It probably is an artifact of a pump that is not emptying mom's breast 
well - the emptier the breast, the higher the fat content of the milk. 
It seems like it is just enough to keep her supply barely adequate, 
hence the baby just barely gaining. In this case, I have mom pump in 
front of me, and we try to make her own pump work better. If this is not 
possible, I encourage her to rent a better pump.

If the baby were just nursing all the time, the baby would be more 
likely to get what he or she needs!

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 11/12/2011 9:42 AM, Phyllis Adamson IBCLC wrote:
> I worked with a mom whose infant was not gaining at an expected rate but was otherwise healthy and meeting all developmental milestones. But when she pumped her milk (working mom) she had a very thin layer of cream - more like a 1/16", hardly covering the surface, instead of about 1/8" layer. Doc was insisting on supplementing, and on pushing hi calorie foods. She was not on a calorie- or fat-restricted diet, not vegetarian, not experiencing OMER or over supply.
> All I could figure was, it was just that baby's "gene pool" to gain slowly. But the doc was blaming mom's milk and that was a source of family turmoil. She did persist with breastfeeding and chose her own balance between what the doc wanted and her belief in BrFdg for at least 1 year.
> And of course, no one has a crematocrit, so they declare it useless to consider finding out an exact calorie count. Research establishes it at 20 cals per ounce. But with her "low cream", doc assumed hers was less than 20 cals per ounce.
> Maybe this is one side effect of being a pump-dependant society?
>
> Phyllis
>
>
> ---- [log in to unmask] wrote:
>
> I think it is a result of nurses telling mothers to make sure they nurse
> long enough to get to the hind milk, and if they don't nurse long enough, it
> is  possible the baby won't GET the hind milk.  Hence you get the question
> in  the hospital:  "How long do I have to nurse before I get to the "good"
> milk.
>
> When I'm teaching, I tell the students that if there is one thing I could
> get rid of, I would get rid of the whole hindmilk/foremilk discussion.
> It's ALL good milk.  And let the baby breastfeed.  If we would just  pay
> attention to our babies instead of the clocks and the sundials and the  myriad of
> books out there....
>
> Speaking of which, one of my favorite (not) books talked about -- get this
> -- "Quencher milk, fore milk and hind milk".  And it took 18 minutes to get
>   to the hind milk.  I nearly had a coronary when I read that one...
>
>
> Jan Barger, RN, MA, IBCLC, FILCA
> Lactation Education  Consultants
> _www.lactationeducation.com_ (http://www.lactationeducation.com/)
>
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> --
> Phyllis Adamson, BA, IBCLC, RLC
> Glendale, AZ.
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