In answer to your question pamela,
We have found that for these mothers who can't seem to bear the physical
contact of babies at their breast(possibly because of unknown or
subconscious previous emotionnal experiences; the use of artificial
nipples(rubber or silicone) may be helpful at the start to help them
discover the positive pleasureful experiences of breastfeeding, the infant
will do the rest and then you can help her remove the nipple shields as soon
as she feels comfortable.
PierreAt 08:41 06/12/1996 -0500, you wrote:
>Date:     Fri, 6 Dec 1996 08:41:15 -0500
>Reply-To: Lactation Information and Discussion <[log in to unmask]>
>Sender:   Lactation Information and Discussion <[log in to unmask]>
>From:     Automatic digest processor <[log in to unmask]>
>Subject:  LACTNET Digest - 5 Dec 1996 to 6 Dec 1996 - Special issue
>To:       Recipients of LACTNET digests <[log in to unmask]>
>
>There are 14 messages totalling 412 lines in this issue.
>
>Topics in this special issue:
>
>  1. Infant Death/Stored Milk
>  2. Emotional basis for nipple pain (2)
>  3. Nipple soreness...Linda V
>  4. (no subject)
>  5. Tobacco and abm
>  6. Insufficient glandular tissue
>  7. Volufeeders
>  8. Thrush...
>  9. recommending books/Nestle boycott
> 10. Tongue-Tie/Frenotomy
> 11. Frozen Breast Milk
> 12. Amitriptyline Exposure in a Premature Infant
> 13. amitryptiline and premature
>
>To post to the subscribers of  LACTNET, send your note to
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>
>Date:    Fri, 6 Dec 1996 00:06:03 -0500
>From:    Debby Kearney IBCLC <[log in to unmask]>
>Subject: Re: Infant Death/Stored Milk
>
>Hi everyone! I'm back following a six month break. I've been lurking awhile
>and trying to get back into the habit of reading, saving, and deleting.
>Several days ago there was a post concerning a mother who had saved a large
>quanity of milk for an infant who died.
>I have had this happen (so tragically) several times in my practice. In each
>case the milk bank the mother contacted was unable to accept her milk due to
>collection guidelines, etc.
>I think it is emotionally hard to just flush the milk down the sink. The
>mothers I worked with took my suggestion to incorporate their milk or some of
>it into their greiving ceremony for the baby. Suggestions included things one
>might do with ashes of a loved one. Watering a tree planted in remembrance,
>pouring into a stream, or some similar ceremonial ending seems more healing
>than the sink. Mothers are often more than a liitle emotionally invested into
>those tiny bottles of her love for her baby.
>                                                                         From
>cold and dreary Florida!
>
>
>                                                                        Debby
>Kearney IBCLC
>Date:    Fri, 6 Dec 1996 07:03:00 GMT+0200
>From:    Pamela Morrison IBCLC <[log in to unmask]>
>Subject: Emotional basis for nipple pain
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>I have been following the theories that nipple pain may have an emotional
>basis with great interest.  Breastfeeding is promoted so strongly in
>Zimbabwe that it is the very brave new mother who will say outright that she
>does not want to breastfeed.  Consequently she may feel "forced" to initiate
>breastfeeding in order to be seen to be a "good" mother.  She will often
>say, within the first few minutes "I really want to breastfeed!" but then do
>almost anything to prevent breastfeeding from taking place and/or list
>reasons why she or the baby "cannot" breastfeed.  At the extreme end of the
>scale is the new mother who appears to experience severe pain in the total
>absence of any physical cause and I have to conclude that the cause must be
>emotional.  I have worked with three women in recent months who draw back
>and cry out in apparent agony and terror just before or just as the baby's
>mouth brushes the nipple - the baby is not yet latched (and has never
>latched before, so there is no question of trauma) and the latest one
>(yesterday, still fresh in my mind!) reacted this way to a breast pump.
>Concerned family (if present) are naturally shocked and sympathetic.
>Formula (ABM?) is simply not available in the hospital for full-term healthy
>babies.  Any ideas out there for ways to handle this very fraught kind of
>situation?
>
>Pamela, Zimbabwe
>Date:    Fri, 6 Dec 1996 01:14:42 -0500
>From:    Janet Simpson <[log in to unmask]>
>Subject: Re: Nipple soreness...Linda V
>
>Hi All,
>Linda, my questions would be:
>1)  How long does the soreness last?  Is it only for a few days, then goes
>away?  If so, I'd hazzard a guess that it is hormone related, even tho her
>periods have not stabalized yet.  Personally, I had no nipple tenderness
>before my cycles before, during and after BF my oldest son.  But after the
>birth of my 2nd son, when I got my cycles back, OUCH!  For about 4 days they
>would hurt and be a tad red (almost so you couldn't notice) and it took a few
>months before it dawned on me that it was hormones related to my mentrusl
>cycle.
>
>2)  Is she pregnant?
>
>3) Has she tried treatment for yeast as a "just in case"?  Sometimes
>babies/toddlers can be asymptomatic with thrush, and since she has been on
>antibiotics she may be in the process of devloping the yeastie beasties.
>
>Let us know what happens!
>
>Jay Simpson, CLE
>Date:    Fri, 6 Dec 1996 16:26:44 +0800
>From:    T & V Best <[log in to unmask]>
>Subject: (no subject)
>MIME-Version: 1.0
>Content-Type: text/plain; charset=us-ascii
>Content-Transfer-Encoding: 7bit
>
>To any U.K lactnetters,
>I am trying to trace the address or better still the Fax number for St
>James Hospital in Leeds, can anyone help me out with this info.
>Val, in Busselton, Western Australia
>RN RM IBCLC
>Date:    Fri, 6 Dec 1996 06:23:39 PST
>From:    gritter <[log in to unmask]>
>Subject: Re: Tobacco and abm
>MIME-Version: 1.0
>Content-Type: TEXT/PLAIN; CHARSET=US-ASCII
>
>Jeanette asked : "When is CU going to address the formula companies?  What
has made them such an
>untouchable group?"
>
>        Jeanette, the other day, when I heard this lovely snippet at the
end of a piece about a
>new treatment for cellulite - "Over 90% of women are afflicted with
cellulite!" I turned to my
>husband and said, "Well, if the percentage is that high, maybe cellulite is
*normal*!"
>        My point is that unfortunately, in the USA, bottle feeding is seen
as *normal*. Even
>though over half the mothers start off breastfeeding, only a small
percentage of them continue
>beyond the first weeks. Very few people recognise the value of human milk,
and even fewer
>recognise the risks of artificial feeding. Abm can be justified as
life-saving in certain
>circumstances, but the same cannot be said of tobacco.
>        It all depends on your perspective. Remember how horrified
Americans were to hear that
>starving Third World citizens used donated cow's milk powder to whitewash
their walls? I *can*
>forsee a time when CU will address the formula companies, but I think that
we have a lot of work
>to do, raising the public's consciousness about the risks of formula
feeding, before that will
>happen.
>
>Norma Ritter, IBCLC, LLLL
>[log in to unmask]
>"If not now, when? If not us, who?" R. Hillel
>Date:    Fri, 6 Dec 1996 07:42:21 -0500
>From:    "Jane A. Bradshaw" <[log in to unmask]>
>Subject: Insufficient glandular tissue
>
>Thanks to those who responded to my questions about ways to test for
>insufficient glandular tissue.
>Yes, the mom did use some hand expression in addition to the pump.  Good
>suggestion.
>No, I don't think a galactogram would help.  I have already discussed this
>with the 2 radiologists that I confired with and only 1 duct at a time is
>canulized and dye injected.  As one doctor put it: "It would take days to do
>all the ducts in both breasts."  (plus I would imagine it would be very
>expensive)  It is used to diagnose problems in a single duct, as I understand
>it.
>Can anyone give me more information about "transillumination" as mentioned in
>Dr. Lawrence's book? I have searched LACTNET and not found anything on it.
> Or do you have any other ideas?  Just to refresh your memories about this
>mom--she has already weaned.  Baby is about 3 months old.  She tried
>valiently for about a month and never pumped more than 5 to 20 cc despite
>frequent (10 or more/ 24 hrs) long pumpings, and efforts to nurse.  She would
>like to be able to find out if she just has too few glands so as not to be
>disappointed again when she has another child.
>TIA
>Jane
>Date:    Fri, 6 Dec 1996 21:33:53 +0800
>From:    T & V Best <[log in to unmask]>
>Subject: Volufeeders
>MIME-Version: 1.0
>Content-Type: text/plain; charset=us-ascii
>Content-Transfer-Encoding: 7bit
>
>We used speciman container in our level 3 NICU in South Africa with no
>problem and I have used them in a level 3 NICU here in Australia with no
>problem too.
>Val in Busselton Western Australia
>RN RM IBCLC
>Date:    Fri, 6 Dec 1996 11:51:56 -0000
>From:    David and Nofia Altman <[log in to unmask]>
>Subject: Re: Thrush...
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>For fabrics, towels, washcloths - Don't forget that often washing and
>drying in a commercial drier and then ironing an item, can be just as
>effective as bleach.  Bleach tends to wear out fabrics.
>
>I've even had a lot of success killing those pesky lice with the clothes
>drier. (Same idea as using a hair drier on the body, usually.)
>
>
>Nofia
>Date:    Fri, 6 Dec 1996 12:08:13 -0000
>From:    David and Nofia Altman <[log in to unmask]>
>Subject: Re: recommending books/Nestle boycott
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>A friend of mine had a woman who called her umpteen times a week for
>advice, and then did the opposite.  Seems she didn't believe us, treated us
>like fanatics and probably called to hear what we did so she could do the
>OPPOSITE.  (Yes, she made us want to scream)  I think in her case she would
>have benefitted from a no-nonsense book like Bestfeeding, if anything at
>all.  One of her friends went out and bought her a different book of ABM
>philosophy, and a week later she weaned the baby.
>
> At least with Bestfeeding, Chloe et al's. credentials would have stood
>out, whereas Yael and I were "just mothers". of two healthy Bf children
>each.
>She also refused to go to LLL meetings or call an LC.
>
>I   got a good letter into the Jerusalem Post this week about the Nestle
>boycott.  I've also gotten some positive feedback from people who've read
>it.
>You can find it at:
>http://www.jpost.co.il/jpost/letters/
>
>This week the Nestle people came to sell their products to our local
>grocery and the owner told them, "There's a Nestle boycott in our
>settlement."
>This is where it helps that I worked as a cashier in this man's store last
>year...Also, since I told his wife and sent him the URL's for Baby Milk
>Action, he's been more aware.  Ahhh, the pleasantness of open-minded
>people.
>
>Nofia
>Date:    Fri, 6 Dec 1996 12:17:01 -0000
>From:    David and Nofia Altman <[log in to unmask]>
>Subject: Re: Emotional basis for nipple pain
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>Isn't this often a result of being sexually molested, more than anything
>else?
>
>Nofia
>Date:    Fri, 6 Dec 1996 07:31:07 -0600
>From:    Roland A Muller <[log in to unmask]>
>Subject: Tongue-Tie/Frenotomy
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Dr. Evelyn Jain of the Lakeview Breastfeeding Clinic in Calgary, Canada has
>produced an informative video covering this subject.  It is
>entitledTongue-Tie:  Impact on Breastfeeding, Complete Management Including
>Frenotomy.  It covers diagnosis of tongue-tie, determining whether this
>condition is affecting breastfeeding, and concludes with an actual
>demonstration of a frenotomy.  Mothers share the problems tongue-tie caused
>for their breastfeeding relationship, and improvements after frenotomy.  An
>invaluable learning/teaching tool.  Available in the U.S. through
>Ameda/Egnell.  Please e-mail me privately for more information.
>
>Yours truly,
>Roland Muller
>Ameda/Egnell Corporation
>Date:    Fri, 6 Dec 1996 07:31:29 -0600
>From:    Roland A Muller <[log in to unmask]>
>Subject: Frozen Breast Milk
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Ameda/Egnell manufactures freezing bags specifically designed for freezing
>breast milk.  Unlike standard bottle liners, they are constructed of
>multiple layers which protect against freezer-burn, and they will not crack
>or split open in the freezer.  These layers also form a unique odor barrier
>which greatly reduces the permeation of odors into breast milk from other
>(far less precious!) items in the freezer.  For more information, please
>e-mail me privately.
>
>Regards,
>Roland Muller
>Ameda/Egnell Corporation
>Date:    Sat, 7 Dec 1996 00:06:34 +-10-30
>From:    Laureen Lawlor-Smith <[log in to unmask]>
>Subject: Amitriptyline Exposure in a Premature Infant
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"

>
>I was interested, Kathleen to read of the premature infant described in
your post denied breastmilk because of maternal intake of Amitriptyline.
>I can't find any references which specifically deal with Amitriptyline
exposure in the premature infant, however I would like to make several points.
>Firstly the infant would have been exposed to much higher levels of
Amitriptyline in utero than she would from breastmilk. There is an
interesting case report in the literature describing a fullterm newborn
infant with toxic effects at birth related to another TCA, Clomipramine.
This baby was born with hypotonia, tremor and respiratory distress and then
went on to become quite jittery at 12 hours of age. The baby was denied
breastmilk for 7 days and then fully breastfed from then on. All symptoms
resolved at 6 days and did not recur at all. (Schimmell M. et al, Toxic
Neonatal Effects Following Maternal Clomipramine Therapy, Clinical
Toxicology, 29 (4),479-484 1991). My point is that if this baby was going to
have problems with Amitryptyline it should have done at birth.
>A second point that the same article makes and one that I have seen
discussed before is the possibility that these apparently toxic effect of
this TCA may in fact be due to sudden withdrawal of the drug. If  this were
the case then surely it would be more sensible to breastfeed the infant and
continue to expose it to albeit small quantities of the TCA thereby possibly
minimising the effect of withdrawal?
>My third point is that as far as I am aware no one has ever demonstrated
any long term adverse consequences for infants exposed to TCA via their
mother's breastmilk. On the other hand a study by Buist looking at infants
exposed to a TCA, dothiepin via their mothers milk revealed higher cognitive
scores when they were later examined at 3-5 years. (Buist A, Janson J,
Effect of Exposure to Dothiepin and Northiaden in Breast Milk on Child
Development, British Journal of Psychiatry, 1995, 167, 370-373)
>No, I am not trying to suggest that we expose all newborn infants to TCAs
to improve their cognitive scores! What I am saying is that we have
absolutely no evidence that TCAs in breastmilk damage infants long term in
spite of the fact that these drugs have been on the market for four decades.
>On the other hand do we have some evidence that formula increases both
morbidity and mortality in infants! - and most particularly premature
infants. For example just look at the risk of this infant getting neonatal
necrotising enterocolitis. Lucas and Cole's study found that prem infants
fed formula alone were up to ten times more likely to develop NEC than those
who received any breast milk at all. With a mortality rate around 25% and
serious long term morbidity in survivors how can this paediatrician possibly
justify denying this baby its mothers milk.(Lucas A, Cole TJ, Breast milk
and neonatal necrotising enterocolitis, Lancet 1990, 336, 1519-1523)
>And, I haven't even started to talk of the potential for adverse
psychological consequences for the mother being forced into ceasing her
Amitriptyline so that she can breastfeed her infant 30 days later!
>
>Laureen Lawlor-Smith BMBS IBCLC
>South Australia
>Date:    Fri, 6 Dec 1996 08:51:06 -0500
>From:    Jack Newman <[log in to unmask]>
>Subject: amitryptiline and premature
>MIME-Version: 1.0
>Content-Type: text/plain; charset=us-ascii
>Content-Transfer-Encoding: 7bit
>
>Dear Kathleen,
>
>        It is very disheartening to read your note about the neonatologist and
>amitryptiline.  This is a perfect example of the neonatologist
>"mindset", combined with "we really don't trust breastmilk", never mind
>breastfeeding.
>
>        One of the best ways, of course, to maintain breastmilk supply for a
>premature baby is encourage the mother that pumping for the baby is
>something worthwhile.  It helps a lot.  This mother isn't getting much
>of that, is she?
>
>        To the point that the mother was taking amitryptiline throughout the
>pregnancy, the neonatologist will respond, but the mother was
>metabolizing it for the fetus.  This is a valid point, but not
>compelling enough to stop the baby getting breastmilk.
>
>        However, how the neonatologist can then go on and say that even a trace
>of amitryptiline renders breastmilk unsuitable for the baby is going to
>far.  We have evidence that prematures getting even some breastmilk
>increases their cognitive function at 8 years.  We have evidence that
>breastmilk decreases the incidence of NEC.  We have evidence that there
>are in milk, antibodies etc.
>
>        Furthermore, for the archetypal bean counter (the neonatologist) to
>then go on and say that the mother has to sacrifice breastfeeding on the
>altar of ignorance for a month to make sure that all the amitryptiline
>is out of her body is irrational, and fits poorly with his/her bean
>counting approach.
>
>        The half life of amitryptiline in adults is 10-22 hours.  Thus, the
>amitryptiline would be eliminated from the mother's system completely in
>5 times the half life, or about 5 days, at the most.  It is true that
>amitryptiline has active metabolites, but these would not continue in
>the mother's system much longer than the amitryptiline itself.  Thus, we
>could reasonably expect that at the outside, the mother could start
>giving her milk to the baby after a week, being extremely conservative.
>Surprisingly, for a bean counter, the neonatologist did not suggest
>measuring the mother's milk amitryptiline levels once she had gone off
>the drug for say a few days.  Maybe the level would be unmeasurable
>before a week (as I suspect).  The measurement includes amitryptiline
>and nortryptiline (one of the active metabolites). By the way, to oral
>bioavailability of amitryptiline is only about 30-60%, at least in
>adults, suggesting that only a about half of the amitryptiline in the
>milk gets into the baby.
>
>        Finally, the approach of the neonatologist shows his/her special
>treatment of breastmilk.  We have long given extremely premature babies
>drugs of all sort with only very little evidence of their safety.
>Remember indomethacin to close the ductus?  Indomethacin which can cause
>acute renal failure?  How about gentamicin which can cause deafness and
>renal failure?  Is there a premature baby who ever gets out of the unit
>without having any gentamicin?  That's okay, of course, because it is
>the neonatologist who is in charge.  But that's another story, and I've
>already blathered on enough.
>
>Jack Newman, MD, FRCPC
>
Dr. Pierre Bitoun
SIDVA 91
95 avenue Roger Salengro
91600 Savigny s/o FRANCE
TEL: 331 6912 2550
FAX: 331 6912 2551
email: [log in to unmask]