Denise,
You wrote:

<Regarding using the 'mother lying on her back' position to breastfeed in
the hope that the fat-rich milk will rise to the top I'm sorry but I
don't
think it works that way.  The fat, from my understanding, is actually
fairly adherent to the walls of the alveoli and ductules and it isn't
until
the breast is emptying well and the myoepithelial cells are squeezing
both
ductules and alveoli that the fat is dislodged.

I'm led to believe this position was invented in Australia, but as a fair
dinkum Aussie I'm afraid I really don't like it for anything.  I don't
believe it helps babies to feed no matter what their problem and I've
seen
some mothers with some corker blocked ducts from feeding like this.
Plus,
just how convenient is it - it could well be another reason why a mother
would say no, breastfeeding just doesn't fit into my lifestyle, if she
has
to find a bed to lie down every time she wants to feed.>

I think I was the one who started this subject most recently, in part,
half joking.

I was most kindly "re-educated" by Joy Anderson and Gonneke and have gone
back and done a good bit of reading. I have now formed a better picture
in my mind, and can accept it on the basis of the ductules, immediately
next in line after the alveoli being so small that, while the aqueous
part of the milk can indeed "trickle down", the large fat globules are
"hung up" (as if in a funnel with a tiny
opening) until a really good MER or two comes along to "squirt" them
forward.

I even came across one reference just last night that stated that the MER
actually temporarily "ruptured" the membrane in many of the alveoli,
resulting in the sudden release of fat globules that had previously not
yet even been secreted across the membrane into the lumen of the
alveolus. I had read that somewhere long ago, but I don't remember it's
being mentioned in recent articles. Or did I miss that?

It is indeed a fascinating exercise to imagine the whole process.
And it is quite possible that I have too active an imagination. Or at
least, I devote too much time to using it on things like this!

But I still cannot help but think that part of my reasoning has merit:

1) Depending on the mother's degree of fullness for her storage capacity,
cream that has been released into the ducts may end up getting leaked  if
the baby is switched too soon to the other breast.

2) Or if it doesn't leak, but baby doesn't remove much of it before he
releases that breast, my logic tells me that even if a lot of the fat
remains mixed with the skim, at least part of it will, given time, rise
against gravity, like cream used to separate in the glass bottles on the
doorstep in my childhood.

And depending on whether mother were vertical or horizontal for several
hours between, I can visualize this having some bearing on just which
surface of the ducts it adhered to till the next feeding. (This is how I
interpret Peter Hartmann saying that we ought to discard the terms
foremilk and hindmilk, as during some feedings, at certain times of the
day, baby may get more fat as he begins to feed than he got when he fell
asleep at the breast earlier in the day.)

That was the basis for my whimsical "for instance" of a mother with an A
cup or a conical breast, sleeping on her back for several hours, might
end up with any "leftover" cream rising up to collect nearer the nipple,
to go into the baby first even if she sat upright to nurse. I doubt
anybody's going to "experiment" based on my whimsy to disprove or prove
it though.

I don't remember linking any of this with nursing in the Australian
position per se though. I don't know how it got its name either, but I
suspect the platypus figures into it somehow.

What you say may be very true for longer term breastfeeding. But I found
it a spendid position to show moms and their significant others in the
hospital, for use at least in the early postpartum period. With a pillow
tucked firmly under the arm that cradles the head, and the baby draped
over the mom's other breast, or toes pointing to either hip, I found many
moms exceeding grateful to be assisted into this position because:

1) It enabled them to relax and close their eyes, and maybe even catch a
few winks of a nap. They invariably remarked how relaxing it felt, and I
think that helps the MER, and gave them an alternative for when they felt
sleep deprived later at home.

2) it avoided pressure on any CS incision, and took pressure off of
epesiotomy and hemorrhoids.

3) The weight of the baby's head compresses the breast against the chest
wall, so that the baby tended to get a deeper latch and keep it.

4) Gravity distributed much of the breast tissue away from the baby's
face and nose automatically, without any need to hold the breast, and no
chance of "drag" tugging it out of the baby's mouth.
Interstitial fluid would tend to gravitate more toward the lymph nodes
rather than gathering as dependent edema in the pendulous breast.

5) It involves the significant other in learning how to help mom into the
position while she and the baby are learning.

And now, I need to turn my imagination to other things!

Jean
**************************************
K. Jean Cotterman RNC, IBCLC
Dayton Ohio USA

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