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
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