Thank you, Denise. 
<Dawn Hunter from New Zealand presenting her observations at a conference
I went to last year confirms these findings in case studies of women who
experience increased breast edema, decreased volume of colostrum and
delayed lactogenesis II, until serum albumin levels reached 30g/L. 
Have you or others thought of continuing the research looking at the
serum albumin levels, and if we can't prevent or change their low levels
start working out ways to treat these low levels rapidly.>

How interesting. Has she yet published this information so that I could
get a copy to give to a local obstetrician who is responsible for OB
residents' training at our Level III perinatal center? He has had a wide
and varied practice background in several countries, and seems,
therefore, not "locked into" the current way of doing things here in our
community. When he spoke to a group of childbirth educators, doulas, LCs,
etc, here last year, he mentioned administration of IV's and having
suggested to the residents the administration of albumen after the first
several IV's. I hope to revisit the discussion.

I myself do not have the academic expertise nor do I work in a facility
in which I could do such research even if I knew how. But I remember that
when I was trying to understand colloid osmotic pressure when I was
writing my article, I sought more information from a good friend who is a
lab tech in a commercial lab serving that particular hospital.. She
looked it up to explain it to me, but told me the test is seldom done at
that large facility. It seems to me that the serum albumin might be
simpler to obtain.

Victoria Nestorova was kind enough to supply me with her translation of a
Ukrainian article 
Morozova NA Pilipenko OM Clinical-ultrasonographic correlations of
lactation
// Pediatria, akusherstvo ta gynekologia.-1997. 
Of special interest to me were the concluding paragraphs. (Victoria's
comments are in brackets)
"Milk stasis was more often seen in women who delivered by cesarean
[C-section moms are often not able to put baby to breast for 1-2-
sometimes 3 days – may be, the answer is here]. Milk stasis was caused by
the general edema of the alveolar epithelium, narrowing [constriction] of
milk ducts, and reduction of contractile and evacuatory capacities of
myoepithelial elements of the mammary gland. We think that milk stasis
after c-section is caused by the stress of the surgery, which influences
normal course of lactation. This hypothesis is confirmed by the
effectiveness of actions for removal of milk stasis as surgical wound
healed. 
Therefore, ultrasound scans of mammary glands during pregnancy can be
used for prognosis of postpartum lactation [I cannot see from the article
whether they were able to predict this]"
This last sentence itself is a startling revelation. I'm not aware that
it's being done in our country. Would that we in the lactation community
can persuade our physicians to use it in difficult lactation situations.
Of course, I don't agree with their conclusion <We think that milk stasis
after c-section is caused by the stress of the surgery, which influences
normal course of lactation. > I doubt it is so much the stress of a
uterine incision and anesthetics, but the things that accompany them,
such as multiple bags of crystalloid IV solutions, extra pitocin, perhaps
epinephrine, and as Victoria notes, delays in putting the baby to breast
regularly.
I hope Lactnetters who have the opportunity to discuss these things with
hospital physicians and nurse researchers do in fact circulate
information of this type so that research can take place and changes in
routines can evolve. I believe that many professionals who care for
mothers and babies in one segment of the intrapartum/neonatal period are
sufficiently aware of the problems that certain policies can create in
early lactation and establishment of successful breastfeeding.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA


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