Dear all:

I don't really think that following the baby's pattern of swallowing (including normal 
pausing) is really inconsistent with a baby "finishing" on one side. If the baby can't get 
more milk out, then the baby really is "finished" with that side.  If the baby is not 
growing well, then keeping the baby on that breast for longer when the baby isn't 
swallowing is not going to help the baby at all.  If the baby isn't swallowing, the intake is 
zero and it is wasting the baby's energy.  So, switching breasts when the baby isn't 
swallowing is much better than a rule that may have the baby expending energy to try to 
get milk out of a breast when he/she can't do it any longer or taken off the breast when 
the baby is still swallowing rhythmically.

If that baby is growing well and generally satisfied and the mother is relaxed and enjoys 
breastfeeding, there is no need to rush that baby. 


Now, Nikki sent me an article a while back that compared a study looking at two "rule-
based" approaches.  It generally was to leave the baby on the breast as long as possible 
(with no guidance on how to read swallows or rhythms) and switch breasts after 10 
minutes.  The article showed better growth in the latter group. It was conducted in a 
population that was quick to supplement and quick to wean. These results are not 
surprising to me.

So mothers are told to keep the baby on the breast as long as possible (or until they're 
done or pop off spontaneously).  In a hospital setting babies are more likely to be more 
sleepy due to the bright lights, beeping noises and constant interruptions.  They will be 
more prone to fall asleep on the breast.  If they are falling asleep on one breasts, 
mothers will be more likely to interpret the advice to mean that the baby has finished and 
put the baby back into the plastic box. In the box, the baby may not be stimulated to 
wake up and eat as frequently as with skin to skin contact.  Thus, there will be fewer 
infants that have sufficient contact or stimulation to swallow from both breasts.  So, you 
probably have a higher proportion of mothers for whom each breast is being drained (not 
that Chris Mulford has reset my thinking about this word) every 4-6 hours than every 2-3 
hours.  Given that the first two weeks after delivery are when more prolactin receptors 
are generated, this means that a higher proportion of women are not going to have 
stimulated their supply adequately for their babies.

For the mothers who are told to switch breasts at the 10 minute mark, you are going to 
end up with more women having had each breast "drained" at each feeding -- every 2-3 
hours rather than every 4-6 hours.  Some of the infants may have needed more time on 
those breasts, but there is some possibility of compensating if they are allowed to eat 
more frequently.  

In both cases, supplementation is frequent.  So you are not dealing with a normal infant 
feeding situation. We are having to overcome the superstitions of modern regimentation.  
So, it makes sense to me that you get less supplementation with more frequent draining 
(but often incomplete) of the breasts than with less frequent draining of the breasts 
(which in some cases might end up being as low as 4x/day per breast).

Looking at the baby's cues circumvents both of these rules.  Both sets of rules will fail a 
fair number of babies in the long term goal of returning to normal feeding of exclusive 
breastfeeding to six months and continued breastfeeding for at least two years.

Best, Susan Burger

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