On 22/11/2003, at 9:06, [log in to unmask] wrote:

> Lara says,
>> Colour me sceptical about the "low-fat" milk, without any more
>> information being provided about how full the breast was when the
>> creamatocrit was taken, and what precautions were taken to get a
>> representative sample. A full breast of a completely normal mum will
>> give lower fat results than that.
>
> It seems to me that a *good* creamatocrit would be done by taking equal
> amounts of milk from the beginning, middle & end of feed and doing the
> same at
> varying times throughout a 24 hour period, mixing it well, and then
> doing the
> creamatocrit.

Would this be routine in 1990? Was enough known about the changing
composition of human milk throughout a feeding at that time? How many
readings/feedings are needed before you see consistent, reproducible
results? What other investigation was done into this "failure to
thrive" case? Did anyone check to see if the baby was even transferring
milk well? Unfortunately I have no fax access and the Pediatrics report
is unavailable online, but I would like to hear a Lactnet colleague's
critical reading of the methods used.

My time on Lactnet and elsewhere has resulted in a very deep-seated
scepticism of suggestions that a mother's milk is "deficient" and that
she therefore needs to feed artificial baby milk. Extraordinary claims
require extraordinary evidence. The OP's client was apparently told in
no uncertain terms that she "couldn't" breastfeed - and yet she could
sustain a healthy pregnancy? This just doesn't make any physiologic
sense to me. With adequate nutritional advice/supplements and competent
breastfeeding support, I can see no reason for a post-gastric-bypass
mother to choose artificial feeding.

I strongly doubt that her milk will be "low fat" with maternal
nutritional precautions, especially looking at the research that has
been done on the milk of malnourished mothers. If for some reason the
milk does have a lower fat content than average, this is still no
reason to choose exclusive artificial feeding - ask Trish Whitehouse
how well a baby can thrive on supplemented skim breastmilk.

Lara Hopkins

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