The following is from Ruthy Wilson, RN, IBCLC in Cocoa Beach FL. Please
privately email her with and references or suggestions for the following:
From:   [log in to unmask] (ruthy wilson)
To: [log in to unmask]
a couple of things i need from Lactnet:
More info on the glucose/colostrum study for the neonate with hypoglycemia.
I need a copy for my neonatologist.
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Are LC's doing research on "best bottle teat" to give babies that "retain
breastfeeding competency" ....one pump company ,(maybe two) send out kits
with an orthodontic shape. Who has confirmed this is the "best teat" for a
breastfed baby?  I am inclined to go for a broader based symmetrically
shaped teat with (softer not more rigid) structure.

In regards to the ortho-teat it seems to me that the tongue and jaw movement
tend to be restricted by the constraints of the rigid "trough" that
orthodontic shaped teats provide and that the mouth adapts to the rigid
shape of the irregular slopes of the ortho shape, rather than what happens
to a real breast and infant mouth.....the baby's mouth is filled by the
elastic breast tissue and the breast moves with the baby's oral cavity
supporting the excursion of jaw and tongue peristalsis.
I must admit there are not a lot of "normal" teat choices, including the
newest lines.....but they are improving....My question: since bottles are
here to stay, which teats are being actively researched?
I am kind of liking the latest Elite by evenflo, has anyone studied or
experienced it?  We see and use so few bottles at the Cape hospital I get
little opportunity to trial them.
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I also need some sources for current management of hyperbili in the normal
term neonate with bili levels at 20 after "milk comes in" and intake has
been established) we still lose babies to ABM (permanently) after 2 local
peds puts the  mom on 48 hours pump and dump (the milk "causes hyper-bili
and is dangerous to give at any age")
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The Pharmaceia (Depo Provera) Reps got "sent to me" (un-announced by OB-GYN
group) attacking  my advise to newly delivered mothers that they  reconsider
getting DEPO shot at 1-3 days postpartum, (and deferring it to 6-8 weeks
post partum visit while Lactogenesis II settles into
Galactopoeisis)......They (REPS) say the Literature shows NO NEGATIVE
effects on Lactation success (whatever they define that to be...) I have
used Ruth Lawrence's information in her textbook outlining the precipitous
drop in progesterone and estrogen (related to expulsion of the placenta) as
a critical physiologic event necessary  for Lactogenesis II....(Depo
theoretically  being an  unnatural event that (potentially?) disrupts this
natural cascade of hormonal changes necessary for normal LACTO II....

My question is: What other literature supports this "theory" that Dr Ruth
outlines? and where can I get my hands on it?  Why does the Pharmaceia
company recommend in it's package insert that the lactating mother wait 6
weeks? Who is doing studies on frequency, duration and intensity of
lactation on mothers who get DEPO at 48 hours postpartum?

 I have yet to meet a single breastfeeding mother who maintained lactation
after recieving the DEPO in the immediate postpartum....Dr Miriam Labbock
where are you? and have you investigated the effects of immediate admin of
Depo on lactation success?

Pat thank you if you can post these issues for me....see you Friday....

Warm regards,
Pat Lindsey, IBCLC - Lactation Services
Pediatrics Plus Staff LC & Private Practice
Orlando, FL

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