As someone who gave birth sixteen years ago and entered birth work shortly after, triple feeding seems like a trend. Why? Well, it simply wasn’t frequently recommended as affordable double electric breast pumps weren’t readily available.

As doulas in the home and certified breastfeeding counselors (CBC) after hospital discharge, we run into supporting exhausted parents trying to triple feed.

However, in talking with IBCLCs who provide hospital support, triple feeding is sometimes deemed necessary by nurses, pediatricians, and IBCLCs. Some hospitals have policies which require triple feeding in certain circumstances. Hospitals need to ensure babies remain hydrated and are not losing too much weight before discharge. Triple feeding can often ensure that. But is it the only option?

As post hospital support, however, we often see how unsustainable triple feeding can be. What can doulas and CBCs do to support these exhausted parents?

What is Triple Feeding?

Triple feeding takes three steps, hence the name. Triple feeding is:

1. Putting baby to the breast
   1. Often a minimum of 10 minutes, at times as long as baby is interested.
   2. If baby will not latch within a few minutes, some move on to step two.
   3. If using a breast shield, practice without it if recommended
2. Supplement baby – Typically via bottle
   1. Feed baby with a bottle after time at the breast
   2. This can be previously pumped milk, donor milk, or formula.
3. Pump
   1. Pump with a double electric pump for 5-15 minutes
   2. Pumping longer than 15 or so minutes is not typically beneficial.

The exact recommendations can vary, but in short, it is baby to breast, supplement baby via bottle, and follow up with pumping.

For new parents, this looks like offering the breast every 2-3 hours, offering bottle, and then pumping. While some suggest this entire process takes 45 minutes, it often looks like an hour or more. Settling baby, practicing at the breast, changing and burping, washing pumps and bottles. It becomes a big task to feed.

When is Triple Feeding Recommended?

Once upon a time, it was rarely recommended as many parents did not have easy and affordable access to breast pumps. It is also rarely recommended in some countries and regions. This is not to say bottles and supplementing were not recommended, simply that the process of triple feeding was not frequently suggested.

In some hospitals, it is standard to require triple feeding for babies under 37 weeks gestation. It is recommended the duration of the hospital stay. The challenge is not so much triple feeding at the hospital, it is adjusting to other feeding methods once home. Parents of babies born under 37 weeks have this feeding pattern to ensure baby is growing, but they aren’t always given the tools to transition breastfeeding to a more sustainable way.

Triple feeding might also be recommended when:

• Anatomy of mother or baby makes latching and milk transfer difficult.
• Delay in mature milk coming in.
• Prematurity
• Health condition
• Low milk supply
• Losing near or more than 10% of birthweight

The goal of the hospital staff is to ensure a baby does not lose too much weight and has enough intake to ensure no dehydration. Hospitals also aim to have ‘Baby Friendly’ statistics so that they can be a certified Baby Friendly facility.

Triple feeding is one method to ensure the above occurs. While it can work wonderfully in reaching those goals, it can make feeding at the breast long-term very challenging. It can also have a significantly negative impact on a parent’s confidence in breastfeeding.

How Do Doulas and CBC Support Exhausted Triple Feeding Parents?

First, it is important to remember scope of practice. You provide education and evidence-based information about. You also aid in typical breastfeeding initiation and support with typical latching and positioning.

You cannot evaluate or diagnose tongue ties or oral motor issues. You are not licensed to evaluate or diagnose low supply causes such as insufficient glandular tissue or thyroid issues. Neither are you able to evaluate a baby’s weight.

However, in educating and supporting families you can:

• Provide information about and support trying different positions. For example, if a mother has flat nipples, you can suggest alternative positions beyond cross cradle or football hold which don’t work well with flat nipples.
• Remind parents they have alternative feeding options such as a supplemental nursing system (SNS). They can also just offer a bottle at some feeds where they only pump, and other feeds only offer breast if baby is capable of latching. Remind them to follow up with an IBCLC and pediatrician to ensure safety of this option for their specific circumstances.
• Share evidenced based information from reputable lactation sources such as the World Health Organization, UNICEF, International Breastfeeding Centre, and other evidenced-based sources.
• Remind parents of the option to rent a newborn scale, or even purchase one, to do their own weighted feeds. This can assist in confidence as they adjust to more feeds at the breast.
• Encourage skin-to-skin and positive touch. Remind them that breastfeeding is not purely about nutrition but rather part of relationship. All contact should not be associated with stressful attempts to feed.
• Educate families prenatally about the option to use a private IBCLC even before hospital discharge. Private practice IBCLCs sometimes offer bigger picture solutions versus just navigating the early hospital days.

You can also direct parents to Dr. Jack Newman to get personalized resources based. While this is not a substitute for in-person support, the evidenced-based information from a doctor and lactation professional can be helpful. Dr. Newman offers an Ask a Question option.

Ongoing Triple Feeding Support

As a doula or CBC, you can certainly offer practical support. Providing infant care in between feeds can be vital. When a parent needs to only do at the breast and pumping, while another person does infant care and bottle, they can maximize rest between feeds.

Emotional support and building confidence is also important. You can reassure parents about typical pumping output versus an unrealistic expectation of large amounts. Reassurances that breastfeeding does not need to be all or nothing is also helpful.

Helping a parent define their breastfeeding goals and supporting them to meet those, is important. All the recommendations and advice in the world mean nothing if it does not work with a person’s goals.

Whether triple feeding is simply a passing trend, or a long-time lactation recommendation here to stay, we can help our clients meet their personal goals. Support, evidenced-based information, prenatal education, and more are all vital to helping support clients.

Ready to offer even more breastfeeding support? Be sure to learn more about our Certified Breastfeeding Counselor program.