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Date: | Sun, 23 Aug 2009 09:58:57 -0400 |
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Dear all:
I don't really think that following the baby's pattern of swallowing (including normal
pausing) is really inconsistent with a baby "finishing" on one side. If the baby can't get
more milk out, then the baby really is "finished" with that side. If the baby is not
growing well, then keeping the baby on that breast for longer when the baby isn't
swallowing is not going to help the baby at all. If the baby isn't swallowing, the intake is
zero and it is wasting the baby's energy. So, switching breasts when the baby isn't
swallowing is much better than a rule that may have the baby expending energy to try to
get milk out of a breast when he/she can't do it any longer or taken off the breast when
the baby is still swallowing rhythmically.
If that baby is growing well and generally satisfied and the mother is relaxed and enjoys
breastfeeding, there is no need to rush that baby.
Now, Nikki sent me an article a while back that compared a study looking at two "rule-
based" approaches. It generally was to leave the baby on the breast as long as possible
(with no guidance on how to read swallows or rhythms) and switch breasts after 10
minutes. The article showed better growth in the latter group. It was conducted in a
population that was quick to supplement and quick to wean. These results are not
surprising to me.
So mothers are told to keep the baby on the breast as long as possible (or until they're
done or pop off spontaneously). In a hospital setting babies are more likely to be more
sleepy due to the bright lights, beeping noises and constant interruptions. They will be
more prone to fall asleep on the breast. If they are falling asleep on one breasts,
mothers will be more likely to interpret the advice to mean that the baby has finished and
put the baby back into the plastic box. In the box, the baby may not be stimulated to
wake up and eat as frequently as with skin to skin contact. Thus, there will be fewer
infants that have sufficient contact or stimulation to swallow from both breasts. So, you
probably have a higher proportion of mothers for whom each breast is being drained (not
that Chris Mulford has reset my thinking about this word) every 4-6 hours than every 2-3
hours. Given that the first two weeks after delivery are when more prolactin receptors
are generated, this means that a higher proportion of women are not going to have
stimulated their supply adequately for their babies.
For the mothers who are told to switch breasts at the 10 minute mark, you are going to
end up with more women having had each breast "drained" at each feeding -- every 2-3
hours rather than every 4-6 hours. Some of the infants may have needed more time on
those breasts, but there is some possibility of compensating if they are allowed to eat
more frequently.
In both cases, supplementation is frequent. So you are not dealing with a normal infant
feeding situation. We are having to overcome the superstitions of modern regimentation.
So, it makes sense to me that you get less supplementation with more frequent draining
(but often incomplete) of the breasts than with less frequent draining of the breasts
(which in some cases might end up being as low as 4x/day per breast).
Looking at the baby's cues circumvents both of these rules. Both sets of rules will fail a
fair number of babies in the long term goal of returning to normal feeding of exclusive
breastfeeding to six months and continued breastfeeding for at least two years.
Best, Susan Burger
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