Rosie’s low milk supply has meant that she has used an at-breast supplementer since her son was five weeks old. Here she tells us the practical details of how this is working for her and her son.
I have been using an at-breast supplementer system for six months now, and it has made a huge difference to our complicated and initially very difficult breastfeeding journey. Our reason for supplementing is my very low milk supply: we discovered when Wilfrid lost a lot of weight after birth that I have Insufficient Glandular Tissue (IGT), leading to less than a third of a full supply. Happily we were able to persevere with breastfeeding through the difficult days, until now I honestly feel completely happy with our feeding set-up, and a large part of that has been due to our supplementer.
When it was mentioned at our local LLL meeting in Cambridge that I could write something for Breastfeeding Matters, my first thought was to write about the day-to-day reality of using a supplementer, as they are not at all common. All in all, I don’t think it’s more work than combined breast and bottle feeding, but at a potentially stressful time it can feel difficult to start using something so unknown. So here is my guide to how we do it:
There are a variety of scenarios where an at-breast supplementer can be used. Like us, it could be due to a low supply or worries about weight gain, but they can also sometimes be helpful if the baby seems to need a supplement during a period where a mother and baby are working on improving their latch, as an alternative to supplementing with a cup or bottle. In addition, some women who adopt babies or want to re-lactate after stopping breastfeeding, use them.
I was very lucky that practically as soon as we knew there was a problem, I was put in touch with two other mothers with IGT. Speaking to, and emailing, them was a real lifeline. One, Ruth, had started using a supplementer almost immediately, and continued using it and breastfeeding for a long time (the other, Sarah, also managed to keep up combination feeding).
Ruth’s story was published in Breastfeeding Matters issue 198. Just knowing one other person who’d used one helped my confidence in giving it a go.
We tried a homemade system (just some tubing and a bottle) a couple of times early on, but actually this was quite tricky to use. There are two commercially available at-breast supplementer systems. One is the Supplemental Nursing System (SNS) made by Medela, which is a bottle to which you can fit three sizes of tubing. It is available in the UK, so arrives quickly, and is not that expensive.
The second is the American designed Lact-Aid. This consists of bags with a top with just one size of tube, and you clean out the top each time you refill. Both have straps so you can hang them round your neck but early on I discovered it was much easier putting it over my shoulder, as it didn’t then get in the way of positioning the baby. As you have to order the Lact-Aid from America it takes a while to arrive, and is more expensive. When I was trying to decide which to try, I found a couple of reviews online from people who’d tried both and preferred the Lact-Aid. I do think the Lact-Aid is really well designed but I’ve never used an SNS so can’t directly compare the two, and there are probably pros and cons to both systems. Anyway I ordered a Lact-Aid kit, and waited…
We started using the Lact-Aid when Wilf was five weeks old and the biggest surprise for me was that very quickly, using a supplementer actually made feeding easier, not harder. Before, every feed had involved breastfeeding on both sides, then supplementing with a bottle, then at some point before the next feed trying to express in order to increase my supply as much as possible. Once we started using the supplementer the first two became combined, so although I start every breastfeed ‘just with me’, I then put the supplementer on and carry straight on. As a result of Wilfrid breastfeeding for so much longer I found I started getting literally nothing when expressing after his feed (before I would get 5-30ml from both breasts combined), as he was taking as much milk as he could from the breast. So after a few weeks I also dropped the expressing, and feeding suddenly stopped taking 2.5 of every 3 hours of the day and night!
In practical terms, using a supplementer is a matter of positioning the tube so the end is at the end of your nipple, and near the top of your baby’s mouth. Very precise positioning isn’t necessary and you can tell fairly easily if it’s working as you can see the milk flowing through. We don’t warm the bags, and because the milk flows through a thin tube which is next to your skin this warms it a bit: Wilf has never seemed fussed anyway! You need to make sure the baby doesn’t half swallow the tube (this was something which happened with the homemade system and put me off somewhat!) but this can be achieved by taping it onto the breast, which I do with medical tape. I have found I can keep the tape on for quite a number of feeds and it retains enough stickiness to reuse, which also speeds up the process of getting it in place with a hungry baby.
As we have supplemented so far with donated breastmilk (a whole other story in itself!) which has antibacterial properties (as well as being extremely precious) we return bags to the fridge when unfinished, and continue with them at the next feed. The Lact-Aid kit I bought came with two devices, so we always have one full bag in the fridge, plus the one we are currently using. This means we don’t get stuck in the middle of a feed having run out. Once a bag has been emptied, you need to clean out the tubing. We have a three-step process for this, first soapy water then a water/vinegar solution, then boiled water, which we’ve now honed to a six minute routine. The instructions say use distilled water to prevent build up in the tubes, but we’ve found boiled water works perfectly fine. The manufacturers also recommend using a new bag each time, however this is expensive, and after reading online reports of people washing the bags out we decided to try that instead (again we do a thorough three-step process).
At his peak milk consumption Wilf was having six bags worth a day, and I tended not to go out for more than half a day at a stretch as I would need to refill the Lact-Aid, but now he’s on solids that’s dropped to three and it’s very easy to be out for longer periods of time. Some people buy more Lact-Aids so they can have several filled at once and do the cleaning in batches.
With a cool bag to store the Lact-Aids plus freezer packs we can be out for quite a long time, and a whole day if visiting someone’s home with a fridge. Overnight we have a Lact-Aid in a cool bag by the bed. Our most ambitious trips have been holidays, but the challenge there has mainly been transporting lots of frozen milk rather than any difficulty in using the supplementer, you just take all the cleaning stuff and you’re fine. For long journeys we usually take a bottle of milk as well in case Wilf finishes the Lact-Aids, but more often than not we don’t need to use it.
It is a bit more involved than just putting a baby to the breast when out and about, but I’ve never had any rude comments or stares, and I think a lot of the time people don’t notice it at all.
The Lact-Aids are amazingly robust, considering the amount of use they get, and that they are pulled around by a baby daily. However, we did have one disaster when one of them got blocked, and in an attempt to fix it, I broke it permanently. Cue ordering a replacement but having to wait over a week, so we made do with one system, cleaning it several times a day.
The advantages to us of using an at-breast supplementer have been many. It immediately simplified our feeding routine rather than complicating it, it has helped keep my supply as high as it can be, and it has meant we have as ‘normal’ a breastfeeding relationship as possible. I feel I can operate in the same way as if I had a full supply. Although for us using the supplementer has been a long-term undertaking, in other scenarios it could be used for a while and then gradually weaned off. I think it can massively boost the chances of maintaining breastfeeding in difficult circumstances.
My aim in this article was to outline what using a supplementer entails, to remove some of the mystery or potential worries people might have. I don’t think any of it involves more work than supplementing breastfeeding with bottles, although I’m sure it’s not for everyone. I would also say that for me having an extremely supportive mum and partner has played a large role in both starting and continuing using it, as well as the very positive reaction I’ve received from others, especially at LLL meetings.
If you are considering using a supplementer, or have questions about what it’s like to use one, please contact firstname.lastname@example.org and we will arrange contact with Rosie.
An LLL Leader can help you with support and information: find your local Leader here.
Our page on Nursing Supplementers has information you might find useful.
This story was originally published in issue 205 of Breastfeeding Matters (Jan/Feb 2015).
Copyright LLLGB 2016