Hi all
I want to make another distinction in this discussion.  Seems to me that we
are getting distracted by research that demonstrates that it impossible to
accurately estimate the volume of milk (ie the number of cc's) transferred
simply by watching an infant feeding at the breast.  I would never dispute
those findings (seems a no-brainer to me).  What I am trying to point out is
that it is possible to know with a high degree of confidence whether or not
a baby is getting enough milk without knowing how many mls he swallows.  I
would never try to guess the volume taken by an infant because I cannot see
how that information is relevent, given the Hartmann team findings about
storage capacity and 24 hr intake.

Peter Hartmann's research team here in Aus found huge deviations between
exclusively breastfeeding dyads in 24 hr intake. 'normal milk production
would be 830 ± 195 g (mean ± s.d.) giving a normal range of 440—1220 g (mean
± 2 s.d.)'. JACQUELINE C. KENT *, LEON MITOULAS, DAVID B. COX, ROBYN A.
OWENS † and PETER E. HARTMANN, BREAST VOLUME AND MILK PRODUCTION DURING
EXTENDED LACTATION IN WOMEN, Experimental Physiology (1999), 84, 435—447.
Would we all be OK sending a mother home whose baby was taking 440g of milk
in 24hrs at 4wks.  Yet this is, for some babies, enough.  Would we trust our
qualitative observations that all is well in a case where the baby was only
taking 440g or would the scales tell us authoritatively that this baby
needed ABM?

So what I am trying to get at is that while accurate test-weighing may well
tell me how many mls a baby swallows, it will not tell me if that number
reflects sufficient intake for that baby. I hear that no-one uses this
measure in isolation but I also hear that the scales are the final word on
sufficiency of intake.  The current wisdom about how much is enough, seems
to mirror the intakes of artificially fed infants - intake that according to
the Hartmann research would be twice what some breastfed infants need to
thrive.  Does this lead to unecessary supplementation?

(Importantly, in a related study, they came to this conclusion "the breast
can rapidly change its rate of milk synthesis from one interfeed interval to
the next. This is a newly discovered property of the human mammary gland. In
the past, it has been assumed (Russo & Russo, 1987) that the rate of milk
synthesis of a breast could change significantly only over a period of
days."  SE Daly, RA Owens and PE Hartmann The short-term synthesis and
infant-regulated removal of milk in lactating women Exp Physiol
1993;78;209-220.)

Nina Berry BA/Bed(Hons) Dip Arts(Phil)
Breastfeeding Counsellor
PhD Candidate - "Ethical Issues in the marketing of 'Toddler Milks'"

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