When Nursing Is Not Enough: Supplementing With Care
There are many reasons why nursing mothers find the need to supplement. While many of us strive towards exclusive breastfeeding, that is just not always possible. I struggled with significant low milk supply issues, first with my singleton and later my twins.
Here are my tips and suggestions for supplementing with care, in a way that also preserves the nursing relationship. These are things that worked for me, given my issues and our circumstances — keep in mind every mama, baby and family situation is a bit different.
I strongly recommend working with medical professionals and lactation specialists when working out the best options for your baby.1
Supplementing with Care
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Supplementary Nursing System (SNS) or Lactation Aid
Supplementing Through Bottlefeeding
Supplementary Nursing System (SNS) or Lactation Aid
This is often the best way to supplement if you are trying to preserve or increase nursing and boost milk supply. There are two styles available commercially — The Lact-Aid Nursing Trainer and the Medala Supplemental Nursing System. Both work by holding milk in a receptacle hung around your neck, with a very thin tube leading to the breast which you can tape or hold in place. You can also make a homemade system using the right tubing dropped into a bottle of milk. When the baby nurses with the SNS/Lactation Aid, she gets both the supplement and any breast-milk you may have: a win-win situation!
There are pros and cons to both SNS systems, but I believe the Lact-aid often comes out on top for several reasons. The bag works by vacuum and by positioning in different ways you can adjust the rate of flow. Unless you choose a gravity assisted flow, the supplement will not drip out of the tube (unlike the Medala SNS), so the baby has to suck harder at the breast to get it to come out — meaning more stimulation for the milk supply! Also, because of the vacuum effect (as I understand it), if there is more milk coming from the breast, the amount coming from the supplementer decreases — helping avoid over-supplementing. Some mothers also find the Lact-aid easier to conceal under clothing than the Medala SNS bottle.
That said, for me the Medala SNS was easier to use, since it has fewer parts and was faster to clean. I could also mix formula right in the bottle. It also had two tubes coming out of it so I could tape one to each breast — a huge pro for twins! The fact that it flowed faster also helped when my twins were so little and not as efficient at sucking, too.
There are a couple of downsides to any type of supplementary nursing system, which is why we also tried other things. The main one for us was that my girls seemed unable to get enough of the supplement for a full feed — perhaps because unlike thinner expressed breastmilk (which I usually did not have), formula is thicker and flows slower through the tubing and can sometimes clog. The SNS’s are harder to clean than other supplementing methods. And finally, an SNS means a partner or caregiver cannot give the feeding, which for me, with round-the-clock nursing of twins going on, was actually a welcome thing!
We didn’t do this one, but with this method, you squirt or dribble milk into the baby’s mouth using a plastic syringe. You can do this while they are nursing (if you get one with a long, curved tip), as long as you can slide the syringe into their mouths while latched (or have them latch on to nipple plus syringe). Pros for this method: you can get a decent amount of milk into a young infant fairly easily, without expensive gear. Cons, which kept us away: if not at the breast this does not satisfy sucking urges or help them learn how to nurse effectively, and at the breast, often requires a second person to “assist.”
For the first few weeks after my twins were born, this was a fairly easy way to supplement them while still avoiding artificial nipples (though I can imagine finger sucking might alter a baby’s suck, too, just not as severely). Like an SNS, we had a tiny tube attached to a syringe (acquired from my lactation consultant) that we would hold or tape to an upturned (palm up) finger.2
As the baby sucks on the finger, you slowly, slowly press on the syringe, allowing milk to flow into the baby’s mouth. Pros for this method: easy and fast, other caretakers can feed the baby. Cons: not nursing at the breast, no stimulating supply or learning HOW to nurse, and soon, my girls needed more milk than the syringe would hold.
Another thing we tried early on, but only a few times. Just fill up a small cup or glass (shot glass works well!) with milk and hold it up to the baby’s mouth, and she should be able to lap it up. Make sure you let the baby lead — don’t pour milk into her mouth! I have heard of babies who really take to this method, though we felt like our girls didn’t get enough down to make it practical. The pros: the baby can get milk without an artificial nipple (avoiding nipple confusion) and it fairly easy, needing no special equipment. Cons: baby is not getting her sucking needs met and is not practicing nursing.
Supplementing Through Bottlefeeding
Though these alternative supplementing methods can be useful, especially with newborns who are still learning to breastfeed, for us bottles soon became the go-to method. We had to supplement so much, in addition to endless hours of nursing, that it just wasn’t feasible for us to do the other more labor-intensive methods. We started with bottles around two weeks old with my twins, after I felt their latch and nursing was fairly established (I was able to utilize the SNS for a lot longer with my singleton). Here is how we supplemented with bottles:
Use “nursing friendly” bottles: Experts recommend using bottles that imitate the breast to avoid changing the baby’s latch or drinking preferences. That generally boils down to three things: a wide nipple base that requires a wide open latch, a short, round nipple, and a flow that mimics the nursing mother’s.
For most supplementing mamas that means a slow flow, so the baby has to work equally hard to get the milk out. Several bottles I have used and that come highly recommended include the BreastFlow bottle and the Adiri Nurser, though many others can work well too (my twins had a hard time getting enough milk of those bottles early on, so we went with a different brand). Some babies have strong preferences for bottles, so I recommend buying one of several different types to try.
Time supplements to allow frequent nursing: I knew given my particular milk supply issues (and my preference to nurse and not pump), I needed to breastfeed very frequently to keep my supply as high as it could be. That meant not tanking the girls up with large amounts of formula at one feeding. I wanted them to be hungry and ready to nurse again in a few hours — which is normal for breastfeeding infants!
We started by topping the girls off within 15 minutes after a nursing session with a few ounces of formula until they seemed sufficiently satiated — but not offering unlimited amounts. I quickly learned my girls would eat more out of a bottle than they needed in one feeding, and I wanted to avoid that. Eventually as they got older and I learned their feeding rhythms, we moved to replacing some feedings with a larger bottle, but I still never went more than two to three hours without nursing. I kept a close eye on the scale (watching trends over time, not ounces per feeding) to make sure they were gaining appropriately and adjusted supplements as needed.
Bottle feeding with love and connection: An important thing for me when bottle feeding was continuing to hold and cuddle them close (or at least giving them eye contact if I was tandem bottle feeding twins), just as I did when nursing. I would give my singleton a bottle while in the ring sling or hold her upright in the crook of my arm. With my twins I frequently used the twin nursing pillow with them on an incline in the double football hold, just as we did for nursing. This worked really well and it allowed me to switch back and forth from bottle to breast when needed. Though I understand the temptation with multiples, I avoided “bottle props” for numerous reasons, particularly because I wanted to be there, close, bonding while feeding and reading their cues for when they needed to slow down, take a break, be done or be burped.
Dealing with bottle preference: All three of my daughters struggled with bottle preference (my twins until they were ten months old!). Sometimes bottles were just easier and more predictable than nursing. Here are the things that helped us work through it (keeping in mind my issue was low milk supply and slow milk flow):
- Nursing (or at least attempting it) A LOT. Every few hours or more often. Especially at night when they were sleepy and less likely to resist.
- Mixing it up with positioning. Nursing while lying down, in the bathtub, or in the sling while in motion — swaying, walking, bouncing on the yoga ball. For me, a ring sling was easiest; a Mei Tai or the Ergo also worked.
- Keeping on top of the baby’s hunger by offering nursing before they were obviously hungry (looking for early hunger cues, not waiting for late ones)
- Bottle feeding in the same or similar position to nursing, and quickly switching to nursing mid-way through or even after a bottle feeding, once the baby is less frantic. This was really key for me, and it’s counter to the standard advice of “always nurse first.” In my mind, it’s better to nurse second than not to nurse at all!
- Once you do get them latched and sucking, do breast compressions to keep the milk flow coming when it wanes.
- Try “switch nursing” — switching sides often, back and forth several times each session if you can, to keep the baby interested and possibly stimulating more let-downs.
- Allowing — and in fact encouraging — comfort nursing. If they fussed even a little, I usually tried nursing first. I avoided pacifiers because I wanted my girls to nurse for sucking needs, to get every drop of milk they could and to become attached to nursing as a means of comfort, not just nutrition (since the nutrition, often, would be coming from the bottle!).
- Most importantly, keeping in mind this quote: “You are working to seduce your baby back to breast … coax, don’t force!”3
It’s no secret, the early days of supplementing are really hard! I was emotional, exhausted, frustrated and jealous of others who had it easier.
The endless feeding routines got old, fast. Some folks suggested I quit, or noted they would never go to the lengths I did (which is fine, they didn’t have to!). There were days when even I thought we would be better off if I did — that switching to bottles and/or formula full time would make us all happier. But I also knew, especially after my nursing successes with my oldest, that this challenging time might be only a blip, in the long run. That nursing is so much easier once it’s established, and if we could get past these first intense months, we would have many months — or years! — of the good stuff.
The key for me was keeping that long range goal in mind, while also focusing on just this day, this week, this month. I could always reassess tomorrow, but for today, I would keep trying.
Photo credits: Author
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- The product recommendations in this post are the opinions of the author alone and are included for information only. They are not sponsored, and no advertising or affiliation earnings will be generated from this article in order to comply with the WHO code of marketing of breastmilk substitutes. ↩
- Check out Hobo Mama’s post on supplemental feeding for more info and pictures about finger feeding as well as syringe, cup and other feeding methods! ↩
- From Help, My Baby Won’t Nurse on Kellymom.com ↩
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