> And hence my question - how do we apply the knowledge of breast storage
> capacity when each baby seems to have a pattern of feeding that is unique
> unto itself? Could the storage capacity of the mother change to fit the
> needs of the baby rather than the storage capacity dictate how the mother
> needs to feed the baby? If I had visited Perth with each baby, would the 24
> hour computerised breast measurements have shown different readings ?

Dear Rose, the examples and subsequent questions you raise are very
relevant. Breast storage capacity is but one variable among many that should
be considered when assessing breastfeeding. (Also good to hear a "real live"
example of how an A cup mum can have a chubby child who feeds 4 hourly!)

The examples you have given are representative of how important it is to
remember that one lactation can vary considerably from another. Just as one
baby may be very different in the way they breastfeed from their siblings.

 When women wean, the milk producing cells go through a process called
apoptosis. This is where the cells are programmed (as involution or weaning
occurs) to die a natural death without initial loss of structural integrity.
This is followed by degradation of the extra cellular matrix and eventually
almost all of the mammary epithelium is reabsorbed.  Therefore, with each
new lactation new lactocytes, alveoli and ductal systems will be formed.
There is nothing to say they will differentiate and form in the same way
they did with the previous lactation. Therefore storage capacity may be
different for each breast from one lactation to the other.

Then there is the baby to consider. Even if a mother has a large storage
capacity, meaning she has a large volume of milk available to her baby at
any one time, there's nothing to say that the baby HAS TO take advantage of
this and have big feeds with long intervals. His metabolism (or personality)
may be such that he likes frequent shorter feeds.

So how it this important for clinical application? It isn't, except that it
shows what a great diversity there is amongst, not only individual women,
but between each lactation and indeed between each breast (and between each
baby). And that despite this diversity the mother/baby dyad will manage to
get breastfeeding right most of the time, if they follow their own instincts
and their baby's cues. Unfortunately there is this belief that there is
always a "right way" to do most things - including breastfeeding. Mums get
worried because their baby doesn¹t fit into the expected pattern of bigger
feeds and longer duration between feeds, or not sleeping through the night
by 12 weeks or not having enough milk because their breast are small etc
etc. Knowledge of the normal variation that exists enables us to reassure
mothers that what is right for them and their baby may be different from
what's right for someone else and their baby. And what works for this baby
may not be what worked for the last baby or for their next.

Also, of course, a good understanding of the normal variations in anatomy
and physiology assists us in diagnosing and treating problems or pathologies
when they arise. But I suspect we have a long way to go yet before we learn
all the secrets of the breast!

Regards
Cathy Fetherston CM MSc IBCLC
Perth Western Australia

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html