On 12/03/2006, at 20:17, Wendy Blumfield wrote:

> My concern is not for the occasional bag of milk that has been  
> stored for some time, but for the guidelines we give mothers who  
> have to pump regularly, e.g. returning to work.
> Instead of aiming to keep a full freezer, I am now advising mothers  
> just to keep a couple of days ahead of themselves, pumping at work  
> for the next day and catching up on supply when they are home at  
> weekends and can breastfeed and pump more often.  In this way they  
> do not need to store milk for long periods.
[snip]
> Women returning to work do not have that choice so again it is our  
> job to make sure the milk is stored safely without reducing the  
> health benefits by prolonged refrigeration.
> Is that promotion for formula? I don`t think so.

I mostly agree with you, but perhaps end up viewing it slightly  
differently. I guess I'm a bit surprised at people who say that these  
data have changed their recommendations dramatically - has it been  
routine advice in some places to give a separated baby frozen-thawed  
milk all of the time? I was under the impression that we've known for  
some time that the freshest milk is the best, but that stored  
mother's milk is a second choice far ahead of the other alternatives.  
I think it's of absolutely prime importance to talk about that "far  
ahead" gap - something the mass media seem to go to great pains to  
ignore or even cover up.

My take: given a situation where a WOHM (work-outside-home mum) is  
planning to pump while at work and feed mother's milk (MM) as the  
only milk source for a full year at least: from my experience I think  
that staying only a day or two ahead, with no freezer stash, is not  
very likely to result in an 100% MM-fed baby. It might not be obvious  
formula promotion, but I can see how some people would see it as de  
facto formula promotion, as it has a high chance of resulting in  
increased formula feeding.

The pumping mums I know have goals much more focussed on avoidance of  
cows milk formula, on maintaining gut integrity, avoiding allergenic  
foreign proteins, avoiding the diabetes risk associated with cow  
casein(etc etc). Focussing on small differences in antioxidant  
content, just one of hundreds of components of mother's milk, and of  
uncertain clinical significance at that, is not a priority - and they  
HAVE to prioritise. Many are fighting an uphill battle as it is,  
besieged on the one hand by people having a go at them for not  
staying at home with their child, and on the other by bosses,  
workmates, family and friends who have never encountered someone  
pumping for their baby, and think it's weird, pointless, and gross.  
Adding a "well, stored milk isn't really much good anyway" just adds  
more fuel to the "Why bother?" fire.

Mothers get sick, have bad days, have slumps in pump response  
(related to periods, stress, a missed session, mastitis, pump  
resistance, and multiple other causes), and babies have appetite  
spurts; a freezer stash is a reassuring buffer at those times,  
avoiding the need for formula. What pumping mum hasn't felt that  
frisson of cold panic when she suddenly sees half the usual amount of  
milk in her collection bottles? Where a SAHM (stay-at-home mum) might  
be able to just feed much more often and for longer at those times, a  
WOHM is unlikely to be able to adjust her schedule to pump hourly or  
for twice as long for a few days to catch up.

I really don't see a big problem, from these antioxidant data, with  
feeding fresh milk 90% of the time, while maintaining and rotating a  
deep freeze stash just often enough to keep it from expiring and for  
a buffer in the lean times.

Lara Hopkins

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