< Or did I just totally blow this cultural
experience?>

No. I think you did a wonderful job, and happened on a good solution. You
guaranteed that the baby is going to get mostly hindmilk and saved him
from relative overload of lactose.

In addition to reassuring the mother and building her confidence, you
also supported the milk-making process by the pumping. And you built a
stronger working relationship with a very open pediatrician, and gained
an opportunity to educate staff. Please keep us posted on the baby's
progress, and be sure to write this one up for the literature! What a
fascinating day you must have had!

I think the clues are <has been in airports and on airplanes for 3 days.
She is fasting for Ramodan>. If I understand it correctly, this fasting
is for the daylight hours only, and eating is permissible during hours of
darkness.

Granted, this would be stressful on the physiology of a breastfeeding
mother who was up and around during daylight, but it is not at all
equivalent to starving, despite the limitations of food available while
traveling.

Physiologically, it seems to be sort of reverse of the eating cycle the
rest of the year, when most nursing mothers would probably be fasting for
at least 8-10 hours all night. And it has oft been quoted that milk
changes (components and production) are not in relation to nutritional
intake until a mother is actually starving.

Her body position has probably been upright for 96 hours, in very
stressful conditions (few if any forceful MER's), especially since she
stopped nursing. I'll wager she has pendulous breasts.

Here is an excerpt from a post I just sent a few days ago to someone
else:<As far as foremilk and hindmilk, there is a lot of disagreement
about that. It is not as clearcut as what comes out of the breast first
vs. what comes out last.

I for one, strongly disagree with PART of what the Australian research
experts (Hartmann, et al) have been saying to "defuse" the issue of
hindmilk/foremilk lately, as far as their saying there is not much true
real difference, and that it differs from morning till night etc., etc. I
think there are other factors to be considered as well.

What cup size is the mother's breast? What position does she have most of
the night before and during nursing (lying down)? What position has she
been in for the 3-4 hours before pumping?

I for one, believe we are talking about 2 issues. First, I agree that the
milk that is released from the glandular portion of the breast during MER
is relatively higher in fat, because the foremilk has had time to filter
out of the alveolus and down and forward into the ducts continuously, due
to its thin, watery nature and higher specific gravity. That leaves the
fat globules, refrained from entering the tiny ductules ay size and low
specific gravity, to be forced out by subsequent MER's. So I can agree
with "the more well drained the breast, the higher the fat content" part
of what I have read.

But secondly, from what I have seen and heard clinically, I think there
is also the issue of what happens to milk that has been previously let
down into the ducts (and therefore cannot pass back up through the tiny
ductules into the alveolus), but has not as yet been removed from the
breasts.

To me, by logic, this milk would act according to specific gravity as we
are accustomed to expect of other mammalian dairy products that have not
been homogenized, with the cream rising vertically toward the ceiling,
and gravity drawing the skim in the direction of the floor.

This would mean that if the mother with a more pendulous breast and
longer tubings (C cup and beyond, IME) has been sitting or standing
upright for several hours between MER's, much of the cream near the parts
of the breast closer to the floor will have risen to the upper parts
closer to the ceiling and stick to the walls of the larger ducts that are
receiving only a slower filtering of watery milk due to slower production
as the breast fills.

This means that such a mother who has been sitting or standing upright
for several hours, would indeed tend to get more watery-looking milk when
she pumps, especially if she is single pumping.

If she keeps the milk from the two sides separate, she may well note that
by the time she gets to the second side, any MER's that have happened
during pumping have begun to mix a little more cream forward in the
breast and "enrich" it so that it will not appear to be quite so watery.

OTOH, if she has been lying down for the previous 3-4 hours, the cream
left in the milk that had not been removed from the ducts at the last
nursing would re-distribute itself "up" in the direction of the ceiling.

This would theoretically mean that the cream would "rise" and stick to
the "ceiling side" of the full length of each duct, and that if she
remained lying on her right side, the cream would lie distributed along
the left sides of the ducts of both breasts, and vice versa.

(If she then turned over and remained on her left side for 3-4 hours,
nursing at least once during that time, much of the cream still left in
the remaining milk in the ducts would gradually shift to the right side
of the ducts, though some of it would still remain stuck to the walls
where it was previously)

At any rate, this means that if she has been lying down most of the time
at night, both the "fore" and the "hind" milk would have a relatively
even amount of fat in it, and that in essence, the baby would not receive
the relative lactose overload etc. etc. This is all theoretical, I
suppose you can figure out, but I think it explains it far better than
other theories I have heard.>

No flames please. Just my opinion.

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

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