Well, Denise, at least we are disagreeing without being disagreeable.
(And I know all too well how disagreeable night duty can make one feel,
having spent over a dozen years on nights in the past.) Your comments
will definitely stimulate me to go back and read more carefully for
further understanding. But to answer some of the questions you raised:
< So,
by 'leaked', you mean released into the milk?>
No. I mean leaked out the nipple between feedings into the mother's
nursing pads and discarded. I hear plenty of moms complaining (or
bragging) about going through boxes of nursing pads in a week.
<Two 'musings' here: if it hasn't been released (?leaked) then it is
still
adherent to the walls of the alveoli and ductules, therefore it isn't
'mixed with the skim'.
Let's say though that baby was 'half way' through 'emptying' that breast
and wanted no more. So the milk was definitely not 'skim'. >
Perhaps for the purpose of this present discussion, it would be better if
I used the term " aqueous portion of the milk", in which all components
except the fat globules are actually dissolved.
While in the example above, there may not be "technically" skim milk,
once the fat globules have been released and dispursed forward in the
breast, I don't see how it can be other than at least mixed in with the
aqueous portion for an hour or more after a feeding, and therefore,
wasted in any leakage out of the breast.
Many moms here, especially if raised in the city, are only familiar with
"milk" as like what they have been drinking since they can remember
(whether they drink 1%, 2% or 3 1/2%, it has all undergone
homogenization), Or, thinking of milk they've seen given to babies, they
are equating it with formula, which does not separate either, probably
for the same reason.
The younger they are, the less understanding most of them have that milk
in its natural state separates into aqueous and milkfat portions. They
have been exposed, however, to the concepts of "skim", "low-fat",
half-and-half and whipping cream, as separate products in the dairy case.
I take advantage of this by using the words "skim" and "cream" in
explaining some of their questions about the color of their milk, the
baby's behavior and stool pattern, etc.
<What happens to
that fat if baby doesn't return to that breast to feed for say another 5
hours? My understanding is that it re-adheres to the alveoli and ductule
walls again.>
I cannot conceive of the same globule of cream ("that fat"), once having
been let down, ascending back up again into a ductule or alveolus, (since
there is no "let-up" reflex to squirt it back through the narrowest
tubing!)
Strict terminology that I have been reading uses the word "ductule" only
for the smallest branch of the duct system, immediately off the alveolus.
The word "duct", perhaps modified by "smaller" or "larger" or "major"
etc., is used for all other tubings in the duct system, I believe.
So while I can see it beginning to migrate slowly toward the walls of the
nearest duct, I still visualize specific gravity also causing it to float
slowly in the direction of the ceiling till it contacts a duct wall or
other globules adhering to a duct wall. But the mother's vertical or
horizontal position, if stable, as in sitting and standing, versus lying
still for several hours, plus the "hang" of her breast, would have some
small effect on where "ceilingward" would make some individual fat
globules end up.
Since most moms spend perhaps as much as 2/3 of the 24 hours vertical, my
assumption then is that most of the fat that has made it past the barrier
of the tiniest tubing into the larger, more distant ducts will float
upward as far as possible, but not re-enter the actual ductules.
And the longer she goes between MER's, the more chance for obvious
separation to occur in the milk stored in the ducts. The longer the
tubings in her breast (generally C cup and beyond), the more aqueous
would be the portion closest to the nipple, and the further away in the
duct system the fat globules would have floated. I sometimes wonder if
breast massage and compression might help "mix it up" a little even
before it stimulates an MER.
I find this line of reasoning, this "model in my head" definitely helpful
to ME (emphasis) when signs of lactose overload, overactive MER, and
overabundant milk supply seem to be present. Perhaps I oversimplify it
for the mothers (I can hear my friends say "Jean? Simplify anything?
Perish the thought!"). But many moms seem to see the point in the way I
explain it and are thereby empowered to manage their feedings a little
differently if they so desire.
But as you say, it probably doesn't make a whit of difference in a 24
hour time period. Perhaps I am belaboring the point, sort of like
debating how many angels fit on the head of a pin. As you say, we need
only to have another MER or two and there would be a different mixture in
the next "batch" anyway.
<Why teach a mother something that is only ever useful for such a brief
time. >
Oh, but how vulnerable I find they are with early dismissal and
especially during those first 2 or 3 weeks home! Sleep deprivation in the
early weeks is one of the primary reasons I find the lower-income and/or
less educated mothers (yes, and fathers and significant others too)
turning to formula for at least a little respite, starting the downward
spiral of "too little milk so I gave him another bottle".
<And side lying in bed gives mother the rest and all the other advantages
of
lying down without risking the lousy drainage that this position affords
the breast at such a crucial time in establishing her lactation.>
Many of them here are so confused over the issue of co-sleeping by now
that they are afraid to try to nurse at night in side lying position. I
will admit that this is the first I have heard that drainage in this
position could be termed "lousy". I was operating on the assumption that
the mom is developing a good MER. Or if she has an especially strong one,
a few night time feedings in this antigravity position might even be
beneficial.
I would particularly like to hear the experiences and opinions of others
about recommending this position for occasional use when the mother is
"craving" sleep in the early days.
Craving sleep now,
Jean
***********************************************
K. Jean Cotterman RNC, IBCLC
Dayton Ohio USA
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