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One breast or two; pumps; mastitis
By Anne Smith, IBCLC
Q. When I had my daughters 14 and 11 years ago, I was taught to feed from one side only--putting baby back on same side after burping to give her rich hindmilk, but all the magazines I read now that I'm expecting my third child say to nurse from both sides each feed. I live in Australia and don't have access to nursing experts like I did all those years ago! I also am interested in finding the best pump so my family can take turns to feed the baby. I never used one before as both the girls were fully breastfed and wouldn't touch a bottle. Seeing as I have you here, is there a good way to reduce the chance of mastitis as I had it six times with my first and eight times with my second child. I lived on antibiotics and ultrasound and would obviously like to avoid that this time. Nothing I tried worked, and as you know, the pain is excruciating.
A. You have discovered the "downside" of trying to educate yourself about breastfeeding. When you are nursing your baby, there are no hard and fast rules to follow. Women managed to successfully nurse their babies for millions of years before they ever had books, lactation consultants, and breastfeeding classes. Nowadays everything has become complicated and conflicting advice abounds. The actual process of breastfeeding hasn't changed, but now there is tons of information available, and it can become very confusing for mothers who want to nurse, but don't know whose advice to believe.
As far as the advice about nursing on one breast versus two at a feeding, both opinions are valid. Depending on variables like the mother's milk supply and breast storage capacity and the baby's size and sucking ability, your baby may take both breasts at a feeding or he may take one. He may take both at one feeding, and be satisfied with one at the next. Babies are really good at regulating their own milk intake, and for the most part, will let you know whether they need to feed on one breast or two at a feeding.
It's a good idea to offer both breasts when your baby is a newborn, because you need lots of stimulation in order to build a good milk supply. If your baby won't take the second breast and is gaining weight appropriately, then don't worry about it. If your baby isn't gaining weight well, then you need to make sure he finishes one breast, and use techniques to wake him up and stimulate him to take the other side.
Many mothers find that their newborn baby will nurse on both breasts at a feeding, then as they gets older, will start taking only one. I suggest that you start out by offering both and then see how it goes after that.
There are lots of options regarding breast pumps, and no one pump that is right for every mother. A lot depends on how often you pump. If you're home with your baby and pumping only occasionally, then you might do fine with a manual or small electric pump. On the other hand, if you are working outside the home regularly or plan to leave your baby with caregivers often, then you might find it worthwhile to rent or buy a good double pump. For more details about the different types of pumps that are available and the pros and cons of each type, see my article "Collecting and Storing Breastmilk."
I hate that you had so many problems with mastitis when you were nursing your first two babies. There is something very wrong anytime that you experience recurrent mastitis. Nobody should have to go through that! If you do develop mastitis with this new baby (and hopefully you won't), then you need to find out why this is happening and treat the cause of the infection effectively, once and for all. I don't know exactly what treatment you have received for the other infections, but obviously they didn't take care of the problem.
In many cases, the infection reoccurs after treatment with antibiotics because the original infection wasn't ever completely cleared up in the first place. This can happen when you don't take the complete course of medication (you feel better after a few days and stop taking the drug - it usually takes at least 10 days of antibiotic treatment in order for it to be effective), or when the wrong antibiotic was prescribed for the particular strain of bacteria causing the infection. Recurrent yeast can be caused by other, less common reasons as well: chronic bacterial infection, cyst or tumor in the breast, maternal anemia (this causes a lower resistance to infection), and a secondary fungal infection.
Dr. Ruth Lawrence (Breastfeeding: A Guide for the Medical Profession) suggests that after the first recurrence of mastitis, mothers should have their milk cultured (be sure to get a "clean catch" - midstream, into a sterile container). The baby's mouth and throat should be cultured at the same time. That is the only way to know for sure what is really going on. If the infection reoccurs, then you will need to find a "breastfeeding friendly" doctor who has both the willingness to work with you on this, as well as the expertise and the capacity to perform the tests that are indicated (not all doctor's offices or labs are set up to perform the necessary cultures, and even if your OB's office is, he may not we willing or able to culture the baby as well as the milk).
It is possible that you had a secondary fungal infection, also called "fungal" or "candidal" mastitis. If that was the case, then simply taking antibiotics might not clear up the infection completely, unless antifungal treatment to address the underlying problem with yeast was administered at the same time.
For suggestions on how to prevent and treat mastitis, see the article "Breast Infections and Plugged Ducts."
Best of luck with nursing this time around. I hope everything goes smoothly for you. You have two built in babysitters, so that's a plus!
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