Going to try to reply to everyone all at once
RE: Empty breasts
I've been following the discussion on *empty the breast*. First, although
I've heard the modified sweat glands idea about the breast (In microscopic
structure they resemble sweat glands) and the apocrine theories this is not
something I would share with moms in a class. Too many of the mothers already
have problems identifying milk apart from other bodily secreations and
excreations.  (I also try not to use *secrete and excrete* terms in classes.)
My understanding is that the terminology *empty the breast* comes to us via
the dairy industry. An udder empties and then refills after about 4 hours
depending on the animal. This is one of the reasons we used to tell moms to
only nurse every 4 hours because the breast was empty.
********
Estrogen often used for uterine infections
Judy K wrote about a woman with a uterine infection post partum and baby's
subsequent slower weight gain.  It brought to mind a practice of some OB's in
my area. Women with postpartum uterine infections are often given high dose
estrogen to prevent uterine scarring. I am not sure of the phisology re the
scarring but I do know that the estrogen causes a temporary drop in milk
supply. It has been my experience that within a few days after the last dose
the supply becomes ample again.
**********
RE: Food refusal
Our clinic dieticians (sp?) often get referrals for children who will not
eat. One of the most unusual was a toddler who refused all solid food. The
diagnosis was anorexia nervosa (right :-(  ) There were no physical problems
but months went on with no change in behavior. Finally, someone thought to
ask the mother if she knew of a reason why the behavior started. She said "I
tried to tell them months ago, this all started when she choked on a piece of
hot dog. She hasn't taken a bite since." (Strange how mom never mentioned it
again) Anyway, this child was sent for some type of behavior modification to
reduce the fear the child had of choking. Within a few weeks she was eating
like a horse!
Another stopped eating after being orally (sexually) molested.
Imagine the trauma to the child if this mom does wean and force feed the
baby. What if the poor child can't eat? Allow the babe to starve, put in a
tube? Why don't these doctors think before they speak? Does the doc think the
child is *willful or being stubborn*? Like these kids plan this out or
something: really!  :~(   = symbol for a punch in the nose. Someone should
wake him and his kind up! Any wonder why eating disorders are so prevelent?
 I agree with Jan . <Guess the moral of the story is we shouldn't make food
an issue, because as we know, we can't control children through food - though
they can control us. (Look at the number of anorexics....)<
************
RE: Migranes
Being a migrane suffer myself, I know that my worst migranes follow my cycle
especially in the pms period. :-( . I had migranes while nursing and the
popular treatment was an ergot preparation. (Some docs still use these and it
reduces supply.)
Some migrane suffers like myself experience attacks that last for several
days. Self education is a key in treatment. The mother should be questioned
regarding aura-- does she know before they hit? If not  she should watch for
an aura. The aura can be subtle, a flash of light in the eye, a funny twitch
in the face, color distortion, or just a strange feeling. Do they seem to
start if there's a sudden change in barrometric pressure (I discovered this
connection by accident)? Do certain foods set it off?  Mine used to get so
bad that I had to be hospitalized for rehydration.  If I can get on top of
mine in the aura stage they won't go on for days. I take Fiorinal (no
codiene) generic is: butalbital CPD tabs.  I've been lucky and haven't had to
resort to shots of Toradol (ketorolac tromethamine) for over 2 years-- knock
on wood. My daughter was diagnosed at age 7 my son at age 9 They take
naprosyn when they become aware of the aura. I worried about passing on my
hip to my kids, instead I gave them migranes (Wait a minute-- they give me
migranes some days)
**************
RE: Janet's ? Premie
Janet,
A baby born 3 weeks before the due date is not a premie. Normal gestation
range  is 37 to 42 weeks. A 37 weeker should have a developed suck reflex.
Even at 36 wks there should be a suck reflex. Give us some info on the birth,
I think that we might be able to find some other cause for the poor suck.
*******
Medline search info,  me too please
Will someone please email me privately too re: HOW to do a medline search for
breastfeeding or other medical literature. TIA (Davisrnclc@ AOL.com)
**************
Which one of US do you want?
Seeing how a lot of us have the same first names, maybe we should add the
last name or at the least the initial. There appeared to be a post addressed
to Marie about milk loss from nipple shields. I don't remember addressing
this issue. Did you mean me? Marie Davis or Marie Biancuzzo?  I see Marie
Biancuzzo answered the post however I'd like to avoid confusion for others as
well,
**************
No mystery to 3 mo milk disappearence.
Several things are happing that lead to the false belief that the milk is
gone at 3 mo.
Prolactin levels have returned to normal. Mom's body just figured out there
aren't twins to be fed so she stops overproducing. Thus, her breasts are more
efficient at making milk. She doesn't have to be engorged or overfull all the
time. Leaking also stops at about this stage. Most women find that at 3 mo pp
they can return to their origional bra cup size. Those of us who nursed
children well into toddlerhood can attest that the breast begins to soften
and feel more normal around 3 months. With the prolactin near baseline, milk
supply becomes dependent on suckling, milk removal and oxytocin release. (See
Lawrence for more info)
3 mo growth spurt happens.
Lastly the baby's oral structure has changed, so the baby who had a suckling
problem in the begining either gets better, because he can produce more
suction; or worse because he can't get the same compression.
I find that if mother's are warned of these events in advance they continue
to nurse and don't express fears about lost milk.
********************
RE: CPS (Child Protective Services) and cocaine pos mom
Robin H, Many counties in Calif. now have a policy of removing the baby if
the mom tests positive for illegal substances. It is considered by many to be
prenatal child abuse. There are statistics on abrupted placenta and pre-term
labor with crack cocaine use.  I am glad the social worker is concerned
regarding the BF.  Couldn't they test the milk for cocaine and it metabolites
too? If she's been saving it, couldn't the court send someone out to take
random samples (provided they are dated and timed) Perhaps they could make a
decision to return the baby earlier if mom truely is clean. Unfortunately, it
has been my experience that if mom was using in pregnancy and shortly before
labor she  doesn't stop just because she's nursing.
*********
Table Sugar and botulisim
Arly Helm asked if they were sure about the source in the cases I mentioned
previously.
The neonatologist sent someone out from public health in all three cases. Two
of the sources were indeed table sugar. Think about the typical family sugar
bowl for a moment. The sugar inside gets damp from spoons etc and then sits
around. Who knows how long the bowel itself goes between washings. My own
pour type dispenser  even gets damp inside if its held above a steaming cup
of tea. On the corn syrup the health department found it in the cabinet. I
had been open for months and mold was clearly visable in the bottle.
If I remember correctly, botulism is loading dose dependent. It takes a
fairly small amount of spores to infect an infant compaired to the adult.
That's why some are now recommending no honey for children under 5 yrs, here
in my area. We routinely caution parents about table sugar and corn syrup as
well.
We had another case that baffled the health department last year. A toddler
came down with botulism and it took a Sherlock Holms to put the clues
together. The family recently had an in ground pool constructed. Needless to
say they weren't housekeeping fanatics. The dust in the house and the carpets
contained botulism spores. How's that for kids putting everything in their
mouthes?
The results of the toxin are treatable if caught quickly. The babies required
respiritory support and several weeks (months) in the hospital. Horrid thing
to watch. By the way the neonatologist insisted that these kids have
breastmilk (via tube because the swallow reflex disappeared for a time)
******
Marie Davis