Catherine, (and everyone)
What you say - that the babies who gain weight the best are those
whose mothers have the lowest creamatocrit at the end of the feeding
- is fascinating! I'm not the least surprised to hear it because it
seems logical to me that the higher the milk supply, the higher the
overall intake, of lactose _and_ protein _and_ fat, and the better
the baby would gain weight. But it seems to fly in the face of the
argument for correction of foremilk/hindmilk imbalance, which is put
forward so often as a problem that needs to be rectified, but which
nevertheless worries me a lot since it intuitively seems to make so
little sense.
I've just been working with a mom whose baby was 35% underweight at 5
months. She reported a history of an unhappy baby which had been
attributed to "foremilk/hindmilk imbalance" at about 2 months. She
followed advice to resolve this by block-feeding in order to increase
the fat content of her milk. My take on this (after the event, of
course, ...) was that the baby's distress was probably due to an
unrecognized already inadequate intake, and that block-feeding would
have left the un-fed breast deliberately and unnaturally undrained
for several hours, several times a day, thus decreasing an already
low supply still further, ie compounding a pre-existing problem.
We know that leaving the breasts too full results, over time, in a
dwindling breastmilk supply, and that more efficient and more
frequent drainage boosts production. And that the emptier the breast
the higher the fat content of the milk (fat content being a marker
for breast drainage). So I guess the paradox that intrigues me now
is how mothers with consistently lower fat in their milk (the marker
for less thorough drainage, which theoretically would depress
production over time) can have babies who consistently gain weight better.
Could we take this one step further and hypothesize that mothers with
higher fat content in their milk are those who under-produce, as the
reports you cite, Catherine, seem to suggest? In other words, that
fat-content in the milk is a marker not only for inadequate drainage,
but also for low production? Is it a cause, or a
consequence?? Studies on adult obesity seem to suggest that
low-carb, high-fat diets result in somewhat increased weight loss
compared to low-fat, high-carb diets. Why should babies respond any
differently to sugar and fat intake? Conversely, I know, from
working with stabilized prem babies who are fed higher-than-average
quantities of as-it-comes breastmilk (?high volume,
high-lactose/low-fat) that they can gain weight very quickly (up to
75g/day), whereas I haven't read that manipulation of EBM in order to
provide them with low-volume, low-lactose/high-fat milk, as described
in many LACTNET posts, achieves this phenomenal result. So the key
to weight-gain seems to be lactose intake. And, coincidentally,
lactose-output is also the driving force for breastmilk production.
So do we need to re-visit the recommendation to "correct"
fore-milk/hind-milk imbalance??? And for mothers with low
breastmilk production, how do we maximize lactose-output? Catherine,
I'd love the references for the research you cite. And - anyone -
I'd welcome comments on my rather rambling thoughts above. Perhaps
these principles are already set out somewhere in a nice review article?
Pamela Morrison IBCLC
Rustington, England
>Date: Thu, 30 Jul 2009 20:37:28 -0400
>From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
>Subject: Re: Bariatric surgery and lactation
>
>........If there's no fat in the pumped milk, it most likely means the breast
>wasn't emptied well! The way milk is produced, protein, sugar and fatty
>acids are all kept in balance, so it's very , very unusual for there not
>to be enough fat in the milk. Studies also show that the babies that
>gain best are those whose moms have the LOWEST creamatocrit at the end
>of the feeding (in other words, their moms make more milk, and the
>babies have emptied the breasts less by the end of the feed).
>
>Catherine Watson Genna, IBCLC NYC
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