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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 30 Mar 2008 10:00:01 -0400
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Ah Jaye:

I can empathize.  I saw a client this week who was told she had flat nipples and given 16 
mm shields right from the start.  Fortunately, this mother would flow for anything so 
intake was not a problem.  I try to keep in mind that what is seen in the hospital is 
different than what is seen outside --- but I have to say these nipples were completely 
AVERAGE AND NORMAL.  Mom had also read some book about foremilk hind milk 
imbalance and was keeping her 7 day old on one breast at a time.  The baby attached 
better without the shield, less pain.  AND the baby really did not finish on one side (1.5 
oz --- and did not need the scale to tell me that).  The baby was put on the other side 
(another 1.5 oz) and was happy and content.  Mom didn't understand why her baby was 
waking up every hour and a half at night.  

This case was an easy fix, but....

I am seeing a HUGE increase all of a sudden in iatrogenically induced low supply from 
mothers worrying about foremilk hindmilk imbalance when they really need to switch 
their babies to the second breast.  I really hate it when they come in with a three week 
old who has been on one breast per feed, given a pacifier to hold the baby off to the two 
hour mark, baby is not yet back to birth weight and they are worrying about whether or 
not their milk has enough fat.  

Nikki Lee sent me an article studying the 10 minute switch versus finish on one breast.  It 
was a while back, but I remember the flaw in this study is that the education did not 
consist of training parents how to watch the cues for switching and stimulating.  They just 
swapped one rule for another rule. I think the reason why there was better gain in the 10 
minute switch group is that it stimulated the milk supply faster --- if you drain both 
breasts every three hours as opposed to one breast every six --- of course your body will 
be triggered to make more milk.  The study was done in a population that did supplement 
and so I also think that the 10 minutes per breast as opposed to some infants who 
probably could not get enough on one breast and were hanging out in a desperate attempt 
to get more was much easier on the moms and led to less supplementation.  BUT I would 
argue that both approaches are wrong.

I think if you had done the same study by training mothers to watch their baby's cues, 
taught them stimulation tactics to see how their babies responded if their babies were 
lethargic AND to their babies alone if they were swallowing well, had them offer the 
second breast and stop offering if the baby refused --- etc.  you would see much happier 
babies and mothers than ANY of the rules.  

Please think about this, if a baby is drinking all of the milk that mom makes, the baby is 
getting the appropriate fat content for the day because the ebb and flow of the fat content 
equilibrates over the course of the day. Cathy Genna has already posted about 4-6 
articles on how measuring the fat content of the milk makes no difference to overall 
growth. If there is a problem with a baby who is drinking all of the milk --- it is the FLOW 
of the milk.  Just by watching the flow and how the baby drinks --- you can figure out 
when or if to switch breasts and that is better than any timed rule.

If, however, mom is pumping double what her baby needs and having the baby drink first 
and she is pumping second, then there might actually be a problem with fat content.  So, 
the books that tell mothers to feed and squeeze the breast and torment their babies to 
finish on one side and then PUMP the other side can actually CREATE an oversupply that 
might lead to foremilk hindmilk imbalance if the mother has very high storage capacity or 
CREATE growth faltering in an infant that can't do the job on one breast alone with a 
mother with a lower storage capacity. 

Best, Susan Burger

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