The Case for Cue Feeding
by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC
It is now commonly accepted that infants, most especially breastfed infants, thrive best when allowed to feed as they indicate their needs. Breastfeeding is, after all, a dynamic process between every unique mother-baby dyad, for which man cannot possibly do a better job than God in designing how infant feeding should work.
This has not been the general consensus throughout the twentieth century, however. Even in the late nineteenth century, there were those, mostly male physicians, who began to believe that infant feeding should be regulated by the clock. As artificial baby milk became all the rage in the twentieth century, both formulations of this milk and schedules to feed babies came into popularity. These schedules often stretched feedings to 3 or 4 hour intervals, and though they apparently worked for bottle fed infants, they did not work so well for breastfed infants.
During the seventies and eighties, as breastfeeding again resurged through a grass roots movement first sparked by La Leche League, many mothers have returned to demand feeding, finding the most breastfeeding success when following baby's cues rather than the clock. The medical establishment lagged behind, and has followed suit only after its own research was undertaken to prove the wisdom of cue feeding-for breastfed babies.
The Evidence
Production and storage capacity.
Until recently, it was believed that the majority of the milk was made at the time the mother sat down to nurse and/or pump, as a result of the prolactin surge that occurs during feeding. We also knew that some milk was made between feedings, as some of the nonfatty constituents collect passively in the sinuses behind the areola to form foremilk. Knowledge of this process has been changed by the work of Peter Hartmann.
Dr. Hartmann is a researcher in Perth, Australia, specializing in human milk production. In his laboratories, Dr. Hartmann has studied mothers before and after nursing sessions by making topographical-type maps of lactating breasts using video cameras and computer equipment in order to analyze changes. Their accuracy has been assessed at +/- 5%, an excellent percentage for this type of work. Dr. Hartmann has discovered, through this work, that the breast does not make all of the milk at nursing time, but rather is making milk around the clock. The rate of milk production between feedings varies according to the degree of fullness of the breast; the fuller the breast, the slower the milk production rate, and conversely the emptier the breast, the faster the rate of production for replacement.....
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