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From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 12 Sep 2005 07:40:46 -0400
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So, in addition to developing an LC exchange program, we could do a multicultural study on using 
time series analysis - e.g median time to reaching an x% supply as defined by proportion ot breast 
milk to breast milk substitutes in various cultural settings.  The mental attitude I'm sure has a 
huge amount to do with success.  I don't think we need Peter Hartmann's fancy tools for this 
because what WE need to know is what is the effectiveness of:

1) Putting baby to the breast
2) Using a tube on the breast
3) Pumping

It would have to look at the interactive effects of combinations of these interventions.  I would 
probably combine as follows:

Group 1:  Putting baby to breast
Group 2:  Putting baby to breast, using a tube
Group 3:  Putting baby to breast, pumping
Group 4:  Putting baby to breast, using a tube, pumping

I would feel that it is unethical to not have a putting baby to breast group.  If we did not have the 
putting the baby to the breast alone group - we would not be able to determine whether or not 
pumping and using the tube had an interactive effect.  It may be unethical to have a group that is 
just putting baby to breast which would leave this comparison:

Group 1:  Putting baby to breast, using a tube, not pumping
Group 2:  Putting baby to breast, not using a tube, pumping
Group 3:  Putting baby to breast, using a tube, pumping

Since we are not dispensing pills, we would not be able to get at "efficacy" of these interventions.  
However, if we did this in various cultural settings we would be able to get at "effectiveness" of 
these interventions in different cultures.  

We would have to set tight parameters around the women we choose for inclusion in the study and 
have careful pre- and post-feeding weight checks as well as pre- and post-feeding weight checks 
on what is in supplementers and bottles.  Probably weighing the baby would be a better idea, but I 
can't imagine mothers doing this around the clock in addition to the interventions.

I think we should screen out, as best as possible, known conditions that may limit the supply - 
including IVF, insulin resistance, thyroid problems, etc.  Then we'd also have to set some 
parameters around the babies as well.  I think I'd screen out tight frenulums and other suck-
limiting factors as special cases.

Knowing my population and having using the SNS extensively prior to running support groups 
where I saw the dropouts from the practice with whom I did my initial training, I am certain that I 
won't see much of a difference between the using the tube and not using the tube groups except 
among some babies .  Initially I was pretty horrified that these women were happily bottle feeding 
and pumping away and how would their babies ever figure out how to feed at the breast when 
they were taking 0.1 oz.  They weren't even using Dee Kassing's paced bottle feeding technique - 
fast flow Avent bottles tilted vertically and babies drowning in the fast flow.  

BUT this population is not every population and I'm sure that there will be strong cultural 
differences (and even within the populations that we serve).  I think it is very important to not only 
identify the effectiveness of various interventions but to look at who responds to various 
interventions in different settings.   AND long before I watched this support group, I wanted to do 
a study on use of the tube.

If there is anything I have learned from my work in international settings, it is that the 
effectiveness of interventions is highly dependent upon the setting and population.

So, now here is the problem in our so-called modern society that doesn't believe in funding 
research (everything is supposed to come from corporations).  How do we get funding for a 
multicultural study?  I remember CDC having a request for proposals about interventions.  


Best regards, Susan Burger

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