09/07/2021
Feeding, pumping and supplementing aka triple feeding is sometimes necessary and can seem so daunting and overwhelming for many new parents when faced with this prospect. Some very helpful and encouraging information from LMJ Infant Feeding Support below:
'I've been advised to feed, pump and top up 3 hourly. Is it the best way? Is there another way?'
This is often called triple feeding, or as I like to call it - triple feeding torture. It is HARD.
It's meant to be a very short term, intensive plan but often parents aren't given a way back out again.
It can feel like all you're doing is feeding, pumping, washing up, repeat. Like every feed rolls into the next and you're getting no time at all for rest, or anything else for that matter. Physically, mentally, and emotionally hard, it's not sustainable in the long term, so work with some skilled breastfeeding support to come up with exit plan if you don't have one.
Is there any way of making it easier? More effective? How can you make the triple feeding plan work for you?
What's important to keep in mind is that you're doing this for probably two reasons. One, to get more milk into the baby, and two, to stimulate/increase your milk supply.
We need to make sure that whatever you're doing, whether it's a breastfeed, pump, or top up, that you're doing it in the most effective and efficient was as possible to meet those two goals and give yourself as much opportunity for rest and downtime as you can.
So...
Deep latch
For a breastfeed, a deep latch is really important. And it takes a bit of time to learn this usually, so if you're struggling you're not alone. Keep asking for help. If the baby isn't latched deeply and asymmetrically, they won't be taking as much milk as they otherwise might, so it really is worth working on.
Active feeding
It's also important to learn to recognise active breastfeeding. This means when the baby is effectively transferring milk from the breast. Actually drinking, not just sucking.
Often you can hear a baby swallowing, but if you can't, watch for a nice deep, wide chin drop.
When babies are transferring milk effectively they will usually swallow with every one to two sucks. So that's what we're working toward and encouraging plenty of.
When a baby is feeding actively they will be alert, and active but relaxed. Their arms will usually be up close to their face, and fists will be lightly balled. If they are sleepy, with arms down at their sides, and lightly sucking with long pauses, it's less likely they're taking on milk.
To encourage this active feeding there are things you can do.
-Feed skin to skin
-Encourage a deep latch
-Use breast compression, a hands on technique for helping to move more milk and encourage flow.
-Switch sides. This is important. When the active feeding slows and the compression is no longer working, it's time to switch sides. Watch your baby to see when, this may be after 2 minutes, or may be after 15 or so. The chances are though, for a baby that is needing a triple feeding plan it's probably a shorter time. The reason for switching sides is because the flow of milk that comes from that second side encourages more active and alert drinking which is important for weight gain.
You can actually repeat this pattern a few times over if you need to, whatever encourages the most active drinking. Feed, compress, switch. Repeat!
When to top up
The breastfeed may last up to 20 to 30 minutes in the above pattern before it's time to stop and top up. Why? Well hanging out on the breast when they're no longer actively taking milk isn't helping them gain weight, helping your milk supply, or giving you any time or energy back. Giving the top up now should help them settle and give you time to express and rest.
How to top up
To give the top up there are a variety of ways.
A lot of people choose a bottle, because it's what we're most familiar with. If you do use a bottle, look into paced feeding. It'll help transition between breast and bottle a little better.
Some people use cup feeding. Can be great for avoiding teat/ni**le confusion, but if your volumes of breastmilk are small and precious it may not be suitable as it can be dribbled or spilled and that's pretty heartbreaking.
Finger feeding is another method, where you use a feeding tube in some milk alongside your finger which they then suck. Finger feeding is also thought to cause less ni**le confusion.
You can also supplement at the breast which I love!
You use a feeding tube (or specialist system) next to your ni**le so that they suck up the top up at the same time as breastfeeding. Fiddly at first, but lots of benefits to this.
How much top up
How much top up to give is very individual depending on your baby, their age, their size, how much weight they need to gain, and other factors.
So you'll need to work with your support to get the right volumes for you.
Expressing
Expressing can be a key part of the plan, but it isn't as straightforward as 'then Express'
How long, how much, what with, why?
The reason you're expressing, is because for some reason the baby hasn't been able to drive milk production as needed, or transfer as much milk as required. So by expressing, you're giving your body extra stimulation and helping remove some extra milk that your baby hasn't been able to.
If you're able to, get hold of a hospital grade double electric pump. This will really help in the short term in getting bigger volumes, but also the long term by increase supply quicker and getting you off the plan and back to breastfeeding.
Whichever pump you use, it's vital to check it's the right fit for you. The actual breast shield that fits over your ni**le comes in different sizes, and having the right size for you can make a huge difference to your output.
Doing breast massage before and during pumping has been found to be a really effective way of increasing volumes expressed. Also adding in some hand expressing before and at the end of pumping. Having something that smells or reminds you of your baby can be useful too.
Rest. Rejuvenate.
Ideally we want to try and keep this whole feeding plan of active feed (with compressions and switching), top up, and express, to an hour or less. That way the plan is effective but marginally more manageable.
Should it be three hourly?
The reason 3 hourly is often mentioned, is because that's 8 feeds divided up in 24 hours. What actually may work better, is working toward 2-2.5 hourly in the day, so that you can do 4 hourly overnight.
The key is getting in at least 8 feeds no matter what pattern you do it in. And remember, if the baby wakes before the planned next feed, start the cycle over. They often start to get quite the appetite as they get more milk on board!
So I guess the 'too long:didn't read' version is
-Get a deep latch
-Watch and encourage active feeding with compressions and switching sides. 20 to 30 mins.
-Top up, doesn't have to be by bottle
-Express using hands on and a well fitting pump
-Keep the whole thing under an hour
-Fit at least 8 times in 24 hours, doesn't need to be 3 hourly
-Get yourself as much support as you can
-Have an exit plan.
