How much is too much? One breast or two? Nightmare nipples - Christine Hill gets the breast balance right.
From You and Your New BabyBy Christine and Peter Hill

One breast or two?

Some midwives argue for the baby to be fed from only one breast per feed ‘so that he gets his pudding’ or hind-milk – the thicker milk from the back of the breast, which is especially rich in fat. They will also have been taught that it is important for each breast to be completely emptied at each feed, which is more likely to happen if the baby is offered only one at a time. Other midwives will suggest swigs from alternate breasts to ‘balance’ both breasts (which might be kinder to your appearance), and indeed this is what several millions of mothers and babies have been doing up to now. If pushed, we would argue for the latter approach, since it seems to be rooted in common sense, but the main point is that it doesn’t really matter; a recent study has shown that babies are adept at regulating their own fat intake. If you decide to opt for two breasts per feed, you should start with the breast you finished on at the previous feed. At the end of each feed, put a safety pin in the bra strap of the second breast to remind you to start with that one at the next feeding time.

How often?

How frequently you feed your baby is largely up to him – as a rough rule of thumb, when your milk comes through, most new babies will want to suckle about every three hours during the day. Small babies will demand relatively more frequent feeds than heavier babies. At night, a longer interval between feeds is perfectly all right, unless he is jaundiced, and four hours or a little longer is quite reasonable. In fact, if you are lucky enough to have a baby who sleeps for a long period during the night, there is no need to wake him for a feed before six hours. Most newborn babies will need between six and nine feeds during a 24-hour period (count from midnight to midnight), but don’t even think about routines at this stage.

How long?

In these first few days, the length of a feed is a question bound up with the potential problem of sore nipples. Sore or cracked nipples are horribly painful and, from our experience, are the commonest reasons for women to decide that breast-feeding is not for them. They occur as a result of the baby not being latched on properly, which leads to too much suckling (because the baby isn’t getting the colostrum or milk) too soon. Fair-skinned mothers are particularly vulnerable, as are those who burn easily in the sun; both these characteristics are signs of a delicate skin.

When the midwife or feeding sister has helped you put your baby on to the breast correctly, she is likely to suggest how long your baby should be allowed to feed. Some midwives will suggest you feed him for a short period of time – a few minutes – and some will tell you to keep him plugged on for as long as possible. Current trends are in favour of the latter approach. Much will depend on your baby, as quite a few seem to be totally uninterested and have to be coaxed to suckle at all. On the other hand, some babies have a very powerful suck immediately and, if left suckling too long, can readily produce sore nipples unless properly latched on. It is worth remembering that just because a baby is suckling at the breast, it doesn’t necessarily mean that he wants more milk. He may just like suckling.

Because there are all of these considerations – proper latching on, strength of suck and type of skin – no simple rule applies. The vast majority of mothers find that it helps to build up gradually the length of suckling time in the first few ‘colostrum’ days, lengthening to around ten to 20 minutes on each breast when your milk comes in (or up to 40 minutes on one breast). This gives nipples that aren’t used to being vigorously sucked every two hours, under normal circumstances, a little time to get used to the new activity and adapt accordingly. Unfamiliar use produces soreness. (If on the first day of spring you did a whole day’s vigorous digging in the garden, your hands would be very sore indeed.) Nipples are the same: too much too soon usually leads to soreness.