First a comment, as briefly as I can, on three excerpts of recent posts

>Some of us got to talking about Peter Hartmann's work, and wondered how the
idea of milk made during a nursing fits into it.  Is it true that milk is
synthesized during a nursing, or does it simply move out of the alveoli
during a nursing?  If milk is actually made during a nursing, then
comparing volume of the breast before and after wouldn't give a fully
accurate picture of volume consumed.<

Linda Smith's response is absolutely correct. The belief that milk is made
more rapidly during feeding was a clever idea someone had to counter the
"you can see what he is getting " so-called advantage of formula; this
idea, never proven, was rapidly adopted by breastfeeding groups. It had no
basis in fact; now it has been proven to have no basis in fact. Hartmann's
work has such a high correlation between amounts measured in volume and
both weight gained by baby and lost by mother that it simply cannot be
wrong on this issue. It's about time that any US centre which is serious
about milk volume studies bought the Uni. of WA technology and installed
it, in my view. For an understanding of milk synthesis, get a copy of Floyd
Schanbacher's ILCA 1996 conference talk and go through it carefully. Could
I strongly suggest that ILCA make this paper available as a module, because
it's obvious that some LCs are hazy on these basic physiological issues?
And they are very IMPORTANT clinically.

>The following foods made the "most wailing" list:  cabbage, cauliflower,
>broccoli, cow's milk, onion and chocolate (Journal of the American
>Dietetic Association, January 1996).<
Thanks for this latest reference, Pat. The link between maternal diet and
colic is incontrovertible and long established. Only those most remote from
community reality (like hospital-based specialists) have challenged this
since the late 1980's, although it took us a lot of work and research to
get the idea accepted in the decade from the 1970's era of total rejection.
But long lists of foods to avoid IS NOT the way to go. Certainly you can
establish what whole communities are most likely to react to, but this is
utterly irrelevant to the individual mother. Taking care to follow a proper
and detailed line of investigation for each mother of the young breastfed
baby usually gives one or more foods likely to be that individual mother's
problem; these can be very different from her sister's, or yours, or anyone
else's. It is simply irresponsible to publish long lists that may exclude
25 good-for-that-mother foods which were a problem-for
-other-mothers-foods. I do wish that people would take time to read what is
already published on this, even if I did write the most detailed book about
it and therefore cannot advertise here! But it may be symptomatic of the
continuing US power of the orthodox hospital-based researchers that a LC
Series issue on this was commissioned and then quashed; and that ILCA
presentations on allergy and breastfed babies to date have NOT included
anyone for whom this is an everyday experience and something readily
diagnosed and fixed in the early stages. I would love to do a long session
on this topic: perhaps this ongoing Lactnet discussion will inspire me to
write and offer an abstract to the 1997 ILCA conference organisers.

>anecdotal evidence suggesting that some of these discharges are due
to allergies. I have heard at least one LC speak on this topic; she has seen
the association of allergies and a grayish liquid discharge that can be
expressed from the nipples.<
As we all know, breasts are made up of glandular tissue and connective
tissue, ducts and the rest. The glandular tissue/ductal system at any age
is quite likely to contain varying amounts of secretion or simply what is
referred to in breast literature as resting breast fluid. Resting breast
fluid (liquid capable of being expressed) is not nipple discharge. To be
significant, nipple discharge needs to be a DISCHARGE: something you find
spontaneously oozing out and staining clothes. Studies of resting breast
fluid have been done and show that the colour range is huge. Smokers
typically have very dark, even grey-black fluid; grey-olive-green is
associated with high levels of cholesterol epoxides (break-down products);
milky-coloured probably means high prolactin levels and still some small
secretion of milk, as in the recently retired wetnurse of 81 who could
still express "milk which was nice, sweet, and not different from that of a
younger woman"; beta carotene etc. might change colours, as does artificial
suntan lotion. The fact that so much colour change is associated with
smoking suggests to me that one of the many ways that smoking increases
breast cancer risk is because the breast, as an organ of excretion as well
as secretion, is designed to get rid of those nasty fat-soluble compounds;
they rest there instead of being excreted because we lactate so little in
our society. I personally think induced lactation would bne a very useful
way of a heavily-contaminated woman (or man: it could be done) lowering the
body burden of pesticides and other nasties. But that would not be milk to
donate to a baby!

Finally: I'm looking forward to seeing the honour roll of new IBCLCs in the
JHL...And a query: I'm writing a piece on lactation consultancy for
publication: outside Australia, is there any self-proclaimed Lactation
Consultant group that anyone knows of which excludes from membership any
IBCLC who is not a healthworker as they (not WHO) defines healthworkers?
Don't tell me about nurses groups, or doctors' groups, or even
breastfeeding groups, which have arbitrary membership rules; just groups
which have LC somehere in their title and By-Laws, but do not support IBLCE
as the sole standard for international recognition. If you know of one, and
the group accepts any other credential as criteria for membership, include
details of the credential as best you can. (e.g., completion of an X- hour
course run at Y by Z; IBLCE but only plus RN training; etc. ) It doesn't
matter if they have membership provisions wider than IBCLC alone, like
ILCA: only if they refuse entry to some IBCLCs and not others. I'm trying
to assess how widely understood the importance of the IBLCE credential, as
a stand-alone health professional qualification, actually is. Thanks!

Maureen Minchin