<< Mom reports that sometimes (not always) when she pumps, there are "lumps"
or "strings" in the  milk which are there immediately after pumping.  She has
no evidence of plugged ducts.  She reports that when the lumps are there the
milk has a "greasy" texture and the baby does not like that milk. >>

Any chance that she needs to add more good fats to her diet? Perhaps she has
too many saturated fats in her diet. I often find that in women with plugs
and strings like you describe benefit from adding essential fatty acids to
her diet. I usually recommend a combination of Flax and Evening Primrose
oils. Although we know that the quantity of fat in mother's milk remains
constant, the composition of these fats can be altered by mom's dietary
intake.

Don't know if this has come up on the list already but:
Doesn't the DEFINITION of *prescribing* come under both the state's Medical
Practice Act and the Nurse Practice Act (which would apply to you only if you
also have RN with your IBCLC)?
If I am remembering correctly from nursing school eons ago, recommending OTC
products is considered prescribing and/or practicing medicine without a
license, at least it was here in California in the 1970s and 1980s.

Marie Davis, RN, IBCLC
Who is still here, wheelchair bound and now considered 100% disabled.
Is there an IBCLC (retired) category? LOL!!
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