Should I offer one breast or both?

Should I offer one breast or two? - Transcript

I often get asked by ladies ‘how long should my baby feed at the breast?’ and also ‘do I need to offer both breasts at each feed?’ And there is quite a lot of confusion about this because historically there’s been a lot of regimented ideas about breast feeding, where feeds were limited to a certain length of time on each side, and mothers have been told to swap over to the breast after a certain length of time, whatever it is.

So we have a lot of old school ideas, mixed in with the new, and a lot of those old ideas were not based on good evidence. So first of all before I actually make a blanket statement about whether you should offer one breast or two breasts, I think would be good to just talk to you a little bit about what happens when your baby actually comes to the breast to feed.

So first of all, let’s say your baby comes to the breast, say the left breast, and does fast sucks initially – those fast sucks send impulses to the brain. The brain releases hormones, and those hormones act on lots of grape-like structures within the breast. That’s where the milk is made and stored. When the hormones act on these, milk is, in effect, squeezed out of both breasts at the same time. So this is commonly known as the let-down.

You may or may not feel the let-down – some people have a really strong initial let-down and they can feel that quite forcibly. Others will not feel it at all. Whether you feel a let- down or not is immaterial. Some women feel it really strongly. Some feel it is a tingling. Some feel it stronger than that and other women never feel it at all. So don’t worry if you don’t feel the let-down.

The most reliable sign to prove that it has happened (the let-down) is that your baby who was doing fast sucks initially to call that milk down, has suddenly felt that milk hitting the back of the throat and has started to swallow – so the pattern starts to become more slower, more rhythmical, with swallowing as well.

That first letdown that comes is usually higher volume at the beginning of the feed, and as your baby starts to swallow and swallow and swallow, the volume is going to reduce after a while, and your baby will eventually start to do a little bit of flutter sucking at the end of that let down, where the volume is very low. There’s actually quite a high content of fat there because of the low volume.

After your baby has been flutter suckling for a little while, this will then stimulate another letdown of milk, and your baby can actually call down on average three to four let- downs in the course of a feed, on one side, if he works hard, and works through those patterns. Once another letdown comes, once again you’ll see that slower more rhythmical pattern emerging as your baby is swallowing, and then the volume is going to slow again, and so on and so forth.

You may know that your milk supply is based on a supply and demand concept.That means that as milk comes off the breast (so demand has gone in, and your baby has then swallowed that milk), your body will then make more milk on that particular side. So every time there is an extra bit of emptying, more is made.

The first milk that your baby gets when he latches on after the initial fast soaks is high in volume, and it’s low in fat and low in calories (because of being low in fat), and there are some studies which are showing that there is quite a variation in the fat content of the milk. As the feed progresses the fat content generally increases too. So it’s good for your baby to be able to feed through as many of those letdowns as possible.

Now for some other women there may not be such variation. So it’s certainly been suggested that it’s good to allow your baby to be in control of that feed, and to let your baby feed for as long as he wants to do, to get the calories that he needs. So it certainly seems important to allow your baby to stay on one side for as long as he can until he comes off himself if possible.

It’s also worth knowing that when your baby feeds from one side and calls that milk down with the initial fast sucks, that milk has let down on the other side. So in effect there are calories waiting for him on that other side. So once your baby has come off the breast, either because he is being an efficient feeder, or because you’ve used compressions as well to keep him on for as long as you can, still offer that second side because this is going to give extra calories that he wouldn’t have had the access to, had you not offered that breast.

It just means that he’s going to get more calories in one sitting. Of course next time round you can offer the second breast as the priority breast. Let your baby feed as long as he can and let him come off on his own or use breast compressions if necessary, and then offer that first breast again just to give those extra calories. In this way you can see how supply is going to build up day after day after day and provide all the milk that your baby needs.

But to the question of how long your baby spends at the breast – there’s certainly a variation here. Some babies will feed from anywhere between 10 to 30 minutes. We certainly say to mums where the baby is only feeding for say five minutes slots, usually those babies will need some breast compressions to help them. Or maybe the baby is spending 40 minutes plus, at the breast. That usually means that your baby is hanging out a bit – a bit longer than needed without some added extra swallowing going on. So once again breast compressions can be really useful.

The truth is that as time goes on you’re going to see certain patterns emerging so you’ll get to know your baby’s normal patterns. And I just want to say that if the way you are feeding your baby now is working for you and you are not experiencing any difficulties, your baby is gaining weight everything’s fine, then that is absolutely fine.

Just to mention that if you have an oversupply a lot of ladies in this situation will generally find that the baby is more settled when only one breast is offered per feed. So all of these are normal variations.

Review dates, references & further resources

Review Dates

V1 published June 2017. Next review date: April 2020

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