Do most women both breastfeed and pump, and how often is triple feeding, which involves breastfeeding, pumping, and feeding expressed milk, necessary?

Breastfeeding and Pumping Practices Among Mothers

Most women do both breastfeed and pump, with approximately 98% of breastfeeding mothers intending to use a breast pump, though "triple feeding" (breastfeeding, pumping, and bottle feeding expressed milk) is not a standard practice for most mothers and is typically only needed in specific clinical situations. 1

Prevalence of Pumping Among Breastfeeding Mothers

Breast milk expression through pumping has become extremely common among breastfeeding mothers in the United States, representing what researchers have called a "quiet revolution" in infant feeding practices 2. Research shows that:

• 98% of women who intend to breastfeed for at least 6 months plan to use a breast pump at some point 1
• Most mothers (69%) intend to start pumping within weeks of delivery 1
• 29% of mothers start pumping while still in the hospital or intend to start within days of delivery 1
• First-time mothers are more likely to start pumping earlier than experienced mothers 1

Triple Feeding: When and Why It Occurs

Triple feeding (breastfeeding, pumping, and bottle feeding expressed milk) is not a standard practice for most breastfeeding mothers but rather a specific feeding strategy used in certain clinical situations:

• Triple feeding is typically recommended temporarily when there are concerns about:
  • Insufficient milk transfer during breastfeeding
  • Poor infant weight gain
  • Latch difficulties
  • Establishing or increasing milk supply

While specific statistics on the prevalence of triple feeding are not provided in the available evidence, it appears to be a targeted intervention rather than a routine practice for most breastfeeding mothers.

Reasons Mothers Pump Breast Milk

The most common reasons mothers express milk include:

1. Maintaining or increasing milk supply - This is the primary reason reported by mothers across studies 1
2. Overcoming latch difficulties - Particularly among mothers who start pumping in the hospital 1
3. Return to work - Pumping enables continued breast milk feeding after returning to employment 3
4. Sharing feeding responsibilities - Allowing other caregivers to feed the baby 4
5. Flexibility and convenience - Managing feeding schedules and social situations

Workplace Considerations and Challenges

For working mothers, combining employment and breastfeeding presents specific challenges:

• Return to work is associated with decreased breastfeeding intensity and duration 3

• Most effective strategies for maintaining breastfeeding while working (in order of effectiveness) 3:

  1. Direct breastfeeding during the workday (on-site childcare, telecommuting)
  2. Combination of pumping and direct feeding
  3. Pumping only
  4. Neither pumping nor breastfeeding during work hours (least effective)

• Workplace stigma remains a significant barrier for many mothers who need to pump at work 5

Best Practices for Initiating Pumping

The American Academy of Pediatrics and other guidelines recommend:

• Establishing direct breastfeeding before introducing pumping, typically around 3-4 weeks postpartum 6
• Frequent feeding on demand (8-10 times in 24 hours) to establish milk supply 6
• Earlier pumping may be necessary for preterm or very low birth weight infants 6

Clinical Implications

Healthcare providers should be aware that:

• Many mothers start pumping very early, often while still in the hospital
• This early pumping may indicate concerns about milk supply that require additional lactation support 1
• Triple feeding, while sometimes necessary, is time-intensive and potentially unsustainable long-term
• Workplace accommodations that allow direct breastfeeding (such as on-site childcare) are most effective for maintaining breastfeeding duration 3

For mothers who need to triple feed, clear guidance on when and how to transition away from this intensive regimen is essential to prevent maternal exhaustion and premature weaning.