The discussion on foremilk/hindmilk/fat content etc reminds me of several 
cliches: don`t put the cart before the horse; what came first, the chicken 
or the egg; don`t throw the baby out with the bathwater.
The concept that the composition of breast milk changes a) during the feed 
itself and b) over the first six months after the birth gave a welcome 
explanation as to why some babies do not thrive even though their mothers 
have a plentiful milk supply.
It was not so long ago that mothers were advised to feed "five minutes each 
side on the first couple of days" and "ten minutes each side thereafter." 
Baby-led feeding, latching on issues etc were not on the agenda, but mothers 
were told to feed similar periods on each breast so that "there would be 
milk in both breasts" or "for symmetry."
Many mothers were misled and confused by this advice put out in the hospital 
nurseries and in the well-baby clinics and many babies were malnourished 
because of it - the obvious consequence was that when babies did not gain 
weight mothers were told that their milk was not good enough and babies were 
given supplementary bottles of formula - and in most cases that was the end 
of breastfeeding.
It was my mentor Chloe Fisher of Oxford who ran a drop-in centre at 
Radcliffe Hospital as well as working on the wards for many years who to my 
knowledge was the first to suggest that the short spurts of sucking from 
each breast did not perhaps give the baby access to the richer milk left in 
the breast at each feed.  And so we began to suspect that  the baby was 
missing out on a higher source of calories.
It was also found that the first flow of milk from each breast was higher in 
lactose which also explained why babies who only got that first flow from 
each breast suffered more from gas pains.
It was never suggested that this applied to the smaller quantity but 
consistently high quality of colostrum and our advice during preparation for 
breastfeeding in the prenatal class as well as if we managed to speak to our 
clients in the immediate postpartum two or three days was to feed as much as 
possible from both breasts to get the milk flowing.
Once the milk supply is well-established it is quite likely that the baby 
will not finish both breasts at one feeding and so we suggested trying to 
feed for as long as possible from one breast before offering the other.
Even that was flexible.  Babies sometimes get very tired sucking the breast 
for a prolonged period.  Even with compression techniques, they often give 
up on the harder sucking but after a few minutes breather will happily take 
more from the other fuller breast which is easier to access.
Trends seem to go round in circles, but breastfeeding is not a trend and my 
feeling is that if something works, go with it.  If it doesn`t, look for 
another approach.
Wendy Blumfield
NCT Trained Prenatal Tutor/BFC
Israel Childbirth Education Centre

----- Original Message ----- 
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Sent: Monday, August 24, 2009 2:49 PM
Subject: LACTNET Digest - 23 Aug 2009 to 24 Aug 2009 - Special issue 
(#2009-828)

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