A Supplemental Nursing System Saved My Breastfeeding Relationship

by Sarena Jonah
Petri Oeschger/Getty

I am a combination feeding mama, meaning I feed my baby a combination of breastmilk from the chest and formula from a bottle. Due to damaged milk ducts from two previous breast surgeries, exclusively breastfeeding is not something my body is physically capable of.

My second son, McCoy, was born in November 2020. McCoy was on my breast almost immediately and as with my first, it felt like he was a permanent fixture there. Everything was looking promising: his latch was great (unlike my first’s), and I was armed with breastfeeding experience and more knowledge this time around. I felt hopeful that maybe the removal of my breast implants would help increase the chances of a successful breastfeeding journey, but on our second night in the hospital things took a familiar turn: McCoy was losing weight, purple crying angrily at the breast, and not sleeping longer than a few minutes at a time.

By our third day in the hospital, McCoy had lost a total of 11.4% of his birth weight despite having him on the breast constantly. I was instructed to feed, top up with formula or breastmilk, and then pump in order to bring my milk in. The public health nurse visits began a few days after we were home from the hospital, and as with my oldest son, McCoy was continuing to lose weight despite every best effort to keep him at the breast as often and effectively as possible while topping up with an appropriate amount and pumping.

Courtesy of Sarena Jonah

When McCoy was five days old, I mentioned to our public health nurse/IBCLC that I was barely getting any milk while pumping – a couple of drops here and there – and that I felt like my body responds better to breastfeeding than to the pump. She gave me the option of trying a supplemental nursing system (SNS), which involves placing a tiny tube inside of your child’s mouth while they are breastfeeding, and holding a small cup of formula or breastmilk that the tube sucks up with your child’s suckling at the breast. After having been down the road of breastfeeding, topping up, then pumping with my first son, I was willing to try any other alternative as pumping wasn’t something I was wanting to do again.

The placing of the tube into McCoy’s mouth was tedious and not something that could be done without an extra set of hands, but I loved the idea of McCoy getting his formula topped up while breastfeeding so there couldn’t be a chance of nipple confusion or favoring the bottle over the breast. Plus, baby suckling at the breast is the best way to bring your milk in, so the SNS does two jobs at once while saving you from having to pump afterwards. With a busy preschooler at home, I was hoping to spare any extra time that I could.

Courtesy of Sarena Jonah

I learned that Medela makes a supplemental nursing system that you are able to wear around your neck so it is somewhat hands free. The supplemental breastmilk or formula goes into a bottle-like device that you clip onto a necklace and it sits in the middle of your chest. From there you tape the feeding tubes to your breasts, and gently place the end of the tube so it is aligned with the end of your nipple for ease of baby latching on both at the same time. I was able to find a secondhand SNS from someone who used it for an entire year, after having supply issues to a prior breast surgery herself. I was pleasantly surprised at how easy it was to figure out, though it did take a lot of practice and patience at getting the feeding tube placement just right.

At about ten days postpartum, it was apparent that I needed more help in increasing my supply if I had a chance at keeping McCoy on the breast. I began taking domperidone and continued using the SNS for every single one of McCoy’s feedings. His top-up amount was increased so he could gain weight. It took about two weeks for the effects of the domperidone to start. By then, McCoy had started to gain weight steadily and was a champion on the breast.

Courtesy of Sarena Jonah

Through my time with the IBCLC, I learned that some of my milk ducts were likely cut and damaged as a result of my most recent breast surgery. The damaged milk ducts as well as reduced nipple sensation are most likely the reasons my body can’t produce all of the milk requirements for my children. Providing at least some of their milk, as well as breastfeeding in general, is important to me. At our last appointment, the IBCLC told me she believes my giving the SNS a chance was the reason I was able to salvage breastfeeding. In doing so, I created a feeding system that is not only sustainable but also enjoyable.

Today, at five months old, McCoy is breastfed first then topped up with a bottle (the amount he drinks from the bottle is dependent on his milk intake during his feed and varies). This is a system that works well for us. Many people have told me they would never want to try the SNS for a variety of reasons, and that is great too! However, I do think there is a lack of information about supplemental nursing systems. I think many people are still under the assumption that feeding tubes are only for people who need help eating or otherwise cannot eat without a tube. The SNS encourages milk production, promotes a better latch, and enables parents to breastfeed when they otherwise couldn’t. At the end of the day, we must make choices that resonate with our values, beliefs, and fit into our lifestyles as well. Thanks to the SNS, I was able to reduce the overall amount of time spent on feeding, completely eliminated the need to pump, and created a positive breastfeeding relationship that I am proud of.