One breast or two... when to switch

[@llli*tbirdie]

Hi, I'm new here and excited to be part of a supportive community for breastfeeding. This has been a rough battle for my baby and I, but things are finally falling into place. She is 6 weeks old. I will put a short intro but feel free to skip straight to the questions below.

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When baby was born, she had a short tongue and recessed chin. She was not able to latch properly and lost 7% of her body weight in 24 hours so we were told to put her on formula. My milk came in on day 4 and we immediately started bottle feeding her this. She was getting what little colostrum I could get before that. On day 6 our peditrician's lactation consultant suggested trying a nipple shield to get her to the breast. It worked and I cried I was so happy to be able to breastfeed my baby. Her weight gain was still slow and, in retrospect, I think she was fighting with slow flow through the shield. When the doctor started talking about exclusively bottle feeding, I worked on weaning her off of the shield and directly onto the breast. It took several nerve-wracking days but we got there. It was a sore start, as her suck was still impaired from her anatomy. She started dramatically gaining weight and I knew we were finally on the right track. We have been straight at the breast for the last 3 weeks.

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It used to be that baby always ate at both breasts. It was clear to me when she was ready to switch and she would usually eat about 15 minutes or so at each. Lately though, she has started confusing me. I should mention that we are also suddenly dealing with a bit of a forceful letdown over the last week. Sometimes she will eat about 13 minutes on one side, get fidgety, and I will put her on the other side. She will only eat for 3 - 5 minutes. I started to worry that this was not the best of her and read up on feeding only on one breast. Is this okay? Does it reduce supply? I'm happy to offer her both breasts, but she tends to latch even when she is just tired and then gets irritated at the milk flow (I think she just wants to comfort nurse). So, how do I know when to offer her the second breast? Just now she fell asleep at breast one, I burped her and she woke up. I was going to put her on the other side, but my husband recommended sticking with one side. So confused! She seems to be overtired today and getting fussy at the breast when she gets sleepy. She latches and then fusses as she fights falling asleep.

I appreciate any help! I don't know why I am so suddenly and severely second guessing myself, but I can't seem to find an instinctive answer yet.

[@llli*carm3]

Congrats on overcoming such a difficult start!

I think that you need to stop watching the clock so much, and just focus on watching your baby. Babies become more efficient as they get older and more practiced at nursing, so it could be that your LO is getting enough in a shorter period of time. It's perfectly acceptable to nurse on one side, and then if baby seems hungry still, to offer the other side. If she doesn't, then just start the next feeding on the side she didn't take. That's what I did (I've always had an abundant supply). I would keep a close eye on baby's diaper output, and of course, weight gain. Good luck!

[@llli*lllmeg]

First I want to say great job on working through those early issues! I bet moms on here would like to know what gave you the ability to do that. Support, help, etc?

I agree with carm 3. It is perfectly normal and fine for a baby to only want one side at a time, some or even every nursing session. (Just as it is normal and fine for baby to be a 'switcher." ) Encouraging a baby to 'switch sides' during a feeding is a tool for increasing milk production. If milk production is good at this point, no need to do that. Let baby nurse however long baby wants, and only switch sides if baby wants (or you feel full and would be more comfortable with a little drainage on the other side.)

Just to make sure we have the whole picture, can you tell us, How old is baby now? Generally how is weight gain/output going? Are you still pumping? And do you have any idea about how often baby nurses (how many times a day? )

Forceful letdown is not a problem unless it is causing problems! Is it?

[@llli*tbirdie]

Thank you very much for your responses! It was just strange that we very suddenly started nursing on one side and taking half the time. I think part of the culprit is oversupply from going longer in between sessions at night, but I could be wrong. It's hard for me to understand when to switch sides as per the baby.. I guess if she's acting hungry but crying at the breast... she may still be hungry and not getting enough? It hasn't happened, but I feel confused when the game changes so much and so suddenly, lol.

Baby is 6 weeks old now. I haven't weighed her since her last doctor's appointment when she had gained almost a pound in a week. That was about a week and a half ago. I have only pumped for a few minutes when painfully engorged, to help relieve pressure and be more comfortable. She usually nurses about 8 - 11 times in 24 hours.

The forceful letdown does seem to cause coughing/choking and she has been burping and spitting up more since. We can't seem to get the hang of side-lying or semi-reclined, but I do try to lean back or unlatch her to help.

First I want to say great job on working through those early issues! I bet moms on here would like to know what gave you the ability to do that. Support, help, etc?

The primary source of support that I had was my husband. He helped in every way he could (diaper changes, keeping me company, emotional support). He is the one that sent me a link to this forum and encouraged me to read some posts to see that I wasn't alone. The lactation consultant at the pediatrician was also a great source of support: scheduling frequent visits, responding to emails and phone calls, and encouraging me to keep working at it. I think my strong desire to breastfeed was the major source of push forward, but when I was at a breaking point of pain and frustration, I called the La Leche hotline and spoke with a very kind leader who listened to my concerns, offered advice, but mostly, provided support and encouragement when I needed it most. I'd be happy to post a more detailed account of what we did and what worked for us if you think it would help.

[@llli*tbirdie]

Well, whatever was going on, it seems to have passed. Matter of fact, I feel like we are in the midst of a growth spurt. Things felt a little less engorged after this morning when I pumped for a couple of minutes, and then she started eating on both sides again, anywhere from 25 to 30 minutes. Hm Hm

[@llli*lllmeg]

Thank you for answering the question of what helped. Certainly you are welcome to post a more detailed account but what you posted about what helped you stick it out is exactly what I was after. I hope you continue to visit the forums as other moms will benefit so much from your input.

Isn't it funny how babies love to change it up? This is a perfect example of why following baby's lead when nursing is so important, rather than timetables. And yes, it is often difficult to know exactly what baby wants! That is ok. Baby may not be sure herself! It never hurts to offer to nurse or offer to switch sides, or burp baby and offer the same side, etc-whatever feels right at the time. There are no rules that work for every baby and mother pair every time when it comes to this stuff. That is why LLL calls the their book the Womanly ART of Breastfeeding.

[@llli*andie613]

Glad you are doing better! Also, welcome to the forum! I, too, had difficulties nursing (baby with tongue tie that was corrected, cracked and bleeding nipples, vasospasms, you name it!)and only continued because of my great determination to breastfeed.

As to your original problem, when my LO was the same age, he usually ate on both sides for about 20 minutes each. As he got older, the time shortened, especially on the second side. Now, at 7 months, he will nurse on one side for about 15 minutes, unlatch himself or fall asleep, at which point I move him to the other side, then he will nurse for about 5-7 minutes on that side, then either fall asleep or unlatch himself. Sometimes he is so busy looking around, wanting to play, he will only nurse maybe 10 minutes on one side and a few on the other. He's doing great in terms of weight gain and is a very happy baby. If your LO starts to nurse less on her 2nd breast, I wouldn't worry about it .

Also, props to your hubby for being so supportive! Breastfeeding at the beginning can be hard, but now that you've made it this far things will only get better. And if problems do arise, like teething , I've found this forum to be very helpful. Wishing you the best!

[@llli*tbirdie]

I was concerned that if she was only eating 4 - 6 minutes on the 2nd side, she was getting too much foremilk. Is that not a valid concern?

Definitely a growth spurt, it feels like she's constantly eating. When the supply is high, her easy suck / swallow / suck pattern does not hurt, but I am noticing that as she has to work harder, it all starts to hurt again. And it hurts in the beginning half the time, but not always. Sheesh, I would love to get to the no-pain part, I thought it wouldn't take quite this long. Sigh.

[@llli*lllmeg]

Alll concerns are valid, but the foremilk hindmilk 'issue' is not really an issue. Babies who are truly getting 'too much' foremilk do so because mom has a forceful letdown, and even THAT is not always a problem. When it is, it is obvious, you usually have a baby who is pretty unhappy most of the time and definitely unhappy at the breast. And gaining very well, typically.

Generally foremilk/hindmilk is simply not a health issue. Babies need all the various milk consistencies and when they are cue fed, they get enough of all. All breastmilk is healthy, and has fat in it, and baby gains on it. If there are slow weight gain issues due to feeding, it is because baby is not getting enough breastmilk either due to low production, poor milk transfer, or baby not nursing often enough, or a combo. Not because of 'too much' foremilk.

I did not realize nursing was still painful for you. That concerns me. Did you see an ibclc before or after the tongue tie was treated? Were you given excercises to do? Does your IBCLC know you are still having pain?

[@llli*tbirdie]

I don't know what IBCLC stands for. Nursing was only painful for the first 15 seconds for several days, but that was also while I had an oversupply of milk... I think she wasn't having to work as hard. Further into the feeding, in between letdowns perhaps, when she sucks more vigorously is when it hurts. Sometimes we go days without much pain, at latch or otherwise, and then some days it will be sore and hurt at different times during the nursing.

She was not tongue tied, but had a short tongue, I was told. And a recessed chin. They said as time goes on this will improve, and her tongue did very much so. She started sucking better (not just gumming all the time) and that's when I started to get her off the nipple shield. The pain now is nothing compared to the beginning when her suck was not as good and we were just starting out with all sorts of latching issues etc. But it's still not pain free entirely. I have seen the lactation consultant at my pediatrician multiple times, but only once since I got the baby to the breast without the nipple shield. She said her latch looked good and to hang in there, her suck would get better with time and the soreness should at least decrease. So that's where we are. I will be back at the office in a couple of weeks, but I haven't talked to anyone recently. I thought about trying to meet with someone to just double check us, but I didn't know where to start. And I've been avoiding taking the baby out with flu season so very bad here. Her latch looks so picture perfect, I really think we are just short-strawed with her anatomy still.