Hello, all.  I've been hanging around for about a month now.  The numbers of
messages/day are certainly skyrocketing!  I've been reading but never have time
to "talk."

INTRO:
I'm an old NICU nurse clinician, old LLL Leader, and have been IBCLC since 1989.
I work primarily as an LC in a hospital that does about 1200 births/year, run a
Sanvita program at a large insurance company, and have a pump depot that I'm in
the process of giving away (too busy, most disruptive to my home life of the
things I do).  I have 3 kids, all breastfed in the LLL style.  I'm in Appleton,
WI.

PITOCIN:
I, too, have noticed what seems to be a frequent association with delayed milk
production and the use of pitocin.  I have not seen the edema that Jan Barger
referred to, but if there is an association with pitocin + epidurals, that would
fit with practice at my hospital.  Our induction rate is 40-45% but epidural
rate is only 15%.  We seem to have a ridiculous number of babies that need
supplementation (not routinely, but with good indication) because of delayed
milk production/seemingly little colostrum.  As an example, a LLL Leader friend
had her fifth child last fall with a pit induction after ruptured membranes and
no labor.  She had mega amounts of pit for 12+ hours to get this kid delivered,
no other intervention or meds.  Baby nursed well and often but was one hungry
kid--Mary felt her milk had never come in so slow and none of her other babies
acted like this.  When it finally "came in" she had plenty, but the lack in the
first few days was a real issue.

MULFORD'S ASSESSMENT:
We use Chris Mulford's Mother-Baby Assessment (JHL June 92 pp. 79-82) as our
assessment tool and it seems to be working pretty well.  Mostly it gets the
nurses at least paying attention to how the baby's feeding.  I'm virtually
certain that some of them just chart 6's because they know that's what I'm
looking for, but when it's done well it gives us objective criteria for who gets
discharged with an electric pump and who gets closer follow-up.  I'm blessed
with an administration that supports the follow-up--there's no charge for
outpatient LC visits and we have a twice a week postpartum support group where
we can deal with minor difficulties and follow weights.

FILLED MILK DUCTS/Denise Parker:
You might try asking about a history of candida or risk factors for yeast.  We
have found that in some mothers yeast seems to be responsible for
ducts that repeatedly plug.

NIPPLE THRUSH HANDOUT AVAILABLE FROM KAY HOOVER:
I just got a wonderful handout from Kay in the mail today that she has had
printed to help educate health care professionals who don't treat mothers
because they can't "see" anything on their nipples.  It has color pictures of
thrush in babies mouths, on their bottoms, and mother's nipples.  It gives
treatment recommendations and references.  If anyone is having trouble getting
moms and babies treated, this may be a real help.  A single sheet is $2
including mailing, and she has lower prices for multiple copies (ex. 50-99 @
$.55 + $9 for mailing).  Her address is:
Kay Hoover
613 Yale Avenue
Morton, PA  19070-1922
610-543-5995


I guess that's it for now; nice to meet you all!

Becky Krumwiede
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