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The Triple Path: Breastfeed, Pump, and Bottlefeed.

The 'triple path' feeding routine is often used in the first few days or weeks of breastfeeding when those babies who may have lost 10% or more of their body weight - with the end goal of turning weight loss into weight gain. Moms are told to first breastfeed, then pump after, and lastly offer a bottle of breast milk or formula.

This 'triple path' routine was first developed by lactation consultants for short term use in specific situations. Since the creation of the 'triple path' however, this routine has been incorporated into a standard of care by many pediatricians, general practitioners, and may even be a part of your discharge orders from the hospital.

Sounds like a great idea? ... To breastfeed first, then pump and bottlefeed baby any amount of milk you have pumped. Or, if your milk supply is perceived as low, you might be told to offer a bottle of your breast milk mixed with formula. Mothers may even be told to skip pumping altogether, and to offer a bottle of formula right after breastfeeding the baby. This regimen is not only exhausting (taking all of mom's limited time), but it is not sustainable!

Unfortunately, when the 'triple path' routine is used by practitioners who may feel they do not need to follow mother and baby closely (since mom is supplementing baby), this suggestion causes a variety of problems. Some are: decreased breastfeeding success, early weaning, nipple confusion, breast aversion, reduced milk production, depression and burnout in these exhausted and confused mothers.

How to optimize the 'triple path' method for breastfeeding success:

Find a board certified lactation consultant to help you. It's critical that you learn why breastfeeding is not going well. A skilled lactation consultant will exam you and your baby, watch the entire feeding and do test weights. They can determine if a problem lies with you, or with the baby and then form a plan to turn things around. An IBCLC, (a Board Certified Lactation Consultant) is trained to assess, identify and correct both normal and medical challenges, or will refer to the appropriate practitioners for help.

Mothers often assume all breastfeeding problems are 'their fault'. Most of the time, it is the baby who is just not nursing well yet. A latch can 'look good' but not yet be effective in transferring milk. Because of newborn jaundice, long/ difficult labor, induction of labor, multiple birth interventions, cesarean birth - some babies have a variety of obstacles to overcome in the early days after birth. Other babies may have mechanical issues like oral motor problems, torticollis, neurological challenges, tongue/lip tie, or tight oral-facial muscles.

  • Have an exit strategy ... a defined date to stop.

  • Have a 'lactation plan' for breastfeeding success. Your private practice lactation consultant working closely with you to correct any breastfeeding problems will provides a Care Plan to guide to your goals.

  • Learn the difference between 'active' drinking at the breast and 'non-active' nursing.

  • Always look and listen for swallowing. You should hear, 'Suck, Suck, "Kaw" swallow' sound. If baby has a long, continuous suck pattern before swallowing - it is a 'red flag' sign that milk transfer may not be occuring. 'Sleeping at breast' without any change in suck pattern, or for the entire feed without rhythmic swallowing, is another.

  • Undress your baby to breastfeed. Skin to skin contact stimulates natural feeding cues. "But won't my baby be cold?" No - Human babies maintain their body heat and temperatures stabilize better during skin to skin contact with their mothers, than when they are wrapped in a blanket

  • Allow your baby's head to 'fall back' to latch, so baby can open their mouth wider to take in more breast tissue. This lifts baby's chin and he'll drop his jaw to open wider.

  • Use deep breast compressions to increase milk flow to baby.

  • Have someone else bottle feed baby so he will connect you with the breast.

  • Pump 15-20 minutes after baby breastfeeds. This will encourage your body to have another big letdown. (Short frequent pump sessions make more milk).

  • Try 'double-double' pumping sessions twice daily. (Both breasts pumped at the same time, 2 times each session) ie: PUMP for 12 minutes, REST for 12 minutes, then PUMP for another 12 minutes.

  • Get as much rest as possible. Take one 4 hour sleep-stretch nightly after you've nursed or pumped. Baby can be fed by someone else while you are sleeping.

  • Use PACED bottle feeding as it slows down the feeding process, so baby will not develop a bottle flow preference, or overfeed and be more uncomfortable.

  • Eat well, snacking every couple of hours and stay hydrated. Eat those comfort foods that you like. You do need to nourish your body to produce enough milk.

  • When pumping, use 'hands on pumping'. Binge-watch your favorite series when pumping. Don't focus on the pump, watching the flow or total ounces. Just Relax.

  • If your baby has newborn jaundice, try bottle feeding baby a partial feeding first - with just enough milk to stimulate baby to wake up and be more alert.

  • Try alternative therapies like craniosacral therapy, bodywork or Infant massage.

  • Try 'baby wearing' (sling or pouch) to stimulate natural feeding cues.

  • If using a nipple shield, make sure it is the correct size. Learn how to apply it correctly. Nipple shields should not fall off easily. If they do, they are the wrong size, not applied correctly, or both.

Helpful videos:

How to Breastfeed - Deep Latch Technique:

4 day old feeding with Breast Compressions:

Nibbling- Non active breastfeeding:

Breast compressions:

Dr. Jack Newman's Visual Guide to Breastfeeding:



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