To Triple Feed or Not to Triple Feed

Triple feeding refers to the practice of following direct breast/chestfeeding with pumping and bottle feeding, often in cases of low milk supply or when the baby is not able to effectively drain the breasts. Why is triple feeding so commonly recommended? Because in many (not all) cases it works, if you can do it without losing your mind. And with round-the-clock triple feeding, it’s that part that really isn’t a given.

Feel free to skip to the next section if you have been through triple feeding; there is no need for you to relive it here. But if you recommend triple feeding and haven’t done it yourself, here’s what some people in our group have been saying about it:

I felt like I was going insane. I did it because I was told it was the best practice. I wanted my supply to go up, and I wanted to know I was doing everything I could, but I was so tired that my husband noticed me falling asleep while caring for our baby in a recliner. There has to be a way to do what we can to increase our milk supply without making us so sleep-deprived that we can’t safely take care of ourselves—or our babies.

I was not in the best state. I remember having this visceral feeling of hating one of the lactation consultants I was working with. I felt so misunderstood with one of my appointments, like I was being asked to torture myself (triple feed) and keep trying for something that I was pretty sure was not going to work.

That lactation consultant was undoubtedly doing her best. But it wasn’t the right approach for this mom, especially in her vulnerable and sleep-deprived state. At the same time, other moms in our group want to triple feed. Low supply parents are not a monolith, and we do all deserve choices. Many of us believe that triple feeding should never be presented as The Thing that we have to do. There are other options, and our mental health matters.

Rule #1: Spell it out

If you do recommend triple feeding, the first rule is to make it really, really, REALLY clear that it is TEMPORARY. Why the emphasis? We’re hoping that everyone who recommends triple feeding is already saying that it’s temporary? We really don’t have so little faith in humanity to think that anyone would be so negligent as to give that advice without this critical qualification. But new parents are not exactly in the best place to remember everything that they heard at the hospital or during the pediatrician or lactation visit. Especially if they’ve been…triple feeding. Do you see where we’re going with this? This guidance bears repeating. A lot. And writing down. There is a way to do this without coming off as rude or condescending, but it is so important to make sure that this particular message, of all messages, is being received.

Why? Because a lot of people apparently do not get this message. And triple feeding has such a high cost. (We go into this in more detail in our article for professionals The Low Supply Talk.) It is not ethical to ask someone to triple feed a moment after we know that it is not effective or needed. 

Rule #2: Check in

With that in mind, the second rule is EARLY FOLLOW-UP. Like really early. Especially if you suspect primary low supply. No one should be doing this for more than a week before checking in with a knowledgeable lactation professional—and the sooner you can check in, the better. That is how we can prevent causing further harm when we ask someone to triple feed. We say further because triple feeding is intrinsically harmful to most people. It just is. It makes them even more sleep-deprived than they already would be, and we should not underestimate the effect of lack of sleep on maternal and paternal mental health. The question is if the benefit is worth the cost, and every family gets to decide that.

Rule #3: This may seem obvious but…

The third rule: make sure the person who is triple feeding knows that pumping bras exist. Some people actually don’t realize it and hold the flanges up to their breasts eight times a day on top of everything else. For a more affordable option, there are also ways to secure flanges with a normal nursing bra, or you can cut holes in an old sports bra.

So with all that said, triple feeding really is an option. It’s just not the only option. Here are some other strategies for increasing milk supply. They may or may not be as effective at increasing supply as triple feeding, but in some cases they are a better choice for the family:

Triple feed sometimes

Definitely not in the middle of the night if you’re hoping to get any sleep then; for your mental health, this is an appropriate time to pump and have someone else feed the baby, or just direct breastfeed, depending on your situation. When the baby is not draining your breasts well, we really do need a pump to tell the body to make milk, and if we are actively working on breastfeeding skills, it’s important for the baby to have nonstressful opportunities to breastfeed and positive experiences at the breast. But we don’t need to do it all around the clock. Every patient can work with their lactation team (including specialists in oral-motor function like speech-language pathologists and occupational therapists, as well as ENTs and dentists when indicated) to figure out what balance feels doable to them and protective of the baby’s developing skills, strength, range of motion, and stamina—while making sure they are providing adequate stimulation to the breasts to build or maintain supply if that is the goal.

Use an SNS or at-breast supplementer and pump after

This really isn’t for everyone, and a lot of people with low supply have not had positive experiences with at-breast supplementation. But others do. And if there’s not an additional support person to bottle feed, it is maybe the only way for triple feeding sessions to not take what seems like forever. There’s a learning curve with at-breast supplementers but some people with primary low supply will go on to use them for their entire breastfeeding experience, and the option should be presented, but (as with every option) with no pressure.

Breastfeed on one side while pumping on the other

Alternate the direct breastfeeding and pumping breast at each feeding session. This also isn’t for everyone and can take some finagling. But it’s another more balanced way to make sure the breasts are being stimulated while also eliminating the need for an additional pumping session. 

Is this even humanly possible?

And we suppose the best of all worlds would be…triple single feeding—using an SNS and direct breastfeeding on one side while you pump on the other? If you are dexterous enough to have achieved this, please let us know. This one would certainly be easier with a helper.

Pump with a wearable for some pump sessions

They might not be as effective at removing milk as your wall pump, but depending on how you respond to them, if they let you pump more times a day and you are trying to increase supply, they can be worth using—even in the early days if you can access one.

Latch and hold the baby more

We really can’t forget this one. It won’t necessarily work if the issue is ineffective milk transfer, but if the baby can remove milk well and supply is still low, we do not need to default to having everyone triple feed. That’s why it’s so important to have a lactation visit with a weighted feed soon after milk comes in, especially if there are risk factors for low supply. You may even find it helpful to rent a lactation scale in the first weeks. In addition, skin-to-skin care, which to varying degrees is a natural part of direct breastfeeding, has many benefits for milk production, mom, and baby, including promoting oxytocin release (Altit et al., 2024; Vittner et al., 2018). If the baby is actually more effective at transferring milk than a pump, then it is counterproductive for pumping to displace direct breastfeeding just because low supply parents are made to feel that triple feeding is the best practice to increase supply. It really depends on the situation. Please work with a skilled lactation consultant to figure out what is best for you.

There is always a choice

The point is, we have options. Another very significant one is this: we don’t have to try to maximize, or even increase, our milk supply. That itself is a choice. Many parents will stop breastfeeding if the burden of building a milk supply is too heavy. Lactation professionals and pediatricians may find that more babies get more milk for longer if they help patients find ways to breastfeed or pump that feel doable. And parental mental health may improve if they are actively deciding to continue or stop breastfeeding, instead of making a decision that doesn’t seem like a choice but a physical and psychological necessity. We have talked to too many people—including ones capable of making a full supply—that have chosen to stop because of the all-or-nothing mentality so prevalent in the world of lactation. 

Families should be informed about the risks of not intervening to increase supply—which for some will just be continuing to have a lower supply, and for others will mean that supply will go down significantly when breastmilk production switches from hormonally driven to demand-driven after the first weeks. Some babies might be less interested in latching after that, and others will still be perfectly happy to do it for a smaller supply. But still, it is a choice. The job of lactation consultants is to help parents make informed choices with consideration for their mental and physical health and the health of their babies.

The bottom line

Should you recommend triple feeding? Maybe, and always with alternatives. And should you do it? Only you and your family can make that decision. And you also get to decide if you want to change the plan at any moment.

Thanks to Low Supply Mom Kaia Lacy for ideas about triple feeding and its alternatives. You can hear more of what she has to say about low supply and triple feeding in the podcasts featuring her on our resources page. And thanks to Rotem for inspiring the last line of this article. These words are so important in our community.

References

Altit, G., Hamilton, D., & O’Brien, K. (2024). Skin-to-skin care (SSC) for term and preterm infants (Canadian Paediatric Society Position Statement). Paediatrics & Child Health, 29(4), 238–245. https://cps.ca/en/documents/position/skin-to-skin-care

Vittner, D., McGrath, J., Robinson, J., Lawhon, G., Cusson, R., Eisenfeld, L., Walsh, S., Young, E., & Cong, X. (2018). Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship. Biological research for nursing, 20(1), 54–62. https://doi.org/10.1177/1099800417735633