Breastfeeding with a low supply or poor milk removal ability

Sometimes breasfeeding doesn't work out the way you dreamed it would.

But it doesn't have to be ALL or NOTHING.

Triple feeding can help sort out why your baby doesn't gain weight.

Perhaps you have a low milk supply for some reason.
Perhaps there's an issue with the latch and milk removal.
Perhaps it's both.

Triple feeding will hopefully improve milk supply, and at the same time, promote weight gain and the strength to nurse better.

It's an exhausting situation, so it is discouraging when your hard work does not solve these problems.

Breastfeeding does not have to be all or nothing.
A long-term feeding plan can be established, in which you focus on doing the things that work well, and limit the time spent struggling with things that don't work well.

Sustainable Feeding Plans

1. Supply is good. Milk removal is good.

The best case scenario is that your baby removes milk well and thus stimulates an ongoing good milk supply.

Nurse regularly when you're with your baby.
When apart, you pump and someone else feeds your baby expressed breastmilk.

2. Supply is good. Milk removal is poor.

In this case, you've learned that the pump removes milk and stimulates the milk supply better than your baby.

Nurse for fun and don't stress about milk removal. Spend time skin to skin.
Feed regular bottles of pumped breastmilk.
Pump regularly. You'll need to figure out how many times to pump each day to maintain an optimal milk supply (usually 7-8).

3. Supply is poor. Milk removal is good.

Nurse regularly when you're with your baby, because you've learned your baby removes milk well. He will thus empty your breasts to stimulate an ongoing milk supply.
Consider using a supplemental nursing system while your baby is at your breast.
Feed regular bottles of formula, plus any available pumped breastmilk.
Pump occasionally as desired, but don't stress about it.

In this case, your baby can still get some breastmilk and you can experience breastfeeding for as long as desired. Understand that if your baby leaves milk behind that you don't then pump out, your supply will decrease over time.

4. Supply is poor. Milk removal is poor.

Nurse for fun as desired, to experience breastfeeding if you'd like to. Don't stress about it.
Feed regular bottles of formula, since there isn't enough breastmilk.
Pump occasionally as desired, but don't stress about it. Feed this milk to your baby.

Kay Anderson, MD, IBCLC
5/23

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