I've been wondering about this for a while and yesterday saw some evidence of
it.  A frequent question of those going back to work is when to start pumping.
I don't have an easy answer to that.  One thing I've wondered is whether
beginning to pump early means that thre breast will be called upon to make
more milk than the baby needs and therefore the baby will be receiving more
foremilk and not as much hindmilk.  If a mother is pumping at work when
separated from her baby, then at those times the pumping is taking the place
of a regular feeding, not making an extra demand on the breast.

I saw evidence of fussiness yesterday when a mother who recently began taking
a class on weekends, told me she decided instead of pumping a little every day
that she pumped a lot with a double pump during the previous week.  As we
chatted I saw was classic signs of the baby being ready to nurse.  A content
baby had come into a room after a 30 or 40 minute car drive.  A while later
started sucking at his hand.  Was content a while longer, then started the
sounds of I'm not so happy anymore, and fist going to the mouth.  I casually
said he looked like he was getting ready to nurse, seeing if she would agree
with me.   She offered the breast.
This 3 1/2 month old baby was coming off the breast at let-down.  The milk was
spraying into his mouth so hard that he couldn't handle it.  The mother's
interpretation of the baby's behavior was that he wasn't really hungry because
he didn't get down to business and eat.  She was convincing herself of that.

We talked about over-active let-down and that this spray could be stronger
than what the baby ordinarily experiences because her breasts had been making
more milk than he needed after her pumping sessions.  She had a lot of milk in
her breast and the back pressure upon let-down was quite high.   Indeed, the
baby continued to come off the breast, stick his fist in his mouth, fuss, etc.
and the breast would be sprayng milk.  He'd go back to the breast, nurse a
little, come off again.  The MER was still quite strong and the mother let
more milk run off and even expressed some milk into the sink, but the
fussiness still continued.  The baby was burped, and also passed a lot of gas.
Finally after going back to the same breast several times, the baby was able
to eat.  I do know some babies will not continue to nurse if they feel the are
about to stool, that they pause for a while, defecate, and then resume eating.
But this was different.

How many mothers do not like to pump everyday and figure that if they work
part-time that they can 'marathon' pumping sessions to have milk in the
freezer? Or only pump at home since they feel they wouldn't then have to pump
at work?  How many start to pump in the second week or their baby's life and
keep the demand up on the breast and therefore end up with more milk in their
breasts then the baby needs, experience foremilk/hindmilk imbalance, and might
then even quit breastfeeding because they have fussy babies?

Any comments?

Mardrey Swenson
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