Regarding:
Pediatrics. <http://www.ncbi.nlm.nih.gov/pubmed/10545587#> 1999
Nov;104(5):e61.

>A retrospective cohort study design was used. Subjects were identified from
an ongoing pregnancy outcome study conducted through the California
Teratogen Information Service and Clinical Research Program. A total of 64
women were interviewed who had taken fluoxetine during a pregnancy between
the 1989 and 1997; 26 of these women breastfed their infants and continued
to take the medication, and 38 breastfed their infants but did not take the
medication. Postnatal weight gain was taken from pediatric records, and the
frequency of side effects was measured by maternal response to the
interview questionnaire.<

Interesting that the results of this retrospective cohort study "indicate
that breastfeeding
while taking fluoxetine *is associated with* (emphasis mine) reduced growth
that may be of
clinical importance in situations in which infant weight gain is already of
concern."

Can someone with more expertise in psychology and/or statistics please tell
me -- what are the therapeutic implications here?  I have known women and
been a woman who had to adjust SSRI dose with changing stressors (and
uplifters).  Mightn't continuing to take fluoxetine be a marker for
continuing mood (and probably other) struggles relative to those who quit
postpartum?  And don't we already know that mothers with depressed mood
tend to have babies who thrive less (whether due to less food or higher
stress)?  So it seems crucial to me to offer concerted followup to
determine whether prozac is to blame, or inadequate treatment for mood
disorder is to blame.

We know that U. S. mothers experience a degree of postpartum social support
RANGING WIDELY from being alone at home with baby and other small children
starting Week 1, to live-in extended family ensuring mother is well fed and
rested for months.  To me, the most telling thing about Laura Coulter's
client is that the mother did not bring enough milk to the daycare.  This
suggests to me that the mother is still adjusting to returning to work --
whether because she just returned last week, or because she is persistently
not getting the necessary social support to address her level of coping.
 It also suggests that baby is adjusting to separation.

Another factor is the "tons" of milk at home, which suggests too much time
spent with the pump instead of the baby, and stimulation of oversupply so
that baby is not getting enough time at the breast bonding with mom and
consuming fat.  So Laura, I suggest you keep doing what you are doing,
encouraging block feeding, encouraging avoidance of pacifier use, and just
being encouraging to this mom who is adjusting to her circumstances that
baby needs her much more than every 3-4 hours.

Ruth Piatak
-- 
Ruth Piatak, BA, MS, LLLL, IBCLC
Tulsa, Oklahoma
918-585-9114
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