breast pump with double pumping capability, using the hands-on pumping technique and pumping frequently enough are all important . Pumping is the key piece of the Triple Feeding puzzle: removing more milk increases milk supply.
Consider how you can combine different elements of Triple Feeding: use a hands-free bra to double pump while bottle feeding or settling your baby to sleep. Pump one breast while your baby feeds on the other and switch sides when they do. Use a Supplementary Nursing System (SNS) to feed expressed breastmilk to your baby at the breast while they breastfeed. Cup feeding can also be used to reduce the risk of nipple confusion and can be used for breastmilk or formula. Explore options to collect milk which might seep from the breast you are not feeding from while your baby is at the breast eg: breast shells or silicone milk catchers.
Use Paced Feeding to give supplements of expressed breastmilk or formula to your baby. Regulating their intake will prevent them taking too much, too quickly before they register satisfaction. Babies process human milk very differently to formula, which can be sedating. Sleeping longer after a formula top-up does not mean you don’t make enough breastmilk.
What next?
Ideally, you were given a plan before leaving hospital or your appointment when Triple Feeding was recommended. But if not, this is what that might look like:
If baby’s weight gain was of concern, you have a date for a follow-up weigh-in soon to clarify the situation.
You have an appointment with an IBCLC lactation consultant to assess your baby’s feeding and identify issues.
You have information on how to improve your baby’s positioning and attachment at the breast.
You have information on how to encourage your baby to go to the breast and feed effectively.
You have information about any functional issues identified as possible causes eg: In the baby - jaundice, late pre-term birth (34-37 weeks), tongue tie, clefts of lip or palate. In the mother: Insufficient Glandular Tissue (IGT), retained placenta, postpartum haemorrhage.
You have a timeframe clearly explained by your nurse or doctor that Triple Feeding is temporary and short-term.
Long term options
Some women are not able to fully feed their baby at the breast due to problems beyond their control. Their babies might be exclusively fed expressed breastmilk or mixed fed with donor milk and/or formula in addition to breastfeeding. Their expressing and feeding routine will not look the same as Triple Feeding as the goal is to maintain supply and intake rather than steadily increasing it. Whatever the outcome, nothing is as demanding as this period.
