I'm not going to say much on this clinically because I think the Joy
Anderson contribution etc really says it well and I've written about in in
BFM. But someone suggested that Charlotte Naish might have been the source
of the foremilk/hindmilk rhetoric. Published in 1947, Naish's first edition
of Breast Feeding (Oxford Medical) certainly helped popularise it, but she
quoted Harold Waller's 1943 work and the concept goes back even further
than that: Pierre Budin's studies of wetnurses from the 1890s showed that
foundling homes which employed wet nurses knew how to manipulate the
changing fat composition of breastmilk, and they talked explicitly of
hindmilk etc. (If anyone ever finds a copy that they don't want of Le
Nourrison - The Nursling - in French or English, I'd love to buy it!) To me
Dr Paula Meier's programme which has often indigent or uneducated mothers
using the creamatocrit to calibrate the density of their baby's caloric
intake is another example of this manipulation of milkfat being used
wisely.
There is a clear lineage from Waller to Naish and Gunther to Fisher (Chloe
knew Mavis) which helps explain why this was more commonly talked about in
UK sources. However, it was at the International Confederation of Midwives
meeting in Sydney in 1984 that Sue Cox gave her paper on one-sided feeding
in hospital, showing that in the early postpartum period this led to fewer
problems, and so inadvertently setting in train the vogue for one-sided
feeding that by the end of the second week was leading to inadequate
supply. I think Naish said some pertinent things very well: eg
"Once the gland is activated by the necessary hormones, it will secrete
milk unless it is too full, when it will stop. When each breast is left
untouched for 12 hours in every 24, the chance of secretion being stopped
by back-pressure in a full breast is obviously great. I believe this to be
the reason why, in practical experience, the one-breast method leads to
more failures than the two-breast method." This assumed that the 1/2 breast
method imposed by a doctor was being followed persistently over time, and
was combined with 4 hourly intervals between feeds, which was then de
rigeur. As it still was in the early 1980s in many places!
Sue's paper came after a lot of discussion within NMAA from 1979, when the
NMAA Newsletter published an article on infant colic that eventually led to
my book, Food for Thought, in 1982, which talked about transient benign
lactose intolerance in breastfed infants, and Breastfeeding Matters, which
was given to Prof David Baum (Mike Woolridge's boss) to review in 1983,
when I visited the UK to meet all my personal gurus, from Mavis to Chloe to
Mary Renfrew. From teh early 1980s the Oxford/then Bristol studies on human
milk volume flow and composition were ongoing, and collaboration between
Mike and Chloe led to the lactose malabsorption paper in 1986 which is
where the medical journals finally aired the theory. And the
interpretations started! So that's the outline pedigree for any aspiring
historian to trace if they want to chronicle the development of an idea in
western science.
These old books are a fascinating blend of wisdom and non-science at times.
Naish begins, as so many breastfeeding advocates did, by disclaiming any
belief in breastfeeding as a universal panacea, acknowledging its
limitations and dangers, and so on. But she has a marvellous paragraph
which states, inter alia, that
"Breastfeeding is the natural way to raise an infant. Obvious as this is,
the fact is not fully grasped in all its implications. Owing to the
peculiar helplessness of the human infant, human reproduction cannot be
considered a completed task until (at the earliest) the infant is weaned
on to solid food. In some parts of the earth the species has maintained
itself through long ages in the absence of any other mammalian species that
it could rob of its milk; and in those circumstances humans can be
considered free-living animals. In Western Europe it is an open question
whether the human species may ultimately have to be classed as a parasite
on the cow. I am not certain if there are moral aspects to the status of
parasite... the question of whether Europeans are to be considered a
free-living species depends on the number of women who succeed in feeding
their own offspring."
I wonder if we could get the animal rights movement working to promote
breastfeeding by arguing that we are parasitic on the cow, equivalent to
ticks and lice? In the late 1980s there was a marvellous picture in Massey
University of a placid herd of milk cows sub-titled "Mothers of the Human
Race."
Maureen Minchin IBCLC
PO Box 1569, Business Mail Centre, Geelong 3220
Tel/fax: 61 3 5221 2021; 9537 2640
She who trims herself to suit everybody will soon whittle herself away. Anon
Taking the path of least resistance makes rivers -and people - crooked.
Anon again!
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