Nellie, you wrote: <Just had a call on the Help Line from a woman who was hand pumping and got 2 ounces of clear fluid -- it did not look like milk so she says. > < She remembered that she had pumped clear milk before but only a small amount that turned more white as she continued to pump.> I agree with your reasoning thus far. I think you are on the right track. This is a perfect illustration of what I was trying to explain in my post just 4 posts ahead of yours in the same Lactnet. I believe this was foremilk from which the cream had risen and separated high up in her ducts. I will hazard a guess that it had been at least 4+ hours since she had had a MER by pumping or nursing, that her bra cup is at least a D or beyond, and that she had been sitting or standing, with relatively moderate activity, for the several hours previous to pumping. It would be interesting if you were able to check it out. It's perfectly ok with me to tell me if my guesses were wrong, too! Were the baby to be fed this, or nursed just 10 minutes or so on that same breast rather than having pumped it, and then also nursed 10 minutes on the other (as some mothers are instructed to do "religiously"), chances are this baby's stools would be explosive, perhaps tinted somewhat green, and the baby crying and drawing up his knees within 45 minutes after he first started to eat, from a relative lactose overload. Examples of lacto-engineering in this case might include encouraging her to trigger an MER manually before a feeding, by hand expression, or better yet by massage of the breast to help move some of the hindmilk forward, before latching and/or breast compression during the feeding when baby slows his swallowing. It might also include encouraging her to let the baby remove as much milk as possible from the first side, perhaps massaging and relatching in a different position rather than switching to the 2nd breast, of course, explaining why this change was worth trying. She in fact might benefit from feeding the baby from the same breast for 2-3 feedings in a row, to assure thorough milk removal and reach more cream. (Attention to the other side by just a little milk removal for comfort would be important while the breasts were adjusting to the new pattern.) If this were an baby who had periods of being extremely colicky, and mom was distraught, then just saving the foremilk and letting the baby remove as much as possible from the breast just pumped would be another example of lacto-engineering. This would give the baby a concentrated bolus of hind milk and might calm them both down. The foremilk could have some pumped hindmilk added to it sometime in the next day or so to avoid re-triggering colic. These are examples of reasoning that I have found helpful to some mothers whose situation is as described. Jean ************************************************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html