I have just returned from my son's wedding so please forgive me for being
late with this info...
Kathy Dettwyler posted this on Tue, 22 Feb 2000
Norma Ritter, IBCLC
private practice in Big Flats, NY
[log in to unmask]
>Subject: Deem and McGeorge/Spence
OK, given that someone else reminded me of the authors, I was able to put
my hands on these articles from my file cabinets. It's good to go back
to
the originals, as you can see my memory of Deem and McGeorge was not very
accurate in the specific details.
Spence, J.C. 1938 "The Modern Decline of Breast-Feeding." British
Medical Journal, 2:729-733.
p. 732: "Concerning the normal mechanism of lactation there remains one
other question. What percentage of women are incapable of breast-feeding
because of physical abnormalities? Less than one cow in a thousand fails
to lactate. Is the greater number of women who fail due to inherent
structurs faults or to environmental causes? In many rural districts in
this country at least 95 per cent. of women successfully establish their
lactation. There is no reason to think that with proper management the
proportion of urban women capable of doing this is less than it is among
the rural women. An endocrine mechanism which has allowed a woman to
conceive and give birth does not at that stage fail to provide for
lactation. There remain a few, less than five per cent., in whom it is
physically impossible to establish lactation either because of diseased
or
malformed nipples, or because the infant cannot suck on account of mental
defect or of cleft palate or other physical fault. All women who are not
handicapped by these physical defects can breast-feed their infants if
they
desire to do so and if they are not prevented by an unsuitable
environment."
NOTE: He says less than 5% is the true figure, and includes those cases
where the infant is the one who cannot suckle properly.
Deem, Helen and Murray McGeorge 1958 "Breast-Feeding." New Zealand
Medical Journal, 57:539-556.
p. 542+: "Feeding Timetable -- Normal infants were put to the breast for
brief "practice feeds" twice on the first day and three times on the
second, while the schedule of five feeds a day was introduced on the
third
day. Small infants not requiring the full premature regime received six
or
seven feeds a day. If for any reason infants were not put to the breast,
lactation was established by manual expression.
Estimation of Milk Production -- After each feed the residual
milk was
expressed by the mothers. All infants were test-weighed on the fourth,
seventh, and tenth days, and on intermediate days if necessary, and the
milk expressed after each of these feed was measured and the day's total
recorded. The sum of the test-weigh and the expressed milk totals
provided
an indication of the "available" milk production for the day.
Painful Nipples -- Cases of even mild overdistension were
carefully
watched and the nipples regularly inspected with a hand lens for damage.
Suckling was interrupted for a day or two whenever there was complaint of
pain or evidence of nipple damage, lactation being maintained by hand
expression. Any cracks were treated by rest and a suitable local
application.
p. 544: "For various reasons, 82 patients (9.2 per cent) were
artificially
feeding their infants by the time they were discharged from the hospital.
Primary Failure of Lactation -- In it generally recognized that
the most
frequent reason for early bottle feeding is primary failure of lactation,
which occurred as the major factor in 36 of these cases (43.9 per cent)
[NOTE FROM KD: 4% of the total sample]. Of the 36 cases, 28 were
multiparae, of average age 35.3 years, each with an average of 5-6
children. Ten of these patients had been able to breast-feed their
earlier
infants satisfactorily, but not the later ones, while the remaining 18
had
not been able to feed adequately any of their infants. In addition,
eight
primiparae, of average 30.6 years, produced practically no milk at all.
A
study of the characteristics of the breasts of this group showed that
they
possessed many features in common. The eight primiparae, in particular,
presented a remarkably uniform picture. Without exception their breasts
at
the initial antenatal examination had been described as small and
inelastic, and of a homogeneous "doughy" consistency lacking much
palpable
granular tissue. There had been little or no increase in breast
development during pregnancy, while little or no colostrum could be
expressed during the first two days after delivery. As was to be
expected,
practically no milk was expressed on the fourth, seventh and tenth days
of
the puerperium. The breasts of the multiparae in this group presented
the
same general characteristics. Even those who had fully breast-fed their
earlier infants now showed little or no glandular development during
pregnancy, and after delivery quite inadequate secretion of colostrum and
of milk. These breasts had evidently failred to respond to the
stimulation
of later pregnancies."
He goes on to discuss how many cases of lactation failure were due to
inverted, "tied" or deformed nipples, severely cracked nipples,
tuberculosis, other health issues. I love this line: "In addition, there
was one case of puerperal mania and two of nervous exhaustion due to
domestic worries." Another 11 cases were due to maternal refusal to
breastfeed.
In the conclusions, he says 4% of their sample was unable to lactate, but
more than 95% of all women should be able to do so without any difficulty
given adequate management and maternal motivation.
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