Dear all:

I can understand why the dessert model might operate for some mothers, but the more I think about it, the dessert model sends the wrong message.  

1) It could make it seem as if the second breast is an unnecessary fatty extra for babies.  Physiologically, this is not what the evidence tells us.  When you put a baby on the second breast, you get a fresh flow of initially LOWER FAT milk followed by increasing the fat content.  So, why ARE we calling this the dessert breast.  For mothers who have eating disorders who often have difficulty reading signs of healthy gain in their infants, this could make it more challenging. They might decide not to give that "dessert" to their babies in an effort to keep them trim.  The most challenging cases of underfed babies have been with mothers who have eating disorders and cannot see that they are limiting their babies intake in ways that are unhealthy.

2) It could make it seem that the baby doesn't really get that much extra calories so its OPTIONAL.  Again, clinically, it is not what my evidence tells me.  I have to say that about 80% of the babies I see take what would be considered much more than a top up on the second breast.  I'd say about 50% take almost as much volume from the second breast as the first.  As Cathy Genna pointed out with many references, the growth rate of babies is actually due to VOLUME and not the FAT content.  

Here, Nikki sent me a study a while back where they trained health care practitioners to trade one rigid message for a different message.  The second message was to switch sides at the 10 minute mark or maybe it was the 15 minute mark. Their was a better success record with the advice to switch breasts with the second approach.  This was in a population that did not breastfeed normally in either exclusivity or duration.  It was a culture that used rules.  So, in a rule based culture, this did not achieve normal breastfeeding, it achieved more breastfeeding.  

I have to say, that working in just such a culture, I see a HUGE number of women with iatrogenically induced low supply because someone told them that their baby would suffer from foremilk hindmilk imbalance.  I see a HUGE number of women with 3 month olds complaining that they really do NOT want to sleep train, but their baby is waking up every 90 minutes hungry because someone told them that their baby would suffer from foremilk hindmilk imbalance.  In fact, it is almost as many as I see from a pediatrician who tells women to put their 8 week olds to bed for 12 hours in a separate room and shut the door and don't go in  - and that 4 feeds in 24 hours is enough.  The cure is simple, but sometimes comes too late -- to simply offer the second breast again.  When that second breast enters the picture, the mom feels like it is a miracle cure.  When her supply has been too compromised it is a miserable drag to have to rebuild it with a pump when her three month old just gives up trying. 

3) Saying the second breast is dessert doesn't really give mothers the information they need to tell whether their baby is the baby that guzzles down a lot in 10 minutes and is done on one breast versus the baby that leisurely take 25 minutes on each breast.  

It doesn't help the mother understand the difference between rhythmic swallowing, sucking from lethargy arising from inadequate caloric intake, and sucking for comfort when full.  It doesn't help the mother understand that by interacting with her baby, trying different things and observing how her baby responds, that she will LEARN what works for HER baby.  I doesn't help the mother understand that there are three different things going on:  a) what her baby brings to the situation, b) what she brings to the situation, and c) the interaction between the two of them.  When we say "baby-led"  or others say "mother-led" --- neither of these sayings really takes into account the fact that those terms are woefully incomplete.  It is the INTERACTION between the mother and baby that we should be fostering so that they learn to understand each other and develop communication in ways that work for them.

Saying it is dessert is just another made up rule.  And given that there is a childhood obesity epidemic, I would never label breast milk with a term that could be interpreted as contributing to childhood obesity.

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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