Hi Anne,  I agree with every thing that Nina Berry said and would also like 
to ask if the mother had fed on both breasts at each feeding?  That is a 
common way of giving a baby low fat milk when the mother has an abundant 
supply.  For example, it was common for a mother to be instructed to feed 
her baby 10 minutes on each breast.  We know now that a baby will get a full 
complement of fat if the baby finishes the first breast before mom offers 
the second breast.

I'm sure that the military hospital would be able to perform a crematocrit.  
It is the same proceedure as is used for a hematocrit.  I was part of the 
process when our lab was certified to do creamatocrits.  The difficult part 
was finding another hospital that would run the comparison tests.

The crematocrit machine being sold by Medela is around $1,000.00 and would 
be an expensive investment if just used for this one case.  The fortifier 
made by Prolacta is made for preterm and provides a inappropriate mineral 
composition for term babies.  It is extremely expensive.  Please keep us 
posted about how this goes.  Sincerely, Rachel Wahl RN IBCLC

  >Date:    Thu, 14 Jun 2007 17:50:06 -0400
>From:    Anne Hinze <[log in to unmask]>
>Subject: Multiple children with insufficient weight gain, expecting 10th 
>baby
>
>Hi there, I'm posting this for the LC I'm training under... any ideas, su=
>ggestions=20
>are most welcome.
>
>This mom is expecting her 10th (yes 10th) child sometime this month. She =
>is=20
>41 years old and her oldest child is 21 years.=20
>
>After the birth of her sixth baby she had her thyroid removed. She is cur=
>rently=20
>taking synthroid, although I'm not sure of the exact dose. I can find out=
>  if=20
>that information is helpful.
>
>Babies 7, 8 and 9 all had insufficient weight gain. Mom supplemented ABM =
>with=20
>2 of the three. She starts solids at 4 months and stops supplementing wit=
>h=20
>ABM at that time. After solids are introduced, the babies no longer 
>have=20=
>
>insufficient weight gain.
>
>She contacted the hospital LC by phone for #9 when her pediatrician=20
>suggested stopping supplementation cold turkey. Mom was concerned about=20=
>
>negative effects this could have on the baby's weight gain. LC 
>suggested=20=
>
>weaning off the ABM...
>
>She is currently pregnant with #10 and came to see the LC to develop a pl=
>an,=20
>hoping to not have to supplement with this child. The LC believes that=20=
>
>supplementation was required sometime after 2 weeks of age in the babies.=
>
>
>So other than increasing mom's fat intake in the hopes it would bolster t=
>he fat=20
>content of her own milk, are there any other suggestions? Mom reports tha=
>t=20
>there is a good cream layer on her milk when she pumps...
>
>LC is interested in getting the mom's milk analyzed for fat content, but =
>is=20
>unsure if the military hospital lab where she works would be able to perf=
>orm a=20
>creamatocrit. She is going to look into possibly purchasing the new=20
>creamatocrit tool available through Medela. Do any of you have experience=
>=20
>with this tool and know of it's limitations in this type of situation? Ar=
>e there=20
>any outside labs that could perform the correct analysis of the mom's mil=
>k in=20
>the hopes it would provide answers as to why her milk is not rich enough =
>to=20
>allow the babies to gain weight? Would there be a benefit to using someth=
>ing=20
>such as the prolacta human milk fortifier for preemies vs. ABM to add fat=
>  and=20
>calories to EBM? I'm not sure if it would be cost prohibitive, though (i'=
>m sure=20
>it's extremely expensive).
>
>I forgot to add that her supply is not the issue. She has an abundant sup=
>ply.=20
>She also has a history of gestational diabetes, does not require 
>insulin=20=
>
>(regulated with diet) and it has resolved at birth each time.
>
>Are there any other things that might cause her babies to have poor weigh=
>t=20
>gain that we haven't thought of?=20
>
>Do any of you have suggestions for other ways to help this next baby gain=
>=20
>weight without supplementation of ABM?
>
>many thanks!=20
>
>Anne Hinze
>
>              ***********************************************
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>------------------------------
>
>Date:    Fri, 15 Jun 2007 08:13:48 +1000
>From:    Nina Berry <[log in to unmask]>
>Subject: Re: Multiple children with insufficient weight gain, expecting 
>10th baby
>
>Hi Anne
>Something odd going on here.
>Your post seems to suggest that the quality of this mothers' milk is
>inadequate to meet the nutritional needs of her infant (given that the
>supply is adequate). I have never seen any evidence that this is possible
>(wih the exception perhaps of post gastric-bypass surgery mothers but even
>then, I suspect that the issue is poor supply as a result of severe
>malnutrition in the mother).
>My questions are
>1. What is happening with baby's output? (won't know that til after birth"
>2. How frequently is the mother feeding? (I suspect that the answer lies
>here somewhere.) Is she using a dummy (pacifier) to buy her time to attend
>to the older kids? (I would encourage this mother to prepare for the need 
>to
>feed *at least* 12 times in twenty four hours in the first month to 6 weeks
>- including a cluster-feed period (usually in the evening at about dinner
>prep time) in which baby feeds almost constantly for three to four hours.)
>3. What growth charts is the paed using? If s/he is using the WHO/CDC
>charts, it is likely that the 'required' gains are overestimated.
>4. What kind of birth (intervention) does she have?  Does she practice BLA
>and s2s immediately after birth and for at least the first 48hrs?
>5. Co-sleeping is known to improve breastfeeding exclusivity and duration;
>How does the mum feel about taking her baby to bed with her?
>6. Is mum expressing unnecessarily (to give bottles when she goes out or in
>the night or just so someone else can do the feeding)?
>
>Lastly, don't blame the milk.  If a baby is not growing as expected, is
>exclusively breastfed on cue, having 5 heavy wet one use nappies every 24
>hours and three or four poos in the early weeks (beyond day five), then
>there is likely something wrong with the baby and that needs to be checked
>out.  The thyroid history is interesting (overactive thyroid will burn
>calories, if I remember rightly).
>
>We have a deep suspicion of breastmilk in our culture.  It (the lack of it
>or the inadequacy of it) is regularly blamed for every infant anomoly.  
>This
>enables us to 'fix' so many problems with commerical non-human milks that
>are viewed culturally as so much more reliable (measurable, predictable).
>If a baby is not gaining well on human milk, the answer is invariably
>formula. If a baby is not doing well on formula, everyone agrees that this
>is a situation that warrants further investigation. We have our 
>expectations
>upside down on this.
>
>Hope this helps
>Nina Berry
>Breastfeeding Counsellor
>PhD Candidate
>Australia
>

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