Dear All, 

1) re: bolus discussion - This discussion has been very interesting. In my hospital experience I have seen both results with pumping. Some mothers will get a measurable amount with their first pumping and then little for several pumpings thereafter. Others would get very little, if anything, for the first day or two. I just assumed it had to do with the length of pregnancy prior to the delivery - very premature, not as much time to make colostrum, longer gestation, more time to manufacture colostrum. Very few mothers think to hand express and we are working to make that more of an emphasis in education and practice. 


2) re: The Geddes article - There are three possibilities: 


Geddes D. Inside the lactating breast: the latest anatomy research. J Midwifery Womens Health. 2007; 52:556-563 



Geddes D. The use of ultrasound to identify milk ejection in women – tips and pitfalls. Int Breastfeed J. 2009:4:5 



Geddes D. Ultrasound imaging of the lactating breast: methodology and application. International Breastfeeding Journal. 2009;4(4). 
Her research showed that when there is a milk ejection, it happens on both breast but since the baby is only at one, the milk in the other retreats back into the alveoli. I am not sure if that happens from birth contractions and oxytocin release, as that was not the focus of her studies. 


3) re: bottles/nipples - There was an article many years back in the Journal of Human Lactation that addressed this. (Sorry, I do not have that citation.) The author suggested that the mother let the baby suck on her finger and she used that as a gauge for how long a nipple would be to most appropriately fit the baby's oral cavity. I usually tell mothers who ask that the bottle is just a container for her milk. It has no special properties. And that there are no studies done on bottles other than those done by the company promoting the bottle. As for nipples, it will be trial and error to see what the baby accepts. Some babies have very strong oral sensitivities and preferences and there is no one nipple that will meet the needs of all babies. I do stress, as has been previously mentioned, that the base of the nipple encourage a wide open mouth and ot avoid the nipples that seem perpendicular to the base. 


Cindy Garrison BS IBCLC 
practicing in Pittsburgh, PA 




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