Margaret wrote:
<this comment caught my eye:
". . . so called "foremilk hindmilk imbalance", another
term I dislike, incidentally."
Pleading ignorance here -- why the dislike for this term? In my limited
experience it seems useful.>
Jan answered:
<Jack says:
> Talking like this has mothers coming in and asking "when do I get to
the
> hindmilk", so it gives the wrong idea, that there is a moment when the
> foremilk becomes hindmilk, and this is not true.
Well, it is a problem that has been created from the "nurse the first
side
first" approach rather than "taking him off after 5 minutes and putting
him
on the other side so each br gets equal stimulation" approach. What I
get
from moms is, "how long do I have to breastfeed before I get to the
"good"
milk?" ARGGGGGGGH! It's ALL good milk! >
I, too, find this concept has a great deal of usefulness, especially in
detective work to unravel the tale that begins with complaints that
suggest OALD, oversupply, gassy, fussy, crampy baby with greenish tinge
to the explosive stools.
Many of these mothers are religiously following directions that "They
NEED to use both sides at a feeding." These directions have either been
given
* during this birth experience, or
* at previous birth experiences, or
* by grandmothers, aunts, sisters, friends, older books and articles (and
some physicians and office and home visit nurses) who want desperately to
be supportive and are without updated information, other than what they
were told so emphatically at one time.
And yet, yielding to the wisdom that says "Don't make it too technical",
I have begun saying something to the effect:
"We have newer information now. You can notice your milk gradually begins
to look creamier and creamier the more thoroughly your baby (or your
pump) has been removing it from your breast."
This allows all kinds of opportnities for reassurances that are really
"lactoengineering" in disguise.
* "Watch your baby, listen to make sure he is drinking, and let him
satisfy himself on the first breast first. When 'burp time' arrives, you
can even massage the breast a little bit and offer him the first side
again, to offer more 'dessert'. He may not get a large amount, but what
he gets is usually creamier, with lots of calories."
* "Or, you can offer him the other side if you want, but it's ok if he
prefers to wait till next time for it."
* It makes the logic of "cluster feeding" behavior easier to understand.
*For mothers with greater storage capacity, they can then seem to
understand that some babies feel happier if they have 2, or maybe even 3
feedings on the same breast, then the next 2, or 3, on the opposite side.
(It may be helpful to suggest that for a few days, slight relief of the
opposite side may needed for comfort till the supply balances.)
*Mothers of premies or FTT babies then seem to understand better the
value of extra pumping at the end of a feeding, not only to build supply,
but to obtain creamier milk for supplementing during feedings with an
SNS.
*This also helps them understand some of the extra benefit of breast
compression if their baby slows his drinking and seems to fall asleep at
the breast.
I've picked up a lot from you, Jack, but let's not "throw the baby out
with the bathwater!" Let's just modify our semantics a little so we can
keep the pendulum somewhere closer to the middle.
It's a little like achieving attitude adjustment just by calling the
glass "still half full" rather than "already half empty".
By not dwelling on the "skim milk/too much lactose" aspect, but helping
them appreciate more the "gradually richer and more creamy aspect", we
can keep it sounding simple and yet tailor our counseling to do some
lactoengineering when it seems appropriate.
Just my $.02.
Jean
********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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