At 09:36 AM 7/8/97 -0400, you wrote:
>Date: Tue, 8 Jul 1997 09:36:42 -0400
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>Subject: LACTNET Digest - 7 Jul 1997 to 8 Jul 1997 - Special issue
>To: Recipients of LACTNET digests <[log in to unmask]>
>
>There are 10 messages totalling 433 lines in this issue.
>
>Topics in this special issue:
>
> 1. Update on 24 wk preemie
> 2. St Johns Wort
> 3. goldenseal
> 4. ABC news
> 5. diabetes on the increase in US children
> 6. Titillating Taxi Tales
> 7. infertility & milk supply
> 8. lactose - free milk - not
> 9. YEAST AND NIPPLE PAIN
> 10. baby who won't latch -- Paula's baby
>
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>Date: Mon, 7 Jul 1997 22:53:06 -0700
>From: Janet Simpson <[log in to unmask]>
>Subject: Update on 24 wk preemie
>MIME-Version: 1.0
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>
>HI All,
>Need some help from those of you who are in the know.
>My client with the 24 wk twins (one who just dies last week) is struggling
>to keep it together. She is pumping religiously (amazing, all things
>considered), but they have gotten more bad news re: the surviving twin.
>At 26 wks, baby Allyson is now fighting CMV, yeast and pneumonia. She also
>had rectal tearing due to constipation as a DIRECT result of the formula the
>NICU nurses gave her (bc, they said that moms milk was too strong, and that
>the ABM was better for her right now. Babys DR threw a FIT! Hell is going
>to be paid by a couple of nurses, methinks...). The Dr said to the parents
>that the constipation was bc of the ABM, and that in the future, when the
>baby is put back of feeds, she will get full strength momma milk (not
>diluted...the nurses struck again...the Dr is really angry). Baby is off
>feeds right now bc she is so sick.
>My question is: What is CMV, how is it caused, what does it do, etc...?
>TIA!
>Jay
>Saying a prayer for the little one and her family tonight...
>Jay Simpson, CLE
>Sacramento, CA
>"No Miracles performed here, just a lot of love and hard work."
>Date: Mon, 7 Jul 1997 22:54:06 -0700
>From: Janet Simpson <[log in to unmask]>
>Subject: St Johns Wort
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>
>HI All,
>Has no one any info on whether or not this herb (for depression) is OK with
>BF? I have had a couple of "it probably is..." but I need some real
>documented info. I understood from the show I watched that one country
>(Germany?) has been using St Johns Wort for years, but, of course, they did
>not mention if it was used in BF moms.
>TIA!
>Jay
>Jay Simpson, CLE
>Sacramento, CA
>"No Miracles performed here, just a lot of love and hard work."
>Date: Tue, 8 Jul 1997 11:00:31 +0000
>From: Moshe Srebrnik <[log in to unmask]>
>Subject: goldenseal
>MIME-Version: 1.0
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>
>My books on medicinal herbs state that goldenseal affects circulation,
>muscle tone and uterine contractions. It is also an antiseptic and
>antibiotic. Precautions include over-use because it can be toxic
>in large doses. It shouldn't be used if you have high blood pressure
>or heart disease. It doesn't say anything about lactating women. (If
>an herb is thought to be unsuitable for pregnancy and/or lactation, it
>says so.) As far as I know, goldenseal is used mostly externally
>anyway.
>
>Susan Nachman-Srebrnik
>Ranana, Israel
>Date: Tue, 8 Jul 1997 11:25:04 +0300
>From: Evi Adams <[log in to unmask]>
>Subject: ABC news
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>
>I too saw the Peter Jennings newscast, the address given was for email -
>[log in to unmask], I think we should all write in and give positive feedback
>on the news item. In Israel we can see the news in the middle of the night
>and I just happened to catch it yesterday.
>
>Get with it, all of you LACTNUTS who were at the LLLL conf. and let us have
>some gems from the conference.
>
>Evi, in Tel-Aviv
>Date: Tue, 8 Jul 1997 08:14:05 -0400
>From: Alicia Dermer <[log in to unmask]>
>Subject: diabetes on the increase in US children
>MIME-Version: 1.0
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>
>Hi, all: Just heard a blurb on my local radio news that the current issue
>of Pediatrics has a paper about a dramatic increase in diabetes among
>American children, especially African-American. I'll pick it up and read
>it and see what the authors postulate as to the possible reasons (DUH -
>let's see now - anybody think the low bf rates and earlier supplementation
>might have anything to do with it ;) ? Watch for stories in newspapers,
>etc. Alicia Dermer, MD, IBCLC, in surprisingly not too hot Central New
>Jersey.
>Date: Tue, 8 Jul 1997 22:55:20 +0930
>From: Laureen Lawlor-Smith <[log in to unmask]>
>Subject: Titillating Taxi Tales
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>
>The following article appears in the latest edition of the Network of
>Australian Lactation Colleges Newsletter. It is written by Bronwyn Mascord
>RN CM IBCLC. Bronwyn is a laction consultant working in Sydney and this is
>a true story. I hope you find it as funny as I did. I still smile whenever
>I think about it.
>Titillating Taxi Tales
>I (BM) arrived back at Sydney airport after having spent a thoroughly
>enjoyable but exhausting weekend as a guest speaker at the Queensland NMAA
>counselor conference. To say I had reached breastfeeding saturation point
>was an understatement. I get into a taxi driven by a 50’ish heavily
>accented man (TD). I settle back, dream of home and hope for a quiet and
>quick trip home.
>
>TD: ‘Been away?’
>BM: ‘Yeah, Brisbane.’
>TD: ‘Have a good look around?’
>BM: ‘No, I was there on work.’(Oh great, one that wants to talk!)
>TD: ‘What do you do?’
>BM: ‘I’m a nurse.’ (Be evasive Bronwyn)
>TD: ‘So you work in hospital in Brisbane?’
>BM: ‘No, I was lecturing.’ (Just to sound aloof)
>TD: ‘What do you lecture about?’ (Oh here we go)
>BM: ‘Breastfeeding.’ (It’s fate, there is no escape)
>TD: ‘Oh!!! That’s wonderful.. You know, I can tell you a story because you
>will understand!’
>BM: ‘Oh yeah.’ (This’ll be good)
>TD: ‘Where I grow up in Bosnia I had a very special job. I sucked tit.
>You know when the milk it not come, or it not enough, or it get stuck, I
>suck it out for the ladies of my village. Arr, such wonderful memories.’
>BM: ‘Oh yeah.’ (Did he say memories or mammaries? What have I got myself
>into?) How old were you when you did this job?’
>TD: ‘Oh, from baby up to about nine years old. You see my father he rent
>me out for cigarettes. Sometimes I suck tit before school and some days
>after school. The ladies they think I very cute so they give me cakes and
>sweets after I finish. Some days I so full of milk and cakes I have pain
>in belly.’
>BM: (Oh my God!) ‘How come you got the job?’ (Keep a straight face Bronwyn)
>TD: ‘Well I have a special mark. I have extra nipple.’ (spoken with pride)
>BM: ‘Oh yeah, that’s not that uncommon; a lot of people think they are
>moles.’
>TD: ‘Oh no! Mine proper nipple.’
>BM: (Oh my God, he’s not going to show me...he is!)
>
>So as we drive down Botany Road towards Redfern, TD proceeded to lift his
>shirt and display his very well formed accessory areola and nipple that was
>located about 4cm below his left breast. I duly admired same.
>
>TD: ‘You see if I press enough I can get something out of it.’
>BM: (He can express better than some of my mothers) ‘Oh I see. Yes you
>can get something (?) out of it. Well how about that!’ (Oh God just get
>me home)
>
>So as we sped along through Ultimo other facts came to light...Yes he was
>very healthy, yes all mothers milk does taste different (who better to
>ask!) and he volunteered without prompting that he was smarter than the
>average bear. To his credit and manners he did constantly check that he
>was not being offensive and that I understood where he was coming from
>(well, I think I did). But more was to come.
>
>TD: ‘You know I can’t understand some of these modern women - why sometimes
>when they in my taxi and feed the baby bottle milk. I say to them, “Why
>you feed that muck to your baby?” Arr they don’t care. This country, as
>soon as baby can walk, no more tit. Terrible thing. Babies, they need tit
>for long time, till go to school...’ (on and on)
>BM: ‘Yeah.’ (Who gave him the soap box?)
>TD: ‘You know, women, when first have baby are very tired, no feel like
>making love.’
>BM: (and there’s more!) ‘Mmmmm.’
>TD: ‘But after a while when baby suck tit it feel er...it feel...er...’
>BM: ‘Sensual?’
>TD: ‘Yes! You know the best time to make love to a woman is after she has
>fed her child because she is ready for a man’.
>BM: ‘Mmmmm.’ (I nod knowingly)
>
>We are on the Glebe Island Bridge and gladly only a couple of blocks from
>home; although I must say this was the encore of my weekend.
>
>TD: ‘Well thank you for the memories.’
>BM: ‘Oh no, thank you.’ (This is going to make a great story, can’t wait to
>tell the girls at work.)
>
>So our journey was over. I paid my fare (no, he didn’t give me a
>discount), offered him an honorary life membership of the Lactation College
>and bade him Good Night...Off he drove into the night with a smile on his
>face.
>
>
>Laureen Lawlor-Smith BMBS IBCLC
>South Australia
>Date: Tue, 8 Jul 1997 08:34:42 -0400
>From: Jan Barger <[log in to unmask]>
>Subject: infertility & milk supply
>
><< I have a question re: the effects of infertility on breastfeeding. If a
> woman has a history of infertility or a difficult time getting pregnant
> (with this baby), can her milk supply be deficient in some way? Less supply
> even though she does everything the "right way". >>
>
>I have seen this anecdotally in my practice. It is one of the questions I
>always ask in a history taking. Generally speaking, it doesn't seem to be an
>issue with moms who have just needed a boost with Clomid or Pergonal or one
>of the other drugs, but it seems to be a bigger issue with moms who have
>undergone IVF or GIFT or one of the more esoteric infertility treatments.
> And even then, it doesn't happen with everyone of them. Some of the moms
>produce lots of milk -- some produce none. I've had prolactin levels tested
>on a couple of them that didn't produce any milk (or very little), and they
>have been subnormal. I suspect then that it may be a hormonal system that is
>screwed up; that they either didn't have enough progesterone or prolactin to
>produce the milk making alveoli in the first place -- I don't know. I've
>also had OBs who have scoffed at me saying there was absolutely no connection
>whatsoever. This is something that wouldn't have been studied in the past
>necessarily because if a woman didn't get pregnant, she obviously wasn't
>lactating. Except for those few that tried adoptive nursing.
>
>Let's put it this way -- it's one of my "red flags" and I watch these moms
>extra closely until I know all is well and I heave a sigh of relief. And no,
>I don't tell them why I'm asking, and most of them don't ask. I'm not into
>self-fullfilling prophesies here. Unless she doesn't produce milk, and then
>we talk about it.
>
>Jan B
>Wheaton, IL
>Date: Tue, 8 Jul 1997 07:42:02 -0500
>From: Julie Graves Moy <[log in to unmask]>
>Subject: lactose - free milk - not
>MIME-Version: 1.0
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>
>Re: using lactose - free milk during/after diarrheal illness - no one
>(except perhaps the manufacturer) recommends the use of this product. The
>American Academy of Pediatrics has a practice parameter on diarrheal
>illness - they recommend breastfeeding during and after the illness, and
>using regular formula if the baby is not breastfed. Research has shown no
>decrease in duration or severity of illness when the infant takes human
>milk, or even artificial formula.
>
>following from the syllabus for my standard one-hour breastfeeding lecture
>to doctors:
> Incidence of diarrhea in children under three years of age is
estimated
> to be 1.3 to 2.3 episodes per child per year. "Infants fed human
milk can
>be nursed safely during episodes of diarrhea." Ad libitum
breastfeeding,
> alternating if necessary with oral rehydration
solution, is recommended.
> from: American Academy of Pediatrics. Practice Parameter: The
Management
> of Acute Gastroenteritis in Young Children, Provisional.
Committee on
>Quality Improvement, Subcomm. on Acute Gastroenteritis, Pediatrics
1996,
>97(3):424-435.
>
> Early feeding did not increase stool volume or dehydration.
> Brown KH, Gastanaduy AS et al. Effect of continued oral
feeding on
>clinical and nutritional outcomes of acute diarrhea in children. J
>Pediatrics 1988;112:191-200.
>
> Unrestricted breastfeeding did not prolong the course of illness or
>increase stool output.
> Margolis PA. Litteer T, Hare N, Pichichero M. Effects of
unrestricted
>diet on infantile diarrhea. A practice-based study. Am J Dis Child
>1990;144:162-4.
>
>
>Julie Graves Moy, MD, MPH
>Austin, Texas
>Date: Tue, 8 Jul 1997 09:16:49 -0400
>From: "Cher Sealy, LLL Leader" <[log in to unmask]>
>Subject: YEAST AND NIPPLE PAIN
>
>I need to introduce myself. My name is Cher Sealy. I'm a La Leche League
>Leader, an IBCLC, and an RN, and have been in private practice in Montgomery,
>AL as an LC for the past 10 years. I am thrilled to finally be on LACTNET!
> I have a mom who needs some of your collective help. She is currently BF
>her 5th child (7 lb 5 oz girl, born 5/16/97, normal vaginal birth.) All
>others were BF, and babies 2,3,& 4 BF until babies initiated weaning. She
>reports her nipples became very sore at 1 week. Blisters, cracks, bruising,
>and bleeding occurred. Dr. tried lanolin and then cortisone cream--no
>improvement. At 5 weeks, Dr. suspected yeast as mom had had a vaginal yeast
>infection just prior to delivery and baby had both thrush in mouth and a
>yeast diaper rash. Baby was put on oral Nystatin and mom on Mytrex cream.
> After 1 week - no improvement. Cracks healed but new ones continually
>developed. Bleeding was so profuse that stools became tarry and baby spit up
>"a good amount of fresh red blood from one feeding to the next." Also mom
>was experiencing deep breast pain. (Even with all this going on, baby was
>gaining well--up to an ounce a day.) Mom was referred to me at this point,
>but lived an hour away, so I hadn't seen her yet. Suggested she talk with
>Dr. about Diflucan. Also gave her info on Gentian Violet and other tips
>(modifying diet, hand washing, boiling pacifiers, etc.). She also tried a
>nipple shield, but reported that it made pain worse. After discussing with
>doctor, mother tried three applications of Gentian Violet--no improvement.
> Dr. put mom and baby on Diflucan. Mother has been taking 150 mg daily now
>for 11 days. Deep breast pain has stopped, bleeding has stopped, cracking is
>better. But nipples still look purple and bruised after feeding. Also there
>are blisters on tip and a horizontal crease in both nipples. (I find this
>interesting since she uses different positions on each side--football hold on
>left breast and cross-cradle on right.) She has experimented with this and
>these are only positions that are tolerable. Finally this past weekend I was
>able to watch baby nurse. Latch-on looks "picture perfect." Baby actually
>has a large mouth and opens wide drawing plenty of breast tissue in. Baby's
>tongue can be seen when bottom lip is pulled back. Mom still reports that it
>feels like baby is biting at base of nipple, but I cannot see how this could
>be occurring, so feel it must be from yeast.
>I have actually had a great deal of experience in working with yeast and have
>seen some really stubborn cases, but this one is the worst. Has anyone seen
>someone take longer than this to get relief? Are there other things that
>could be causing this pain that I am overlooking? Any advice to pass on to
>her would be so welcomed. She desperately wants to nurse this "last baby."
> She reports pain is excruciating at times. She has never been able to enjoy
>a feeding with this baby and is "heartsick" because of it. ---Thanks
>everyone!
>Date: Tue, 8 Jul 1997 08:35:30 -0500
>From: "Barbara Wilson-Clay,BSE,IBCLC" <[log in to unmask]>
>Subject: baby who won't latch -- Paula's baby
>MIME-Version: 1.0
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>
>Paula Birmingham writes about a breast refusing baby who has already been
>exposed to many bottles, and who has not responded to her very best
>(in-person, hands-on) tricks to bring baby to breast. Now mother is
>over-whelmed, only willing to pump and bottle feed. Why would this not be a
>good time to try a thin silicone, newborn small-size, nipple shield? The
>mother, who has not ever had success bringing baby to breast, will melt with
>delight as baby looks up from the breast. Baby will be at the breast
>helping to pull out the flat nipples (which are probably the problem --
>alone with being doped to the gill from birth meds, or banged on the head
>from delivery, so that the mouth is not responsive to these little, flat,
>nipples, but requires a big SUPER-SIZE stimulus like a bottle teat.) So
>give the baby a super-stimulus which protects breastfeeding and wait until
>things improve and then wean baby off the shield. You have nothing to lose.
>Basically, this mother is going to soon find pumping so much work and so
>distancing that she'll say What the Heck? If the baby is never at breast
>during the time it takes to fix the problem, the liklihood begins to
>decrease that baby will accept the move back to breast. This situation fits
>my rationale of when to try a shield.
>
>Now this next part has nothing to do with Paula, who sounds as if she did a
>wonderful job trying to help this mother, and is agonizing (as all good LCs
>do) when she leaves feeling unsuccessful. But I want to talk a minute about
>the continuing grief I get for sometimes suggesting nipple shields. I find
>it interesting that people who find shield use scandalous have no
>compunctions about renting or selling expensive pumps to mothers who have
>babies who have never been to breast. I wonder what kind of follow-up has
>ever been done on outcomes of duration of bfg. when baby has never been to
>breast? Anybody ever seen that data? Anybody interested in collecting and
>publishing some results from their own cases on this issue? I follow my own
>cases looking at outcomes. In my experience, the lactations don't last much
>longer than a few weeks.
>
> The cynic in me doesn't often pop out as I believe mostly that people are
>trying to do the best they can in any given situation. But just
>occasionally I wonder if there isn't a lot more money to be made in "fixing"
>a situation with more expensive machinery like pumps and feeding tube
>devices than there is in bringing a baby back to breast with a $6.00 piece
>of plastic. I say again: nipple confusion is not generally a permanent
>condition. Babies who WON'T nurse, CAN'T nurse. If you can bring them to
>breast, then you buy time to fix the reason they can't nurse, or you wait it
>out if it's developmental or requires recovery time. THEN you fix nipple
>confusion. In the end you may (if the mother is willing to hang in) have an
>exclusively breastfed baby. Situations requiring the help of an LC are BY
>DEFINITION not normal.
>
>Barbara
>
>Barbara Wilson-Clay, BS, IBCLC
>Private Practice, Austin, Texas
>Owner, Lactnews On-Line Conference Page
>http://moontower.com/bwc/lactnews.html
>
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