Ellen,

I am confused. Were you referring to the article I mentioned in an
earlier post with the same heading?

Evans K, Evans R, Simmer K, Effect of the method of breastfeeding on
breast engorgement, mastitis and infantile colic, Acta Paediatr
84:849-52. 1995.

If so, are you going on the abstract only, the whole article, or just the
discussion on LN?

<blank recommendation of bfg from one side only each meal, from birth. =
This reference does refer to engorgement, mastitis and colic, but it =
does not refer to FTT and insufficient milk production.>

In one paragraph, the article itself states "However, concerns are often
expressed that the practice of prolonged nursing on one breast may lead
to an insufficient milk supply for the infant, and that longer intervals
between feeds may lead to a higher incidence of mastitis. . . . . .We
attempted to address these issues objectively in large groups of mothers
allocated to one of two methods of breastfeeding. The first method was
based on prolonged emptying of one breast at each feed while the second
method involved using both breasts at each feed to facilitate equal
drainage of both breasts.. . . . . Mothers in the experimental group were
asked to empty one breast, and only place the infant on the second breast
if the infant still showed signs of hunger."

The main thing that caught my eye was that there was significantly less
engorgement in the experimental group (prolonged emptying of one breast
at each feeding) and there was no difference in infant weight loss/gain
between the groups on days 3,5 and 8.

Since I volunteer for WIC doing follow-up phone calls after the mother
has left the hospital, this is the time period that my concerns zero in
on. So many of our clients just plain give up during that time. If we
can't get them through that time perod, we are certainly never going to
have them reach long term breastfeeding.

Despite our encouragement and explanation of our services (for office
consults, etc.) so many don't call for help. They are vulnerable to the
suggestions of family and friends and less-than-informed HCP's, and so
often, the "supplement cascade" starts there, because the baby can't
latch successfully and the frantic crying and/or nipple pain and damage
does them in. (I know just how they feel. That's exactly what happened
with my first three, 4-5 decades ago.)

I have been thinking "if we could just alter the occurrence of
engorgement (and its effect on nipple pain and damage) in the first
place, maybe they would not be so discouraged before we even get much of
a chance to follow them up with phone calls and consults."

I was surprised to find that in both the control group and the
experimental group, 8 out of each group,150 & 152 mothers, also used
formula after discharge from the hospital and through the first 6 months.
Also, solids were introduced at a mean age of 4.5 months in each group.
Perhaps that is part of the reason no FTT was noted.

"Only 37% of mothers in the experimental group were able to satisfy their
infants' hunger with one breast per feed, with 63% offering the other
breast after emptying the first breast." So nearly 2/3 of the mothers in
the experimental group did eventually make a judgement to switch to using
both breasts.

So I think the authors were just reporting what happened with each
approach, and certainly did not "forbid" the mothers to use their own
minds to decide to do otherwise as time went on.

I don't believe they were trying to give any blanket recommendations to
use one breast only at each feeding-"period." It seems to me their focus
was on "prolonged emptying on one breast at a feeding" rather than trying
to equalize the amount removed from both breasts each feeding.

To anyone interested, I would recommend reading the entire article,
rather than just the abstract. The study itself was done in Australia. I
expected to have to appeal to someone on LN in Scandinavia to locate the
journal for me, but I was very surprised to find my own local medical
school library stocked the journal.

Jean
*********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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