This is likely more than you ever wanted about creamatocrits and my views on them. Heather Welford Neil asks about situations in which a creamatocrit might be of use as part of a clinical assessment of breastfeeding, and what baseline one would use for comparison. Maggie Payne provided two examples of using creamatocrits, though in only one was the information relayed to a health care professional. The examples were illustrative for two reasons: they were both done in uncommon situations, cases many of us would never see in an entire career of working with breastfeeding, and they were done to convince skeptics that breastmilk actually was an appropriate food in the situation. In both cases it seems the baseline reference was breastmilk substitutes. In nearly all situations we see, including those where failure to thrive is involved, knowing the fat proportion of a sample of the mother's milk does not add to our ability to solve the problem. I don't have the possibility of doing creamatocrits and in all the years I have worked I have never missed it. I work with mostly term newborns up to a few weeks of age, but am seeing more and more older breastfed babies who are having feeding difficulties of one kind or another, many involving growth patterns that deviate from what is expected. I can't think of a case in which having a creamatocrit done might have changed our handling of the situation. This is not least due to the fact that we really don't know what creamatocrit values are normal, nor what influences the value obtained from a given sample of milk. There may have been babies who weren't growing because they were not getting enough fat. The basic tools I use in helping breastfeeding mothers include observing what a baby does at the breast, listening to what the mother tells me, particulary about what she thinks the problem might be, and taking a careful history of the whole course of breastfeeding with the child in question. Sometimes I find it useful to do pre- and post-feed weight checks, but not often. I am more cognizant the longer I practice, of subtle signs that a child really isn't nursing effectively. A lot of that awareness has come from reading Lactnet. I don't have much direct contact with other IBCLCs or even other clinicians working with breastfeeding. In my own workplace I am the one the others turn to when they are stuck, at least at the moment. If I were not aware of clinical signs of ineffective feeding, I don't think it would help that I knew the creamatocrit value. One pitfall of relying on a test that spits out a number is that we may start thinking that the things you can measure with numbers are more important than the things you have to observer more globally and more intuitively. In breastfeeding as in all else, the things you can measure and quantify simply are a tiny part of the story and in many cases they are a red herring, making you miss the real story altogether. I know that I and my colleagues with more advanced skills in breastfeeding guidance and support can write a couple of pages of text after observing a feed, to describe everything we saw, while many of the staff on the post partum ward would be hard put to write more than a sentence or two. With any diagnostic test, no exceptions, it's a good idea to ask yourself before deciding to do the test, how will the result influence the way I handle this case? If you can't think of a single one, or, and some might find this provocative, if the result might make you change from a treatment you have every reason to believe in and want to use, to something you really don't want to use, then you ought to ask yourself why you are doing the test at all. At best you are wasting your time and the time of whoever will analyze the test. At worst you could be groundlessly sowing doubt about the normalcy of something that is exactly as it should be. In Maggie's case, there was a reason for the test, though it was less a clinical reason than a judicial one. Fortunately the test supported doing what Maggie and her child's health care provider were doing already, in line with their convictions and their reading of the situation. But as Heather points out, it could just as easily have backfired, if the creamatocrit had been lower. Concerning the mother expecting her 10th child, the case in which creamatocrits came up, starting this thread, I agree with previous posters, especially those who describe problems when a baby doesn't manage to compress anything but nipple shaft because it is lengthened after feeding numerous older sibs. I have seen this clearly only once myself, in a mother whose love for breastfeeding motivated her to help her youngest baby become a more effective feeder through careful attention to latch. When we discovered the problem she was on the verge of giving up, and he was only a couple of months old. He learned over several weeks what he really needed to do to maintain and boost his mother's supply and went on to breastfeed as long as his older sisters had. Kathleen Bruce was visiting me when I worked with this mother, and Cathy Genna helped me via e-mail with her, and I learned more from their help on that one case than from the last five conferences I'd attended put together. Rachel Myr Who will never forget that mother or her older daughter who wailed in horror, when her mother tearfully said in despair that she didn't know if she could manage to continue breastfeeding the youngest, 'Oh, but Mama!! You MUST breastfeed him!' She could not bear the thought of her brother missing out on something so essential :-) *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]