G'day Denise! you wrote
>he was seeing more mastitis now in the mums feeding prem
babies and he feels it's because of the 'finish the first breast before
offering the second' management we teach.<

I'd concede that this is highly likely, indeed probable, if the midwives
were not being very careful about the second of the three basic rules
1. finish the first breast first; offer the second;
2. always check the second and express to comfort and to soften lumps as
often as needed in the interval between that and the next feed; (may be 3
or 4 times initially)
3. save and store surplus expressed. (I always add this as it's
demoralising to see good breastmilk discarded, and a hideous waste).

You might need to commend your paed on his good observation after you check
out what is happening to the non-suckled side. First breast first does
decrease milk supply overall, and by the usual process of peptide buid-up
as well as pressure, wherever the mother's supply is so far ahead of the
baby's volume needs that the baby rarely takes the second side at all.

It's a bit like the belief about demand feeding leading to more cracked
nipples. Yes it does, if the rules say feed as often as baby wants for as
long as baby wants and no one has taught women about feeding effectively.
Demand effective feeding is no problem. Demand feeding with bad attachment
means more cracked nipples: more of a bad thing means worse outcomes. Does
this make sense? I'm way behind on posts and out of time, and have saved a
few bits to comment on if there's time: but couldn't resist this one.

All the best, Maureen