It is really unlikely that the quality of the milk is the root problem 
in this case.  Women have indeed breastfed through famines and dire 
situations, and everyone pulled through (and even this person's 
slow-gaining children would likely have squeaked by in an era without 
weekly weigh-ins).  Lactation is an amazing process -- it does 
prioritize the baby's needs, and draws on the parent's resources to 
provide the baby a consistent product, even at her expense.   Some of 
the pregnancy fat is laid down as a reserve to draw on across lactation. 
People have very different diets around the world, so a mother should 
not feel that she needs a perfect or special diet to breastfeed.

But that is not the same as saying that diet doesn't matter at all.  
(And, as in many issues, if one tries to stake out a middle ground, you 
can be attacked from both sides).   All our body systems run better when 
we're eating reasonably well, and someone needs to feel energetic and 
stable enough to cope with the needs of a new baby.  A year from now, 
the baby will be sharing the family meals, so the foods optimal for the 
breastfeeding parent are a good diet for anyone.

Diets overall and breastmilk, that varies within the day, within the 
feeding, and with the length of lactation, are each notoriously 
difficult research topics.  This roundup study (including some formula 
company backing), started with a big pile of articles and winnowed down 
to a few https://academic.oup.com/ajcn/article/104/3/646/4668536 The 
excellent new edition of  "Making More Milk" by Marasco and West, 
includes a chapter, with references, on maternal diet.

As author Anthony Trollope said "One can only pour out of a jug that 
which is in it/." /  So while it seems that the macronutrients of 
protein, carbohydrates and fats (though types of fat can vary with diet) 
stay fairly consistent, micronutrients, especially ones that we have to 
replace in our own bodies fairly frequently, may be more variable, 
though generally sufficient.

Everyone feels that they eat a "normal" diet, but ask in detail what she 
ate yesterday and the day before. Is she unusually thin or overweight?  
It may warrant a good check-up for the mother to rule out a vitamin 
deficiency -- D, B-12, and zinc are common enough deficiencies (and may 
be due to a metabolic problem or medications interfering with the 
absorption). Maybe a couple of crematocrit readings would be reassuring.

Going back to this particular case -   If the mother has been able to 
pump, it doesn't seem like a primary milk production problem.  So then 
we look at the logistics of milk getting out of her and into the baby.  
All the milk is nutritious, and as the breast drains, there's a smaller 
volume of higher-fat milk, but studies show that babies do need the 
overall volume to gain well -- it's not the type of milk. (I'm skeptical 
of the idea of pumping and discarding precious and nutritious "foremilk" 
when weight gain is a concern).   In studies of breastfed babies daily 
intakes there seems to be a wide range.

Perhaps discuss in detail her nursing style. Mothers are sometimes told 
to feed just on one side "so the baby gets the hindmilk" or persist 
there so long there that the baby doesn't have the endurance to do much 
on the second side. Perhaps you could encourage starting with a "milk 
shake" massage, to knock some fat off the cell walls  to increase the 
milk's fat content, and maybe even temporarily try some switch-nursing 
from side to side to keep the baby feeding actively, and perhaps 
draining both breasts better.  I often reassure mothers of a 
slow-gaining baby that is the baby is gaining anything and lively and 
producing diapers, the basic metabolism is being covered -- a big 
percentage of our caloric needs, and just a few more ounces a day can 
make a big difference in the rate of gain.

Help her look at the basics -- how many times a day is she feeding?  
Does she have someone around to help? Without practical supports, a 
mother of multiple children will be hard-pressed to sit down and feed 
frequently, and may be using pacifiers and trying to make the baby sleep 
long stretches night.

And people who are tired and stressed and worried can fall quickly into 
"all or nothing" thinking.  She will be watching this new baby's weight 
gain and will quickly take action if need be -- the child won't be in 
danger. Worst-case scenario, if this baby needed some supplements, she 
would do what was needed to help with the gain -- and this baby would 
still keep getting breastmilk and cozy one-on-one time with the mother 
amid the busy family life.

Margaret Wills, IBCLC, Maryland USA

> From:    Riva WeissfishIBCLC<[log in to unmask]>
> Subject: "low quality" milk
>
> PTP. A women I was trying to help retain breastfeeding, told me that she bottle fed three of her children EBM and even with adequate volume they did not have appropriate weight gain. When they were fed the equal amount of formula they did gain weight. She was told by her physician that her milk was "low quality".  We are not speaking about which charts were used. They fell off their own rate of growth curve.
> In the past, she starts with breastfeeding, switches to pumping and then continues with supplements until she finally switches entirely to ABM.  This time she wants to change to ABM already "before he starts to lose weight".
> Is it possible for milk to be so low in fat that infants will not gain weight? According to her report she has an average diet and reasonable calorie intake. She does not have oversupply issues (thinking: too much milk -not finishing sides). If this would be the case, is there a solution to the problem? Would pumping out beginning of the meal to access fattier milk be effective?
> Thanks for your insights!
> Stay Well!!!
> Riva
>
>              
>
> Date:    Wed, 20 May 2020 13:48:26 +0000
> From:    Patricia Young<[log in to unmask]>
> Subject: Re: "low quality" milk
>
>   Oh wow.  Of course the dr told her her milk was "low quality".  Baloney.  Even women in concentration camps were able to breastfeed their babies.With 4 children I wonder when she has time to pump....First I would question volume .Were/are babies being satisfied with low volume? Get used to being a little hungry as normal and don't protest or yell for more.  Also how long does she pump ?  Long enough to get a couple of let downs to squeeze the fat out ?
> I just don't think it is the quality of her milk.  Some other factor.  Hope some others have good ideas.  Pat in SNJ
>   
>
>

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