Rockville Lactation

Lynnette Hafken, MA, IBCLC

Lactation Consultant

text (fastest response) or call: (240) 888-2123

email: [email protected]

se habla español

(Realistic) Triple Feeding

Triple feeding—that is, breastfeeding, supplementing, and pumping every two to three hours—is often prescribed for low milk supply. Since frequent and thorough milk removal is the best way to increase milk production, this makes sense, right?

Sure...if you were a machine that never required sleep, food, and down time. But as a human, you require sufficient sleep and nutrition for your mental health, not to mention well-deserved enjoyment of your new baby.

While the intention is good—to help mothers reach their breastfeeding goals—mothers describe triple feeding as “profoundly exhausting,” “one of the worst times in [her] life,” and “hell on earth.” The graphic below describes the typical feeding plan often prescribed, and mothers have followed it for even up to 9 months in an effort to increase their supply. No one had told them it's supposed to be a short term plan, and that if it's going to work, they will see results within a week.

Here is a more reasonable model, based on the basic principles of breastfeeding success. I call it Realistic Triple Feeding, because it's doable without going insane from lack of sleep. This plan prioritizes three things: (1) sufficient sleep for mother, (2) sufficient breast emptying to stimulate milk production, and (3) sufficient time breastfeeding for the baby experience their mother’s breasts as a nice place to be. 

In a nutshell, here is the Plan:

  • Ensure baby is fed until full at each feeding with breastmilk and/or formula as needed (by “full,” I mean completely refuses more)
  • Breastfeed directly when you and baby want to, for as long as you want to
  • Pump after (or instead of) breastfeeding at least every three hours, except...
  • Get one five-hour chunk of sleep while someone else does a feeding*
  • Power pump after waking up from the long sleep period
  • Determine when the regimen will end!

*Some mothers do need to empty their breasts every 3 hours to maximize their supply due to having a smaller storage capacity. If this is true for you, you will know, because your breasts will get uncomfortably full about three hours after feeding/pumping. In that case, you will have to choose what is more important to you and your family, more ounces of breastmilk, or sufficient sleep for you. Don’t feel guilty if you choose sleep—research shows that sleep deprivation negatively affects mental health, and maternal depression can negatively affect babies’ physical health and mental development.

To save precious time, the baby should only breastfeed directly when you feel up to it (you may want to just pump at night) and only for as long as the baby is actively swallowing. Whether you put baby to breast for a few minutes once a day, before every daytime feeding, or just decide to defer latching for a while, it's a good idea to keep baby familiar with (and enjoying) your breasts.

Some babies, particularly those who are born early, will sleepily nurse for a long time with just the occasional sucking burst. This is time consuming, and those sleepy sucks don’t do much for the milk supply, which is driven by robust demand (frequent and thorough milk removal). The pump doesn’t get sleepy—it just removes the milk, signaling to your body to make more.

Hands-on pumping provides an extra boost, as does pumping when the prolactin levels are highest, between 12 and 6 a.m. Some mothers find that an at-breast supplementer cuts down on time spent feeding, and a technique called parallel pumping can also save time. Here are some pumping hacks you can also try if things don't seem to be working well.

Breast compressions (massaging and squeezing—gently—while baby sucks) can also help keep baby awake and feeding efficiently:

I want to emphasize the importance of feeding a baby to satisfaction at every feed. This is not only for the baby’s health and comfort, but also to allow them to have the energy to breastfeed well at the next opportunity.

It is important that this plan be flexible and individualized, as you may have specific needs, for example: insufficient family support, a non-latching baby, difficulty letting down to a pump, and/or a history of mental health issues. There are countless other infant and maternal factors that benefit from an individualized plan. 

In some cases, such as with insufficient glandular tissue (IGT) or postpartum hemorrhage (or for unknown reasons), triple feeding might not even significantly increase your supply, leading to false hope, frustration, self-blame, and burnout.

If you reach a ceiling in your milk production (no increase over a period of 4–7 days), there are a few options: investigate further by talking with your doctor; make peace with the amount of milk being produced and successfully breastfeed through combo-feeding (see this page if you have very low supply); or wean from breastfeeding. Only the parents can decide what is best for their family. 

Here are two examples of patients who used this plan, individualized to their situations (names and some details changed for privacy):

Nancy sought help at six weeks postpartum with her baby still under birth weight. She had been triple feeding for most of those six weeks. Her score on the Edinburgh Postnatal Depression Scale indicated she was probably suffering from severe postpartum depression. Her baby Margot was sleepy and apathetic at the breast, because she did not have the energy to feed vigorously.

Step one was to test weigh the baby before and after breastfeeding. The scale showed Margot transferred 1.5 oz. After this, Nancy pumped 0.5 oz. Two ounces every 3 hours—16 oz/day—was far short of the 25–35 oz needed for healthy infant growth for a baby of her age and who started out at the 60th percentile.

Step two was to create a plan that allowed Margot to eat enough to start gaining weight. Once she was fed to satiety with a combination of breastmilk and formula, she started gaining weight appropriately and quickly went from the <2nd to the 50th percentile.

Step three was to ensure Nancy got enough sleep. Initially, Margot’s father took over some feedings so Nancy could sleep until she was refreshed, and she power pumped when she woke up. She decided together with her lactation consultant that she would breastfeed at each feeding for a limited time (Margot would sleepily suckle for an hour if allowed), and pump at least six times a day.

It quickly became clear that Nancy had hit a ceiling on her milk production, and it would not increase beyond about two-thirds of what Margot needed. Margot also started showing signs of frustration at the breast. We then switched the breastfeeding and bottle-feeding around so Margot was bottle-fed until she was relaxed, then breastfed for “dessert.” Pumping was gradually discontinued, as it was a source of frustration and sadness, and Nancy wanted to spend time with her baby, not her pump.

Nancy started seeing a therapist for her postpartum depression, which she attributed largely to the pressure she had put herself under to exclusively breastfeed, and the feelings of anguish that her daughter had gone hungry for six weeks. Margot continued to breastfeed with formula supplementation and then solids until age three.

Pamela sought help at five days postpartum. She was mostly bottle-feeding breastmilk and formula, as her son Thomas would cry and fight at the breast. Although she knew it wasn't true, Pamela felt rejected by her baby and blamed herself for trying to "force him to breastfeed." (Moms don't force their babies to breastfeed any more than they force their kids to go to school; both are valuable endeavors and worth working towards, if you feel they will benefit your child.)

Pamela's supply was low, estimated at about 12 oz a day. Over the next three days, she followed the plan, and her milk supply skyrocketed. Within ten days she was producing a full supply and no more formula was needed.

In addition to paying attention to her milk supply, she worked on helping Thomas relearn that the breast was a nice place to be. She bottle-fed him skin to skin, and offered the breast occasionally when he seemed willing. She gave him back the control of when he would latch, and as he learned to trust that he would be fully fed at the breast from her now ample supply, he was more and more willing to breastfeed. This took about three days. (It may take longer for older babies, and it's important not to rush or pressure babies).

At about three weeks in, Pamela was exclusively breastfeeding. She chose to continue to have her husband give a bottle of breastmilk in the middle of the night, because that worked well for her family.

One-size-fits-all triple feeding plans…

…though well-intentioned, are unachievable by most humans, and they can lead directly to clinically severe sleep deprivation, postpartum depression, and failure to bond. Healing can begin when you’re getting sufficient sleep and are following a plan that allows you to enjoy feeding your baby, while also stimulating your supply according to your goals. Exclusive breastfeeding is important to some mothers; for others, the priority is a happy healthy family, without specific goals for feeding.

Whatever your ideal is, don’t be afraid to prioritize your own well-being—your baby needs a healthy happy mother to thrive!