I must say that I am quite frustrated by the foremilk/hindmilk debate.  The RESEARCH on infant's growth actually runs counter to Chloe Fisher's observations.  Cathy Genna posted about four or five references debunking the idea that babies who drink a higher fat milk grow faster.  It was a higher volume that made a difference. Many of the studies were done in developing countries where, women tend to switch breasts more frequently.  


Indeed, one of the studies I read -- maybe Nikki sent it to me to read?  was in Great Britain where they compared two SCHEDULES for feeding.  They did not have the control group that I would have liked which would have been "on cue feeding' with substantial training for mothers to recognize their baby's cues.  Something that is desperately needed in Manhattan and would have been completely ridiculously unecessary in the area of Congo where i lived for two years.  The two schedules were to:  A) Leave the baby on the first breast for as long as possible, B) Switch breasts at 10 minutes. The B) babies grew better.  I remember there was a lot of scheduling and sleep training and use of formula and the mothers with the B) babies were happier. I think it is because B) drains both breasts and stimulates the breast better than A) which only drains one -- when lactation is being established.  BOTH A) AND B) can lead to low supply when moms have been trained into thinking breastfeeding is work and you have to limit the time on the breast so your baby doesn't become dependent upon you.  Mothers in the Congo -- switched sides constantly and their infants were being carried on their backs and never set down at all.  They wouldn't necessary stop with the 2nd breast or worry if their baby wanted to feed 15 minutes later.  There were no mattresses, just a mat on the floor or maybe a raised platform with some mats if you were "rich".  So no worries about SIDS or sleeping with your baby.

So why is there is a contrast between the many studies on growth and Chloe Fisher's observations about mothers who were complaining that their babies were not growing whose breasts were overflowing with milk? I will also say that what we see in clinical practice never represents the vast majority of women.  We see the women with problems.  Chloe Fisher was observing something real, I'm sure she wasn't just imagining it.  

I think she was probably seeing a subset of the population that would not show up in a larger scale trial.  In thinking about the infant feeding practices in Great Britain, there does seem to be as much or more scheduling than there is here in the United States.  So, I'm wondering if the problem observed in Great Britain is really one of SCHEDULING and of undetected POSTERIOR TONGUE TIE. The key here was the comment about "the baby not finishing on the breast and needing compression".  And in fact, I would like to know if Chloe Fisher actually ever did test weighs to see if these babies actually were taking an adequate volume.  And we may never know if some of these babies were actually suffering from some form of posterior tongue tie.

While many mothers and babies themselves will subconsciously compress the breast -- I find that deliberately telling a mother to compress her breast  isn't necessary unless there has been some problem that interfered with the baby imprinting on the breast and the mother has not been following the hunger and swallowing cues.  

So, really something is WRONG when we have to teach these things.  It can be A) infrequent response to infant cuing behaviors due to interruptions in the hospital and a multigenerational loss of opportunities to learn how normal babies feed, or B) an anatomical or physiological problem whereby the baby cannot drain the breast.  In the case of A) the "faux" oversupply mimics a real oversupply because the accumulation of milk in between too long a stretch is overwhelming.  Yet the "real" supply may ultimately become low because the breasts are only drained four times a day.  In the case of B) more active breast compressions may compensate for a baby with problems or a mother who is impatient.

Best, Susan Burger

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