The only time I talk with mothers about fat content is when a mother
contacts me about a baby who seems discontented after feeding despite
mopther's conviction that there has been abundant milk transfer.

Often these are mothers with too few infants, i.e. they have enough milk for
triplets and only have twins, or only have a singleton and each breast
thinks it has to make enough milk for the whole baby.  The mother has been
switching breasts mid-meal for her own comfort, as the most recently used
breast will be OK while the other is painfully distended if baby doesn't
help out.  This strategy only serves to maintain the overproduction problem.

I focus on letting the baby decide when it's done on a side, and whether it
wants more.  I say that the fat content of the milk increases throughout the
feed, so that the last drop the baby takes is generally the richest.  This
seems to be easily understood, and mothers recognise that milk flows
strongly at the start, when under higher pressure, so that greater volume is
transferred in the beginning of most feeds.  But I explain that babies get
sated on calories, not volume, so that if they get a large volume of milk
but still aren't calorically sated, they will be unhappy again after a short
time.  Then I recommend bringing the baby back to the most used breast from
the last meal, because it may only need a little sip of cream, not a huge
thirst-quenching draught of milk.  If baby shows signs of wanting more, they
can offer the other side as well.  I really encourage the mother to take a
chance on letting the baby determine how long to stay on one breast, and
hand express to comfort if the other breast needs it afterwards.  I
specifically recommend NOT saving the expressed milk unless she is saving up
to take a long trip without her baby.  The last thing these women need is
longer intervals between feedings!

If it seems necessary, I mention that foremilk and hindmilk are relative
terms, and that there is no discernible point in a feed when foremilk ceased
and hindmilk begins.  But babies do the opposite to us.  They quench their
thirst before they sate their hunger.

Skoal!
Rachel Myr
Norway

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