I completely agree with Rachel and Heather on the early intervention
with pumping to collect the first bolus of colostrum. I have so many
concerns and so many questions, For example, how do we know this
bolus is not itself affected by the medicalized birth that makes it
now seem necessary to collect it for interventive feeding?
I found Jan's original post on this, part of which reads:
"Remember that Nancy mentioned the burst of oxytocin which is related
to the
pressure of the infant's head on the transvaginal vault during pushing.
Oxytocin is no respector of myoepithelial cells -- and it is doing
its work on
the myoepithelial cells of the alveoli as well, just pushing that
colostrum
along so the baby gets a nice lovely feed. But if it isn't used --
like an
unsqueezed sponge, the colostrum goes back up the ducts and it takes
awhile for
the the hand expression/pump to get it back down again."
What I wonder is how we know that this is what is happening when the
mother has been given syntocinon--as so many mothers who have
epidurals and other medicalized births have been. Syntocinon is
uptaken by the receptor sites prepared for oxytocin, thus the
mother's own oxytocin production is shut down. How does this affect
the presence of this first bolus of colostrum? What if, instead of
offering the mother a sense of confidence in her body, the mother who
has been drugged finds that she now has one more problem to overcome
if she has a more difficult time producing, as Rachel has pointed
out, the "correct amount"? Worse, what if the mothers who are not
drugged produce less colostrum than mothers who are drugged, b/c
synthetic oxytocin causes hyper-production? Would it now be necessary
to give every mother synthetic oxytocin after birth to assure that
she produces "enough" colostrum? And if this did happen, we would
surely have to pump right away to ensure the correct amount. As is so
often the case with breastfeeding research, there are rarely mothers
and babies included in studies who represent the biologic norm, so we
must always stop to question our compass for what we then expect of
every mother?
While I am personally and professionally deeply invested in the
imperative of uninterrupted mother-baby dialogue, and the truly
magical properties of colostrum, I think we have to weigh the risks
of undermining exclusive and long-term breastfeeding when we
interrupt the healing that needs to take place if boding is to
happen, after a medicalized birth. Given that we are more likely, at
least at this point in time, to view such augmentation as necessary
when mothers have had medicalized births, we cannot know the
implications biologically or emotionally to mother or baby. I think
this is one more example where the cascade of interventions seems to
go on forever. We need to remember that there is no such thing as an
intervention that carries no risk.
Unless we have a sick mom or baby (or collecting colostrum is the
only way to prevent an over-eager HCP from giving an infant AIM),
then I think we would do best to leave mom and baby alone--together,
naked, warm, safe and loved. Better yet, how about we put our efforts
into remembering that we need to keep our machines off of birthing
women and babies and we can let the elegant design of nature prevent
breastfeeding problems in the first place.
Jennifer Tow, IBCLC, CT, USA
http://healinghumanpotential.blogspot.com/
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