This information is taken from the Australian Breastfeeding Association.

What is a breastfeeding supplementer?

This is a device that allows a baby to receive extra milk at the breast rather than by bottle and teat. Two types are the 'Supplemental Nursing System' (SNS) produced by Medela, which is available in Australia, and the 'Lactaid', which is available from overseas via the Internet. It consists of a container that is worn on a cord around the mother's neck. Fine tubing carries expressed breastmilk or artificial baby milk from the container to the nipple. When the baby sucks at the breast, milk is drawn through the tubing into his mouth, along with any milk from the breast.

When extra milk is needed for medical reasons it is better to give it through a breastfeeding supplementer than by bottle:

• Milk given in this way rewards the baby's efforts at sucking and he is more likely to be happy to feed on the breast and stay there for a longer time.
• Since the amount of milk a mother makes depends on how much her baby sucks and takes milk from her breasts, this extra sucking will increase her milk supply.
• Use of the mother's own expressed breastmilk in the supplementer helps a weak or easily tired baby to get more milk with the same amount of sucking.
• The sucking action required during breastfeeding differs from that used with a bottle. Some babies find it hard to do both or reject the breast in favour of the different bottle.
• The mother is able to provide milk at the breast and this helps with both the hormonal and physical aspects of breastfeeding.

Some issues to consider before using a breastfeeding supplementer

When a breastfeeding supplementer might be useful

A supplementer can be a useful tool for starting and being able to maintain breastfeeding. The baby may be premature or sick and unable to suck well; some mothers have problems due to the shape of their nipples or previous breast surgery. In rare cases, mothers may not have enough milk-making tissue in their breasts to be able to make a full supply of milk for their baby. Babies and their mothers may have had a difficult birth, causing a setback to the start of breastfeeding. Other mothers who may find a breastfeeding supplementer useful include those with a very low supply that they are trying to increase, mothers who have weaned and are trying to relactate, as well as mothers who are building a milk supply for an adopted baby. They might use the supplementer for only a short while or long term. A breastfeeding supplementer allows a mother to fully breastfeed while giving her baby extra milk, which could be her own expressed breastmilk, donor human milk or formula. Breastfeeding supplementers may be fiddly to use at the start but they become easier to use with practice.

When a breastfeeding supplementer is not likely to be useful

Most mothers who have problems getting breastfeeding started will solve them without using a breastfeeding supplementer. Often all some mothers need is information and support. Talking the problem over with someone who understands and supports your wish to breastfeed and who knows a lot about breastfeeding can help you work through any problems. Often they will be able to suggest new ideas to try. Sometimes, you can solve your own problems by learning more about how breastfeeding works. It can help give you confidence if you have the support of your medical adviser, child health nurse, lactation consultant or Australian Breastfeeding Association counsellor.

It is important that the baby is able to suck well at the breast, even if he tires easily, in order for the breastfeeding supplementer to work. A baby with a poor or abnormal suck may not be able to get the milk through the tubing any better than from the breast itself.

An Australian Breastfeeding Association counsellor will be happy to talk things over with you. She will help you look at the problem and will suggest options so that you decide what you want to do about it. Every mother and baby pair is unique. Other people can give you the information you need, but only you can decide what will work in your own family situation.

Here are some ideas that you may like to think about and perhaps discuss with a counsellor, a lactation consultant or your medical adviser:

• Sometimes mothers feel that their milk supply is low when it is really quite normal. An unhappy baby is not always a hungry baby — nor are low weight gains always due to low milk supply.
• If a baby breastfeeds often, looks healthy, alert and active, has plenty of wet nappies (at least 5 disposable or 6–8 cloth nappies in 24 hours), regular soft bowel motions and gains some weight, she is usually getting enough breastmilk.
• If a mother's milk supply is low, frequent feeding over several days (perhaps 10–12 times in 24 hours) will usually increase it. Unless your medical adviser feels that there is an urgent need for your baby to have extra milk, it is worth trying extra breastfeeds for a few days before adding any other milk. Giving extra milk will reduce your baby's hunger and the amount she takes from the breast. This is more likely to cause a decrease in your breastmilk supply than an increase.
• Is your baby facing you and tucked in close while feeding? Is she attached well, not hurting your nipples and can you hear her swallowing milk well? A good feeding position and being able to suck well helps your baby get your milk easily.
• If extra feeds are needed, but only at some feeds or in small amounts, it may be easier to give them from a cup or syringe.

How do I get a breastfeeding supplementer?

A breastfeeding supplementer may be bought online from some breastfeeding retailers. Some hospitals and pharmacies also sell them. Based on the experiences of many mothers, it is best if you have your own support while you are using a breastfeeding supplementer. This can be from an Australian Breastfeeding Association counsellor or a health professional who knows a lot about its use.