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At-Breast Supplementer Nursing Mothers' Stories
Updated March 2016
Charlotte Yonge, Paris, France


It is important to know that if a baby gets supplements with an artificial nipple, there is a high risk that he will end up being bottle-fed and will miss out on the benefits that a nursing child has, both emotional and physical.

At-breast supplementer nursing: breastfeeding for everyone

I am a mother of two children (aged eight and three) whom I breastfed. Before the birth of my first child I asked the midwife if the fact I had had breast reduction surgery would affect my breastfeeding. Her answer was very clear, “Not at all. One breast per feed, ten minutes, no more, every two to three hours, and let him really cry before you give him the breast, to make sure he’s really hungry.” I tried very hard to follow her instructions. I considered myself very generous in letting my baby suckle for up to half an hour, and every one and a half to two hours.

But by day four my baby was on bottles. Half the staff accused me of being weak, the other half of sabotaging my breastfeeding. For the first eight weeks of my baby’s life I was torn between knowing I shouldn’t be giving bottles and seeing my baby hungry, nervous, crying, and not sleeping.

Then I went to my first La Leche League meeting. I was suffering from postpartum depression, but at last I heard something that made sense. I could breastfeed, of course, but perhaps I wouldn’t be able to provide 100% of my baby’s needs in breast milk because I’d had breast surgeryBreastfeeding after breast reduction surgery is certainly possible. With advances in surgical techniques for breast reductions, surgeons are increasingly able to preserve milk-producing tissue so that women who have had breast reductions are able to produce significant amounts of milk. The techniques that have resulted in the most milk production are those in which the nipple was not completely severed, even though it may have been moved.

I might need to supplement, but my baby would get a lot more of my milk if I used a Supplemental Nursing System™ (SNS), an at-breast supplementer. (An at-breast supplementer has a bottle or bag of milk that hangs around your neck and a tiny tube that you tape to your breast. You latch the baby on to both the breast and the tube at the same time, so he is sucking on the breast but also gets milk from the bottle. It keeps the baby in control of how much he takes, and keeps the milk supply stimulated.)

Supplementing my milk was necessary to get my baby back on his weight curve. So for the first time since his birth, I supplemented with no holding back. My baby drank up to 700 ml of artificial milk per day until he reached a normal weight. I pumped, as advised, with a good pump, but only ever obtained 10 to 20 ml maximum, from both breasts, after 20 to 40 minutes of pumping. Facing such a harvest was very depressing. So I eventually sent the pump back.

As time went by, my baby needed less supplement (about 300 to 500 ml of supplement per day). I was resigned to supplementing—not exactly what I’d envisioned before birth, but at least I was breastfeeding. When my baby was six months old and had started solid foods, he suddenly refused the artificial milk supplements.

His consumption of artificial milk supplements had gone down with the introduction of solid foods to about 50 to 100 ml total per day. I was terrified that my baby would starve. I weighed him once a week in a panic but after two months of refusing my occasional attempts to give him milk supplements, I had to admit, that my baby was still gaining weight properly, with solid foods and my milk!

The World Health Organization’s infant-feeding recommendation in the Global Strategy on Infant and Young Child Feeding states:

“As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.”

My at-breast supplemented baby was able to go on to breastfeed beyond the World Health Organization’s recommended minimum.

In 2003 I accredited as an LLL Leader and I became the reference for LLL France for mothers who wanted to know about breastfeeding after surgery. Despite investing hours talking to mothers and recommending books, the mothers I talked to were not pursuing breastfeeding after surgery. They were abandoning breastfeeding because they “couldn’t produce enough milk.” Why did I succeed and they didn’t? Most of these mothers didn’t dare go to LLL meetings because they said that they felt that they didn’t qualify as breastfeeders if they were using an at-breast supplementer.


Courtesy Diana West

So I wrote a 50-page illustrated document, in French, based on my interpretation of the book Defining Your Own Success: Breastfeeding After Reduction Surgery by Diana West and she gave me permission to circulate it. By this time more and more women were not accepting, “No, you can’t breastfeed” as an answer and were using an SNS, but they were still not comfortable attending breastfeeding support group meetings, which were full of mothers who “had no problems.”

I created an email mother-to-mother support list called “Allaitement Pour Tous” (Breastfeeding for Everyone) for SNS and Lact-Aid® users, regardless of the mothers’ reasons for using these aids. (The Lact-Aid, invented by the husband of a US LLL Leader who breastfed all her adopted children, is the original at-breast supplementer and, in my opinion, the best one.) In this safe virtual environment, mothers who cannot breastfeed exclusively find information and support. Some of the mothers have had poor breastfeeding management—their babies cannot breastfeed well because they have a high palate or are tongue-tied, and their mothers pump and supplement with their own milk using an SNS or Lact-Aid.

Most of the mothers, however, have had breast surgery, thyroid problems, or they have adopted their babies and are inducing lactation, and their babies receive formula supplements, at least for the first six months. These mothers can, however, breastfeed for up to two years and beyond.

Mothers'Stories_NursingWithAnAtBreastSupplementer_LLL-mothersMothers who use an at-breast supplementer don’t always feel at ease in “gadget-free” breastfeeding meetings. They often just don’t go to LLL meetings. Or they go, but don’t stay long, because they don’t want to give formula supplements with other mothers around. These mothers feel isolated and need a safe environment where they will not be encouraged to reduce the amount of supplements—be it real mother’s milk or the artificial stuff—in the hope that their babies will magically become efficient feeders. These women need a competent diagnosis of their babies’ sucking problem or of their own problem; alternatively, they simply need encouragement to continue breastfeeding, whatever percentage of artificial milk they are using. There is always a breastfeeding solution for a breastfeeding problem.

A baby may need supplements (given at the breast) for as long as eight months (not often longer) but by around the middle of the first year a baby can be given high calorie, iron-rich solid foods in increasing quantities, until the calories provided by the milk supplements are replaced by the solid food calories. Dr. Jack Newman and Dr. Carlos González recommend very little fruit and vegetables, which are, according to Dr. González, just “green water.”

It is important to know that if a baby gets supplements with an artificial nipple, there is a high risk that he will end up being bottle-fed and will miss out on the benefits that a nursing child has, both emotional and physical.

Allaitement Pour Tous does not support mothers who human-milk feed (mothers who pump their milk and give it by bottle). As admirable as their efforts are, we only support mothers who want to or who can maintain an at-breast relationship with their children. LLLI has an excellent support list that supports mothers who human-milk feed. Visit the forums at .


Lynn Adams

On our support list, we have many mothers who are experienced at using an at-breast supplementer, LLL Leaders and IBCLCs who are learning about the particular support that our 100% at-breast fed babies need. Almost none of us can exclusively human-milk feed our babies, but we can all breastfeed for at least two years and beyond.

One mother supported by Allaitement Pour Tous has gone on to accredit as an LLL Leader. I would like to see Breastfeeding for Everyone support lists all over the world, in every language. Breastfeeding while supplementing at the breast should be seen as heroic instead of “not worth it” as it so often is declared to be by health professionals and isolated mothers with no idea of what is at stake. 

I have created a website for Allaitement Pour Tous, filled with mothers’ testimonies, and useful information. Please feel free to start your own “breastfeeding for everyone” mother-to-mother email list and or association in your country, wherever you feel mothers may abandon breastfeeding because they can’t ensure the first six months of exclusive breastfeeding. Involve experienced mothers, LLL Leaders, and IBCLCs. Mothers who supplement at the breast need special, experienced support in a protected environment.

Breastfeeding our babies is important and the benefits of “extended” breastfeeding are just as precious to our babies as to those who have benefited from six months exclusively on mother’s milk, if not even more so.

Mothers who supplement at the breast need special, experienced support in a protected environment.



At-breast Supplementing

Breastfeeding After Reduction

Evolution of a Breastfeeding Mother

West, D. Defining Your Own Success: Breastfeeding After Reduction Surgery LLLI, 2001.


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