Mothers Describe Their Triple Feeding Experiences And The Impact It Had On Their Mental And Physical Health

Written by The Fed Is Best Foundation Lactation Consultant Team

Part 1: What is “triple feeding?” 

Triple feeding originated in the NICU and was used for premature infants. It is now being used for full-term babies, especially in home environments. Triple feeding is a breastfeeding plan in which, for every feeding, a mother feeds her baby at the breast, followed by immediate pumping, and then giving any expressed milk (and/or formula supplement) to the infant by a bottle, cup, syringe, or through a tube at the breast. Triple feeding requires a considerable amount of effort and time, and there is little time between feedings for the mother to take care of her own basic needs, such as sleep, eating, and hygiene.

Many mothers who have followed this regimen say that they were given little guidance on how long to triple feed and when to stop.  As a result, these mothers have endured the equivalent of caring for triplets (feeding a baby at the breast, “feeding” the pump, then feeding a bottle). In addition, there are pump parts to wash up to eight times a day, and sometimes other children to care for.

“I didn’t eat or drink for days because of the time constraints of triple feeding. By the time my baby was admitted to the hospital on day 5 of life, I lost consciousness and then broke down in the corner of his room from profound exhaustion. I’m a doctor and had done surgical and anesthesia residency. I’m used to sleep deprivation. Those five days were hell on earth. Not only did it not work, I unknowingly starved my baby under the care of lactation professionals.  They knew I had a breast reduction, but I was told to triple feed without a back up plan. That week of my life lives over and over in my head all the time.” —Dr. N. King 

Why is the triple feeding strategy recommended by medical and lactation professionals?

The common reasons for prescribing triple feeding are:

  • Poor latching, lack of sustained suckling, oral anomalies, and insufficient milk removal.
  • Delayed onset of full milk production and excessive infant weight loss or failure to gain weight.
  • Chronic low milk supply for poor breastfeeding management, hormonal insufficiency, insufficient mammary physiology, and unknown mammary dysfunction.
The theory behind triple feeding is based on the first two rules of lactation management: feed the baby and maximize the milk supply.  
  1. When a baby is not transferring milk effectively, he is not stimulating his mother’s milk-making hormones adequately, and milk remains in the breast. This causes a reduction in her milk supply and does not provide a full feeding for the baby.
  2. Giving the baby frequent opportunities to breastfeed despite the low milk transfer is thought to help the baby improve his latching and milk transfer skills, and avoids bottle preference.
  3. Pumping after nursing will remove most of the milk from the breasts, thus helping to increase the mother’s milk supply to a sufficient level (a full milk supply is about 25-32 oz/day).  When successful, this will allow her to gradually wean the baby from supplementing and return to fully feeding at the breast. 
  4. Immediate supplementation is necessary to provide the baby’s full feeding, as babies have caloric, nutritional, and hydration needs that cannot wait until the breast milk supply potentially increases. 

Unfortunately, triple feeding has become the default method that is recommended by medical and lactation professionals for a large number of breastfeeding challenges, with no regard to the maternal complications that will eventually occur, or the likelihood of it solving the problem of low milk supply. It is imperative for all mothers to know that triple feeding is not sustainable for longer than five to seven days, and it cannot be recommended unless the mother has a full-time helper. If triple feeding is working, there will be evidence with increased milk supply/volume. This is how we know it is working. If there is no increase, triple feeding will not work for this mother, and her breastfeeding plan will require changes. Most likely it will be a combo-feeding plan. 

Before triple-feeding is recommended, medical and lactation professionals must make careful considerations because of the daunting amount of time that is necessary for every feeding. The things that need to be considered are:

  1. Does the mother have full-time in-house help?
  2. Does she have any preexisting history of mental illness?
  3. Does she have the best mammary physiology and general health profile to sufficiently increase her milk production?  (The word “sufficient” is subjective and is determined by both the baby’s needs and the mother’s goals.)
  4. Does she have a high-quality electric breast pump?
  5. Does the proposed triple feeding plan allow for sufficient sleep, nutrition, and self-care to support her basic physiological needs?

Of course, every mother and baby have unique needs and require individualized breastfeeding management and support. The plan must also be flexible enough to meet unexpected needs. It is very important for the health care professional involved to inform parents that they may find themselves unable to follow the triple feeding plan perfectly. A backup plan should be provided until changes can be made that the parents are confident they can follow. Mothers need to know they can stop at any given time, and that there is no guarantee triple feeding will provide the results they are looking for. This is part of informed consent. 

Complications of triple-feeding: mental health, bonding and preventing accidents

Jessica Montgomery talks about how triple feeding stole her ability to enjoy her baby and did not increase her milk supply.

Literally everything I read about breastfeeding said that undersupply was rare. After she was born, my milk didn’t come in right away. When it did, it was not enough, and she lost weight and had to be re-hospitalized for jaundice, dehydration, and hypoglycemia. 

I was willing to do anything to increase my supply and hoped to eventually be able to exclusively breastfeed. I saw two lactation consultants (IBCLCs) and both gave me different versions of the “triple feeding protocol” to try. I was supposed to complete the following three steps every 2-3 hours around the clock:

  1. Breastfeed baby for at least 10-15 minutes per breast, using breast compressions.
  2. Supplement baby pumped breast milk, and then formula if pumped milk is not enough. If the baby is able to latch, use a supplemental nursing system, to supplement at the breast, with a tube placed and taped next to my nipple. If she wouldn’t latch, I was supposed to finger feed, cup feed, or use a slow flow bottle.
  3. Pump for 15-20 minutes with a double pump or for 15-20 minutes on each side if using a single pump or hand expressing. If the baby didn’t empty my breasts I was supposed to do this right away, and if not, I was supposed to wait an hour after nursing to pump. 

Triple feeding was my life for months, and my mental health seriously suffered. I couldn’t keep up and that made me feel so guilty, and honestly, it didn’t really do much for my supply. I lost so much time being with and bonding with my baby.

After my second baby was born, I met with a breastfeeding medicine physician who told me that triple feeding was too exhausting for most moms, and it wouldn’t fix my low supply issues because I was diagnosed with insufficient glandular tissue (IGT). I stopped pumping, ditched my SNS, and started combo-feeding my baby. It was amazing for my mental health and literally changed my life. 

Bethanne talks about having a psychotic break from severe sleep deprivation while triple feeding her daughter.

I was a first-time mother and was 100% committed to exclusively breastfeeding.  She was born at 36 weeks and was very sleepy. She latched poorly, so the LC prescribed triple feeding. I had plenty of help at home and thought everything was going well. I was profoundly exhausted because I didn’t sleep in the hospital at all. I didn’t recognize my mind was shutting down. I became confused and wasn’t eating or drinking much. I began hallucinating. My husband called my OB who told him to bring me to the hospital. I was admitted for observation, and the psychiatrist diagnosed me with severe sleep deprivation and anxiety. I had IV fluids and sleep medication and slept for 8 hours straight. When I woke up, my milk was in, but I was very frail and kept crying. I decided I would become a pumping and formula feeding mother so I could get some sleep. I tell every mother I know not to triple feed because of the hell I lived through. My OB filed a formal complaint about the LC who prescribed triple feeding to me.

According to Dr. Marianne Neifert, “the rigors of a triple feeding schedule aren’t for every woman: some are too exhausted or have too many other responsibilities to devote the necessary time and energy to this demanding regimen. Dr. Neifert states, “if a mom’s emotional well-being is at risk because she keeps trying and trying and it’s still not a rewarding experience, we have to assess whether it’s realistic for her to exclusively breastfeed. Many moms who are having a great deal of trouble and are ready to quit will breastfeed longer if they see it as doable for them” — doable, in other words, by combining breast- and bottle feeding.

Sleep deprivation has very serious consequences. As health professionals, we need to protect maternal mental health when developing complicated breastfeeding plans. Very serious sleep deprivation conditions while triple feeding has resulted in postpartum depression, anxiety, psychosis, deteriorating physical health, and serious accidents.

In Part 2 of this blog, we will share stories from mothers describing how a modified triple feeding plan worked for them. It’s important to recognize that every infant feeding situation requires individualized care for the best outcomes.

 


HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. We have:  FIBF Advocacy Group, Research Group, Volunteer Group, Editing Group, Social Media Group, Legal Group, Marketing Group, Perinatal Mental Health Advocacy Group, Private Infant Feeding Support Group, Global Advocacy Group, and Fundraising Group.    Please send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our FREE infant feeding educational resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. Send us your stories. Share with us your successes, your struggles and everything in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

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I Want To Tell Mothers That Bottle Feeding Is Also Beautiful

 

Kristen Elise Umunna
Kristen joined the Fed Is Best Foundation’s Mental Health Advocacy Team to be a voice for mothers, especially mothers of color who are struggling to breastfeed and are experiencing shame for feeding their babies formula.
‘ I want to be a voice that tells every mother that bottle feeding is also beautiful and formula is the best nutrition for the babies who are being nourished by it.’

My story:

February 12, 2014. I was just 1 day postpartum after delivering my firstborn and I remember bawling my eyes out. The nurses at the time were assuring me that I was doing everything “wrong” in regards to feeding my daughter. They woke me out of my sleep at least 7 times in one night to feed my baby and they assured me she was getting enough to eat. One nurse told me to stop crying about breastfeeding pain as it is going to hurt! “If you want to build your supply, you have to keep going!” Never has I felt like more of a failure.

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I Attempted Suicide From The Pressure Of Breast Is Best

When I first wrote this blog post, I was blown away by how many mothers related to my breastfeeding story. So many women reached out to let me know I wasn’t alone, and shared nearly identical stories. Which made me both relieved, and also very sad that this mental health side of breastfeeding isn’t talked about enough. I don’t understand why so many people act like it doesn’t happen and don’t talk about it. We can SAVE lives if we DO talk about it!

I was just as equally shocked to see how many mothers thought that I should have kept breastfeeding anyway, even if it meant resenting my son, and being nothing more than a food source and a shell of a person. My story has been picked apart by many lactivists, from accusing me of being selfish, to thinking I just didn’t have enough support or encouragement. I had more than enough support for breastfeeding, but very little support for switching to formula when I knew it was best for my own mental health, and for my son. I can’t fathom telling a mom she’d better breastfeed or might as well be dead. I’m not against breastfeeding. I successfully breastfed my second baby for almost a year! But I don’t believe in breastfeeding at all costs, especially at the expense of the mother’s health, and that includes her mental health. A mother’s mental and emotional health are just as important as her baby’s health. Not every mom gets that oxytocin-induced happy breastfeeding experience. Sometimes it’s the opposite, and those moms need support and recognition too.

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How Do I tell the Hospital I Don’t Want A Lactation Consultant Visit When I Deliver My Next Baby?

Dear Fed Is Best Foundation,

Thank you for everything that you do! Your organization has made me feel so much better about my situation and personal needs. I did have a question for you though, although I should probably explain my situation first. My daughter is now 14 months old. When I was pregnant with her, I had preeclampsia from about 28 weeks onward. I had to take maternity leave eleven weeks sooner than planned because my job as a full-time middle school substitute teacher was too stressful on my blood pressure. I went to the hospital at 37 weeks with a blood pressure of 177/100, and they decided to induce me. After 45+ hrs of labor, followed by an emergency c-section, Clara was born three weeks early.

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Maternal Mental Health Feels Like it Comes Second to Breastfeeding When It Should Be First

This story is for you mommas whose mental health feels like it comes second to breastfeeding, when it should be first.

I have a long history of mental illnesses in my family. I inherited most of them. While they do not define me, they are a part of me. I have Bipolar 1 Disorder, Generalized Anxiety Disorder, Borderline Personality Disorder and a Panic Disorder.

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The Breastfeeding Support I Received Almost Killed Me And My Daughter; I’m Still Suffering From Breastfeeding Trauma

This is hard for me to write. My breastfeeding experience is a trauma that I don’t like to relive but is undoubtedly the biggest cause of my postnatal depression and anxiety (PNDA). But perhaps I can save someone else unnecessary pain and heartache. I know some will disagree, but hopefully, my story can be a tiny cog in the wheel of feeding guideline reform.

Going into pregnancy, I knew Fed is Best. I decided I would attempt breastfeeding but if it didn’t work out, there’s always formula. Simple. Now, I’m a scientifically minded person. I respect those in the field and the scientific consensus. As I progressed through my antenatal appointments, it became clear. The general consensus is, the breast is best, at all costs, with an inference that ‘formula is dangerous’. By the time my daughter was born, I had made up my mind. If other people formula fed, I wouldn’t judge, but I was going to breastfeed no matter what. I’d get all the help I needed.

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Thank You, Thank You, Thank You From The Bottom Of My Heart

 

I just want to say thank you so much for your foundation’s web page and support group. I can’t say thank you enough! This is exactly the support system I have needed in my life since my daughter was admitted into the hospital at 3 weeks old due to failure to thrive.

This was worst experience of my life as a new mama and when the doctor told me my daughter could have died I was broken.

Because of the intense pressure, I felt the need to exclusively breastfeed my daughter. Yet for the 3 weeks that I tried I had no idea that I was starving my daughter ? My midwife was absolutely useless and she is a the biggest reason why this happened to us as she told me to keep breastfeeding and everything was fine. Long story short, I just didn’t have enough milk, and I didn’t find out until after my daughter was admitted to the hospital. This was the worst feeling in the world.  Formula is the only reason my daughter is alive today.  Formula saved my daughter’s life!

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My Lactation Consultant Slapped My Nipple And Called My Nipple Shield A Cheater

I’d heard pretty much since starting puberty that breast is best. It’s in movies, books, social media, health class, and even in my own family. So, you can imagine my surprise to be sitting across from a very concerned doctor with a starving infant hearing that my breast milk wasn’t enough.

My baby gained only 7 ounces in 1 month.

I wanted to breastfeed because I wanted to do what was absolutely best for my son, no questions asked. But before he was born, the intense pressure to exclusively breast feed was causing anxiety attacks, frequently. I have flat nipples but I was assured breast feeding would be no problem.

Then I had my beautiful baby boy. We immediately had issues with breastfeeding. One lactation consultant slapped my nipple trying to get it to poke out and called the nipple shield a “cheater”. So I didn’t use one after that. We were not allowed to give him a pacifier. It was four days of pure hell in the hospital with both of us crying.

I was told over and over my body would produce enough milk for my baby and to just keep breastfeeding.

We went home and it wasn’t much better. So, every time I held him he’d cry, and then I’d cry because I’d have to feed him. I began dreading my child. No parent should have to dread their child. Continue reading

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I Am Not a Formula Feeding Mom

Writing helps me process my emotions. A few weeks ago, I wrote this, and have debated whether or not to share it, because sharing the things I write makes me feel really vulnerable. But, today I needed to reread it to remind myself that I am not a “formula-feeding mom”, I’m just a loving mother. I decided to go ahead and share it with you guys. I’m hoping that this can maybe help someone else who may need a reminder that motherhood is not defined by how we feed our babies!

Some days I have to remind myself that I am not a failure.

I didn’t fail at breastfeeding. I did not fail at being a mother.

Society and my inner voice may sometimes convince me that I came up short in the infant-feeding part of motherhood, but in the rare moments of clarity, I know that this is not true. I am confident in my decision to exclusively formula-feed my son.

You see, I didn’t start out motherhood with the goal of breastfeeding my son. It wasn’t my plan to exclusively pump. Nor was it my plan to formula-feed my baby. My only plan was to feed him.

 

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