Further to my earlier posts on this, one person challenged the basis of the figures for infant intake days 1-5, wondering if it was volumes obtained by pumping which she assumed could be lower than the infant's intake, while some others also obviously found it all very new information. So today I went out to a library, got a copy of the original article referenced in the book I quoted, (a book written by 2 very competent research-based midwives, so I have to confess I trusted their reading of the literature) and re-read it. The original reference is Houston Howie and McNeilly, Factors affecting the duration of breastfeeding:1. Measurement of breastmilk intake in the first week of life. Early Hum Dev 1983; 8: 49-54. The basis was 24hour testweighs before and after feeds, conducted by the mothers themselves, with a highly reliable electronic balance. (accurate to within 2gm) Before anyone leaps in to criticise the methodology, please read the article; you may find that your concerns were known and addressed. This was a sample of only 18 mothers (18 more than anyone else has followed so carefully, however), but certainly the amounts recorded square with clinical experience here in Australia, where very tiny quantities of colostrum obviously satisfy many babies on day 1-2. [The usual caveat about averages always applies, of course.] Curiously or predictably, the average total intakes to day three are just above the total intakes to day three which have been shown to result in at least 95% of exclusively breastfed babies being PIVKA negative on day 5 (i.e., showing not the slightest sign of being low on vitamin K and so at no risk of classic haemorrhagic disease, an iatrogenic epidemic of earlier times when babies were separated and not fed ad lib by their mothers). (And sorry, I don't have time at the moment to locate and cite that reference but am preparing a talk entitled Bleedin' nonsense: the vitamin K controversy re-considered, which will contain all such references when it's done.) Now that I've looked at numbers involved, I think it would be good if someone in a position to do so, reads this article carefully and tried to replicate the methodology and see if the findings were similar. Meanwhile it remains the best data we have on this issue. (I'd certainly like to see it done for those mothers who have abundant flowing colostrum: do their babies self-limit intake, to reduce strain on immature kidneys?) I don't want to be controversial or to call down more heaps of coal upon my head, but feel I should say that I believe Americans need to read the UK and Australian literature *as much as* UK and Australian LCs need to read the American literature, and that in my experience it seems that the latter happens more than the former? Perhaps it's because America is so big and the literature generated so vast and varied, but it is sad that books like Akre's "Infant Feeding the Physiological Basis" or the Henschel/Inch "Breastfeeding a Guide for Midwives", or Brodribb's "Breastfeeding Management in Australia" seem not to be known as well as some standard US texts. And no library is complete without Sandra Lang's "Breastfeeding Special Care Babies", Enkin, Keirse Renfrew and Neilsen's "A Guide to Effective Care in Pregnancy and Childbirth", and a subscription to MIDIRS (see previous post for details.) All are incredibly reasonable by comparison with some US book prices. If you have trouble finding books, ask amazon.com to find them for you. And no, I don't get any commission for telling you about these books: I just think they're really important sources that can free people from the solely-US perspective, which tends to be far more medically-oriented and formula -friendly (in the absence of a strong midwifery profession and normative breastfeeding), and so sometimes disadvantages breastfeeding. Enough from me. I really am off now for some time. Maureen Maureen Minchin, IBCLC, 5 St, George's Rd., Armadale Vic 3143 Australia tel/fax till maybe end January or mid Feb: 61.3.95094929 or 95000648 tel/fax after that: will let you know Address (date depends on renovations; will post): Christ Church Vicarage, 14 Acland St., St.Kilda, Vic. 3182 Australia