>>We have a very IUGR (just over 4# at 41 weeks) baby whose mom has a long
history of anorexia and >>bulimia, especially bulimia.  Mom is in strong
denial that her eating could have contributed to baby's >>low weight-.NICU
is questioning whether her milk will be "adequate". The social worker (a
strong >>breastfeeding advocate and nursing mother herself) feels that
nursing and pumping may be another way for >>the mom to "purge".  They are
currently saying that mom must alternate breast and bottle.  I suggested
>>that fortifying might be a way to use what she's pumping (a fair amount).
Have any of you experienced >>any problems with milk quality in cases of
anorexia or bulimia?  Is there any reliable, feasible way to >>check her
milk for nutrients that doesn't cost a big chunk of the national budget?

This makes me very sad, this poor mum must already have severe psychological
problems related to her anorexia/bulemia and now it appears everyone wants
to tell her her breastmilk is not good enough for her baby. Many studies
have shown that undernourished mothers (even those in developing countries
who have been undernourished all their lives) provide adequate breastmilk
both in quality and quantity for their newborns. There is no reason to
believe that nutritionally her milk should be any different from the next
mothers. In undernourished mothers it is the mothers who suffer adversely,
not the breastmilk. If as you say she is pumping ³a fair amount² (which I
have interpreted as being a good supply) then there appears to be no
evidence which would lead you to question the quality of her milk.

I would like to think she would receive praise and encouragement for a job
well done if she has managed to maintain a good supply in the face of all
her adversities and a sense of excitement that at at last her baby can now
receive her milk (and hopefully not suggestions from a social worker that
this is another way for her to ³purge²).

Cathy Fetherston CM MSc IBCLC
Perth Western Australia

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