Ann,
Babies are not meant to *not* breastfeed well. Milk supplies are not 
meant to fail. The way we handle birth (drugs and seperation, and 
sometimes more invasive techniques), the cultural ignorance about 
breastfeeding, the fact that mom and baby are clothed (reduces skin to 
skin, and reduces baby's natural breastfeeding stimulus), scheduled 
feedings, embarassment to bf in front of visitors (and the profusion of 
visitors to new moms) all these things increase breastfeeding failures. 
Reproductive technology also increases the number of women with hormonal 
problems who are having babies, and who might have difficulty making 
enough milk.

Hypernatremic dehydration is very dangerous, for breastfed and formula 
fed babies. This is not a manufactured problem. I've "caught" a few 
cases (sent babies right to the hospital because they were bright orange 
or just too lethargic) and let me tell you, it's scary.

The increase in sodium in lactation failure is not by design, it's a 
byproduct of the failure of tight junction formation. During involution, 
mastitis, and before lactogenesis 2, the lactocytes are small, with gaps 
between them. This allows the immune system better access to the 
interior of the milk ducts. As lactogenesis 2 proceeds, the lactocytes 
grow, and form tight junctions between them, which allows better control 
of the levels of milk components. Lactose outcompetes sodium in the milk 
(they are inversely proportional to each other). Lactose production is 
the rate limiting step for milk production, if production slows, it is 
because lactose production slows. If lactose is not getting into the 
milk, sodium is. Perhaps there is an adaptive reason for the higher 
sodium level in acute weaning milk, but I don't know it.
Catherine Watson Genna, IBCLC  NYC

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