In discussing hand expression during pregnancy to save colostrum for diabetic mothers, I was asked what studies I can provide that will show this will not initiate labor.  I tried to do some searches (and contact Sue Cox, but her e-mail bounced back to me), and didn't find this particular evidence, so I'm asking for your input/suggestions.

HOWEVER I also wondered if I was not being asked  "to prove the negative" when, in fact, we haven't been able to use nipple stimulation effectively to initiate labor (or we wouldn't be giving Pitocin by IV...just had moms stimulate their nipples).  

In the Hale and Hartmann TEXTBOOK OF HUMAN LACTATION (page 146) it states "There is evidence that oxytocin is not the driving force for parturition in both humans and animals, but rather plays a role late in the second stage of labor."   And "Although the role of oxytocin in the maternal circulation is greater in the late stages of labor, oxytocin is commonly used as an effective pharmacologic agent for the induction and augmentation of labor due to its uterotonic properties. "

Is the prohibition of nipple stimulation based on the effects of the pharmacologic uses of vastly higher and more consistent levels (rather than the pulsating release occurring in nipple stimulation, labor or breastfeeding)?  

Of course I understand the desire to avoid ANY potential risk to a mother with preterm labor signs and symptoms - but for the healthy (but diabetic) pregnant mothers?  What do you do - and when (as often babies of diabetic moms are bigger and may deliver earlier than 37 weeks)?  Do you have research/references I could use?

Jeanette Panchula, BA-SW, RN, PHN, IBCLC
California, USA

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