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. ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html