Emptying the breast and other confusing things

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I have completely confused my self by too much googling and now I don't have a clue what I'm doing

Ds2 is 19 weeks olf and ebf. He has several of the symptoms associated with so-called foremilk-hindmilk imbalance, but I spoke to a bf consultant last night who basically said not to worry about that as he is growing and developing as he should. However, I am still worried as he never stays on the breast for very long, and I never know whether I should be swapping sides or not

He feeds for about 3-5 minutes, in several goes (ie he comes off and I put him back on) then refuses to go back on. If I offer him the second breast he will sometimes take it sometimes not. I know he isn't emptying the first breast, though, because I can hand express and jets of milk come shooting out!! It's like he gives up when the inital letdown is over? Though I have no idea really...

So which side am I supposed to put him on for the next feed? If I try feeding from the same side again at the next feed (3-4 hours during the day) the other side gets painfully full by the next feed .

I just am so so so confused!!

Oh yes, I also though it wasn't possible to 'empty a breast' as milk is constantly being produced. So therefore I would always be able to express more milk even after a feed. Have I got this wrong?

If baby fed last on the right side I would start the next feed on the left side.

I didn't think there was such a thing as emptying a breast either, seems a very old fashioned notion.

Yes, there's no such thing as emptying the breast.

So far as which side to start the next feed on, I always worked on the basis that if I could tell the difference between the breasts (e.g. one felt more engorged or seemed firmer on an experimental prod) then I'd feed from the one that felt fuller; if there wasn't any detectable difference then I reckoned there wouldn't be much difference in output either. So in your case if the "second breast" from the first feed seems fuller, offer him that one.

If baby feeds for a few minutes then comes off the breast of their own accord (not slipping off the nipple or launching themselves at the breast as soon as they have come off) then offer the other side. If they take it great, if they don't also great - they had enough on the first side.

You are right it is impossible to empty a breast as even if one duct is very nearly empty a) that duct will be working at top speed to make more milk and b) the other ducts in the breast will have milk in them.

Breasts are like a factory with X number of production lines (what that X equals depends on how many ducts you have and this doesn't relate to cup size!) those production lines are staggered so they are all at different stages of work, some might be running at full tilt, some may be on a tea break, and some may be just starting up for the day. That way there is always 'product' coming but not all at the same time.

Thanks everyone for your replies.

TruthSweet, so what about this imbalance thing that I keep reading about? I can't get it out of my head!! Also, if he feeds on one side, then comes off of his own accord, won't go back on and won't take the second breast, to I still offer the second breast at the next feed? How can I be sure he's getting all he needs from the first breast? (I'm still )

Some women have a very large storage capacity (i.e. they have a lot of ducts) and are able to make a lot of milk at any one time and store it.

The longer the milk is in the breast the less fat there is in it as fat 'sticks' to the walls of the ducts and is ejected with later let downs - there are usually 3+ let downs per feed.

The larger the volume of milk available to drink straight away, the less of the milk drunk by the baby has been made more recently (some of the milk a baby drinks is made not long before or even during the feed).

If the majority of the milk the baby drinks at each feed (or even all of it) is stored milk because the sheer volume of milk available, the newer milk further back up the duct may not be used and this newer milk starts to lose it's fat too...

So if you have a large volume of milk that is lower in fat conversely it is higher in lactose which is more than the baby's gut would normally expect so the baby doesn't make enough lactase (the enzyme to digest the lactose sugar) and has greenish poos due to the speed of high lactose milk through the gut.

If he comes off the first side (say the left) then you offer the right and whether that is taken or not you offer the right first for the next feed. You swap the first breast from one feed to the next (e.g. baby takes L 1st then R for his 2nd side, then next feed it's R 1st then L offered, then L 1st, R 2nd, R 1st, L 2nd)

The only exception to this is if you are 'block' nursing in an attempt to lower milk supply - you would only do that if the baby was struggling to cope with the amount of milk and other self help methods weren't working (e.g. nursing uphill/catching letdown in a muslin) or if mum was getting reoccurring plugged ducts/mastitis. Kellymom.com has some good info on overactive letdown/oversupply that you might find useful.

That was all as clear as mud probably!

Read these re imbalance: Foremilk, Hindmilk and a Lot of Confusion, and Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

Generally, you want to keep baby on one breast for as long as they want it, and then if they want more, try them on the other side until they come off again. You can offer 3, 4, + sides in a feed, too.

Re expressing after a feed - there will always be milk being produced, but a baby is more efficient than a pump, and it's easier to induce letdown when there is some milk build-up too. Again it's harder to induce letdown with a pump then for the baby to do it, because it's partly hormonal, so many women find they can't pump much if anything directly after a feed. I used to do it the other way around - pump when DS was sleeping and had gone past the time he would normally have a feed. I always had milk left to feed him directly.

Plus: The problem with googling is that there is a lot of misinformation about BF floating around which gets regurgitated as fact by various websites, books, forums, TV programmes, even so-called breastfeeding "experts".

Always stick to sources you trust. For me those would be this board on MN (because if incorrect info is given out, 99% of the time it's picked up on), those two blogs, the La Leche League website, Kellymom.com, my local La Leche League group/leaders, and the Analytical Armadillo facebook page where again generally misinformation is picked up on by other posters.

That's very useful info. I had similar questions! Without hijacking this thread , can I just ask one more question? If you have oversupply and think baby is mostly getting foremilk because he's satisfied after only a few minutes of bf then why should the second breast always be offered if possible? I'm trying to keep him on the same breast as long as possible so that he can get more of the hindmilk. My supply is still over his needs so what would be the benefit of switching him?

If he's actually full, though, he won't take the second side (and that is absolutely fine). Offering the second side is to check whether he's full or whether he's just got as much as he can be bothered to suck from the first side.

TruthSweet, no it was very helpful. Thanks you so much for taking the time.

Bertie, I particulaly liked that armadillo blog - really clear advie about how best to follow baby's cue re: changing sides!

Really useful info and links, thank you both very much. From reading the stuff on kellymom, I would appear to have forceful let down/oversupply, the best feeding that ds does is when he's slightly 'uphill' of my breast so that does seem to bear out. I will try and encourage more of that kind of nursing and see if I can manage one side feeding for a bit to see if that helps.

I will stop googling. It is bad!!

Don't stop reading, though. Just stick to trusted sources. :)