Dear all:

Now I'm thinking about that study in Ghana that looked at weight gain, intake, and fat content and 
it probably measured "weight" rather than volume.  

An ounce is an estimate of "mass" not volume.  An ounce can "approximate" volume if you assume 
that the liquid you are measuring is close to the one to one correspondance.  Weight is an 
estimate of mass and holds relatively stable unless we start having nursing mothers in space 
where it would fall apart.  Here I truly wish the US would get with the program and use grams 
instead of pounds and ounces because the conversions are truly ridiculous.  

The estimate of volume is actually "milliliters".

For the most part, what the Ghana study (and I'm not promising that I remember the country 
correctly) strikingly showed is that when mothers and infants are feeding on cue, the fat 
concentration is not the determining factor for growth - it is the quantity of milk ingested.  What 
this triggered for me is that the feed to feed variability that we all know so well that can make one 
feeding a higher fat feeding than the next, tends to balance out over time.  That should be 
reassuring for most mothers in most settings.

So, I'm actually thinking that Gonneke's concern is probably due to the fact that she may see a 
clientele more like my own because we may be dealing with a higher proportion of mothers who 
get out of sync with scheduling feedings, overpumping, and other iatrogenically induced ways of 
creating an oversupply.  I'm not talking about the normal variation in supply where one mother is 
copious and another mother must put the baby to the breast very frequently to maintain growth, 
but the mothers that get themselves into the state where they are packing it into the freezer.

Again, I will state that in the case of oversupply, any observation of intake, be it listening for 
swallowing with or without a stethescope; watching the pattern of the jaw dropping, ears moving, 
bullfrog throat, or the feel of the baby pulling at the breast, or using the scale will be subject to 
the same variation.  

About the only time I think you would need to use a scale is if there is some doubt that the baby 
really is gulping down that quantity of milk.  If a baby is gaining at a rate of 1-1/2 to 2 oz per day 
you don't need a pre and post feeding intake to trust your judgements when you think you have 
an oversupply situation.  About the only time I would feel the need to use the scale at all in such 
situations is when a baby has not been on the breast and is now being taught how to feed from 
the breast to see if the baby has some trouble swallowing at the breast or in the case of a baby 
that appears to be gulping away, has not had a weight check to determine if the baby is gaining 
and there is some hint that the baby might be "faking".  I think the vast majority of us would have 
a very good track record listening to mom and eyeballing this particular situation.

Finally, the scale is really just a little estimate.  I don't give different advice for the mother whose 
baby takes in 0.3 oz versus the mother whose baby takes in 0.5 oz at a feeding after 45 minutes 
of breastfeeding.  I ask tons of questions about that feeding versus other feedings, look at the 
baby's skin color, watch the baby's behavior, feel the baby's skin turgor, ask the baby's date of 
birth, etc.  All those other factors play more of a role than minute differences in intake.  On the 
other hand, I might give very different advice to the mother whose baby takes in 2.5 oz in 5 
minutes.  

Within such ranges and with our other observations, I do not believe that we need to get so caught 
up in the fat content.  We do need to use all our other obserational skills to determine if 
oversupply might be a problem and deal with it accordingly, which is where I have Gonneke to 
thank for starting me down a path towards better management of such situations.

Best regards, Susan Burger

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