Dianne, 

While browsing, I came across this:

"Suckling stimulates sensory receptors in the nipple that activate nerve impulses; these impulses are transmitted through thoracic nerves 4, 5, and 6 to the spinothalamic tracts in the spinal cord, terminating in neurons in the mesencephalon. Impulses from the mesencephalon are transmitted to the hypothalamus, resulting in a decrease in prolactin-inhibiting factor (probably dopamine) that releases the lactotrophs from the inhibitory influence of catecholamines. This permits the synthesis and release of prolactin."


http://www.glowm.com/?p=glowm.cml/section_view&articleid=304
 
The Breast During Pregnancy and Lactation, 
 
This chapter should be cited as follows: This chapter was last updated: 
Beesley, R, Johnson, J, Glob. libr. women's med.,
(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10305 May 2008 


Does your client have information on just which thoracic nerves might have been surgically severed? Might this also have interfered with prolactin secretion (as above) as well as oxytocin (mention in first post)? If things have not improved, would it be of any vaue to have her prolactin level checked before and about 45 minutes after the start of a feeding, at the right time in relation to other factors I'd have to look up again, such as time of day and her food intake?


And now, I digress!!!! This site seems to have such high goals and good hearted folks, and many physicians who contribute their expertise to write articles without charge, and an international editorial board, including a lot of Americans physicians at prestigious medical schools:


The Global Library of Women's Medicine
Dedicated to the enhancement of women's healthcare
An expert clinical resource for women's healthcare. Constantly updated. Peer reviewed. Comprehensive coverage 
ISSN: 1756-2228


However, something definitely needs to be done about the chapter on breastfeeding. But ethically, how, and who, should let them know???  It starts off thus:


"The great resurgence in breast-feeding has required the physician who cares for patients of reproductive age to acquire an in-depth knowledge of lactation and breast-feeding. Enlightened and sound advice to the lactating mother greatly increases the satisfaction with nursing for the mother and the overall benefit to the infant. . . . . . . ."


Certainly can't disagree with that!!


Then, shortly thereafter, these paragraphs!


"Nursing should begin at or shortly after delivery for the healthy, mature infant. In earlier times, the infant was put to the mother's breast immediately after delivery to induce uterine contractions for the expulsion of the placenta and for hemostasis. In addition, placing the infant at the mother's breast after delivery also may increase the strength of maternal-infant bonding. . . . . . . . . (can't disagree with that either)


The initial nursing period should be short (2–3 minutes on each breast at 2–4 hour intervals), with a slight increase in duration each day. Nursing may be carried out on a regular basis (every 4 hours) or on demand. During the first week to 10 days of nursing, the infant will not take all of the milk in the breast, and the remainder should be removed by suction to maximize milk production and minimize symptoms of pain and engorgement. By 2 weeks postpartum, supply and demand regulates the volume. Night feedings are usually necessary during the first month postpartum but can be gradually eliminated during the second month for most infants. Nursing time should be increased to a maximum of 10 minutes per breast, because 5–6 minutes is all that is usually required to empty a breast. Excessive nursing can produce nipple fissures and mastitis."



This is the kind of advice we were giving in our hospital nearly 60 years ago! Advice that I followed "religiously" for 5-10 days with my first three children till I couldn't handle the nipple pain any longer!!!



Immediately following the section on Lactogenesis, is a section nearly as long, on Suppression of Lactation!


There is a great deal of hormonal, anatomical and physiological information in the chapter that is very deep, and way over my head. I agreed with some parts of the anatomical section but I'm sure that devotees of the Main Trial will shudder at it. Anxiety is discussed as one of the major problemsto overcome in order to succeed, and physicians are encouraged to advise mothers to seek the support of LLL and "CEA". There is no mention, for the physicians, about the existence of the protocols of the Academy of Breast Feeding Medicine, BFHI 10 steps, or ILCA, or IBCLC's, either. Perhaps that wouldn't be so bad, if the information itself were up-to-date!


I find myself shaking my head in disbelief at incongruity of the levels of advice throughout the total chapter, and wonder what reaction other Lactnetters have, especially any physician members, for whom it says the chapter is written?


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH USA

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