> This is an email I sent to the perinatal complex staff at the busy Level
> III hospital where I am one of the LCs.  Feel free to re-use!
> Martha Johnson RN IBCLC
> Eugene OR
>
>
>
> Hello All,
> It happens fairly frequently that I am in the position of telling new
> parents something different on this topic than what they have heard from
> other staff.  The scoop on time limits at breast (for the healthy term
> baby): THERE ARE NONE!
> *     If you are telling parents to feed the baby on a schedule of every X
> hours, your information needs updating.
> *     If you are telling moms to feed the baby for X minutes on each side,
> your information needs updating.
> *     If you are telling moms that feeding a baby longer than X minutes
> will cause sore nipples, your information needs updating.
> *     All of the above information could lead to low milk supply, poor
> weight gain, and failure to thrive.
>
> Here is the update:
> Frequent feedings in the early days are common, normal, and a GOOD THING.
> Frequent means as often as the baby shows feeding cues; this could be
> every hour.  Frequent feedings during the first 1-3 days help bring the
> milk in sooner, prevent pathological engorgement, and are NOT a cause of
> sore nipples.  I tell parents, "Your baby has no idea what time is.  His
> clock is right here." (while pointing to the tummy).  I do tell them to
> wake the baby up and offer the breast if baby has slept for 3 hours since
> the last feeding; and if he has fed for less than 10 minutes, to wake him
> up and keep feeding.  But generally, they should be watching the baby more
> than the clock.
>
> Why not limit the duration of feedings?  Time limitation for feedings
> lowers not only the quantity of milk (supply), but the quality as well
> (lower fat content).  Research shows that if breast emptying is inadequate
> in the early days, milk supply may always be less than normal.  These time
> limits are probably why low milk supply is such a big concern in our
> clock-obsessed culture.
>
> How about using both breasts at every feeding?  Not necessary, and may
> even be harmful.  Research has found that babies release the breast when
> they reach satiety, which is determined by the fat content of the feeding.
> The foremilk that comes out in the first part of every feeding is more
> watery, like skim milk.  The richer hindmilk does not come until later in
> the feeding.  So if mom is switching breasts according to the clock, the
> baby might be filling up on "skim".  I tell moms to let the baby feed on
> the first side until he releases the breast on his own.  Then sit him up
> for a burp, and if he still has feeding cues, give him the other side.  If
> not, start with the unused side next time.
>
> Sore nipples are caused by incorrect latch, not by longer feedings.  A
> baby who is latching on right can feed for hours without causing nipple
> pain or trauma.  A baby who is latching poorly will not only cause
> pain/trauma, but often will not get enough milk, because he is munching on
> the nipple instead of milking the breast.
>
> Thanks for your time with this update,
>  and Happy New Year from--
> Martha Johnson RN IBCLC
> SHMC Lactation Services

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