Dear all
I am appreciative of all these valuable discussions regarding the controversies around the new protocol.
I am a GP, LLLLeader and IBCLC based in Cape Town, South Africa. I have NO research background. In my clinical experience, around 80% of mastitis cases I've dealt with clear within 48 hours after putting that mother and baby in bed together. Of course assessing for a deep comfortable latch goes without saying, but removing dummies and bottles and pumping is something I've always suggested as its not part of the normal physiology of breastfeeding. And I'm saying this from the perspective of being a working mother (of 4) who is familiar with the need for pumping/expressing.
A babymoon with skin-to-skin contact is disappointingly underappreciated and under-utilised:
- it gets the mother to slow down and put a hold on the rest of "life"
- connects mom's right brain to baby's right brain (reading feeding cues, understanding BF as a relationship and not just a means to feed)
- reduces all the left-brain thinking (schedules, pumps, milliletres etc)
- increases oxytocin which is a powerful pain-fighter
- increases prolactin which among other things has an anti-stress effect
- helps the dyad's microbiome
I do use ibuprofen because pain needs to be treated (and it has an anti-inflammatory aspect).
I have never given instructions for (deep) massage, it never made sense to me, but more importantly there's enough evidence that shows that giving left-brained instructions do not work well for mothers who are mainly (supposed to be) functioning in right-brain mode.
I am grateful for all the academics and all the research but worry that often times we just lose the essence of the basics in breastfeeding care.
I do have a theory (hopefully some researchers will be interested to look at that at some point) that just like babies often become unstable without skin-to-skin and with separation (increased hypoglycaemia, jaundice, oxygenation issues, SIDS, poorer thermal control, latch problems etc); mothers become unstable as well. Of course we all have some built in resilience as adults, therefore many cope despite the abnormal separation from their babies. So is mastitis one of the consequences of separation? (rhetorical for now)
Regards to all
Rahmat Bagus
-----Original Message-----
From: Lactation Information and Discussion <[log in to unmask]> On Behalf Of Françoise Coudray - IBCLC
Sent: Tuesday, September 12, 2023 1:14 PM
To: [log in to unmask]
Subject: Re: Lactnet Mastitis protocol
Hi to all of you,
To all of the comments that have been written by my estimated colleagues, during those last days, and when there was the release of the protocol, I would add:
Evidences are lacking, and what is really lacking is the medical, AND the clinical aspect, of inflammation thru "hyperlactation", how "hyperlactation" entails some inflammation, how do you want us to explain if we don't have the mechanics; it is just a thing a mom reacted about....
there are other evidences which are lacking.
Also what is hyperlactation?
because a lot of moms say "oh I have too much milk" and in fact, the baby has oral or facial issues which entails the baby won't drain the breast correctly which gives full breasts... (until it goes down) or the baby struggles because of tongue-tie and mom thinks she suffers hyper ejection.... or a baby with pacifier will ask less for breast so he/she will empty less often..... and she will have full boobs (before it goes down).
Other point, I am with Pamela... fed up with paying for any information that should be released for free. OK we have the ABM protocols for free, but then one needs to pay for the other articles, notably the Journal of Breastfeeding Medicine; of course one could say "work deserves money", but do you think IBCLCs in the world can afford all the "breastfeeding and lactation" journals? Who are the targets? we all are from all around the world; who are our targets? the families....
Then I wish to bounce back on what you said.... about the difficulty to meet to validate a protocol.... let me give you a parallel example:
I am a pretty good translator of texts, studies, courses, from english to french; I can remember a task, my translation needed to be validated by a Canadian friend, the "computer aspect" (copy paste my translation into a special software) was done with a guy in Australia; I live in France, right between them, so mornings if needed, I was with the computer guy; evenings with my colleague in Canada; I took me ONE week to translate a 100 pages course; it took 3 months before my colleague starts validating my translation; in between, I had copied/pasted into the special software); Do you think the course was put on line (then enabling IBCLC Candidates to
subscribe) before all was checked? Before we were all sure that my translation was OK (and it was) and that all was correctly put into the software (which it was)...
If I may dare, I would say that revision of a protocol should arise when new datas, numbers, arrive that are evidence based, AND that we all should change our way of working, like: a big change in the rates of bilirubine or glycemia so that: in function of this new rate, "we" have to start something and not "wait the former rates", a big evidence based data rather than "oh it was difficult to meet so we take advantage of a revision to fulfill the gaps".
Or I misunderstood...
We all are aware we all are busy; no problem; it is life; it is busy life; at the same time, we have responsibilities, all at our individual level so all facing our individual targets, ibclcs for ABM, families for ibclcs and counselors; to give the best and latest evidence based data and manner to deal; with evidence and mechanical/clinical explanations and evidence.
Thanks for reading me,
Best regards,
Françoise Coudray, IBCLC
Le mar. 12 sept. 2023 à 09:43, Elien Rouw <[log in to unmask]> a écrit :
> Naomi,
>
> Thank you for your kind response and I will give your praise further
> to the Protocol Committee. It is difficult, but through discussions
> like this we bring the field forwards.
>
> Elien
>
>
>
> Elien Rouw
>
> Im Wasserbett 7
>
> 77815 Bühl
>
> Tel: 07223-900302
>
> Email: [log in to unmask]
>
>
>
> Von: Naomi Bar-Yam
> Gesendet: Sonntag, 10. September 2023 03:03
> An: [log in to unmask]; Lactation Information and Discussion <
> [log in to unmask]>
> Betreff: Lactnet Mastitis protocol
>
>
>
> Elien,
>
>
>
> Thank you for your clear comments on the mastitis protocol. Protocols
> and reviews are indeed complex, highly specialized, research is
> lacking, and often not very good quality. This all makes it quite
> difficult to write and review protocols for others to use in their own practice.
>
>
>
> Thanks to ABM and all those who so generously give their time and
> expertise to write and review protocols.
>
>
>
> Naomi
>
>
>
> ---------------------------------------
>
> Naomi Bar-Yam, Ph.D.
> Director Emerita
> Mothers’ Milk Bank Northeast
> Cell: 617-599-2902
> [log in to unmask] <mailto:[log in to unmask]>
>
>
>
>
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