How to Supplement Breastfeeding Your Baby

Adriana Lozada: I’m Adriana Lozada and you’re listening to Birthful, and the topic that I want to dive deeper into today is supplementation while breast or chest feeding. Now, if you’re like most people, you probably are setting out to exclusively breastfeed your baby, but maybe you find that either by choice or circumstances, you might have to supplement these feedings with either your expressed milk, donor milk, or formula. If it’s something that you’re having to do by circumstance rather than choice, that supplementation may trigger fear or strong feelings of doubt of not being able to exclusively breastfeed, or even feelings of failure. And I definitely want to eliminate that. 

Breastfeeding is a learning process that may need help initially, and if it does, that’s fine. If that’s the case, that also may require a mindful plan on how to get back to exclusive breastfeeding, if that’s the goal, or how to make sure that the supplementation isn’t negatively impacting your milk supply or your baby’s ability to be at the breast if you wish to continue doing a combination feeding in the long run. 

Now, an easy way to remember what to focus on is knowing that first, you need to feed your baby. Then, you need to protect your milk supply. And third is about figuring out ways to facilitate breastfeeding. And I said you might need to supplement due to circumstances, so some of those reasons may be related to your baby, like for example, if baby’s having latch issues, such as weak or dysfunctional suckling, which can then create poor milk transfer, or maybe they have insufficient weight gain, or they lost too much weight at birth. And a little side note that weight loss right after birth is normal and the expectation is that your baby will start gaining that weight around three to four days after birth and be back to their birth weight by probably week one, and definitely by week two. 

Other reasons why you might need to supplement for your baby is some infants may have oral function difficulties, such as tongue ties, and then premature babies in general may have the need for supplementing, just because they might have some or all of the issues that I just mentioned just because they’re premature. On the other hand, some reasons for supplementing may be because of parental factors, and this might be that you have primary or secondary lactation insufficiency. The primary lactation insufficiency is that your body actually isn’t able to make sufficient breast milk, maybe because you don’t have enough breast tissue or there’s some hormonal reasons preventing the establishment of a full milk supply, and this primary glandular insufficiency only happens in about 5% of lactating people, so it is something that tends to be rare. 

If you’ve had breast surgery, especially breast reduction, this can affect your milk supply. And there’s other cases, like for example if you are inducing lactation, maybe because you’re an adoptive parent or the other non-gestational parent wants to breastfeed. Another reason is maybe you’re looking to re-lactate or reestablish your milk supply following a planned or enforced separation of the parent-infant dyad. And there are varied individual reasons why that separation might have occurred. One that comes to mind is if baby had to spend a long time in the NICU and couldn’t have the interaction of breastfeeding with the breastfeeding parent. 

Other reasons might be because you had severe nipple trauma or illness, surgery, hospitalization of the breastfeeding parent. If any of these things are happening, then there might be a need for supplementation in order to maintain milk supply despite the challenges, or to deliver sufficient extra nutrients to the baby when medically indicated, and in some cases, it can even be done to help facilitate a more effective suckling pattern. Like for example, by using a supplemental nursing system with or without a nipple shield. 

Since I mentioned supplemental nursing systems or SNS, let me explain what that is. Basically, an SNS is a container that holds human milk or infant formula with a length of thin tubing that runs from the container to the nursing parent’s nipple, and then the tubing is often secured in place with medical tape. As the baby suckles at the breast, then they suck the supplement into their bodies while at the same time providing stimulation to the breast. Ta-da! Two things in one. The point of this is to help increase milk supply by stimulating the breast while at the same time feeding the baby. 

Other ways to supplement can be using a syringe, or a spoon, or a cup, or even finger feeding, and now the benefit of doing these different things over a bottle is that it can help preserve baby’s latch. So, it is a good idea to try these methods before a bottle, especially if supplementing for a short time. 

And so, yes, you can also use a bottle to supplement, but know that there is a possibility that the baby is gonna prefer feeding from a bottle instead of the breast, which can then truly derail your breastfeeding. There might be several reasons for this. The first one is flow preference. When a baby is at the breast, they’ve got to work for that milk. They’ve got to suck, suck, suck to trigger the let down of the milk and then get the reward of that fast-flowing milk. With a bottle, they don’t have to work for it. Whatever the angle that you use the bottle at, gravity is gonna come into play and just pour that milk right into their mouths. 

Another reason why the bottle may derail the breastfeeding relationship is that the shape and the size of the nipple may teach the baby to suck in a way that is not supportive of sucking at the breast. Ideally, you want bottles that offer a narrower, longer nipple, because that’s better able to hit the juncture of baby’s soft and hard palate. If you use your tongue to run it on the roof of your mouth, you’ll feel where it goes from hard to soft. That’s how far back the nipple needs to hit during breastfeeding, so you want a bottle nipple that better mimics that. 

If you’re using a bottle for supplementation, usually the recommendation is to nurse first and then to top up the baby with milk or formula from the bottle. Now, if a bottle feeding is being done in order to give the breastfeeding parent a break, do understand that you are then also eliminating one count of breast stimulation and milk extraction, and unless you somehow make it up later with extra pumping or hand expression, that may affect your milk supply. 

If you want to supplement and also intend to maintain or increase your milk supply, then regular stimulation of the chest tissue is essential. So, if your goal is to continue breast or chest feeding in some capacity, it’s really important that you work with an International Board Certified Lactation Consultant to help you come up with a detailed, customized plan, since they specifically have training on combination feeding and will always be the best resource for support with supplemental feeding, versus say somebody like a pediatrician, who does not have the same depth of training in lactation or other infant feeding. 

I can’t stress this enough since there’s plenty of data to show that early supplementation with infant formula is linked to decreased exclusive lactation rates in the first months of life and shorter overall term of lactation, which can then bring on an onslaught of challenging feelings if you find yourself doing all the things to increase a dwindling milk supply or find that your baby is rejecting the breast for the ease of the bottle, and you end up then either exclusively pumping, which, let me tell you, can be tons of work and extremely frustrating, or end up then having to switch to exclusive formula feeding when that’s not what you wanted to do. 

If you find that the pressure to supplement is coming from other family members so that they can give the baby a bottle in order to bond with them, you may want to offer alternatives to infant feeding to prioritize building your supply. They can instead take the lead in say changing diapers, giving baths, baby wearing. There are so many ways to bond with your baby. If you made a plan to stop supplementing, do acknowledge that when that time finally arrives, it can be a bit nerve wracking. You may have lingering doubts about if baby’s getting enough or if your supply is robust enough to handle your baby’s nutritional needs on its own. Just observe your baby for validation that they are content and thriving as the diapers keep coming and do remember that skin to skin is a great way to help with your supply while nursing or not. 

Whatever your feeding journey turns out to be, only you can decide what works for you, for your baby, and your family. You can connect with Birthful on Instagram @BirthfulPodcast, and to learn more about Birthful and my birth and postpartum preparation classes, go to Birthful.com. 

Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro is our associate sound designer and mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen, and come back next week for more ways to inform your intuition. 

CITATION: 

Lozada, Adriana, host. “How to Supplement Breastfeeding Your Baby.” Birthful, Lantigua Williams & Co., May 19, 2021. Birthful.com.