----------
From: Lactation Information and Discussion
To: Recipients of LACTNET digests
Subject: LACTNET Digest - 5 Mar 1996 to 6 Mar 199
Date: Wednesday, March 06, 1996 6:56AM
There are 11 messages totalling 305 lines in this issue.
Topics in this special issue:
1. epidurals vs intrathecals
2. premature baby with septic mom
3. The "Phen-Fen" diet
4. depo
5. nystatin for breast thrush
6. >Sounded like yeast, > but responded to antibacterial
medication..
7. silicone implants and breastfeeding
8. G2P2
9. boys "nursing" dolls
10. reflux
11. Breastfeeding and family planning
----------------------------------------------------------------------
Date: Tue, 5 Mar 1996 21:23:52 -0800
From: "C. Ione Sims CNM/MSN/IBCLC" <[log in to unmask]>
Subject: epidurals vs intrathecals
For the person who asked what the difference was between epidurals and
intrathecals: the difference comes down to the medication used. Both are
done basically the same way, but epidurals usually utilize one of the
'caine drugs which means that it can act as local anesthesia and also,
depending on the amount and type of drug, can produce motor blockade --
hence the numbing effects that can interfere with pushing, for instance.
An intrathecal utilizes narcotics rather than anesthetics and can provide
excellent pain relief with very tiny amounts of morphine or fentanyl. An
intrathecal is the same as what you may have heard called a "walking
epidural". It does not take away motor function and can be quite useful
for some women. It also does not take away all sensation of pain. Common
side effects of intrathecals are itching (very common!), and urinary
retention. Respiratory depression can be a problem which can occur
several hours after administration and because of this, some anesthesists
insist that the woman be on a pulse oximeter for the first 24 hours after
administration or at least on hourly checks of her respirations.
As far as effects on babies, I really don't know. For the woman, the
intrathecal can be a godsend (and I have labor sat my share of young moms
who begin losing it in early labor) especially for someone with a long,
difficult labor that isn't progressing especially well, and may be
preferable to systemic narcotics because the dosage is much less. I
suspect the effects on babies of most drugs or procedures that laboring
women are subjected to are much more subtle than many of us are led to
appreciate. The intrathecal, at least, does have the advantage of
retaining the woman's mobility, doesn't require a large fluid bolus in
advance, and doesn't appear to interfere as much with pushing as the
epidural, though second stages appear to be longer with intrathecal's than
in unmedicated births.
Ione Sims, CNM, IBCLC
------------------------------
Date: Tue, 5 Mar 1996 21:34:09 -0800
From: John Throckmorton <[log in to unmask]>
Subject: premature baby with septic mom
Advice, friends, please.
Yesterday I recieved a call to the hospital lactation office from one of =
the nurse practitioners in the NICU and it has shaken some of my =
assumptions about advise to give moms of premies, etc. After 10+ years =
in that same NICU before my lactation training, that is a humbling =
experience. =20
The baby is a 12 day old now 28 week premie who is stable and =
transitioning to bolus feedings. The baby has recieved only his =
mother's milk since birth. Mom was just readmitted to another local =
hospital with overwhelming sepsis which was found to be caused by =
methcillin resistant staph. According to the PNP who called me, this =
was presumed to be the organism which had caused premature rupture of =
membranes and was "cooking" for the 12 days since the baby's birth. The =
baby has now been taken off mom's milk and put on formula due to mom's =
illness and the inability to "sterilize her skin sufficiently to obtain =
clean milk." I was told this is similar to what is done with a mom who =
has mastitis until she is on antibiotics 24 hours. There is not a =
written policy related to this and there are no routines for culturing =
mother's milk in our hospital. =20
My first impression was that one protection this baby had been =
getting from this organism was the immunities present in mom's milk. My =
second thought is how will we know when mom is well enough and that her =
milk will be clean enough if it is dangerous for the baby at this point. =
The PNP I spoke with said that her advise was based on what is done in =
Denver by Mariane Neifert. Is there anyone who can comment from that =
hospital, or anywhere else who has a (preferably) written policy or =
documentation.
Thanks in advance. tracy throckmorton, rn ibclc
------------------------------
Date: Wed, 6 Mar 1996 00:44:08 EST
From: "PHYLLIS J. ADAMSON" <[log in to unmask]>
Subject: The "Phen-Fen" diet
This is the latest weight loss craze and it's so popular lately that it's
only a matter of time before I meet a breastfeeding mom who wants to try it
and I
want to be ready for them. Advice please. I've checked both the Briggs &
Hale
books. They have little or no information on the individual drugs. I
understand this is a new combination and may be a case of prescribing them
for
their discovered side effects rather than their original purpose. First,
there's Ionamin (phentermine resin) 15 mg taken in the AM. I believe it's a
stimulant or 'upper'. Then there's Pondamin (fenfluramine hydrochloride) 20
mg taken in the PM. I believe this is a relaxer or 'downer'. People spend
$60
to $90 a month on these drugs, plus doctor's visits. It is also known to be
a
'permanent' solution. Stop the drugs and immediately regain the weight.
Can
any of our physicians, pharmacists or chemists out there provide info on
known
or possible effects on a breastfed baby?
Thanks, all.
Phyllis Adamson, BA, IBCLC
Glendale, AZ
------------------------------
Date: Tue, 5 Mar 1996 22:04:15 -0800
From: "C. Ione Sims CNM/MSN/IBCLC" <[log in to unmask]>
Subject: depo
I, too, have seen a few moms who complained of decreased milk supply
after getting the shot (for the person who asked, it is given as an
injection IM every 3 months), and both have been working and pumping. I
have encouraged more frequent nursing and/or pumping and the problem has
generally resolved within a few days to a week.
Ione Sims, CNM,IBCLC
------------------------------
Date: Wed, 6 Mar 1996 21:25:02 +1000
From: Lisa Amir <[log in to unmask]>
Subject: nystatin for breast thrush
> However, for a mom with ductal thrush..... nystatin never
>gets into her system, it just passes through the digestive tract, so it
never
>reaches her breast. Not much help! :-)
Although nystatin is not well absorbed from the digestive tract, I have
found many women find a reduction in shooting/ burning/aching breast pain
that we associate with thrush in the breast. I have treated literally
hundreds of women in the last 6 years with thrush, and most respond to
nystatin ii tds, in addition to topical antifungal treatment for the nipples
and for the baby's mouth.
We think that nystatin may be effective by reducing the total load of
candida in the woman's body, so that she is better able to fight against the
candida in the breast. Additionally I wonder about the gut-mammary
circulation: could small quanitites of nystatin preferentially reach the
breast? (I have an article somewhere discussing bile salts in a breast
cyst). I remember reading something else about nystatin being found to be
effective for something completely seemingly irrelevant (?a type of
deafness) - so perhaps we don't fully understand this drug.
The major benefit of nystatin is its safety...... No serious side-effects at
all. Also its price is very reasonable.
I'm not totally against fluconazole: but it is expensive.
Lisa Amir
GP / LC in Melbourne, Australia
------------------------------
Date: Wed, 6 Mar 1996 21:25:05 +1000
From: Lisa Amir <[log in to unmask]>
Subject: >Sounded like yeast,
> but responded to antibacterial medication..
Very interesting story.
Miconazole and gentian violet are antifungals that have antibacterial
properties; I'm not aware of antibiotics having antifungal properties.
However, antibiotics do have antiinflammatory properties (which is why
mastitis symptoms may settle so quickly on antibiotics even if the
antibiotic is inappropriate).
How often do damaged nipples harbour bacteria such as Staph aureus? My
thrush study involved swabbing nipples, and I grew a lot of Staph: if the
fissure looks a little yellow it grew Staph for sure. I didn't treat the
Staph (as I wouldn't have treated clinically, and many of the women had just
been taking anti-staph antibiotics for mastitis), but treated them for
thrush and most got better. I think the staph is a contaminant that grows
whenever the skin is broken down. The study has just been published in
Gynecologic and Obstetric Investigation, 1996; 41: 30-34.
More work is definitely needed to work out the relationship between
bacterial nipple infections and nipple pain.
I don't know the answers to this case: but I just wonder - is the story
over yet?
Lisa Amir
GP / LC in Melbourne, Australia
------------------------------
Date: Wed, 6 Mar 1996 21:25:09 +1000
From: Lisa Amir <[log in to unmask]>
Subject: silicone implants and breastfeeding
We don't know the answers at present. Views are extremely polarised. The
doctors looking after women affected by silicone implants and spokesperson
for the women themselves (Lynda Roth, Silicone Survivors USA) were adamant
about not breastfeeding at a recent conference in Sydney. On the other hand,
the majority of the medical profession, LLLI, etc are saying it is OK.
I have been collecting info on this, and trying to come to some conclusion
myself.
I would be hesitant to tell the woman who has had the leaking implant that
it is OK to breastfeed. She will still have silicone in her breast, and
probably in her ducts. It is not inert in the body. In susceptible people it
may be immunogenic (HLA-DR53 may be a marker).
The reports of breastfed children being affected by silicone implants have
been case studies, and therefore not hard data scientifically - but who
knows? Autoimmune diseases may take 10 years to develop, so symptoms in
children may not be linked to breast implants.
The January-March 1995 edition of International Journal of Occupational
Medicine and Toxicology is a special issue on silicone toxicity (I can't see
breastfeeding in it).
What do other people think?
Lisa Amir
GP / LC, in Melbourne, Australia
------------------------------
Date: Wed, 6 Mar 1996 07:28:00 -0500
From: "Patricia B. Drazin, IBCLC" <[log in to unmask]>
Subject: Re: reflux
Mary:
My understanding is that esophageal reflux is defined by: a) the number
of
times the food and bile is sent back up into the esophagus and b) how long
it
sits up there.
The two test done are: a barium swallow that allows one to watch the path
down adn see what happens when the barium pases the sphincter. The other
test
is a ph probe. A probe is inserted connected to a recording device, it is
worn for 24 hours during which time it records the episodes or reflux and
the
time that the food/bile is in the esophagus. The parents are responsbile for
keeping a log of eating times and amounts so that the episodes can be looked
at in relationship to the time of intake.
While MOST spitting is benign as we have discussed esophageal reflux can
be very serious... the difference... MY feeling is that a lot of the
difference lies in the behavior of the infant. An infant with reflux is
usually not a happy person. they can be in a lot of discomfort.
Patricia
------------------------------
Date: Wed, 6 Mar 1996 09:37:02 -0300
From: Grupo Origem <[log in to unmask]>
Subject: Breastfeeding and family planning
Hi, ALL
We're making a booklet, to poor women's group, on family planning and
breastfeeding. This issue, in my country, Brazil, is very, very
important. It's not rare, yet, to meet poor mothers who have 6, 7
children, and this happen because they don't know how to avoid pregnancy.
There isn't a good governmental programme of family planning and the
people don't have access to all contraceptive methods.
We're thinking to give informations especially on what's the
contraceptive methods and how this could affect the breastfeeding. As
well, we want to talk about breastfeeding as a contraceptive method.
Well, we need materials on breastfeeding and contraception.
If you could send us something it will be very, very useful.
We're interested in... ALL!
Afterwards, I promise to send our booklet, when it will be ready.
I'd like to say sorry, again, for my difficulty to write in English, I
hope you could understand me!
Kisses from Brazil,
Denise Arcoverde
Grupo Origem
WABA Brasil
IBFAN Recife.
------------------------------
End of LACTNET Digest - 5 Mar 1996 to 6 Mar 1996 - Special issue
****************************************************************
|
