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From:
Maureen Minchin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 18 Dec 1997 23:22:14 +1100
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Further to my earlier posts on this, one person challenged the basis of the
figures for infant intake days 1-5, wondering if it was volumes obtained by
pumping which she assumed could be lower than the infant's intake, while
some others also obviously found it all very new information. So today I
went out to a library, got a copy of the original article referenced in the
book I quoted, (a book written by 2 very competent research-based midwives,
so I have to confess I trusted their reading of the literature) and re-read
it. The original reference is Houston Howie and McNeilly, Factors affecting
the duration of breastfeeding:1. Measurement of breastmilk intake in the
first week of life. Early Hum Dev 1983; 8: 49-54. The basis was 24hour
testweighs before and after feeds, conducted by the mothers themselves,
with a highly reliable electronic balance.  (accurate to within 2gm) Before
anyone leaps in to criticise the methodology, please read the article; you
may find that your concerns were known and addressed. This was a sample of
only 18 mothers (18 more than anyone else has followed so carefully,
however), but certainly the amounts recorded square with clinical
experience here in Australia, where very tiny quantities of colostrum
obviously satisfy many babies on day 1-2. [The usual caveat about averages
always applies, of course.] Curiously or predictably, the average total
intakes to day three are just above the total intakes to day three which
have been shown to result in at least 95% of exclusively breastfed babies
being PIVKA negative on day 5 (i.e., showing not the slightest sign of
being low on vitamin K and so at no risk of classic haemorrhagic disease,
an iatrogenic epidemic of earlier times when babies were separated and not
fed ad lib by their mothers). (And sorry, I don't have time at the moment
to locate and cite that reference but am preparing a talk entitled Bleedin'
nonsense: the vitamin K controversy re-considered, which will contain all
such references when it's done.)

Now that I've looked at numbers involved, I think it would be good if
someone in a position to do so, reads this article carefully and tried to
replicate the methodology and see if the findings were similar. Meanwhile
it remains the best data we have on this issue. (I'd certainly like to see
it done for those mothers who have abundant flowing colostrum: do their
babies self-limit intake, to reduce strain on immature kidneys?)

I don't want to be controversial or to call down more heaps of coal upon my
head, but feel I should say that I believe Americans need to read the UK
and Australian literature *as much as* UK and Australian LCs need to read
the American literature, and that in my experience it seems that the latter
happens more than the former? Perhaps it's because America is so big and
the literature generated so vast and varied, but it is sad that books like
Akre's "Infant Feeding the Physiological Basis" or the Henschel/Inch
"Breastfeeding a Guide for Midwives", or Brodribb's "Breastfeeding
Management in Australia" seem not to be known as well as some standard US
texts. And no library is complete without Sandra Lang's "Breastfeeding
Special Care Babies", Enkin, Keirse Renfrew and Neilsen's "A Guide to
Effective Care in Pregnancy and Childbirth", and a subscription to MIDIRS
(see previous post for details.) All are incredibly reasonable by
comparison with some US book prices. If you have trouble finding books, ask
amazon.com to find them for you. And no, I don't get any commission for
telling you about these books: I just think they're really important
sources that can free people from the solely-US perspective, which tends to
be far more medically-oriented and formula -friendly (in the absence of a
strong midwifery profession and normative breastfeeding), and so sometimes
disadvantages breastfeeding. Enough from me. I really am off now for some
time. Maureen

Maureen Minchin, IBCLC, 5 St, George's Rd., Armadale Vic 3143 Australia
tel/fax till maybe end January or mid Feb: 61.3.95094929 or 95000648
tel/fax after that: will let you know
Address (date depends on renovations; will post): Christ Church Vicarage,
14 Acland St., St.Kilda, Vic. 3182 Australia

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