The earliest research that I'm aware of on the subject of inhibited MER - in
lactating women specifically, earlier work had been done on cows for the dairy
industry - was done by Michael and Niles Newton (J. Pediatrics, 33, 698, 1948).
Now I'm reading this from secondary sources (authored by Niles and Michael,
though), but what they did was to define two groups of breastfeeding women:
successful (those not needing to supplement with artificial human milk after day
4 postpartum), and unsuccessful (those still dependent on artificial human milk
beyond day 4 postpartum).In querying the women, the *successful* group reported
more of the symptoms of MER (leaking prior to brfdg, opposite side leaking while
brfdg, uterine cramping while brfdg, and cessation of nipple discomfort while
brfdg) than did those women in the *unsuccessful* group. Further, they had the
women pump immediately following a breastfeeding, then injected the women with
oxytocin and pump again. They found that the unsuccessful breastfeeders
delivered significantly more breastmilk to the pump following the oxytocin
injection than the *successful* breastfeeders - the thought was to show that
more residual milk was left in the breasts of those women in the *unsuccessful
group, suggesting that they had poorer MERs. They figured this post-injection
pumped volume (for this *unsuccessful group) to be 47% of the total amount
delivered to: baby, first pumping and second pumping after the injection.
The Newtons also did research on lactating women measuring the volume of milk
received by the baby: under normal conditions, while distracted both physically
and mentally, and after injections with saline and oxytocin. In quick summary,
there is strong evidence that distraction inhibits the MER (in some cases
cutting the volume by almost half) and an artificial boost of oxytocin (via
injection) will augment the MER. There are a few other non-dairy-industry
studies mentioned in Auerbach and Riordan's book.
Fiona, in looking through my breastfeeding *stuff*, I bumped into a compilation
of Newton's (Niles, that is) work on breastfeeding done by the former Birth and
Life Bookstore (1987) of Seattle, WA, USA - it was great to re-read this, Thanks
for the motivation!
Newton, in several pieces, suggests that coitus, birth and breastfeeding have
several commonalities, one is the release of oxytocin, and influence of that
hormone on behavior. So, if one considers one' s reaction while involved in
intercourse and something unexpected happens - say a small child wanders into
the room - you can begin to understand a new mother's reaction as several
relatively unknown medical staff of mixed gender, hover over her as she attempts
to breastfeed her new baby, just having labored and birth US style, the first
few times.
As for the stress levels of those women who breastfed through the bombings of
England in WWII - there is a survival strategy *built-in* to us (humans), that
allows us to acclimate to most newly imposed levels of stress, given enough
time. What I suspect happened is that the initial air raid sirens caused some
inhibition of some MERs but with daily living falling into a pattern of
unexpected bombings and sirens, the women's bodies accommodated the increased
stress and performed despite the situation. I also know, both personally and
professionally, about the high level of engagement between infant and mother
while breastfeeding, along with the prolactin release during the early months of
breastfeeding; I can well imagine a mother attempting to block out much of the
world to focus on just breastfeeding her baby in those difficult times -
especially if she knows that artificial human milk is in precarious supply. When
working with a woman who we suspect has a poor MER, I prefer to have the woman
identify: ways that she relaxes, places in her environment where her privacy is
protected, methods for overcoming any semiconscious obstacle to allowing
breastfeeding to succeed, etc., rather than to suggest her emotions don't play a
part. Possibly an apt analogy might be: how do we counsel women to achieve
orgasm? Could these techniques be modified for the breastfeeding mother with a
poor MER? Just a captured stray thought!!
Jeanine Klaus, MS, IBCLC
Oakville, Ontario
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