Hi!

Thank you for your thoughtful posts on this topic, I think it is
crucial that it be addressed, as mastitis is a very prevalent condition and
one for which there is little hard science...

In my humble opinion, the problem with the current protocol is not its
content, it is that it should not have been published as a protocol. The
content is a series of hypotheses most of which have no good scientific
back up - but they can certainly be valid hypotheses, to be put out there
and tested. This is how science grows. I think if it would have been
published as an original article, to propose a new way of managing
mastitis, it would have been great. Like Pam Douglas has done with her
"Re-thinking benign inflammation of the lactating breast" series of
articles. New stuff to think about, study, discuss and try out.

A protocol is something else and must necessarily be supported by solid
science (or at least as solid as can be) and give clear clinical management
recommendations based on evidence.

I think also there may be a cultural bias in the protocol, in the sense
that not in all places do women use breast pumps as much as in the US, as
Nikki describes so well. Here in Spain, for instance, maternity leave is 4
months, for that reason many mothers don´t even own a pump until three and
a half months after they give birth! So when there is mastitis, mothers
nurse preferently on the affected side - but hardly ever pump. I´ve been a
LC in PP for 18 years and have hardly ever seen engorgement or
hyperlactation as an aftereffect of mastitis management - seriously, very
few. In my experience, most mastitis (when there are no underlying issues)
resolve simply by having an infant that nurses efficiently and by giving
precedence to the affected breast for a couple of days.

And then I also think if going into milk production overdrive were so easy,
we would not have so many cases of low milk production!

I certainly agree that any intervention that hurts the breast (excessive
pumping, excessively vigorous massage, excessive heat that may cause burns,
excessive cold that may cause reactive vasodilation) - will not benefit our
client and may hinder the healing process or cause complications. But this
is obvious!  Anything that gets oxytocin going is good, so the warmth of a
warm shower is bound to help, and a gentle massage is bound to help too, as
well as getting in bed with your baby and having someone take care of you
while you feed your baby often.

So maybe if there is this particular problem in the US or other places
where pumping is a very frequent tool, it should be studied (how many
patients does this mastitis - hyperlactation - complications cycle happen
to, what is the incidence? What population does it occur in?) and addressed
specifically with educational interventions...

Lots of food for thought!!

Cheers,
Kika

-- 
Dra Carmela Baeza
Médico de familia, IBCLC nº L-17694
www.centroraices.com
www.ibclc.es

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome