Why are we talking about one-sided nursing as a "fad"?

This is a very useful tool for mothers with overabundant milk supplies
whose infants are getting more too much lower-fat and therefore
higher-lactose foremilk and thus have unhappy colicky infants often with
greens stools and a relative (I stress relative) lactose overload (i.e.
their normal lactase can't keep up with the overload of lactose). Also
some of these babies may not be colicky, but just hungry all the time. I
had one infant who was gaining weight great guns, mom had huge supply,
but infant was nursing round the clock approx 18 times a day to meet
caloric needs w/skim milk. Never "milk drunk" look. Latch fine, suck
fine, totally comfortable, peeing up a storm, explosive greenish and
yellow stools, no colic. One sided nursing and pumping to comfort did
the trick. (see below)

One sided nursing is also used by any mother who lets her baby lead and
the infant fills up on the first side and is "milk drunk" before s/he
gets to the second. It can work just fine for some mothers if that is
what develops naturally rather than given as a rule without regard to
her breast or infant needs.

Two sided nursing has just as much potential for problems if given as a
strict rule without regard to individual dyad needs.

I find most of the problems with two sided nursing stem from mom taking
baby off first breast at an arbitrary time limit, usually set by the
clock (whether 5- 10- 15- or 20-min, it can be a problem if baby hasn't
signalled s/he's done), rather than letting infant end feeding. It can
also happen if mom takes infant off breast, not by clock, but just
because infant is nonnutrively sucking, she thinks he's not getting
anything, so she thinks he should go to second side. For some babies
this is true, if he's already had enough letdowns, and mom has learned
to read her baby's style, but for some babies, particularly in the
beginning, when letdown is erratic and mom and baby have not settled
into the feeding dance yet, nonnutritive sucking is simply baby waiting
for the next letdown, and stimulating milk production while s/he waits,
so we need to relax and wait, let baby pull off by self, or at least
wait until bursts of nutritive sucking are getting shorter and shorter
while periods of nonnutritive sucking are getting longer and longer.
Then after stimulating baby a little ("burping" routine)if baby is ready
for more, can go to second breast. Mom needs to learn to read her own
baby, and make these judgements herself, not by us giving her arbitrary
rules.

I don't think either one sided or two sided nursing should be
recommended to mothers as a strict rule-- she needs to follow the lead
of her infant and her own breast comfort.

By the way, when one sided nursing ( i.e alternating sides, one at each
feed) is recommended to a mom w/oversupply who has been getting in
trouble w/two sided nursing (because the baby fills up on two doses of
skim milk before the opportunity to get to any cream), she always needs
to be counseled re comfort of the opposing breast and prevention of
plugged ducts, risk of mastitis etc, expressing to comfort frequently
either manually or w/pump; the need for this diminishes quickly over
time, as the milk left behind longer in the alveoli acts to decrease the
oversupply; usually these women either adapt to one sided nursing, or in
my expereince, the consequent decrease in the oversupply leads naturally
back to two sided nursing (the baby is no longer conked out w/ one side
alone, and is hungry for more).

But the plan should not be given as a rule, but simply give her
information how it works, and let her follow baby and breast needs, w/
frequent phone contact w/ you as necessary for continuing Q's.

Tina Smillie, MD, IBCLC