On 24/1/03 7:43 PM, "Automatic digest processor"
<[log in to unmask]> wrote:
> I have contact with a mother with Fibromyalgia Syndrome (FMS). She is
> breastfeeding but she tells me that her skin is very sensitive. She also finds
> it very difficult that the baby is coming irregularly. (She prefers a scheme).
> Her first child received bottle-feeding.
>
> The baby is also very fussy at the breast. She also pumps her milk. During the
> night the baby receives this milk in a bottle. The mother thinks that while
> she can sleep through the night breastfeeding will be less fatique for her.
> But in the morning her breast are very full.
>
> My question:
> Which problems can mother with FMS encounter?
> How can these problems be solved?
This can sometimes be a difficult situation to deal with. Fibromyalgia is
characterized by widespread muscular skeletal pain, stiffness,
non-restorative sleep, easy fatigability and multiple tender points.
Disturbed sleep has been implicated with its pathogenesis, low levels of
serotonin metabolites have been reported in the cerebral spinal fluid of
patients with fibromyalgia, suggesting that a deficiency of serotonin ( a
neurotransmitter that regulates pain and NREM sleep) might also be involved.
It is common for patients with fibromyalgia to experience Raynauds-like
phenomena (which is why nipple vasospasm may be a problem).
They often complain of feeling fatigued and exhausted and wake up tired and
stiff (and this is when you donšt have a baby to care for), and symptoms are
made worse by stress, anxiety, cold, damp weather and over exertion.
Degree of symptoms can be variable amongst patients.
Management is geared to keeping symptoms "under control" and includes
primarily low impact aerobic exercise undertaken regularly (increases
serotonin levels) and encouraging restorative sleep (which means a routine
bed time, uninterrupted sleep, stress management and sometimes medication is
required - a low dose trycyclic). As you can see this is not terribly
conducive to having a small baby/infant who requires regular night time
attention - whether breastfeeding or not.
Things to concentrate on would be making sure her fibromyalgia is otherwise
well managed with regard to lifestyle basics - lots of home support, a
period of rest every day, opportunity for regular exercise (10-20mins walk
with the pram daily if she can manage) and a regular night time management
programme that remains fairly constant - perhaps bed sharing might be an
attractive way to manage feeds. You could reassure her that if she does wake
for breastfeeds she is more likely to return to sleep quicker than if she
bottle feeds, due to hormonal influences. I am extremely surprised she pumps
for the night time feed, as this would increase her day time stress
(especially if she has a toddler) - perhaps she could drop the pumping and
feed formula for one night feed, - is preferable to giving up BF altogether.
An example of one night time management plan might be that she feeds prior
to going to sleep (early - say 9PM), partner bottles next feed (formula)
and cares for baby until mum has had 5-6 hours sleep, then she breastfeeds
again, perhaps in bed, allowing the baby to sleep in bed with her until the
next feed. As the baby grows older she may be able to stretch her sleep time
to7- 8 hours with partner doing the feed in between. Sleep is most certainly
a major key in the management of patients with fibromyalgia. If the baby is
very unsettled at night this can be a real problem for both mum and partner
(who probably must work the next day)
If you chat with her about viable management alternatives she may be able to
find something that helps her and suits the whole family.
Good luck
Regards
Cathy fetherston CM MSc IBCLC
Perth, Western Australia
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