Valerie, you are like the canary in the mines.  I think you are right on
when you call this patent thing 'future shock'.  So please don't give up on
us, keep sending your posts and we will catch up.  I hope we do so in time,
and I certainly hope you are not exactly like the canary (expiring just in
time to warn us that the air is too poisonous to survive in).

Your post on 'lactoengineering' is really what prompts me to respond.  Maybe
we should call it something else when we take expressed milk from two
breasts in separate containers and add the cream from one side to the whole
milk from the other.  Maybe we should call it altering cream content of a
feed, because that is what it is.  (Trish Whitehouse's skim milk production
was true engineering, and the very extreme case of her son points up just
how rarely it is needed.)
When I have used this cream-content altering technique it has come from a
need arising from the use of other technology, i.e. pumping.  Mother and
baby didn't get together in the beginning.  Maybe baby was in NICU or baby
was unfortunate enough to be under our weight limit for on cue feeding, or
just reluctant to latch, and thus subjected to forced feeding every 3 hours
to prevent the dread hypoglycemia, even though baby would have been capable
of getting plenty of food straight from the breast.  Staff fear prevented
them from letting baby show what it could do.  But we have pumps, so it
doesn't matter!  Let mother pump!  And, since baby is getting force-fed at
3-hourly intervals it is never interested in feeding anyway, so mother must
pump to maintain production.  Production is copious; baby is still only 5 lb
or whatever and mother's breasts have no real idea what baby needs, only
what the pump will take.  Baby quickly starts getting fed parts of feeds, as
mother is pumping three times what baby can possibly ingest.  No one is
keeping track of which milk came out first or last, breastmilk is breastmilk
so baby just gets its 1.5 ounces or 2 ounces or whatever and the rest is
frozen for future use (I've never figured this one out either - in case
mother does a runner, or forgets her breasts at the mall, or something?).
Then baby stops gaining, despite taking so much milk that it spits up after
each feed.  It has explosive runny green stools.  It seems unhappy about 15
minutes after a feed.  We have now inadvertently lactoengineered
foremilk-hindmilk imbalance.  Or rather, we have stimulated a supply
suitable to a newborn blue whale and all we have is a little bitty baby
human, who never makes it more than halfway through the appetizer course.
Obviously it would be a great idea to get baby on the breast so they can
sort it out together.  Meantime mother must reduce supply.  And the
pediatrician may be starting to squawk because baby isn't recovering
birthweight and it's going on three weeks here... bla bla bla.  In these
cases I find it preferable to increase cream content of feeds by taking the
cream from part of mother's surplus and adding it to her whole milk, while
working to get baby to the breast.  The alternative is formula, ack.
Ludicrous when mother is pumping nearly a gallon a day, but I have had to
argue against formula and for cream-enriched breastmilk in such situations.

The heart of the problem is whatever separated breast and baby at the
outset.  This was brought home to me the other day when my supervisor told
us that our NICU sees that ALL the mothers of the babies there who are
pumping, experience a dramatic drop in supply after about 2 weeks.  Before
that it is fine.  Turns out that when the mothers get off to a great start,
they are told to reduce the number of times they pump and to only pump the
amount the baby needs because we don't have storage space for all that milk.
Since a lot of these babies are very small, that isn't much, and just when
lactogenesis is becoming dependent on mechanical stimulation rather than
post-partum hormones, supply takes a nosedive.  This is an example of
inadvertently lactoengineering the milk right out of existence.

I believe there are a very few NICUs in Scandinavia who are really letting
babies figure out when they are hungry and when they are not, and they are
seeing that babies can be trusted to eat at very early ages, much earlier
than we have thought.  Most of us are still operating on anxiety and
mistrust of the process.  Breastfeeding is no different from the rest of the
reproductive cycle; one intervention leads to another and only occasionally
does it mean an improvement over doing nothing but letting nature take its
course.

Who put that soapbox under me, anyway?!
climbing carefully down now,
Rachel Myr
Kristiansand, Norway

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