There are different types of supplemental nursing systems. Each works differently and can be used in various circumstances. They provide a great alternative to bottles or other feeding devices if you want to feed your baby directly at the breast. There are many benefits for both parent and baby, but each system has some challenges to keep in mind. Many situations can arise when a supplemental nursing system is a helpful tool during your breastfeeding journey. 

• Premature birth - When babies are born prematurely, they may not have the strength or muscle coordination to sustain latching deeply at the breast and efficiently nurse. They may tire very quickly while breastfeeding. Using a supplemeter at the mother’s chest gives the baby the nutrition and calories they need while offering a little support so they do not have to work as hard or tire as quickly. Allowing the baby to be fed directly at the breast helps develop the muscles needed for breastfeeding, allows the mother and baby to be skin-to-skin, and deepen their bond.
• Induced lactation - People adopting their baby can have a breastfeeding relationship, too. Inducing lactation is a process that usually starts a couple of months before the baby arrives and continues after the baby arrives. Once the baby arrives, a supplemental nursing system can allow the non-gestational parent to begin breastfeeding with the baby latched on at the breast. It can help increase milk supply from the baby’s sucking during breastfeeding. (1) Not all people who induce lactation are able to establish a full milk supply. Using a supplemental system at the chest does not interfere with still having a breastfeeding relationship with the baby.
• Re-lactation - There are many instances in which a parent stops nursing and then decides they would like to initiate breastfeeding again. Using the supplemental nursing system helps provide the baby with the milk they need in the supplementer. Because the feeding is at the breast, they also stimulate the mother’s milk supply. Additional pumping may be necessary as you and your IBCLC decide, but stimulation by the baby is often more effective than a pump alone for increasing milk supply.
• Co-nursing - A supplemental nursing system allows the non-birthing parent to induce lactation or use expressed milk or formula to have a direct feeding relationship with their baby and share the feeding responsibility. (1)
• Latching difficulties - Supplemental nursing systems can be helpful if your baby can latch but cannot effectively get enough milk out themself. Short-term use of a supplemental nursing system at the breast allows you time to get to the root of the issues causing difficulties and still have your baby being fed at the breast. They receive your milk through the supplementer and can simultaneously work on their breastfeeding skills.  Babies with oral restrictions or other oral function challenges tend to do better at the breast when there is good milk flow. They may not be able to create that flow themselves, and the supplemental nursing system can offer the flow they need, which encourages them to suck and become stronger at feeding. As they become more efficient at feeding, the supplementer can be relied on less and less.
• Low milk supply - Chronic low milk supply happens for different reasons, but it doesn't mean you can’t have a breastfeeding relationship with your child. Breastfeeding is a way to offer comfort to your baby and enhance the parent-child bond. Breastfeeding plays a significant role in oral development. Breast tissue fills the oral cavity and is pressed up against the roof of the mouth, widening the palate and drawing it away from the nasal cavity. The jaw movements during breastfeeding encourage the lower jaw to grow forward as intended. During breastfeeding, the tongue moves in a wave-like motion, unlike bottle feeding, where the tongue's action is a thrusting forward and back motion. (2) This can later interfere with proper swallowing. Using a supplemeter at the breast affords your baby all the amazing benefits of breastfeeding, even if you use donor milk or formula to add to your own milk supply.

• Medela Supplemental Nursing System has a firm, BPA-free plastic container for holding milk. The bottle is connected to two tubes, which are placed on the breast near the nipple. This system uses gravity. The bottle can also be squeezed gently to encourage the milk to flow through the tube. It is less expensive than the Lact-aid system and more cost-effective for short-term use. One advantage of it is the bottle is washed and reused each time. It can be bulky, cumbersome, and not very discreet to use. Medela’s SNS is less expensive than the Lact-aid system. It is helpful when the baby does not have as strong of a suck. 
• Lact-aid was developed by a husband and wife team who wanted to be able to breastfeed their adopted children. This system is often preferred for long-term use over the Medela SNS. The holding vessel is a BPA-free bag that is flexible. A short tube is inserted in the bag and attached with a specially designed connector ring with the feeding tube coming out the top end. It is a more expensive system but is easier to use and is very discreet to wear. It does require ongoing purchases of new bags. The system requires the baby to suck to get milk out, as it is not gravity driven.
• Syringe supplementer is a nice option when feeding small amounts of colostrum for a few days. They are less convenient when the baby needs a larger volume of milk since the syringe doesn’t hold larger amounts. A syringe allows the parent to press the plunger and control the flow or use the system as a finger feeder.
• Homemade systems can be made by snipping the hole in the top of a bottle a little wider and inserting a thin feeding tube into the bottle and the other end on your breast. When the bottle is placed above chest height, the milk will flow more from gravity, but it still requires the baby to suck to get milk.

• It stimulates the parent’s milk supply
• Being able to bond with your baby
• Allows for more skin-to-skin contact
• Enable the baby and parent to learn to breastfeed by breastfeeding
• Your baby gets milk from you even while supplementing
• The parent gets the whole experience of breastfeeding
• The baby learns they are comforted at the breast
• The baby gets the benefits of muscle and oral development from breastfeeding

• Takes practice and time to learn
• Can leak sometimes
• Doesn’t work for all babies
• Tubing can be tricky to clean

All supplemental nursing systems have a learning curve to use, but they offer many benefits for sustaining a breastfeeding relationship. Many people find a supplemental nursing system well worth the investment of time and practice to experience all the joys of nursing their baby. Working with an IBCLC and experimenting yourself will help you become comfortable using a system that works well for you and your baby, whether you are using it for a short period of time or the entirety of your nursing journey.

Supplemental nursing systems provide a valuable and beneficial alternative to traditional feeding devices, allowing you to nourish and bond with your baby directly at the breast. While there may be challenges to overcome, the rewards are immense, including stimulating your milk supply, enhancing skin-to-skin contact, and fostering the baby's oral and muscle development. With patience, guidance from an IBCLC, and experimenting, you can find a supplemental nursing system that works best for you and your baby, enabling you to experience all the joys and fulfillment of breastfeeding.

1. https://www.llli.org/breastfeeding-without-giving-birth-2/
2. https://www.brianpalmerdds.com/bfing_import.htm

https://anyflip.com/arvz/nueh/basic

https://happyhumanpacifier.com/which-supplemental-nursing-system

https://www.lact-aid.com/additional-trainers/

https://adoption.com/which-nursing-supplementer-should-i-use

https://www.canadianbreastfeedingfoundation.org/basics/lactation_aid.shtml

https://ibconline.ca/information-sheets/lactation-aid/

https://breastfeeding.support/supplementing-at-the-breast/