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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