Rachel

A common scenario in this part of the world is that a mother with a 
baby with very low weight gain at several weeks/months of age 
fiinally seeks help with breastfeeding.  A history reveals that the 
health  visitor told her several weeks/months previously that her 
baby's fussy symptoms (crying/colic) are due to the baby not getting 
enough "hindmilk".   The mother duly complies with advice to keep the 
baby on one breast per breastfeed and not to switch breasts more 
often than every 3 hours. The rationale seems to be that using both 
breasts per feeding means that the baby is only getting the "watery" 
foremilk, and that keeping the baby on one breast for longer will 
increase the fat content in the milk and thus the weight gain.  I 
think this comes from a myth-interpretation of the 1988 
Woolridge/Fisher paper.

However, a subsequent detailed analysis of the weight record reveals 
that the baby's weight began faltering way before the block-feeding 
recommendation, and that advice to effectively block-feed has only 
made things worse - from gaining inadequately, the baby progresses to 
gaining very poorly - sometimes very poorly indeed.  And because the 
mother has been infrequently draining her breasts (once every 6 
hours) for several weeks..... and because the baby's nutrition has 
become so compromised that he basically gulps for 2 minutes and then 
flutter-sucks on one breast, leading to lower and lower milk 
transfer, it can take that much longer to turn this situation around 
than it would have done if some basic checks and maths had been done 
at the _first_ hint that the baby's intake was insufficient.  By now, 
it is often really necessary to use formula supplements to protect 
the baby's nutrition, and it can take weeks for the mother to do all 
the work of breastfeeding/supplementing/pumping to re-kick-start her 
own breastmilk production to once again meet the baby's needs.

So I do share the frustration expressed by others that this is often 
very poor advice.  I've seen the over-supply/block-feeding thing 
again and again on some of the mother-to-mother message boards 
too.  It seems to fall into the category of 'a little knowledge is a 
dangerous thing' !!   This is such a _waste_ when a little of the 
right information at the right time would have enabled the mother to 
carry on exclusively breastfeeding and - most importantly - for her 
baby to thrive.

Pamela Morrison IBCLC
Rustington, England

At 05:00 21/08/2013, you wrote:
>In what way is
>block feeding being inappropriately used so that it is compromising growth?
>
>Rachel Myr, reluctant oversupply oracle and eternally grateful to Gonneke
>for her article, in
>Kristiansand, Norway

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