On 22/05/2007, at 8:13, Teresa Pitman wrote:

> 1. We know that the composition of breastmilk changes from one  
> feeding to the next and from day to day, and we don't really know  
> all the reasons, causes or effects of these changes. What are the  
> (possibly subtle) effects on the baby of being fed milk in the  
> evening that was pumped that morning?
>
> 3. We know that breastfeeding mothers co-sleep with their babies  
> differently than mothers who are bottlefeeding formula. Where do  
> pumping mothers fall? We don't know. We know that breastfeeding  
> mothers talk to their babies more and touch their babies more than  
> mothers who bottlefeed with formula. Again, we don't know if  
> pumping changes this or not.
>
> 4. We know that formula fed babies are more likely to be obese.  
> Some of the difference may be in the milk itself, but some may be  
> related to the feeding method - the baby feeding at the breast can  
> self-regulate feedings more effectively than babies feeding from  
> bottles, and can adjust the composition of the milk by how he  
> feeds. So babies fed exclusively pumped milk may be at a higher  
> risk of obesity than breastfed babies (but again, we don't really  
> know).
>
> 5. We don't know all the ways that nutrients, antibodies and other  
> components may be lost during the pumping and/or storage of milk.  
> We know that freezing breastmilk destroys at least some antibodies,  
> that some nutrients are destroyed by exposure to light, that some  
> components may cling to the sides of tubes and bottles. How  
> different is the milk the bottlefed baby receives from the milk  
> that originally came from the breast? We don't know the whole  
> answer to this either.

I am pleased to see that these four, of the five, factors are quite  
readily mitigable - there is a strong role for the non-judgemental LC  
in facilitating a mother's learning how to bottle-feed EBM in ways  
that most closely approximate feeding at the breast.

For factor 4, for example, it is very important to offer information  
on the safety of re-offering fresh milk that has already been drunk  
from, instead of letting mainstream information on discarding milk  
take hold. This also reduces waste dramatically, reducing or  
eliminating the need to supplement with formula.

Lara Hopkins

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