I openly admit I have read only one article months ago on scientific
measurement of storage capacity.
I can accept the principles:
* that thorough milk removal drives supply
* that not every alveolus is in the same state of
production at every moment
* that most women have more milk making
capacity than they need
* that a baby's total needs can almost always be
met by either small or large breasts, and
* that we can reassure mothers that if healthy
term babies attain a good latch and feed on cue,
the breast will respond by making adequate milk.
But from my clinical observations, and I suppose, just logic, there are
some ideas I have found valuable to some mothers.
Generally speaking, it stands to reason that mothers with A and B, and
even C cup sizes would have shorter "tubings" as I call them when talking
to most moms.
I reassure them that size has very little to do with total milk making
ability, and that most mothers have plenty of milk making tissue. (In
fact, I think I once read somewhere that besides extending to the armpit,
it can even extend inward toward the mediastinal area. I'd like to know
if anyone knows this to be true or false.)
I seldom tell these moms anything about hind milk, because it seems to me
that the force of the MER would have the effect of mixing the "cream"
frequently and with more efficiency through shorter tubings, and that the
baby's intake would be more blended, so to speak.
Because of that, I don't expect these mothers to get into problems with
lactose overload, even if they do routinely follow the dogmatic rule some
hospitals and HCP's still give out about being absolutely sure to use
both breasts at every feeding.
However, mothers who normally wear D, DD, EE, and HH and beyond cup sizes
often have use for this information about hind milk.
I realize that cup size partly involves more fatty tissue in those
breasts. But given the distance from palpable glandular tissue all the
way down to the nipple, I cannot help but believe that those mothers have
longer storage tubings. And I think that makes for the conditions Cathy
described of fat (released from the glandular area by previous
MER's)adsorbing to longer walls taking longer to re-mix in the tubings.
I often question those mothers more closely about their babies' behavior,
satisfaction, stool color etc. They seem somewhat more likely to react as
if with temporary lactose overload.
Those moms often appreciate an explanation of alternate massage style
breast compression, and cluster feeding at the same breast for several
feedings as a way for the baby to get a "more balanced" diet so that the
"cream" goes to the baby instead of leaking out into the mother's bra
pads.
This often involves helping them "tame" an overactive MER, and taper the
supply slightly if they have an oversupply, in order to avoid
complications in the other breast.
But the empowerment these mothers often feel at being able to understand
how to reduce their babies' fussiness, forceful gassiness, green stools,
and short sleep and feeding spans in general seems to me ample reason to
recommend the "Finish the first breast first" approach.
It won't harm those mom's with A, B, and C cups, and it might be very
helpful to those moms whom I believe simply MUST have somewhat larger
storage capacities by reason of the longer distance from glandular tissue
to nipple.
Perhaps I have opened up another can of worms, because not enough
scientific evidence has been put together to support this view, but I
have found this way of thinking helpful for many mothers, and I wish more
prenatal educators and HCP's caring for new mothers were offering those
alternatives to moms.
Jean
******************
K. Jean Cotterman RNC, IOBCLC
Dayton, Ohio USA
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