Some surprising research findings about how milk is made that have not
been covered yet:
One thing we've learned is that milk goes back up the ducts to the area
outside the milk glands (alveoli), allowing feedback to the breast about
how much milk the baby didn't take. This is Donna Geddes discovery, and
it is in agreement with other research findings, i.e. that germs ascend
from the nipple to cause mastitis, and now that cells from baby's saliva
are found in the breast.
We also found that it's how much milk the baby takes, not the fat
content that leads to growth. The citation for this study that Jean
Riddler mentioned:
Effect of sucking characteristics on breast milk creamatocrit.
Paediatric and Perinatal Epidemiology. 16(4):355-360, October 2002.
Aksit, Sadik; Ozkayin, Nese; Caglayan, Suat
It's well worth reading. Remember the "lack of fat/hindmilk" dx was a
hypothesis. In my experience, babies who are getting relative lactose
overloads are FAT, not skinny. Skinny babies are usually not getting
enough volume.
Peter Hartmann and people working in his lab found that babies
breastfeeding well take about 75-79% of the stored milk from mom's
breast (from their topographic analysis studies measuring breast volume
with a computer). Susan Burger mentions one of their studies of mothers
pumping with the research pump (Symphony) that showed a significant
proportion of successfully breastfeeding mothers did not remove 50% of
their milk with that pump. That's NOT a good thing for their future milk
production if they were to rely on that pump. Research is obviously
ongoing to try to improve that performance. In my work with tongue-tied
babies, some of them only take half or less than the milk mom can then
immediately pump.
We keep learning, and it's fascinating. For now, I advise moms to offer
both breasts, especially in the early weeks, unless baby is gaining more
than 2 lb per month, is miserable, and has gi symptoms.
Catherine Watson Genna, BS, IBCLC NYC
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