< Or did I just totally blow this cultural experience?> No. I think you did a wonderful job, and happened on a good solution. You guaranteed that the baby is going to get mostly hindmilk and saved him from relative overload of lactose. In addition to reassuring the mother and building her confidence, you also supported the milk-making process by the pumping. And you built a stronger working relationship with a very open pediatrician, and gained an opportunity to educate staff. Please keep us posted on the baby's progress, and be sure to write this one up for the literature! What a fascinating day you must have had! I think the clues are <has been in airports and on airplanes for 3 days. She is fasting for Ramodan>. If I understand it correctly, this fasting is for the daylight hours only, and eating is permissible during hours of darkness. Granted, this would be stressful on the physiology of a breastfeeding mother who was up and around during daylight, but it is not at all equivalent to starving, despite the limitations of food available while traveling. Physiologically, it seems to be sort of reverse of the eating cycle the rest of the year, when most nursing mothers would probably be fasting for at least 8-10 hours all night. And it has oft been quoted that milk changes (components and production) are not in relation to nutritional intake until a mother is actually starving. Her body position has probably been upright for 96 hours, in very stressful conditions (few if any forceful MER's), especially since she stopped nursing. I'll wager she has pendulous breasts. Here is an excerpt from a post I just sent a few days ago to someone else:<As far as foremilk and hindmilk, there is a lot of disagreement about that. It is not as clearcut as what comes out of the breast first vs. what comes out last. I for one, strongly disagree with PART of what the Australian research experts (Hartmann, et al) have been saying to "defuse" the issue of hindmilk/foremilk lately, as far as their saying there is not much true real difference, and that it differs from morning till night etc., etc. I think there are other factors to be considered as well. What cup size is the mother's breast? What position does she have most of the night before and during nursing (lying down)? What position has she been in for the 3-4 hours before pumping? I for one, believe we are talking about 2 issues. First, I agree that the milk that is released from the glandular portion of the breast during MER is relatively higher in fat, because the foremilk has had time to filter out of the alveolus and down and forward into the ducts continuously, due to its thin, watery nature and higher specific gravity. That leaves the fat globules, refrained from entering the tiny ductules ay size and low specific gravity, to be forced out by subsequent MER's. So I can agree with "the more well drained the breast, the higher the fat content" part of what I have read. But secondly, from what I have seen and heard clinically, I think there is also the issue of what happens to milk that has been previously let down into the ducts (and therefore cannot pass back up through the tiny ductules into the alveolus), but has not as yet been removed from the breasts. To me, by logic, this milk would act according to specific gravity as we are accustomed to expect of other mammalian dairy products that have not been homogenized, with the cream rising vertically toward the ceiling, and gravity drawing the skim in the direction of the floor. This would mean that if the mother with a more pendulous breast and longer tubings (C cup and beyond, IME) has been sitting or standing upright for several hours between MER's, much of the cream near the parts of the breast closer to the floor will have risen to the upper parts closer to the ceiling and stick to the walls of the larger ducts that are receiving only a slower filtering of watery milk due to slower production as the breast fills. This means that such a mother who has been sitting or standing upright for several hours, would indeed tend to get more watery-looking milk when she pumps, especially if she is single pumping. If she keeps the milk from the two sides separate, she may well note that by the time she gets to the second side, any MER's that have happened during pumping have begun to mix a little more cream forward in the breast and "enrich" it so that it will not appear to be quite so watery. OTOH, if she has been lying down for the previous 3-4 hours, the cream left in the milk that had not been removed from the ducts at the last nursing would re-distribute itself "up" in the direction of the ceiling. This would theoretically mean that the cream would "rise" and stick to the "ceiling side" of the full length of each duct, and that if she remained lying on her right side, the cream would lie distributed along the left sides of the ducts of both breasts, and vice versa. (If she then turned over and remained on her left side for 3-4 hours, nursing at least once during that time, much of the cream still left in the remaining milk in the ducts would gradually shift to the right side of the ducts, though some of it would still remain stuck to the walls where it was previously) At any rate, this means that if she has been lying down most of the time at night, both the "fore" and the "hind" milk would have a relatively even amount of fat in it, and that in essence, the baby would not receive the relative lactose overload etc. etc. This is all theoretical, I suppose you can figure out, but I think it explains it far better than other theories I have heard.> No flames please. Just my opinion. Jean ****************** K. Jean Cotterman RNC, IBDLD Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html