With all new discoveries still nothing refutes the old LLL adagium: breastfeed often and finish the first breast first. It is nice that that is now sort of proven by research, but does that make it worth more? Will it make breastfeeding and breastfeeding counseling different, or more or less difficult?
At the other side of the picture are the findings of Paula Meier that fat actually does make a difference, at least for premies it does. Mums pumping large amounts of relatively low-fat milk (for example after a good nights' sleep) will have babies that do not thrive in NICU, when they instead use the samples pumped later in the day when volume is less and fat content high, babies start thriving and growing.
The more we learn, the more we realize we do not know. Yet, babies and moms do not change that much and the adagium is and will probably stay: breastfeed often and finish the first breast first.
Warmly,
Gonneke, IBCLC, retired LLLL, MOM in hot and sunny southern Netherlands.
--- On Sun, 8/23/09, Catherine Watson Genna, IBCLC <[log in to unmask]> wrote:
From: Catherine Watson Genna, IBCLC <[log in to unmask]>
Subject: Re: [LACTNET] re not two kinds of milk
To: [log in to unmask]
Date: Sunday, August 23, 2009, 3:23 PM
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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