How to avoid the ‘top up trap’
Supplementation (additional milk following a breastfeed) is something many mothers turn to, or are advised to turn to, and unfortunately this can severely disrupt breastfeeding. You may decide to start topping up for a number of reasons such as weight loss/slow weight gain concerns, lack of confidence or simply not understanding normal, healthy newborn behaviour such as cluster feeding. Some babies do need supplementation, but some never needed it to start with and a problem has been created when there was nothing wrong in the first place!
If breastfeeding doesn’t get off to a good start and babies lose more than 10% of their birthweight, they can be readmitted to hospital and mothers put on a feeding plan that includes top ups of formula or expressed breastmilk. But this doesn’t help to improve breastfeeding or find the root cause, it often masks the issues without skilled feeding support alongside the top ups.
Once a mother starts topping up after each feed, this can lead her down a slippery slope into the “top up trap”, leaving her feeling trapped in the cycle of supplementation and unsure of how to phase it out. It can also shatter her confidence in her ability to breastfeed and satisfy her baby.
Read on for my top tips on how to move away from topping up and feel more confident in your plan to move away from supplementation.
Protect your milk supply
During this period of topping up, it’s important protect your supply to ensure that, when you bring your baby to the breast and as you increase breastfeeds, you have enough milk to satisfy your baby and keep them at the breast, stimulating your milk production. If a breastfeed is very short or unsuccessful and you end up using a bottle, make sure you also remove milk from your breasts via a pump to maintain you supply – the more milk you remove, the more you make!
Is it a top up or a full feed?
A top up is a small amount of milk, but too often I see babies being given full bottle feeds after a breastfeed which is keeping mum in the top up trap cycle. Ensuring baby has enough milk and is thriving is of course the priority, but if you want to increase breastfeeding then it’s important to ensure you aren’t overfilling baby with formula to the point where they’re uninterested in the breast, don’t want to work for the letdown and are frustrated at the slower flow of milk compared to a bottle.
Use suitable bottles
If you’re bottle feeding when supplementing, some bottle shapes are better than others in terms of supporting the transition between bottle and breast. We need to ensure baby can latch deeply onto the bottle with their lips at the base of the teat. A wide bottle, advertised as “breast like” is simply a marketing tactic and not a recommended shape – these will encourage a shallow latch and not support your breastfeeding journey. I recommend slim teats that gradually slope into the teat base.
Pace your baby’s bottle feeds
The flow of a bottle is much faster than the breast, and babies don’t have to work for the milk like they do at the breast when stimulating your let down. So it’s very important to pace your baby’s feed, slow it down and give them every opportunity to show you that they’ve had enough. Bottle fed babies can be overfed if the feed isn’t paced. Read my article about the importance of paced bottle feeding.
Understand what’s normal and what’s a cause for concern
Babies should feed a minimum of 8 times in a 24 hour period. But that’s the minimum – they often feed much more frequently! They don’t feed to a clock or schedule and it’s important to responsively feed – but it can be a worry if you aren’t familiar with what’s normal.
Cluster feeding, for example, is normal around day 2-3 and is a good thing – your baby is clever and wants to feed very frequently to stimulate your milk production and help your mature milk to come in. Cluster feeding is only a cause for concern when it’s 24/7 with no settled periods, and this would indicate that they’re not feeding effectively. But normal cluster feeding is a common reason why a mother would worry that she isn’t making enough milk for her baby. Seeking feeding support and education can really help to understand normal newborn behaviour and gain confidence in meeting your baby’s needs.
Find the root cause
If you’re topping up each breastfeed, make sure you’re also working alongside a feeding specialist to find out the cause behind why you’re supplementing. Why is baby slow to gain weight/losing weight? Why aren’t they able to transfer enough milk effectively? How can you improve the situation? There is a reason behind supplementation – even if that reason is just a perceived issue and really a lack of confidence in your abilities. Whatever the reason, you deserve to figure it out and get breastfeeding back on track.
Make sure your feeding plan includes the removal of supplementation
A feeding plan focusing on your baby gaining weight may not always support your feeding wishes. So, if you have been put on a feeding plan that doesn’t mention how and when to eventually remove top ups, seek further feeding support from someone who can help you to feed your baby how you want to.
How to avoid the top up trap
Prioritise uninterrupted time with your baby from birth. Early frequent feeds not only helps your milk to come in, but supports your long term milk supply.
Regular skin-to-skin contact stimulates your milk production and encourage your baby’s natural breast-seeking behaviour. Try to do skin-to-skin cuddles several times a day with your breasts out and available. You can use blankets to keep you and baby warm rather than clothing that separates you.
If your baby is struggling to latch, hand express regularly (every 3 hours) to stimulate your milk production and make sure you’re producing enough milk for your baby. You can collect the expressed milk into oral syringes to feed to your baby and, when your milk comes in, you can switch to pumping if needed.
Once your milk has come in, ensure you’re removing milk at least 8 times in a 24 hour period (whether that’s pumping or breastfeeding)
Make sure you are removing milk at night time too. The hormone prolactin ‘s levels are highest at night and this is a crucial hormone in milk production, so removing milk at this time is very helpful for your supply.
Work on optimal positioning and a deep latch to ensure effective milk transfer and, if you need extra support, seek it out swiftly to give yourself the best chance at getting things back on track. Speak to your health visitor or midwife about breastfeeding support within your local community, search for private feeding specialists in your local area or use national helplines and websites such as The Breastfeeding Network, La Leche League and Association of Breastfeeding Mothers.
Book a home visit or a virtual feeding consultation with me if you need help with phasing out top ups and increasing breastfeeding.
