When does it help to use a supplementer (also known as a supplemental nursing system)?
What is a supplementer - also known as a supply line, or supplemental nursing system (SNS)?
A supplementer is a plastic bottle which has a flattened shape so that it can hang snug against your upper chest or sternum, suspended from a cord around your neck.
The bottle has a valve for letting air in one way as the milk levels drop, and a fine soft plastic tube (or two, one for each breast) attached to it, from which baby sucks.
Baby sucks on the soft tube at the same time as she sucks from the nipple and breast. The tube is taped to your breast so that it extends a few millimetres beyond your nipple. This is because we expect the nipple to length and expand when baby is suckling, and we aim to have the tube rest during suckling at about the level of the face of your nipple. Unfortunately, we really don't know how much your nipple will lengthen during suckling and so we are guessing. The best thing is for you to experiment. You might be instructed to tape the tube so it even extends one centimetre beyond the face of your nipple, but for many babies that amount of tubing will touch on the soft palate and interfere with a deep and stable face-breast bury.
You can alter the rate of the flow through the plastic tubing by adjusting the height at which you hang the bottle from your neck. The higher you hang the bottle above the level of the tube opening, the higher the flow.
Supply lines are often recommended unnecessarily and might actually worsen your milk production
The supply line has become another commonly used compensation for our health system blind spots in breastfeeding support. You can find out about these blind spots here.
There's no right or wrong of course - you can always experiment with a supply line if you'd like to.
However, here are things to consider.
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The supply line aims to increase the amount of milk your baby takes in with sucking. This means that your baby will need to suckle less over a 24-hour period to transfer the same amount of milk. Less suckling results in
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Less stimulation of your nipple and breast
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Less removal of milk directly from your breast
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This is a recipe, of course, for less breast milk production! But maybe things are already so difficult, this is a compromise you are willing to make.
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The supply line is often recommended because your breastfeeding support professional believes that your baby has innate or learned oromotor suck dysfunctions, and is unable to remove milk effectively from your breast. However, Possums Breastfeeding & Lactation aims to show you how (unless your baby is premature or has a diagnosed with a true medical condition) the way the muscles of your baby's mouth, jaw, and tongue function depend upon the context in which they are activating.
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Your baby doesn't have a hardwired or fixed neural dysfunction which needs to be trained differently. Your baby needs to be fitted into your body in a way that achieves good positional stability, and then your baby's mouth, jaw, and tongue will inevitably respond with optimal function, due to the evolutionary power of your baby's reflex responses.
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A baby who lacks an appetite drive (for instance, due to satiation from copious formula or expressed breast milk use) will enjoy drowsing at the breast and not necessarily transfer a great deal of milk. This is not due to suck dysfunction, but is again due to the context.
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The supply line is often recommended because your baby has a conditioned dialling up at the breast, which isn't identified by your breastfeeding support professional. Instead, you might hear that your baby has innate or learned oromotor suck dysfunctions, or is dialling up because he isn't getting enough milk flow. You can find common misunderstandings about your baby and letdowns here.
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Supply line use doesn't deal with underlying problems or repair a conditioned dialling up, and may worsen a conditioned dialling up in some babies who don't like the sensation of the tubing in their mouth.
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Supply line use perpetuates the concept of 'meal-time', which suggests that it's your job to fill your baby up. However, both babies and a woman's milk supply do best with frequent, flexible breastfeeds. The concept of breastfeeds as 'meal-times' can worsen breastfeeding problems. You can find out about frequent flexible breastfeeds here.
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Other ways in which a supply line can worsen breastfeeding problems
Although the tubing is soft, repeated friction with the tube whilst the baby is sucking worsens nipple pain and damage for some women. The nipple expands during breastfeeding, and moves in the mouth towards the junction of the hard and soft palate when baby's jaw drops, sliding back a little as the jaw comes up. This constant slight expanding and movement of the nipple causes repetitive rubbing of the nipple epidermis with the tube for some, no matter how carefully the tubing is taped.
The supply line does not address, and can worsen
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Baby's fussing at the breast
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Conditioned dialling up at the breast
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Positional instability at the breast
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The need for frequent flexible breastfeeds to stimulate or maintain your breast milk supply.
There are some situations where a supplementer might help with breastfeeding
A supplementer may have a compensatory role if you have
- Insufficient glandular tissue
or if you have a baby who is
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Adopted
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Born prematurely
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Jaundiced
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Medically ill with a genuinely weak suck.
Even so, there's no reason to think that the supplementer will improve breastfeeding outcomes, for the reasons we've discussed above. Often, the instructions that come with the supplementer's use perpetuate misunderstandings about how to bring babies on to the breast, and about how babies suck. This makes it less likely that the baby will return to direct breastfeeding without the supplementer, down the track.
Many women find the supplementer very frustrating to use. These women choose to make their breastfeeding experience as positionally stable, easy, and enjoyable as possible - and then supplement as necessary using a bottle. It helps to know that the research shows bottle use doesn't result in dysfunctional neuromotor suck patterns.