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At-Breast Supplementers

A condensed excerpt from "The Breastfeeding Mother's Guide to Making More Milk" by Diana West and Lisa Marasco (McGraw-Hill, December, 2008)

using an at-breast supplementerThe most important feature of a supplementation device is how it affects the breastfeeding relationship you have with your baby. Preserving the breastfeeding relationship while supplementing depends upon three factors: maximizing milk removal and stimulation of the breasts, minimizing nipple confusion and flow preference, and encouraging your baby to use methods of suckling that most closely approximate feeding at the breast. 

Using the at-breast supplementer is the ideal way to preventing nipple confusion and flow preference and to maximize milk production, but it does pose some challenges. It is not a device that works well for every every mother and baby, particularly when baby is not able to latch well or remove milk effectively. It can take a few days, or even a few weeks, to learn how to use the device well enough to feel comfortable and set-up and cleaning can be time-consuming. The supplementer can leak if not properly assembled.  At-breast supplementers are not as easy to use in public as bottles. It is hard to breastfeed discreetly while using an at-breast supplementer, even if you are wearing nursing clothes.  Nonetheless, at-breast supplementers have saved breastfeeding for many mothers, who have found that these challenges are easily overcome. There is no question that supplementing at breast results in more feeding at the breast, which is the ultimate goal.

The basic elements of a commercially produced at-breast supplementer are a receptacle to contain the supplement and a thin, clear, plastic tube that carries the milk from the receptacle to just past the mother’s nipple. An at-breast supplementer is especially appropriate when milk production is low due to the mother’s internal causes.   It can also be used in situations where the milk production problem is related to infant difficulties if the baby is able to draw enough milk from the device.  Since you may not yet have determined the cause of your baby’s low intake or your low milk production, you will need to watch your baby carefully when you begin using an at-breast supplementer to make sure he is able to latch well enough for it to work.

Lact-AidThere are two commercially manufactured at-breast supplementers available in the US:  the Medela Supplemental Nursing System (SNS) and the Lact-Aid Nursing Trainer System.  At-breast supplementers can also be made using a #3.5 or #5 French gavage tube inserted into a regular bottle and nipple.  This may work very well for temporary supplementation.  However, most mothers who must supplement for longer than a week find it more convenient to use a commercial at-breast supplementer.  Even though commercial at-breast SNSsupplementers can be an added expense, a breastfeeding mother who chooses to supplement using this device can reassure herself that this expense is still far less than the cost of formula-feeding. (In 2005, the estimated average cost of feeding powdered formula for one year was $1,300 US.)

Deciding which brand of at-breast supplementer to use is a personal decision and will depend on several factors, including availability, convenience, product effectiveness, nursing style, personal preference, and cost.  Each of the two brands has advantages and disadvantages.  Some mothers find that they like to have one of each brand to use in different situations.

Pros and Cons of At-Breast Supplementers
Medela SNS

> The container is similar to a bottle and is easy to set up

> Switching sides is easy because there are two tubes that can both be taped in place prior to feeding

> There is less on-going expense because there is no need to buy additional supplies

> The SNS can be cumbersome when trying to manage the baby at the breast.

> The second tube can get in the way and be an enticement to play.

> Because milk flow with the SNS operates is regulated by gravity, the supplement may continue to drip and even pour from the tubes when the baby unexpectedly lets go of the breast, especially if both tubes are open.

> Difficult to nurse discreetly in public
Lact-Aid > The Lact-Aid is less bulky and less noisy, so it is easier to nurse discreetly in public.  

> The bag is softer and more comfortable against mother’s skin.

> The main unit is easier to clean because the bags are disposable.

> Because the Lact-Aid uses a vacuum rather than gravity to regulate the milk flow, babies suck more with the Lact-Aid, which may have a more positive effect on mother’s milk production.


> Because the bags are disposable, there is an on-going expense.

> The device is more difficult to assemble.

> Filled units must be stored and transported upright.


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