I believe it depends on several things. I think the mom has a legitimate concern, because if the supplement is given as, or with the primary feeding, it's really not a supplement per se. Digestion begins to take place promptly and satiation may set in quickly enough that the baby may do exactly as the mother fears, and perhaps even if the first breast is nursed fairly well, using the supplement early in the feed makes it seem unlikely the baby will take the second breast with much vigor, or spend that long on it. IME, many babies normally nurse a shorter time and perhaps less vigorously on the second side.

If the baby is alert enough and strong enough to continue nursing on the breasts alone for that amount of time on each side, that would be another factor. The possible addition of alternate breast massage if and when the baby dozed or stopped nursing would be one thing that might help increase the amount of milk removed from the first breast, and the second breast also, if the baby is still willing to nurse that long. If the baby nurses fairly vigorously for the suggested length of time on each side, any nursing would not only be giving the baby milk but giving the mother stimulation of her prolactin level.

Also, if baby will nurse this long, the first side, if relatively empty, will begin producing more rapidly when FIL has been removed, so that when baby goes back, even if the supplemental device is given at that time, the first breast will probably still yield some quantity of newly produced milk. 

Another alternative might be to "split the difference". Instead of such an "iron-clad, clockwatching" type instruction, this might be a good time to be sure that the mother understands the baby's body language and suggest that it may be necessary to "guess" to differentiate satiety from fatigue.  Then let her use her considered judgement, along with the instruction for alternate breast massage during pauses, and let her slip the tube in beside her nipple at whatever stage she judges the baby is beginning to "wind down" the nursing strength on the second side. She will learn a little more from each feeding, and may decide to follow the plan as proposed with a subsequent feeding, or a compromise she develops as her breastfeeding skill and efficacy grow with experience and encouragement to watch the baby, always, and the clock . . . . not too much.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH   

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