Recently, a young mother from Germany posted on one forum a post with recommendations from a midwife and maternity hospital nurses on how to care for a newborn. Among other recommendations was the following: for one feeding 2 breasts, for one 10-15 minutes, for the second 10-15 (or until it lets go / falls asleep), start feeding from the breast that was the last one last time. (from). In theory, such feeding is the prevention of lactostasis, and also helps to increase milk production.
Some mothers agreed with this feeding method. However, some mothers were perplexed by such a frequent breast change, because, according to them, the child will not receive fatty “back” milk, and accordingly, and will not gain weight.
I suppose in order to understand how often to change breasts, it is worth understanding the process of milk production itself.
Everyone knows that in the mammary gland of any adult woman there are ducts with a small amount of secretory tissue. However, during pregnancy, under the influence of estrogen and progesterone, secretory tissue begins to grow and alveoli form at the ends of the ducts, the walls of which consist of secretory epithelial cells – lactocytes and the layer of myoepithelial cells surrounding them.
From mid-pregnancy, lactocytes produce colostrum, and a few days after birth, under the influence of the hormone prolactin, they begin to produce milk. At the same time, the rate of milk production is variable, and it depends on the degree of breast emptying: the more the breast is empty, the faster it produces milk. Accordingly, if a baby emptied one breast during feeding, then milk production in this breast will go in full swing. At the same time, in the second, not emptied breast, the process of filling with milk will proceed more slowly.
The fact is that the milk accumulated in the breast itself stops the work of the cells producing it. This is due to the fact that it contains a substance that inhibits milk production. This substance is called “factor that inhibits lactation” (FIL), or “inhibitor”. The more milk accumulated in the breast, the higher the inhibitor concentration in it, the slower new milk is produced. In the process of feeding or expressing, the inhibitor is removed from the breast together with milk, respectively, the rate of milk production increases. In addition, the lactocytes of the alveoli distended from a large amount of milk react worse to prolactin. Such a mechanism was invented by nature in order to prevent breast overflow and allow the child to regulate the amount of milk in the mother himself.
Thus, although the level of prolactin in the blood is the same for both one and the other breast, the rate of milk production can be different. The produced milk accumulates in the alveoli and ducts, but this process, as we have already found out, is not endless. Every woman has the maximum amount of milk that can be collected in the breast – the so-called “capacity” of the breast. It can be different even for the right and left breasts of one mother, not to mention different women. It should be noted that breast size and capacity do not always coincide.
As milk accumulates in the breast, it gradually begins to stratify into “front” (usually less fat) and “back” (which has much more fat). There is no clear dividing line between the “front” and “back” milk – the transition from one to the other is very smooth. This is due to the fact that the more liquid part of the milk accumulated between feedings gradually flows forward – towards the nipple, leaving behind heavy fat molecules that gradually attach to each other, to the walls of the alveoli and get stuck in the ducts.
When the breast is stimulated, the flush begins: due to the action of the hormone oxytocin, the outflow of milk is accelerated, and it is thrown out along the ducts towards the nipple. As the breast empties, fat molecules detach from the walls of the ducts, alveoli and begin to move along the ducts. Consequently, the longer the feed, the more fatty milk is expelled from the breast as more fat molecules are pushed through the ducts. Accordingly, the level of fat in milk is related to the degree of breast fullness: the longer the break between feedings, the more full the breast, the less fatty milk the baby will receive at the beginning of feeding, the longer it takes to get to the fatty milk.
Thus, in mothers with a large “capacity” of the breast, the newborn sometimes cannot empty the breast completely – so much simply will not enter it. Therefore, if you pick up such a capacious breast 10 minutes after the start of feeding, there will still be a lot of milk (and the fattest) in it, which can lead to lactostasis in the mother and to a lack of fat milk in the child (which is often blamed as the cause of the so-called “secondary lactase deficiency “And increased gas production, since the” front “milk is rich in milk sugar – lactose). Accordingly, for mothers with large breast capacity, the method proposed to the author of the post by the medical staff of the maternity hospital may not be suitable.
At the same time, if the mother’s breast capacity is small, this method seems reasonable: the baby will empty both breasts in one feeding, thereby triggering the mechanism of accelerated production of new milk. This technique is not only justified in such a situation, but is also necessary in the first months to provide the baby with adequate nutrition.
During the transition from colostrum to milk, breast swelling is often observed, and sometimes even engorgement. This is not only due to the sudden increase in milk volume, but also due to the surge of additional blood and fluid that is needed to prepare the breast for breastfeeding. At this time, it is especially important to feed the baby more often, completely emptying the breast, since the released milk makes room for excess fluid, respectively, the swelling subsides slightly.
It is very difficult for a newborn to dissolve swollen breasts, and in 10 minutes he is unlikely to cope, therefore, in such a situation, it may take more time for resorption. A similar situation develops with lactostasis or mastitis.
The shape of the nipple can also affect the time it takes to empty the breast, because when applied correctly, the nipple rests against the baby’s palate, thereby stimulating the sucking reflex. However, there are moms with flat and inverted nipples. Of course, this is not an obstacle to breastfeeding, however, until the nipple is extended, the baby may not be very comfortable to suckle, and accordingly, he may need more time.
The diameter of the ducts in different mothers also differs: the narrower the ducts, the longer the process of emptying the breast takes (at the beginning of lactation, the ducts may be narrower than later). Also, the number of milk jets at the outlet may be different even for one woman in the left and right breast, respectively, the rate of milk outflow will also be different. In addition, the rate of milk outflow decreases when the mother is stressed, painful (for example, with cracked nipples) and other circumstances that reduce the level of the hormone oxytocin.
When a “mature” lactation is established, it is common for those who gave one breast to give two breasts per lactation. And those who gave 2 breasts can offer three or even four (respectively, again the first, and then again the second). This is due to the fact that milk no longer accumulates so actively between feedings, but comes mainly in response to sucking by the baby. For a while, the baby sucks at idle, then the tide comes, and the milk pours in streams, frequent sips are visible and audible. Gradually, the milk is sucked out, it becomes less, the child receives not jets, but droplets. At this time, we can observe that the baby makes one swallowing movement for 6-7 suckers. Often the baby starts to feel nervous at the breast. In such a situation, it is worth offering a different breast. And so you can offer it over and over again until the baby is ready to suck. If there are concerns about
Babies themselves also empty their breasts at different rates. Hypotonicity, prematurity, depression of the baby’s nervous system after childbirth, short frenulum, improper grip, etc. can cause sluggish and ineffective sucking. In such a situation, it is very important to understand the cause of the inefficiency and, if possible, eliminate it.
In order for the baby to receive the cherished “hind milk”, it is much more important to establish effective breast emptying (correct attachment, frequent feedings, cutting the frenum if necessary, etc.) than looking at the clock. If, for example, a baby hangs on a nipple without capturing the areola, then most likely he will not reach the “rear” milk in either 5 or 20 minutes.
As a result: each organism is individual, and in the case of breastfeeding, we are talking not about one, but about two whole individual organisms, respectively, it is possible to choose a method suitable for a particular mother-child pair only by the method of tests. Moreover, in different periods, this method may be subject to revision, therefore, it is worth more flexible approach to this issue. The main thing is that the child is well fed and happy!
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