Returning the baby to the same breast

What’s wrong with putting the baby back on the same breast if it’s not empty?

Instead of following the baby’s hunger and full signs, some mothers return the baby to the same breast during a feed because they think the baby has to empty it or has not fed long enough or have concerns about the baby's stool. This is not good breastfeeding management. Babies are finished on one side once they are through the three stages of breastfeeding or within 20 minutes, whichever comes first. Returning the baby to the first breast can make the baby angry, because there is less milk available in that breast. If mothers only allow the baby one breast when the baby needs the second, each breast is used less frequently and can become painfully full by feeding time and result in a reduced milk supply over time and poor growth of the baby. It may also result in nipple pain, nipple damage, and an early return of periods. 

A) Normal reasons for returning the baby to the same breast

When your baby has finished feeding, wait for five minutes or so to see whether the baby needs more milk. If so, the baby will act hungry and you should offer the other breast and not the just-used (first) one. The majority of babies need both breasts at each feed (Kent 2006).

It is normal to return the baby to the same breast if the baby has let go at the beginning or in the middle of the feed for reasons other than being done feeding on that side.

Rarely, a mother may try to reduce her large milk supply by keeping the baby on one breast for a set amount of time. This is called block feeding.

B) Inappropriate reasons for returning the baby to the same breast

It is not helpful or recommended return the baby to the first side when the baby has finished breastfeeding on that breast and is still hungry or out of concerns that the baby:

  • Has to empty  the breast.
  • Has not been on the breast long enough.
  • Needs to get the higher-fat milk (hindmilk):
    • In order to grow better.
    • Because the stools are green.
    • Because there are no curds in the stool.

Babies generally don’t empty the breast; they usually consume only 70% of the available milk (Kent 2006).

Babies control their own intake. They are done feeding on one side once they are through the three stages of breastfeeding or within about 20 minutes, whichever comes first.

The baby’s growth does not depend on the exact amount of fat they take in at each feed as this is variable. Rather it is the overall amount of milk that is more important. Breastfeeding babies are good at managing their intake and they will give hunger signs and breastfeed according to their needs. If a baby is growing slowly, the real cause must be identified.  

Green stools are not related to hindmilk but rather are due to milk moving rapidly through the baby’s digestive system.

C) Problems created by returning the baby to the same breast

Returning the baby to the first breast and not offering the second can cause the following problems:

1) An angry baby 

There is less milk available in the just-used breast than in the other one. You can probably feel the difference yourself when you cup the breasts in your hands. The baby can get quite angry if denied the greater milk supply in the second breast and is made to come back to the first breast. They may pop off and on the first breast and remain hungry and irritable after breastfeeding or remain on the first breast for much longer than average.

2) Overfull breasts

If a baby breastfeeds every three hours on only one breast, each breast will be emptied only every six hours. Infrequent emptying is just as problematic as skipping a feed and not expressing. The breast will be painful and full by feeding time.

3) A reduced milk supply

Over time, the frequent fullness of the breast may result in a decreasing milk supply and in the baby growing slowly.

We have seen many cases in our clinic in which a baby’s weight gain slows within a few weeks of starting this artificial routine.  

4) Early return of periods 

Mothers’ periods tend to return too early because of infrequent milk removal and breast stimulation. This can further reduce milk supply.

5) Nipple pain and damage

A baby may feed for 40 to 50 minutes on the first side trying to get milk that isn’t there. This is much too long and can make the nipples tender or can even cause damage. 

Some babies make the pain and damage worse by tugging or clamping on the breast in frustration.

Breast fullness can also cause the nipple root to become firm, which can result in more nipple pain and damage.

References

Kent JC, Leon R, Mitoulas LR, et al. Volume and frequency of breastfeeds and fat contant of breast milk throughout the day. Pediatrics 2006; 117;e387-95