Dear Lactnetters - Would anyone know of a LC or La Leche Leader in
Indonesia? If so could you please e-mail me privately as I am usually a few
days behind. Thanks loads, Toby (Haifa, Israel)
Toby Gish RN, BA, IBCLC, LLLL (aapl)
mailto:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 10:53:22 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: William Shine <[log in to unmask]>
Subject: kathy d
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sorry to be posting this to the entire list but my computer is having a tantrum kathy d. would you please email
me with the number for HDIS again? the number my mom called, 1-800-590-8383, answers with someone
who says that they( i think they meant HDIS) are not on their list. thank you so much. ~ mary
mary shine
[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 09:54:46 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Dan & Liz Spannraft <[log in to unmask]>
Subject: know the source
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Here, here, Laurie. I have even had clients tell me that the Lactation
Consultant I saw yesterday( me) said "..." a statement that I never made,
or completely misinterpreted. That's why I'm so adamant on written
materials. I also think a picture makes more of an impact.
On universal precautions. Health departments can have quite an impact both
state, county and local, on regulations concerning breastmilk. We cannot
have breastmilk in any food or medicine refrigerator. It really is a strain
for staff and clients. Many staff members end up hiding breastmilk in
lunchbags etc. Extra expense of a refrigerator is a problem too.
Liz Spannraft IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 09:59:50 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Maurenne Griese, RNC" <[log in to unmask]>
Subject: Grave's Disease and Breastfeeding
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Does anyone have any specific information on this topic for a BF mom with
Grave's disease? I've searched the net with no results. I've tried
accessing the archives via the net for the past two days and I'm getting a
"time out" message. I've also tried accessing the archives via e-mail and
am not getting a response from the listserv address for some reason.
Perhaps I am impatient...
HELP!
Maurenne Griese, RNC, BSN,CCE, CBE
Manhattan, KS USA
=========================================================================
Date: Wed, 3 Feb 1999 11:33:17 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Alicia Dermer <[log in to unmask]>
Subject: Re: Nursing three
In-Reply-To: <[log in to unmask]>
MIME-Version: 1.0
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The discussion on the issue of tandem nursing three (or more) children has
me intrigued. In this instance (as in previous such discussions I can
recall), there is a concern raised about a possible reduction in milk
supply for the youngest nursling. Recommendations are made to be sure
that the baby gets to nurse before the older child(ren). Am I missing
something? If the basic principle that "the more milk is removed, the
more milk is made" holds, then why would the fact that the other nurslings
are older matter? Why in discussions about twins, triplets or quadruplets
nursing, do we not worry about milk supply (simply say that as long as all
of them get adequate time at the breast, the mother's milk will match the
demand), while we repeatedly discuss tandem nursing in a way that suggests
that the older nursing child(ren) will somehow "rob" the baby of its
needed milk. Hope someone can clarify this for me. Regards, Alicia
Dermer, MD, IBCLC, in mild, sunny New Jersey, USA.
=========================================================================
Date: Wed, 3 Feb 1999 11:33:19 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Nikki Lee <[log in to unmask]>
Subject: statistics/HIV
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In a message dated 2/3/99 9:35:48 AM Eastern Standard Time,
[log in to unmask] writes:
> only 49 out of 102 babies were believed to have acquired HIV through
> *breastfeeding*. That's 5%, not 10% and certainly not three-fold. Why
> choose to quote an earlier (larger) statistic and to omit a more recent
> (smaller) one? At best this is selective reporting. At worst it's
> deliberately misleading.
Dear Folks:
Am I missing something here? 49 out of 102 looks closer to 50% than 5%?
Warmly, Nikki Lee
=========================================================================
Date: Wed, 3 Feb 1999 08:44:18 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Janet Simpson <[log in to unmask]>
Subject: Re: Hemat and Hemogl
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Hi All,
Gail writes:
>I don't do CBCs on patients just because they are breastfeeding...
>and still feel that a fingerstick hgb is an adequate test to "screen" for
>anemia.
>If there is a reason from the physical exam, then a CBC is a good tool to
>"evaluate" anemia as you have mentioned.
>All I hear, though, is that these two are breastfeeding. Not that any
>indication to evaluate is present.
The kids in this scenarrio are just fine, healthy, their physicals checked
out just fine.
This is another issue for the mother - the blood draw vs the finger stick.
She feels that the finger stick is all that they need (all they have
received in the past) and that there is no need to traumatize the children
with a blood draw. Now I know that some out there will say "But the finger
stick hurts more than the blood draw and the blood draw gives more info..."
Well, the point here is that the finger stick may hurt more (I agree) BUT it
only hurts for a second and to do a blood draw on a child can be traumatic
for the child and leave lasting scars - to this day I cannot sit up and have
my blood drawn due to the first blood draw I had when I was only 5 yrs old -
I become hysterical and pass out. If I lay down, however, I can even watch
the blood come out! So, since the children are perfectly healthy, mom wants
a finger stick, she will not wean her children. BTW, she called the Dr and
told him to get her references that proved his point that BF affected this
test! (Not my suggestion - thought of it on her own.) Also, told the Dr
that if he was unwilling to perform (or order) such a simple test that she
would switch peds if she had to. She also told her hubby that "not wanting
to hurt a Drs feelings" was not a good enough reason to stay with a Dr who
asked such unreasonable things of his patients and that if the Dr refused to
treat his children appropriately, that she had no choice other than to
change peds. He agreed!
Jay
Jay Simpson, CLE
Sacramento, California, West Coast, USA
"No Miracles performed here, just a lot of love and hard work."
=========================================================================
Date: Wed, 3 Feb 1999 11:44:53 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathleen Bruce <[log in to unmask]>
Subject: professionalism
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Hi all. I'd like to thank those who support professionalism on this list. I
have to agree. If we are truly in this together, to help advance the
professionalism and knowledge base of lactation, then we must act this way
in our professional work, including this list. I myself understand the
frustration involved here, but nonetheless....
Many thanks for your understanding.
Kathleen
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
Williston, Vermont, where the icy winds are blowing hard...
mailto:[log in to unmask]
LACTNET Archives http://library.ummed.edu/lsv/archives/lactnet.html
=========================================================================
Date: Wed, 3 Feb 1999 11:45:28 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Jeanette F. Panchula" <[log in to unmask]>
Subject: organization
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In my office in Puerto Rico we had an additional problem - what LANGUAGE
are we storing things under - we finally decided that whether the materia=
l
was in English or Spanish we would file in English, otherwise we'd be
looking under "Sore nipples" and "Pezones adoloridos"
Then, I have LARGE folders marked "benefits of breastfeeding" "Risks of
formula" "Education" (for ideas for teaching moms) and "Training" (for
ideas on teaching Health Care Prof.) which hold a lot of "stuff" (these a=
re
also copied and filed under each individual subject) because when I'm
looking these things up, it's to get ideas.
On the computer, I started before Lactnet digests were so easily
"searched", so I have a file called Lactnet, with files under it for
"adoption", "baby friendly", "benefits", etc, Each of these files had
individual files for specific items Ex: under "adoption" I have "Donor" =
and "protocol" and "resources" and "books" and "mom" (for a particular mo=
m
who wrote and said she was willing to talk to other moms)...
All these I have saved as .txt files using the Notepad section under
Accessories in Windows, so that I can access from Word or any other PC
compatible program (or send as a file to a friend).
Most of the time now I don't save on my computer as I know I can search t=
he
lactnet files, but in PR, this was not as easy or as inexpensive (toll ca=
ll
to internet service provider).
I got frustrated at trying to remember in which book or journal I read th=
is
or that, and copied the indexes of the books I have and the indexes of JH=
L
and Breastfeeding Abstracts and put them in a 3 ring binder. It helps in=
trying to locate something when I have NO idea where it is!
BUT I have found one great way to get organized - move! I had to get all=
my files into the filing cabinets (2 4-drawers for breastfeeding stuff an=
d
1 for personal), so things got filed or pitched. =
One point that others have made - if you can hire a high school or colleg=
e
student, a lot can be accomplished in a short time just because you don't=
get so distracted. I hired my daughter a few times when she was home to
help with my files at home and at work.
Jeanette Panchula, BSW, RN, IBCLC, LLLL
Vacaville, CA
mailto:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 11:47:48 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Martha F. Johnson" <[log in to unmask]>
Subject: need help with listserv
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Hello All,
Could someone kindly assist me with directions to get the full text of Lactnet
sent to my mailbox? What I wanted was the lactnet format I get at work, which
has all of the topics displayed with envelopes,you can select and click on,
and so I sent a command to "set lactnet index". Which of course is not what I
had in mind.
Now i have sent several commands to "set lactnet fullhdr", and I am still
receiving the index only.
The reason for all this is that I now have a home computer for the 1st time:
WOW!
TIA from:
Martha Johnson RN IBCLC, Eugene, Oregon
where there are signs of spring, oh glory
signs of spring, hallelujah
a bird with a leaf after the flood
there are signs of spring.
=========================================================================
Date: Wed, 3 Feb 1999 12:15:54 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: William Shine <[log in to unmask]>
Subject: nursing three
MIME-Version: 1.0
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>Subject: Re: Nursing three
>
>. " Her concern will not be with milk supply, it will be with the time constraints of nursing 3 children."
>Colette Acker
it did take time for us to be nursing 3 at once. however, the older one did not nurse for near as long and only
1 or 2 times a day, if that. our oldest at that time would say that she, "... would just like five." the largest time
frame was at night when it seemed that i was nursing for several hours before everyone was in bed, bathed and
asleep. it worked for us, had plenty of milk. time well spent, we felt. ~ mary
=========================================================================
Date: Wed, 3 Feb 1999 12:13:36 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
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Crystal Stearns, in Oklahoma, you've just described my dream in life!
Congratulations, and thank you for both doing the work you do and sharing it
with us on Lactnet! I'll consider it my piece of good news for the day.
Cathy Bargar, RN, IBCLC Ithaca NY
=========================================================================
Date: Wed, 3 Feb 1999 10:34:37 -0700
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Linda Pohl <[log in to unmask]>
Subject: Re: Nursing three
In-Reply-To: <[log in to unmask]>
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Sorry Colette,
I must disagree with your recommendation to nurse the newborn first. Back
in the late 80's there were enough moms in Phoenix tandem nursing that we
had LLL meetings just for moms who were nursing tandem and nursing while PG.
The only babies that did not thrive were the ones who were always nursed
first. With the high supply that frequently develops from tandem nursing if
the newborn is always nursed first, he gets fore milk only. If the next
hungriest child is nursed on the next fullest breast the results are much
better.
Linda Pohl, IBCLC
Phoenix AZ
Mother of three who were all nursed two at a time at some point.
Tell mom to nurse newborn first, and keep close eye on wet and poopy diapers
to ensure baby is getting enough.
=========================================================================
Date: Wed, 3 Feb 1999 10:50:14 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Johnson, Martha (PHMG)" <[log in to unmask]>
Subject: FW: Shingles and breastfeeding, again
MIME-Version: 1.0
Content-Type: text/plain
> ----------
> From: Johnson, Martha (PHMG)
> Sent: Wednesday, February 03, 1999 10:49 AM
> To: Johnson, Martha (PHMG)
> Subject: FW: Shingles and breastfeeding, again
>
>
>
> ----------
> From: Johnson, Martha (PHMG)
> Sent: Wednesday, February 03, 1999 10:44 AM
> To: 'Nancy E. Wight MD, FAAP, IBCLC'
> Cc: 'lactnet @library.ummed.edu'
> Subject: RE: Shingles and breastfeeding, again
>
> Dear Nancy and other Lactnetters,
> i just got off the phone with a client who has shingles under her arm, and
> has concurrently experienced an episode of very painful plugged ducts in
> the breast on the same side of her body as the shingles. She went to a
> homeopathic physician and got a remedy, she states "after 3 doses my
> breast came unplugged." She continues to have pain deep in both breasts
> whch she describes as " a dull ache". Negative for sx of mastitis, and
> she doesn't want to try treating for thrush at this point.
> What she and I are both wondering is: can shingles involve tissue deep
> within the breast, and if so, what is the recommended treatment? If the
> lesions are internal, should the baby continue to nurse?
> TIA from :
> Martha Johnson RN IBCLC, Eugene, OR
>
> ----------
> From: Nancy E. Wight MD, FAAP, IBCLC[SMTP:[log in to unmask]]
> Sent: Tuesday, February 02, 1999 10:12 PM
> Subject: Re: Shingles and breastfeeding
>
> Shingles is not a contraindication to breastfeeding or using the milk.
> Like
> any herpes lesion (varicella zoster is a herpes virus) you want to
> minimize
> any infant exposure:
> cover the lesion and wash your hands. I know of no research that suggests
> the
> virus gets into breastmilk. Shingles is a local reactivation of virus
> living
> in nerve endings, not a systemic illness.
> Nancy Wight MD, FAAP, IBCLC
>
>
>
=========================================================================
Date: Wed, 3 Feb 1999 10:59:25 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: cow milk can cause anemia
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To clarify for those who may not know this, cows milk can actually cause
anemia by causing intestinal bleeding. It actually is quite frequent that
cow milk causes micro tears or intestinal fissures leading to bleeding in
the intestine. This is not rare, but mostly undetected. Breastmilk does
NOT do this. The practitioners who think they are one and the same may
conclude the both cause anemia.
Now, onto the next part...the IRON in breastmilk is absorbed at a rate of
50% of the total, whereas the iron-fortified formula and rice cereal iron
is only absorbed at a rate of 5-8%. Even red meat iron is only absorbed at
15-20%. Thus, for example if a serving of brst milk started out with only
half the iron, the baby would STILL get way more iron. This concept is
known in the nutrition literature as BIOAVAILABILITY. : )
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Wed, 3 Feb 1999 11:08:03 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: peer encouragement
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Thanks to all of you for those wonderfully warm words of encouragement. I
will cherish them. : )
Chris
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Wed, 3 Feb 1999 11:08:05 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: brst mlk not biohazard
Comments: cc: [log in to unmask]
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According to the CDC, OSHA and the Am Public Health Assoc. breastmilk is
NOT to be handled according to standard universal precautions. This debate
went round and round a couple of years ago. The implications of calling
breastmilk a biohazard would have been devasting--requiring double gloved
masked feeding of infants, separate storage areas, disposal, etc. This may
change given some recent court cases where brst mlk has been mixed up, so I
think we need to continue educating on this topic.
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Wed, 3 Feb 1999 17:26:23 +0000
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: heather <[log in to unmask]>
Subject: haemoglobin testing
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If Jay's client's children were in the UK, and the doc suggested they were
screened for anaemia, I would suggest (as has been hinted at already) that
the doc has simply equated breastfeeding with milk feeding.
There have been concerns in the UK (and I think elsewhere, too) that some
groups of toddlers, mainly Asian (in the UK that means India, Pakistan,
Bangladesh) , may be running the risk of anaemia because some profs have
observed that they bottle feed (with ordinary milk) for a longish time, to
the exclusion of other foods. Some studies have shown a higher proportion
of toddlers with anaemia in these groups. In the UK these children might
be tested if there were clinical signs of anaemia, or very poor growth, or
if the diet seemed to be almost all cow's milk with virtually no solids.
There's never been any suggestion in any of the research I have seen that
bf is an issue, whether it is 'prolonged' ie over six months : ( , or
otherwise. So I would guess this doctor has his wires crossed, and if he
seeks out his references for this mother, he'll understand where he's
mistaken.
Heather Welford Neil
NCT bfc Newcastle upon Tyne UK
=========================================================================
Date: Wed, 3 Feb 1999 14:06:18 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: ardmore okla
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wow! reading about crystal stearns' program in ardmore oklahoma is great - how
proud i am to point out that i am FROM OKLAHOMA myself. y'all be proud of
yourselves down there, crystal.
carol brussel IBCLC
from tulsa, oklahoma
=========================================================================
Date: Wed, 3 Feb 1999 11:09:09 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Johnson, Martha (PHMG)" <[log in to unmask]>
Subject: Re: Universal Precautions
Comments: To: Jeanne Mitchell <[log in to unmask]>
MIME-Version: 1.0
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Dear Jeanne and Lactnetters All:
Thanks for the CDC and OSHA info re: need for wearing gloves when working w/
breastmilk. I have been trying to get this question answered for a while.
The OSHA letter is supportive for not wearing gloves, but I think it is
outdated, since it's from 1992.
As of sometime in 1998, our local hospitals have adopted a newer
guideline, called Standard Precautions, which I understand replaces
Universal Precautions, for in-patient facilities, at any rate. I work in an
out-patient setting, and have yet to see information that clarifies whether
I should be following Universal or Standard Precautions. Standard
Precautions calls for wearing gloves.
Can anyone shed light on this topic?
TIA from:
Martha Johnson RN IBCLC Eugene, Oregon
> ----------
> From: Jeanne Mitchell[SMTP:[log in to unmask]]
> Sent: Wednesday, February 03, 1999 5:00 AM
> Subject: Universal Precautions
>
> Several people have asked me to post the URL's for the CDC and OSHA
> standards regarding human milk.
>
> Centers for Disease Control and Prevention
> http://www.cdc.gov/ncidod/diseases/hip/universa.htm
> This is a long document that defines Universal Precautions, which do not
> apply to human breast milk. The paragraph about human milk is at the
> bottom.
>
> OSHA (Occupational Safety & Health Administration, US Dept. of Labor)
> http://www.osha-slc.gov/OshDoc/Interp_data/I19921214.html
> This is a letter clarifying that human milk is not considered a
> potentially infectious material.
>
> By the way, I have heard on 2 separate occassions that OSHA requires
> expressed milk to be stored in a separate refrigerator from regular
> food. I have searched their website and can find NO documentation of
> this. It appears that some states and some regions define the standards
> as they see fit. I want a national interpretation on this. I may make
> some calls. I'll be sure to let y'all know if I find out anything.
>
> --
> Jeanne Mitchell, Austin, TX
> http://www.flash.net/~xanth/home.htm
> mailto:[log in to unmask]
> "You can tell the quality of a person by how
> they treat people they don't need." My Dad
>
=========================================================================
Date: Wed, 3 Feb 1999 12:19:01 -0700
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Jerry & Jacie Coryell <[log in to unmask]>
Subject: Re: breech
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I spoke with a friend who is an acupuncturist last night. He said that it
is very easy for them to turn the baby, now bear with me cause I'm new to
this acupuncture stuff, but they put a needle into the web between the thumb
and 1st finger on both hands and also into the little toe, then they twirl
the one in the toe. He said the one in the toe was painful, but could even
be done during labor, I imagine during the early stages. He also said you
could buy the herb, sorry I forgot to write down the name that has been
discussed on Lactnet, at an acupuncture school or store that carries their
supplies, that it smells somewhat like marijuana, and to be careful not to
let it get too close to the toe and burn the toe as the herb does get very
hot. Sounds vile to me, but then I've never had a breech baby and needed
help to turn it.
Jacie in beautiful, downtown Albuquerque, New Mexico, where I'm off to
see the largest collection of infant feeding devices in the USA!
=========================================================================
Date: Wed, 3 Feb 1999 13:36:46 -0900
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Sulman Family <[log in to unmask]>
Subject: Multiple birth and postpartum depression
There have been several posts recently on tragic situations involving
suicides of mothers of multiple babies. I urge those who work with moms of
multiples to read the article, "Depression and Anxiety Disorders During
Multiple Pregnancy and Parenthood," by Linda Leonard, RN, MSN in JOGNN
1998;27(3):329-337. It's the May/June 1998 issue. The author says that
"depression or anxiety disorders may affect more than 25% of multiple birth
parents during the perinatal period. Such parents are often uninformed,
suffer in silence and fear, and are reticent to seek help..."
I find that mothers expecting multiples, frequently in their 30's, very
competent career women who are used to managing everything perfectly, can't
really conceive of the idea of needing help. They believe they can handle
it all themselves. They are not used to accepting help from others. The
loss of control they face in the pregnancy, birth, and newborn period is
very threatening to their sense of self. (Remeber, they also may have
faced years of infertility, premature birth, C-section and other
complications as well.) At home, the feeling of everything in their life
being out of control with new babies - no schedule, sleep deprivation, the
realization that it is 4 pm and they haven't gotten dressed yet and
everyone is crying and they have to go to the bathroom but there is no time
- is especially difficult for these mothers to deal with. They feel
totally incompetent. And if most of their friendships are through their
work, they suffer a loss of their usual support systems as well.
They will not ask for help. Or even if they realize they need to now, they
are so over their heads that they can't go to the phone and look up a
number.
What to do?
It does help if they can build a support system that meets their needs
ahead of time. Other mothers in a similar situation are better than books
or lectures at convincing them about what it will be like, what to do to
prepare, what things make it survivable, and that getting help is normal
and not a poor reflection on their skills.
I find that breastfeeding support group meetings that get these multiples
mothers together are very supportive. Especially helpful is the chance to
see that a mother with babies just one month older has survived the
overwhelming period a mother of young babies is currently in. And talking
about feelings with others actually in the same situation seems to be more
acceptable. We have had some meetings where several mothers cry as they
describe their feelings of inadequacy (often around trying to meet the
needs of the 2 or 3 year old sibling of new multiples), but then seem to
feel better and re-energized to go home and make it through another day.
They keep coming back, so it must help. And in a couple of months they are
proudly displaying their smiling 5 month olds and encouraging another new
mother to hang in there just a little longer.
All of us need to know good resources for referral in our local areas when
severe depression and even psychosis is a risk for a mother and her family.
Multiple births, and also postpartum depression are on the rise. In
Wisconsin, a series of workshops on postpartum depression titled, "More
Than Just the Blues" was given around the state this fall so that
professionals will be alert for, recognize, and refer mothers with signs of
postpartum depression for help. We were given a Center for Epidemiologic
Studies - Depression (CES-D) Scale to screen new mothers for depression.
(It is based on original work by Radloff LW. A self-report depression scale
for research in the general population. Applied Psychological Measurement,
1977;1(3):385-401. It has 20 questions about how the mother felt during
the past week.)
Some of the other resources that were shared:
Wood AF et al. The downward spiral of postpartum depression.MCN,
November/December 1997;22:308-316.
A "Patient and Family Fact Sheet" from an article by Suri R and Burt VK.
The handout is titled, "Coping with Postpartum Depression." It says it may
be duplicated for patients and families. It's in the Jrnl. Prac. Psych.
and Behav. Hlth. March 1997. I don't have the title of the complete
article, or a volume or page number.
Depression After Delivery, P.O. Box 1282, Morrisville, PA 19067
1-800-944-4773
Postpartum Support International, 927 North Kellogg Ave, Santa Barbara, CA 93111
(805)967-7636 e-mail [log in to unmask]
(I have no personal experience with these last two resources, but they were
given to us at the seminar.)
If others would like to conduct similar seminars on postpartum depression,
you could contact Mardelle Wuerger for advice at the Maternal and Child
Health Education and Training Institute, 610 Walnut Street, 707 WARF
Building, Madison, WI 53705
Phone (608)265-3730 FAX (608)263-6394.
Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, Wisconsin
mailto:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 14:54:06 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: universal precautions/joint commission
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A number of local hospitals are undergoing Joint Commission invasion...
there was a quesiton about breastmilk storage which Jeanne was wonderful about
giving us the sites to BUT I want to add that I called Joint Commission and
asked about beastmilk storage... from their perspective, breasmilk is a
nutritional product and as such should geet stored with the other nutritional
products you have on the floor!
Patricia
=========================================================================
Date: Wed, 3 Feb 1999 11:57:38 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: RUNYON Kristi A <[log in to unmask]>
Subject: WIC,hgb/hct
MIME-Version: 1.0
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I am assuming that CA is similar to Oregon in WIC qualification. In our WIC
clinic parents are given a choice (I admit we generally encourage it) about
giving a finger stick to the child. If they choose not to, we inform them
that this will reduce the (long) list of qualifying factors by one factor.
If they had no other qualifying factor then the parent may choose to do the
test. The majority of parents do the test. We are also not in the business
of "diagnosing" anything. If a child had a low hgb by WIC standards then we
would refer them to their physician for further care. Not getting a
hemoglobin or hematocrit does not exclude a person from the WIC program and
our staff wouldn't probably wouldn't address breastfeeding unless that's all
they were doing.
Kris Runyon
WIC Nutrition Educator
Rainy, Dreary Corvallis, OR
=========================================================================
Date: Wed, 3 Feb 1999 15:13:39 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Ann Twiggs <[log in to unmask]>
Subject: New Formula wes site
I had a look at the weg site for Certfied Infant Formula Providers (CIFP)
makers of Baby's Best (sic) infant formula. (The name itself should not
be allowed, since it isn't baby's best) Anyway, much of the information
appeared research based and truthful. However, one section under
Frequently asked questions "Why can't scientists make an infant formula
exactly like human milk?" rubbed me the wrong way. I quote;"It is
important to bear in mind the following, which is often not mentioned by
either makers of common, ordinary infant formula or dogmatic advocates
of exclusive breast-feeding: The composition of breast milk is NOT (their
caps) standard. It varies from mother to mother. It varies with the
mother's diet. It changes dramatically during the course of lactation. It
varies diurnally (by time of day). Human milk composition even changes
during the course of a single feeding! (their exclamation point)
The reason it bothered me is that they seem to be implying that this is a
bad thing about human milk that dogmatic breastfeeding advocates don't
want people to know. Also, I didn't think the use of the term dogmatic
was very friendly.
Also, another section says the reasons why breast-feeding is NOT (their
caps) the best for an infant is illness of mother and maternal medications
both of which are too vague to be listed as contraindications of
breastfeeding I think.
I wrote them a letter pointing out the good things about the fact that
human milk is not standardized and unchanging like formula. They
responded with a polite reply but did not address my concerns. I
recommend visiting the site and seeing what you think.
Ann Twiggs, RD, LD, IBCLC
Ohio WIC Breastfeeding Coordinator
=========================================================================
Date: Wed, 3 Feb 1999 11:47:11 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Sylvia J Boyd <[log in to unmask]>
Subject: Atlanta LC
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Hi,
I am looking for breastfeeding help in the Atlanta area. Could someone
give me some names?
I am no mail so please send to
warmly,
Sylvia Boyd, CLE, PT, LCCE
Hayward, CA
mailto:[log in to unmask]
___________________________________________________________________
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=========================================================================
Date: Wed, 3 Feb 1999 15:24:50 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Katie Allison Granju <[log in to unmask]>
Subject: scientific studies on babywearing
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can anyone give me the cites for scientific studies demonstrating the
beneficial effects of babywearing?
thanks--
katie allison granju
knoxville, tn
=========================================================================
Date: Wed, 3 Feb 1999 14:34:27 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Mary Kay Smith <[log in to unmask]>
Organization: Sinai Health System
Subject: effective breastfeeding care plan
MIME-Version: 1.0
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Can anyone help me with a copy of a care plan for effective
breastfeeding? We have plenty of care plans for "ineffective
breastfeeding" and I can't find a normal bfing care plan in any of my
vast resources. I have plenty of policies and protocols but what my boss
wants is a Care Plan with related nursing diagnoses.
Mary Kay Smith, CLE, IBCLC
Romeoville, IL
email to this address; cc to [log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 15:31:14 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: newman <[log in to unmask]>
Subject: Grave's disease
Comments: To: [log in to unmask]
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There is no problem with a mother with Grave's Disease breastfeeding. Why?
The only issue is not to do a radioactive iodine uptake, which is rarely
necessary anyways. Treatment with propranalol, PTU, even surgery, would not
require stopping breastfeeding.
Jack Newman, MD, FRCPC
=========================================================================
Date: Wed, 3 Feb 1999 15:22:52 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: WIC aggressive re:anemia?
Comments: cc: [log in to unmask]
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Andrew writes:
"I have found that WIC seems very aggressive in
"diagnosing" infants/children with some sort of problem (anemia is one of
their favorites) so that the woman/infant/child qualifies for WIC
assistance."
One of the requirements for WIC is the existence of specific "risk
factors" - i.e. it's not simply an age-and-income based program. So Hgb/hct
screening is a federal requirement for WIC eligibility, and a low H/H is one
of many risk factors. Others include such things as weight/height for age,
inborn errors of metabolism, conditions that interfere with
digestion/absorption of nutrients, poor or no prenatal care, maternal or
second-hand smoking, lack of cooking/food storage/refrigeration facilities,
and all kinds of things related to growth, nutrition, medical and
socioeconomic factors. Is that a bad thing? How so?
WIC also tracks child immunizations, makes referrals to other appropriate
agencies, and serves as a gateway to the health care system for pregnant
women, infants, and children. You can even register to vote at WIC!
There are several reasons for the "risk factor" requirements - the most
obvious being that they are in fact factors increasing the risk of impaired
growth and development and significant associated health problems. Another
is that WIC is not just a food-handout program - a major component of WIC,
and the one that makes it significantly different from, for example, Food
Stamps, is the requirement that WIC include EDUCATION as part of its
program. WIC participants don't just get the vouchers for specific foods,
they are required to show up at specific intervals, be evaluated re:dietary
intake, H&H, growth, age-appropriate feeding practices, etc. At WIC clinics,
clients are required to receive specific education re: these & related
matters - doesn't matter if you're a PhD in nutrition or never got beyond
4th grade! Like it or not, at WIC you'll hear what the results of that H&H
mean in terms of your child's health and diet. If you are a pregnant woman,
whether it's your first or your 15th pregnancy, you will be educated and
encouraged and promoted-to about BFing till it's coming out your ears -
there's no escape!
Now here's the tie to BFing: because of this education component, WIC has
become the major source of BFing promotion in the country. The most recents
statistics (done in 1996, by a you-know-what company, sadly) indicate that
it is among WIC clients that the biggest increases in BFing initiation rates
have occurred in recent years. Can't speak for the rest of the country, but
in the county where I was the WIC BF Coord. ,the BF initiation rate for WIC
clients was been consistently = or >76% for the past four years, while that
for the county as a whole has been around 70%. WIC clients had FREE access
to an IBCLC (me), an entire staff of nutritionists (mostly MS or higher
degrees) extremely well-educated re:BF, free use of medical-grade electric
br. pumps, manual pumps, etc. WIC is the only source of this kind of BF
education locally, and through WIC, workers in other community agencies that
work with pregnant women and infants & children have been educated re: BF as
well. (And since I provided that training myself, I know it's good stuff!)
Dozens of peer counselors (not all of them WIC clients, BTW) have completed
>20 hrs. of training each. I can assure you with total confidence that no
other agency, office, program, or service in the area provides anything like
this scope of knowledge and education and promotion about BFing.
AND...(see, I'm getting back to the point), yes, getting an H&H done
periodically is necessary to have access to all this bonanza of BF benefits.
(Not even to mention the "enhanced food pkg." for exclusively BF mothers..)
So, yes, WIC is "aggressive" in "diagnosing...problem(s)"; the reason
"anemia" is a "favorite" is that it is unfortunately very prevalent among
low-income families. It's pretty easy to fix, by pretty simple means, and
iron-enrichment is one of the main criteria for the foods available through
WIC. I do not mean to sound disrespectful or unprofessional, but they don't
just make this stuff up out of the blue, or to drive doctors crazy. So I ask
again, why is that a bad thing?
Cathy Bargar, RN, IBCLC. Ithaca NY (and if you'd like any more info about
the WIC program or the documentation of its effectiveness, please let me
know privately - theere's lots-o-stuff!)
=========================================================================
Date: Wed, 3 Feb 1999 15:46:19 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: LACTNET Digest - 2 Feb 1999
Mime-Version: 1.0
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In a message dated 2/2/99 10:52:31 PM, [log in to unmask] writes:
<< [log in to unmask]
>>
UNSUBSCRIBE LACTNET
=========================================================================
Date: Wed, 3 Feb 1999 16:25:46 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Susan Keith-Hergert <[log in to unmask]>
Subject: agree with Dr.Andrew
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Yes! I have had patients say strange things to other LC's about what
I've told them and I've also heard things from patients that I KNOW
can't be true. Remember...moms are vulnerable. When breastfeeding goes
down to defeat or, just doesn't go well, there is a grieving process.
Some women will have a tendency to look for someone to blame.
I am always careful about jumping to conclusions about what an LC (or
MD) may have said. If something seems "way out" it can be helpful to go
back to the person who allegedly said it (with the patient's permission,
of course). I just ask "would you mind if I called her about that...to
see what she really meant?"
Susan Keith-Hergert RN, MS, CPN, IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 16:32:22 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kermaline J Cotterman <[log in to unmask]>
Subject: Laundry hint before other measures
Laurie
Are you using 1/2 to 1 cup of distilled white vinegar (and nothing else)
in the last rinse when bras, towels etc. are in wash, and no softener
sheets in dryer? Odor is gone after clothes come out of dryer! From
personal and professional experience, I think it's well worth trying, and
waiting 48 hours to see if the problem resolves. Can't harm a thing to
try!
All it takes is a few clothes too many for a load, or a tablespoon too
much detergent, or a change in the manufacturer's formula for your
favorite softener, or someone else helping with the laundry to create
enough residue for perspiration, breast milk etc. to reactivate and
irritate nerve ends in the skin, nipple or elsewhere.
I recommend a good trial before or if not complete relief, along WITH
other measures.
K, Jean Cotterman RNC, IBCLC
Dayton, OH
Retired and volunteering for WIC
[log in to unmask]
___________________________________________________________________
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=========================================================================
Date: Wed, 3 Feb 1999 16:32:22 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kermaline J Cotterman <[log in to unmask]>
Subject: career or not career-WHEN is the question
Comments: cc: [log in to unmask]
I hear you, Chris!
Everyone has different needs. I NEEDED to "escape" to MY career two
evenings a week because I realized I wasn't cut out to talk exclusively
to people 3 feet high all day, day in and day out without the balance of
the excitement I found in my profession. (No lactnet then!)
But I assure you, there is much potential for LIFE and A CAREER LIFE
beyond 30+! Some wise soul commented to me that I was helping rear the
citizens of the 21st Century. That thought came back into my mind each
time I felt conflicted over kids and career. They were right! I am proud
as can be of each of my 6 baby-boomers and generation x-ers and the
contributions they are making to society today! There WAS a season for
all things, including the career, by sequencing.
I have repeated that thought many times since, as I smiled at a mom,
remarked on her beautiful family and told her truthfully that I thought
she had the most important job in the world-rearing the citizens of the
21st century! I say it again to you. Been there! Done that!
K Jean Cotterman RNC, IBCLC
Dayton, OH , USA
[log in to unmask]
___________________________________________________________________
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=========================================================================
Date: Wed, 3 Feb 1999 16:27:10 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: ppd & mothers of multiples
Comments: To: [log in to unmask]
MIME-Version: 1.0
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Anne, what an excellent, truly moving post! Speaking as one who's BTDT (been
there, done that), I can say that I've never read such an accurate summary
of what's going on for these women. My twins are now 17 years old, and your
post made me cry as the memory of the truth of what you said came pouring
back through my body! I remember when I went to my OB for my 6 wk. post-C/S
check-up, and was so exhausted and depressed and crazed from lack of sleep,
and so ASHAMED of feeling that way, that even when he tried to ask the
appropriate questions I denied any problems. Except I did admit
(reluctantly, and as if it didn't matter a hoot) that (OBTW) I was having "a
little trouble sleeping", and he told me to take Benadryl (diphenhydramine)
and that it was OK to take while I was nursing (my twins were huge and
nursing well), and I went out of his office and just cried and cried because
that seemed so unbearably kind of him!
I thought that by 6 wks. I should be on top of everything - my body should
be back to where it had used to be (right - almost 3 months of bedrest, a
C/S, >17 lbs. of baby + polyhydramnios, a 4-yr old, 2 different kinds of
post-op infections, and newborn exclusively BFing twins!), I should show
only cheerful competence to the world, and shrug off all offers of help
with a breezy "no thanks!" . What was I, nuts? No - suffering, but not
coming anywhere near to admitting it to myself. So still, all these years
later, the thought of that time still makes me cry.
Thanks for the references, too; as you can tell, this has of course become
one of my pet subjects! And now, my beautiful, healthy, strong, creative,
energetic daughters are about to graduate from high school and move on, and
I'll be getting ready in advance for my emotions about THAT (oh, different
list, though...)
Cathy Bargar, RN, IBCLC Ithaca NY
=========================================================================
Date: Wed, 3 Feb 1999 17:11:23 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Cheryl L. Tompkins CLC" <[log in to unmask]>
Subject: thought for the day
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I saw a bumper sticker today I thought y'all might appreciate. It said...
"Silence is the voice of Compliance"
how true!!
Cheryl L Tompkins CLC
Phoenix AZ
=========================================================================
Date: Thu, 4 Feb 1999 00:14:05 +0200
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Pamela Morrison IBCLC <[log in to unmask]>
Subject: HIV/stats
Mime-Version: 1.0
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Nikki - thank YOU! That should read 49 out of 902, not 102. Ooops! Sorry.
> Am I missing something here? 49 out of 102 looks closer to 50% than 5%?
>Warmly, Nikki Lee
Pamela Morrison IBCLC, Zimbabwe (remembering that there are lies, damned
lies and statistics, Mark Twain I believe! - and I hope this language
doesn't offend anyone).
=========================================================================
Date: Wed, 3 Feb 1999 17:23:19 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: lopsided breast milk producer
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I had a phone call from a mom whose baby is 4 months old. She has been back to
work, is doing some pumping, some breastfeeding, gives baby some formula &
some solids. Her dilemma is that left breast is not producing much milk, right
breast is producing lots...she says it is twice as large as left & is very
noticeable now. This has been going on for about 6 weeks. She wants to
continue breastfeeding & is trying to increase the milk in left breast by
nursing & pumping. Baby has learned that there is not much milk in left one so
doesn't stay on but a few minutes at a time. she has no history of breast
surgery, engorgement, mastitis, or sore nipples. She does say that the left
breast (the one without much milk) is a little tender. Do you think that
there could be something going on with the left breast? A disease or condition
that would diminish milk in that side only.
I did recommend that she BF and/or pump about 8 times per day for a couple of
days to see if that would increase milk supply. She has a medela hand pump
that she likes & gets lots of milk from right side.
She is very eager to get answers to her problem....
So, if you have any ideas as to what may have caused the reduction in milk in
one breast or how to increase the milk supply in one side please let me know.
I will be talking to her at the end of the week.
TIA,
Laura Hart, RN, BSN, IBCLC
Winter Park FL , where it is warm & humid...feels almost like summer
=========================================================================
Date: Wed, 3 Feb 1999 16:19:18 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathy Dettwyler <[log in to unmask]>
Subject: baby wearing
Comments: To: [log in to unmask]
Mime-Version: 1.0
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Katie -- were the answers I wrote OK? You never gave me any feedback. If
you need/want me to elaborate them or alter something, just let me know, I
won't be offended.
On the topic of baby wearing, mother nature/evolution/God doesn't publish in
the peer-reviewed journals (not that there could be one for God!!!), but all
the non-human primates practice "baby wearing" as baby primates are not able
to get up and locomote on their own right after birth the way horses and
cows can. Some of the 'lower' primates, such as prosimians, do build nests
in trees and leave (cache) their babies for several hours at a stretch while
the mother goes out to feed - the way dogs and cats and birds do in the
wild. But all of the monkeys and apes carry their babies on their bodies.
The classic research done with monkeys (forgetting the name of the
researcher right now) showed that monkeys taken away from their mothers and
offered either a cloth mother without food or a wire mother with food,
preferred the cloth mother. And that they grew up very neurotic and
anti-social. When they redid the experiments with two different cloth
mothers, one cage with a cloth mother who moved around inside the cage and
one cage with a cloth mother who was stationery, the monkeys on the moving
mother turned out *less* neurotic and anti-social than the monkeys on the
stationery mother (though still not normal, by any means). Obvious, both
clinging to the mother and having the mother move around while the baby is
attached are important experiences for all higher primates, including
humans. Just like breastfeeding and co-sleeping, these are suites of
behaviors that have evolved over many millions of years (more than 40
million for the higher primates). Natural selection has acted to keep those
behaviors that contribute to reproductive success, and elminate those
behaviors that are harmful to the children. NONE of the higher primates
leave their babies in nests -- they ALL carry them on their bodies for many
months/years.
Kathy Dettwyler
=========================================================================
Date: Wed, 3 Feb 1999 16:41:41 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Foretich <[log in to unmask]>
Subject: acidophilus/ not bf related
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Can someone take acidophilus if they are cow's milk protein allergic
(VERY)?
Camille Foretich, BS, IBCLC in Jackson, Mississippi
=========================================================================
Date: Wed, 3 Feb 1999 16:01:07 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Monique Schaefers <[log in to unmask]>
Organization: Daryll Design
Subject: avoiding bfing due to allergies
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Seen this???
Yahoo! News Health Headlines
Wednesday February 3 1:56 PM ET
Breast-feeding tied to some allergies
NEW YORK, Feb 03 (Reuters Health) -- Breast-feeding usually helps to
prevent allergy, but it may not be
advisable for some infants with allergic skin conditions, such as
those with atopic eczema who also have impaired growth, researchers
report.
``Breast-fed infants with allergy should be treated by allergen
avoidance, and in some cases breast-feeding
should also be stopped,'' conclude a team of investigators at the
University of Turku in Finland. Their findings were published in the
January issue of the Journal of Pediatrics.
Most infants derive unique immunological benefit from breast milk,
which contains disease and allergy-fighting compounds found nowhere
else. The American Academy of Pediatrics recommends that newborns be
breast-fed for at least the first 6 months of life.
However, a small minority of children may not benefit from breast milk
due to allergies, according to the Finnish team.
They compared the health of 100 infants with allergic eczema before
and after they were switched from
breast-feeding to soy-based formula.
The authors say they observed ``an improvement in skin condition''
among the infants soon after their diets
changed.
Changes were most significant in allergic babies who also had impaired
growth. In these infants, ``normal
growth was achieved after breast-feeding was ceased,'' the researchers
note. They speculate that infant
allergies may delay physical development.
``It is well established that (food) allergens in the mother's diet
can be transferred to breast milk and may
contribute to... allergic symptoms in the infant,'' the authors explain.
Some breast-feeding mothers might wish to eliminate suspect allergens
(for example, wheat, peanut butter, or shellfish) from their diet. But
the authors believe this is only a partial solution. ``Some
improvement could be achieved by strict elimination diet by the
mothers,'' they explain, but ``an elimination diet adopted by the
mother does not reverse sensitization that has already developed into
allergic disease.''
In an accompanying editorial, Dr. Armond S. Goldman of the University
of Texas Medical Branch, Galveston,
stresses that breast-feeding remains essential to the healthy physical
and immunological development of the
vast majority of infants.
``Premature cessation of breast-feeding should not be advised unless
the evidence indicates that (it) is
responsible for medical problems or unless there is insufficient
social support to continue breast-feeding,'' he writes.
SOURCE: The Journal of Pediatrics 1999;134:5-7, 27-32.
--
Monique
Noah Reilly Schaefers 6/18/97
[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 19:00:20 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: monkey research
Comments: cc: Kathy Dettwyler <[log in to unmask]>
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Kathy D. - re:"The classic research done with monkeys (forgetting the name
of the
researcher right now) showed that monkeys taken away from their mothers and
offered either a cloth mother without food or a wire mother with food,
preferred the cloth mother."
Harry Harlow?
Cathy B.
=========================================================================
Date: Wed, 3 Feb 1999 19:38:37 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: curse words
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.. just wanted to note that switching physician in the world of the hmo is
not all that easy and this mom may have no choice... while lying is not
appropriate we do need to be aware that her choice in hcp may be very limited.
Patricia
=========================================================================
Date: Wed, 3 Feb 1999 16:43:34 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Johnson, Martha (PHMG)" <[log in to unmask]>
Subject: Re: HIV+ In Oregon: update
Comments: To: Cathy Bargar <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain
Dear Cathy B and other Lactnetters:
The case you refer to has got to be my client. She and her husband still
have physical custody of their son, though Services to Children and Families
has had legal custody since very early on. She has not breastfed since day
one, in the hospital, when she was told that to do so would cause the state
to remove her baby to foster care. This woman did lots of research, and had
decided to breastfeed, against our recommendation, but in the spirit of
informed choice.
Their next custody hearing comes up in about 60 days. Any helpful
information would be most appreciated. I have read George Kent's thoughtful
paper, HIV/AIDS and the Nutrition Rights of Infants, and my client has a
copy. Please email me privately as well as posting to the list.
thanks much from:
Martha Johnson RN IBCLC
> ----------
> From: Cathy Bargar[SMTP:cathyb@TWCNY.RR.COM]
> Sent: Tuesday, February 02, 1999 12:38 PM
> Subject: HIV+
>
> I just heard a story on CNN today about a family in (I think) Oregon; mom
> HIV+ (but not sick, I gathered?), 6 wk. old baby removed from the family's
> custody to foster care because the parents "didn't believe" that HIV virus
> causes AIDS or that the virus can be transmitted by breastmilk. The state
> will not allow the baby (HIV+ at this point, naturally) to be fed its
> mother's expressed breast milk, and apparently the main point in this
> custody case has to do with the mother's determination to continue to
> breastfeed the baby. Mom says that breastmilk is more important for the
> baby
> than treatment with AZT (which the parents have not permitted). The
> commentator and a panel of 3 lawyers talked about this for about 10
> minutes - all, of course, agreeing that the state had acted correctly, and
> throwing around some pretty inaccurate info about HIV transmission via
> breastmilk. Although they did say that in countries "like Africa" (sic),
> the
> WHO did encourage BFing over ABM for these babies, all were 100% dead-set
> positive that in the US formula-feeding was the only option.
>
> I hope we'll hear more about this story - except I hope fervently that it
> won't become just another "dangers of BFing" story! The director of our
> local teen pregnancy program and another agency that works with
> "high-risk"
> (not HIV risk, socioeconomic risk) families in our county already feel
> that
> teens (categorically) should not be encouraged to BF because they "might"
> be
> at risk for HIV. They thought we were "always pushing breastfeeding" at
> WIC.
> (No fear of that now, of course, now that there's no longer anyone in
> charge
> of "pushing" breastfeeding at WIC! ........ I say bitterly......
>
> Cathy Bargar RN IBCLC
>
=========================================================================
Date: Wed, 3 Feb 1999 18:54:59 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "[log in to unmask]" <[log in to unmask]>
Subject: Re: acidophilus/ not bf related
In-Reply-To: <[log in to unmask]>
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
>Can someone take acidophilus if they are cow's milk protein allergic
>(VERY)?
The brands of acidophilus that I am familiar with state on the bottle that
it is non-dairy.
Patricia Gima, IBCLC
Milwaukee, Wisconsin, USA
mailto:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 19:49:42 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: Apology
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I find that I must apologize for using language that some found
objectionable. Honestly, I meant to bleep out the "curse word" before I
sent. (But - a sincere question - why is seeing, for example, "b*******" NOT
considered offensive, while the actual word is?) Guess that's actually
irrelevant, as long as people are offended, and I do regret not being more
careful with my language.
As for lying to the doctor & claiming it's "none of his beeswax" (or is that
an offensive word too?): do I honestly believe that that is good practice?
*Of course not!* Have I ever recommended it to a patient? *Absolutely not!*
Do people do it all the time? You betcha! Even without benefit of us LCs. I
DID NOT MEAN IT!!! But those of you who found that part of my response
offensive, I have to admit that you are right - in "real life" I would never
actually suggest that a patient lie to their doctor. It's unprofessional, to
say the least. I was responding emotionally, to what I found some of the
"most offensive" and "least professional" mis-information I've heard in a
long time, and I should have restrained myself. And, as many of you have
rightly pointed out, often what the patient says the doctor said isn't
necessarily what the doctor said - absolutely right on your part, wrong on
mine.
Please excuse me; I hope I'm at least able to learn from my mistakes. I'll
try, and time will tell, and I can count on you all to point out my errors.
Cathy Bargar, RN, IBCLC, Ithaca NY
=========================================================================
Date: Wed, 3 Feb 1999 19:31:15 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "[log in to unmask]" <[log in to unmask]>
Subject: Epidural and duration of suck problem
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
I have searched the archives and read many of the 531 posts in 97-98. I
see that the effect of the epidural on suckling varies with the duration of
the drugs. How long have you found the suck problem to persist?
My client recieved epidural meds for 5 1/2 hours. Her baby is 5 days old
and is still having trouble with co-ordination of suckling. Mom has been
finger feeding and, beginning today, using a supplementer. Baby "looks"
like she is suckling well and there is "audible swallow", but very little
milk transfer.
I was concerned about the firm finger for a prolonged period so I
recommended the supplementer. The baby will latch, after a fashion, and
her suck is a bit stronger with the tube. And she likes to be there.
Do you have a feel for how long the effect will be? Is it something else
entirely?
Patricia Gima, IBCLC
Milwaukee, Wisconsin, USA
mailto:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 19:37:34 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathy Dettwyler <[log in to unmask]>
Subject: Re: monkey research
Comments: To: [log in to unmask]
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
>Harry Harlow?
Yea! My brain is mush sometimes. And James Prescott is the one who did the
moving mother/stationery mother research, with Harlow.
Kathy Dettwyler
P.S. I enjoy your posts to LactNet!
=========================================================================
Date: Wed, 3 Feb 1999 20:54:19 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Nikki Lee <[log in to unmask]>
Subject: Baby wearing
Mime-Version: 1.0
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Dear Folks:
Kathy Dettwyler was talking about the Harlow studies in the 40s and 50s;
some stuff published in Scientific American. The effects of sterile touch,
lack of movement and impersonal nourishment via a bottle inserted in the chest
of the dummy mothers are chilling, especially when one looks around and sees
babies carried in plastic trays!
Another book about baby wearing is the Continuum Concept by Jean Leidloff
(?spelling). The author went and lived with a tribe of hunter-gathers in South
America for nearly three years. Great book. Warmly, Nikki Lee
=========================================================================
Date: Wed, 3 Feb 1999 21:01:35 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Barbara Whitehead, IBCLC" <[log in to unmask]>
Subject: Re: LACTNET Digest - 2 Feb 1999 to 3 Feb 1999 - Special issue
Mime-Version: 1.0
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In a message dated 2/3/99 8:37:16 AM Eastern Standard Time,
[log in to unmask] writes:
<< am looking for any ideas, programs, literature etc for a PHN I work with
who teaches reproduction in the public schools. She was very excited about
how knowledgeable some of the student were about BFing (grade 6-7).
>>
I have found the BFing curriculum by the New York State Dept of Health, Bureau
of Child and Adolescent Health, 1995, to be very good. This curriculum is for
grades k-12. I have pulled out and used parts of it for various grade levels
and found it to be very age appropriate.
I ordered it from the catalog of projects funded by the Maternal and Child
Health Bureau, Health Resources and Service Administration, US Dept of Health
and Human Resources.
Barbara Whitehead, IBCLC
Eastern NC
=========================================================================
Date: Wed, 3 Feb 1999 20:20:32 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Foretich <[log in to unmask]>
Subject: herbs and fertility
MIME-Version: 1.0
Content-Type: text/plain; charset=ISO-8859-1
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At one time someone, an herbalist was posting to the list. I have some
questions concerning herbs and fertility. Please e-mail me privately since
this isn't really breastfeeding related. Thank you.
=========================================================================
Date: Wed, 3 Feb 1999 21:20:24 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Brenda L. Phipps, BS, IBCLC" <[log in to unmask]>
Subject: non-nurse LCs and liability
Mime-Version: 1.0
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I received some distrubing news today from my direct supervisor at my WIC
office.
I am an IBCLC for a WIC office. Last week, my staff attended a one week
course seminar taught by two very well known women whose names I won't reveal.
They were told that if you are practising as an IBCLC and are not in a
licensed profession (i.e. a nurse working at a hospital) where your job
description states that you may touch women, that you are setting yourself up
for a potential lawsuit. Evidently, there are quite a few cases pending right
now in which LCs are being sued for babies who have died or become ill after
mothers followed the advice of an IBCLC.
I stated that I do have liability insurance, but that was discussed at this
conference, and apparently it holds no water in a lawsuit if you are not a
licensed health professional in a job which requires touching in your job
description. According to the teachers at this conference, IBCLC is simply a
piece of paper which states you passed an exam - it does not give you license
to "practise medicine" or provide hands on care.
I am sure that many of you can respond to this, and I look forward to the
discussion, as I am concerned. My superivosr is seriously considering not
allowing me to perform consultations in our health department office any more.
Thanks,
Brenda Phipps, BS, IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 18:39:08 PST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: laurie wheeler <[log in to unmask]>
Subject: herbs/caution re contamination
Mime-Version: 1.0
Content-Type: text/plain
FYI 2/3/99 Heard a blurb on the Dr. Dean Edell (USA) radio show today
(yes, I'm a radio talk show junkie when I'm in the car - I commute 1 hr
each way). He said do not use any herbs in pill form from Asia. There
have been many cases of arsenic and lead poisoning, he said. Chinese
authorities are even passing laws regulating the trade due to this
problem, he said.
P.S. Thanks to the Dr. Laura listeners (there were quite a few of you)
who responded with website, phone, fax, and snail mail. I guess we are a
moral group.
Laurie Wheeler, RN, MN, IBCLC
Louisiana Breastfeeding MediaWatch Campaign
Violet Louisiana, USA
mailto:[log in to unmask]
______________________________________________________
Get Your Private, Free Email at http://www.hotmail.com
=========================================================================
Date: Wed, 3 Feb 1999 18:39:48 PST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: laurie wheeler <[log in to unmask]>
Subject: herbs/caution re contamination
Mime-Version: 1.0
Content-Type: text/plain
FYI 2/3/99 Heard a blurb on the Dr. Dean Edell (USA) radio show today
(yes, I'm a radio talk show junkie when I'm in the car - I commute 1 hr
each way). He said do not use any herbs in pill form from Asia. There
have been many cases of arsenic and lead poisoning, he said. Chinese
authorities are even passing laws regulating the trade due to this
problem, he said.
P.S. Thanks to the Dr. Laura listeners (there were quite a few of you)
who responded with website, phone, fax, and snail mail. I guess we are a
moral group.
Laurie Wheeler, RN, MN, IBCLC
Hospt LC in Slidell LA, USA
mailto:[log in to unmask]
______________________________________________________
Get Your Private, Free Email at http://www.hotmail.com
=========================================================================
Date: Wed, 3 Feb 1999 21:26:25 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Patrica Young <[log in to unmask]>
Subject: H & H
MIME-Version: 1.0
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Dear Gail, I'm getting frustrated with the HMOs. We can do the H & H in
our office for $2 (finger stick) but now we have to send them to a lab
because HMO won't pay us to check. But they will pay the lab. Same with
lead - $80 at lab, $15 from our office. Go figure. Also Cathy, I'd say
BS too! Sincerely, Pat in SNJ
=========================================================================
Date: Wed, 3 Feb 1999 21:42:59 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: AAP BF'ing rec
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In a message dated 2/4/99 12:01:49 AM !!!First Boot!!!,
[log in to unmask] writes:
<< The American Academy of Pediatrics recommends that newborns be
breast-fed for at least the first 6 months of life. >>
I think the AAP now recommends that newborns be breast-fed for the first 12
months, if not longer.
Andrew MD
[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 21:51:48 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: Eczema & BF
Mime-Version: 1.0
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In a message dated 2/4/99 12:01:49 AM !!!First Boot!!!,
[log in to unmask] writes:
<< Breast-feeding usually helps to
prevent allergy, but it may not be
advisable for some infants with allergic skin conditions, such as
those with atopic eczema who also have impaired growth, researchers
report. >>
Everything I have ever read or studied emphatically suggests that
breastfeeding infants, especially those with atopic dermatitis/eczema, can and
will decrease the incidence and severity of eczema! To suggest that switching
eczematous infants from BM to ABM, especially soy, improved their eczema is
really hard to belief or accept. Soy ABM is probably more allergenic that
cow's milk ABM! Eczematous "flare-ups" can naturally spontaneously resolve.
The natural history of AD (atopic dermatitis) can include spontaneous
resolution regardless of interventions, meds/diet/etc. IMHO, it would be much
wiser to work with the mom regarding her diet in avoiding common allergens
than to switch from BM to ABM.
Andrew MD
[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 22:01:19 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
Comments: SoVerNet Verification (on garnet.sover.net) oemcomputer from
arc3a105.bf.sover.net [209.198.82.171] 209.198.82.171 Wed, 3 Feb
1999 22:06:16 -0500 (EST)
From: kersula family <[log in to unmask]>
Subject: He said/She Said
In-Reply-To: <[log in to unmask]>
MIME-Version: 1.0
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Re the great H & H fuss, I too might make it a point to call or "happen to
see" that doc. (Small town livin'!)
One of our docs does this with me.."One of my pts said you said...."
Part of my reply always includes, "...and I promise not to believe
everything they tell me you said, if you promise not to believe everything
they tell you I said."
Interpretation of the the foreign language of medicalese is one of my major
roles in Lamaze class.
Meanwhile, here's a great quote. My boss gave it to me, she thought maybe
it was a Gloria Steinem:
"Never put a wishbone, daughter, where your backbone ought to be."
Don't you like it??
Dawn Kersula RN, FACCE, IBCLC in southern VT where our backyard hockey rinks
all look like wading pools! Boo Hoo!
=========================================================================
Date: Wed, 3 Feb 1999 22:10:12 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Katie Allison Granju <[log in to unmask]>
Subject: monkey research
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In a message dated 2/3/99 9:55:48 PM Eastern Standard Time,
[log in to unmask] writes:
>
> Kathy D. - re:"The classic research done with monkeys (forgetting the name
> of the
> researcher right now) showed that monkeys taken away from their mothers and
> offered either a cloth mother without food or a wire mother with food,
> preferred the cloth mother."
>
> Harry Harlow?
>
> Cathy B.
or Rene Spitz ?
Katie Allison Granju
Knoxville, TN
>
=========================================================================
Date: Wed, 3 Feb 1999 22:12:18 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Stephen Curless <[log in to unmask]>
Subject: inadequate milk supply
MIME-Version: 1.0
Content-Type: text/plain; charset=us-ascii
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I am looking for any information to further help expectant mom (third
pregnancy)who has been unable to produce enough milk with past 2
children. Hospital-grade double pumping was done throughout previous
experiences.
Mom did not give bottles or pacifiers, used SNS, thyroid test normal.
Breast had irregular shape, OB tried hormone shot once. Insufficient
glandular development probably is the problem. Mom does not like the
SNS, and with this pregnancy wants to try other options. OB is seeking
any suggestions: Reglan, hormones, herbs, etc. will be looked into. We
would like to know if anyone has cases with hormone injections, etc.
that helped improve milk supply. Thanks for any suggestions.
(Correct latch, etc. was followed very closely)
Helen Curless,RN,IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 19:33:46 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Janet Simpson <[log in to unmask]>
Subject: LC being sued
Comments: cc: [log in to unmask]
Mime-Version: 1.0
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Hi All,
If I read this correctly, the seminar was most likely a CLE class. It is
probably the same class that I took to become a CLE. The two well known
women (Chele Marmet and Ellen Shell taught my seminar) stated in my seminar
(and at other seminars they have taught in this area, that as a CLE
(Certified Lactation Educator) you are an EDUCATOR not a LACTATION
CONSULTANT and therefore your job is HANDS OFF (caps for emphasis only).
CLEs are educators of breastfeeding, not Lactation Consultants - and they
made sure to stress this very important difference strongly. I think it is
an important distinction. It is one reason why I do not do hands on work -
I have not been supervised and taught how to recognise things visually that
I may know a lot about by theory. (Have the theory but not the clinical
practice)
There are no one week seminars for someone to become a Lactation Consultant
that I know of.
I respectfully suggest that the supervisor contact the women who taught this
class and ask for clarification immediately. It sounds as if someone is
terribly confused and needs to be set straight right away.
Jay
Jay Simpson, CLE
Sacramento, California, West Coast, USA
"No Miracles performed here, just a lot of love and hard work."
=========================================================================
Date: Wed, 3 Feb 1999 22:34:12 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: non-nurse LCs and liability
Mime-Version: 1.0
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i, for one, would be extremely interested in having some more specific details
about "cases involving lcs" being sued. also, are there any states in which
LCs are licensed?
carol brussel IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 22:50:11 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Nikki Lee <[log in to unmask]>
Subject: touching
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In a message dated 2/3/99 10:48:12 PM Eastern Standard Time, Nleeguitar
writes:
> To: [log in to unmask]
>
> Dear Folks:
> This is in reply to Brenda Phipps concern about touching people as an
> IBCLC. For the WIC supervisor to reconsider letting an IBCLC do consults out
> of concern for this issue seems like quite an overreaction. As Chloe Fisher
> and others have encouraged, one very rarely needs to touch to assist with a
> breastfeeding problem. I don't put my finger in a baby's mouth any more , as
> the shape of the mother's nipple the instant it leaves the baby's mouth
tells
> me what is going on in there. If there is any need for suck-training, the
> mother can be coached, as she uses her own finger.
> Different story when I am doing cranio-sacral therapy. In that case I am
> using my finger in the baby's mouth for a very specific purpose, to do very
> specific techniques.
> When in doubt, refer to the ILCA standards of practice! What do they say?
I
> can't find my copy right this second.....probably filed somewhere that I
can'
> t remember. Warmly, Nikki Lee
>
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To: [log in to unmask]
Subject:
Date: Wed, 3 Feb 1999 22:48:12 EST
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Dear Folks:
This is in reply to Brenda Phipps concern about touching people as an
IBCLC. For the WIC supervisor to reconsider letting an IBCLC do consults out
of concern for this issue seems like quite an overreaction. As Chloe Fisher
and others have encouraged, one very rarely needs to touch to assist with a
breastfeeding problem. I don't put my finger in a baby's mouth any more , as
the shape of the mother's nipple the instant it leaves the baby's mouth tells
me what is going on in there. If there is any need for suck-training, the
mother can be coached, as she uses her own finger.
Different story when I am doing cranio-sacral therapy. In that case I am
using my finger in the baby's mouth for a very specific purpose, to do very
specific techniques.
When in doubt, refer to the ILCA standards of practice! What do they say? I
can't find my copy right this second.....probably filed somewhere that I can't
remember. Warmly, Nikki Lee
--part0_918100217_boundary--
=========================================================================
Date: Wed, 3 Feb 1999 22:48:12 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Nikki Lee <[log in to unmask]>
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Dear Folks:
This is in reply to Brenda Phipps concern about touching people as an
IBCLC. For the WIC supervisor to reconsider letting an IBCLC do consults out
of concern for this issue seems like quite an overreaction. As Chloe Fisher
and others have encouraged, one very rarely needs to touch to assist with a
breastfeeding problem. I don't put my finger in a baby's mouth any more , as
the shape of the mother's nipple the instant it leaves the baby's mouth tells
me what is going on in there. If there is any need for suck-training, the
mother can be coached, as she uses her own finger.
Different story when I am doing cranio-sacral therapy. In that case I am
using my finger in the baby's mouth for a very specific purpose, to do very
specific techniques.
When in doubt, refer to the ILCA standards of practice! What do they say? I
can't find my copy right this second.....probably filed somewhere that I can't
remember. Warmly, Nikki Lee
=========================================================================
Date: Wed, 3 Feb 1999 23:23:11 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: lopsided
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Laura:
this is not unusual...
Patricia
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Date: Wed, 3 Feb 1999 21:22:07 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Sylvia J Boyd <[log in to unmask]>
Subject: Baby Blues
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Another fun Baby Blues comic in today's paper (2/3/99). Wanda says to
Darryl "I've been thinking that it might be time to wean Hammie".
Darryl, "well, he is a year old."
Wanda, "and he's doing really well with the solid food now." Darryl,
"plus, it would be a real break for you."
Hammie appears, "num, num?"
Wanda is nursing Hammie & says, "On the other hand, there's no rush."
Jerry Scott's e-mail address is [log in to unmask]
warmly,
Sylvia Boyd, CLE, PT, LCCE
Hayward, CA
mailto:[log in to unmask]
___________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at http://www.juno.com/getjuno.html
or call Juno at (800) 654-JUNO [654-5866]
=========================================================================
Date: Wed, 3 Feb 1999 21:49:55 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: silence=compliance
Comments: cc: "Cheryl L. Tompkins CLC" <[log in to unmask]>
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Cheryl: I must be the most non-compliant person in the world then! :)
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Wed, 3 Feb 1999 21:49:51 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: triplets exclusively nursing
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Now hear this one...our pediatrician (female) relocated to the East Coast
and one of her new partners exclusively nursed her triplets for 2 years
while working (1/2 time I believe after a 4 month maternity leave). Not a
one had anemia or growth problems and this woman pumped enough while at
work. Not to take Mother Theresa's name in vain, but I really think this
doc should be up for some major award or Sainthood. I was impressed!
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Wed, 3 Feb 1999 21:49:57 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Chris Hafner-Eaton <[log in to unmask]>
Subject: orange juice bred Lactobacilli
Comments: cc: [log in to unmask]
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Important...make certain that the Lactobacilli acidophilus is from a
non-dairy source such as orange juice. Then, there is no problem with
allergic reaction.
: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : )
: )HSR & Health Educational Consultant voice/fax: 541 753 7340 : )
: )------------**CHANGE THE WORLD, NURTURE A CHILD!**------------------ : )
=========================================================================
Date: Thu, 4 Feb 1999 00:43:05 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Ann Calandro <[log in to unmask]>
Subject: LLL group - Philippines
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I am looking for a LLL group in metro Manila, Philippines, for a mom who is
looking for support. Could someone please contact me privately with a name
and number for this mom?
Ann Calandro,RNC,IBCLC
=========================================================================
Date: Wed, 3 Feb 1999 12:06:50 +0100
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: =?iso-8859-1?Q?Fran=E7oise_Railhet?= <[log in to unmask]>
Subject: ceftizozime
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Dear Kathy
Datas about ceftizozime
31-38% protein bound
plasmatic half live : 1,1-2,3 hours
volume of distribution : 0,5 l/kg
pediatric dose : 50 mg every 6 to 8 hours
After injection of 1g of ceftozoxime in mothers, maximal level in milk was
0,2 to 0,3 mg/l. Ratio milk/plasma estimated to 0,05. Can be used without
problem in breastfeeding mother.
References :
Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy
1984 ; 5 : 57-60.
Takake Z et al. Clinical and laboratory studies on ceftizoxime in the fields
of obstetrics and gynecology. Chemotherapy 1980 ; 28 (suppl 5) : 863-73.
Kindly
Françoise Railhet
Manager of the LLL France Medical Associates Program
[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 10:18:44 +0000
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: heather <[log in to unmask]>
Subject: reflux and formula
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This month's Community Practitioner journal (for UK community nurses esp.
health visitors) has a double page spread advertsing Enfamil Ar. The text
says that reflux affects 50 per cent of infants (giving a ref from J Am
Coll Nutr - I haven't heard of this journal, but that doesn't mean it's not
perfectly reputable, of course).
I already posted that reflux is hardly ever talked about in the UK,
something MJ clearly wish to challenge...now if mothers tell me their HVs
and docs have diagnosed 'reflux' I shall know their wish is getting across.
In the same issue of CP, there are two other MJ ads for other products,
making them the heaviest advertiser in this journal.
Heather Welford Neil
NCT bfc Newcastle upon Tyne UK
=========================================================================
Date: Thu, 4 Feb 1999 06:42:34 -0400
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Bratt <[log in to unmask]>
Subject: Breastfeeding song?
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Does anyone know the name, or the other words, of a World War II song
from the United Kingdom which contains the phrases, <italic>"Isn't it a
Pity, She's only got one Titty, To Feed the Baby on-"</italic>. It's
from a book by H.E.Bates, titled A Moment in Time. David
=========================================================================
Date: Thu, 4 Feb 1999 06:11:07 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: newman <[log in to unmask]>
Subject: HIV positive
Comments: To: [log in to unmask]
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Why has the mother not been offered the option to breastmilk feed her baby
her own heat treated milk?
Jack Newman, MD, FRCPC
=========================================================================
Date: Thu, 4 Feb 1999 06:18:38 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathleen Bruce <[log in to unmask]>
Subject: LC at Mercy Hospital, Iowa City.
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Does anyone have an email for the lactation consultant at Mercy Hospital,
Iowa City.
Many thanks. Reply privately.
Kathleen
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
Williston, Vermont
mailto:[log in to unmask]
LACTNET Archives http://library.ummed.edu/lsv/archives/lactnet.html
=========================================================================
Date: Thu, 4 Feb 1999 07:25:03 +0100
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Marilyn Norton <[log in to unmask]>
Subject: LDPR's
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I think that this is breastfeeding related in that an improved L&D area may
help us to keep mothers and babies together after birth. We are planning
renovations to our L&D unit and we need some help. How many LDPR's would be
required in a hospital that has approximately 1,000 births per year, with a
20% c/s rate. We rarely do epidurals ( but I'm afraid that the trend will
soon change). Please e-mail me privately if you have any ideas or
suggestions. Thank you sincerely,Marilyn Norton
PEI, Canada
=========================================================================
Date: Thu, 4 Feb 1999 06:54:43 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: Re: aap
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... "exclusive breastfeeding is the ideal nutrition aand sufficient to support
optimal growth and development for apporoximately the first 6 months after
birth"
"it is recommended that breastfeeding continue for at elast 12 months,
and
thereafter for as long as mutually desired"
Patricia
=========================================================================
Date: Thu, 4 Feb 1999 07:28:54 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Nikki Lee <[log in to unmask]>
Subject: apology
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Dear Folks:
I apologize for the posting in html. I have no idea how it happened as I
have not touched that button, as I never use that option. And I don't know how
my message got posted three times. Guess the computer had hiccoughs. Warmly,
Nikki Lee
=========================================================================
Date: Thu, 4 Feb 1999 07:31:34 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Patrica Young <[log in to unmask]>
Subject: Re: reflux
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Dear Heather, It's semantics. 1/2 of all babies do spit up. Now we are
calling spitting up reflux. Makes it a medical dx. and can generate more
tests, meds etc. Actually a baby only needs to be investigated for refux
if not gaining or having breathing problems from reflux. I repeat happy,
gaining spitters are a laundry problem. Also breastfeeding seems to have a
positive effect. The spit doesn't smell bad or stain and mothers sort of
ignore it. Re: vomiting. I think there has been research that shows there
is less pyloric stenosis in BF babies.
Babies spit. It's a fact of baby life. Sincerely, Pat in SNJ
=========================================================================
Date: Thu, 4 Feb 1999 08:33:46 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Ann Twiggs <[log in to unmask]>
Subject: Baby wearing
Dr. John Kennell and Dr. Marshall Klaus had an article in Pediatrics in
Review Vol 19. NO.1, January 1998 that I think is very good. It is entilted
"Bonding: Recent Observations that Alter Perinatal Care." On page 9 the
paper discusses research on the use of hard plastic baby carriers as
opposed to soft carriers. They found that at 13 months of age 83% of
the babies carried in the soft carriers were securely attached compared
to only 39% of the infants that were carried in the firm infant seats. Dr.
Kennell told me he is working on a research project right now on
attachement and holding infants. I can't put my hands on his ph no. right
now but you can write to Dr. Kennell :
John H. Kennell, MD
Professor of Pediatrics
Case Western Reserve University
School of Medicine
Behavioral/Developmental Pediatrics
Rainbow Babies & Childrens Hospital
11100 Euclid Avenue
Cleveland, OH 44106
Ann Twiggs, Ohio WIC Breastfeeding Coordinator
=========================================================================
Date: Thu, 4 Feb 1999 07:35:38 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Karen Zeretzke <[log in to unmask]>
Subject: Re: non-nurse LCs and liability
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As a non-licensed LC in private practice, I have a 'permission slip' at the
bottom of my new client information form (which the client fills out for
me) which says in part, ".....I understand that this may involve touching
my baby and/or my breasts." The client signs right below this.
I also ask, "May I touch?" before I do so, **always**.
Karen Zeretzke, MEd, IBCLC
Baton Rouge, Louisiana
[log in to unmask]
http://www.prairienet.org/laleche/bfcost.html
=========================================================================
Date: Thu, 4 Feb 1999 07:47:18 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathy Dettwyler <[log in to unmask]>
Subject: HMOs and doctor choice
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>.. just wanted to note that switching physician in the world of the hmo is
>not all that easy and this mom may have no choice... while lying is not
>appropriate we do need to be aware that her choice in hcp may be very limited.
We also need to remember that anyone can choose a doctor outside their HMO
if they are willing to pay the cost. Some people seem to forget that you
can pay out of your own pocket to see any doctor you want. I have twice
gone to doctors outside my HMO, and paid the $100 office visit out of my own
pocket. It was well worth the cost. Of course not everyone can afford to
do this, but one of my pet peeves is people who could easily afford to do
this complaining that they *can't* go see another doctor because it isn't
covered by their HMO. Same with brand name drugs over generic, and second
and third opinions, etc.
Kathy Dettwyler
=========================================================================
Date: Thu, 4 Feb 1999 09:22:07 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Brenda L. Phipps, BS, IBCLC" <[log in to unmask]>
Subject: clarification on my post re liability
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Just want to remind those of you responding to my posting on LC liability - it
is not just the touching issue that I am concerned about. The LCs who are
involved in lawsuits gave advice, consultation, and follow up to moms with
infants. When the infants died or became sick, then they were put into a
litigation situation.
Thanks,
Brenda Phipps, BS, IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 09:23:50 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: NECSI <[log in to unmask]>
Subject: HIV: Petra Study
Comments: To: Pamela Morrison <[log in to unmask]>
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>A major moment of risk may occur in the first few days, when the child can
>take in more than 25,000 HIV-containing cells in the thick fluid known as
>colostrum.
>This is unbelievable. Blaming infection on "HIV-containing" colostrum.
>When it is *just as likely* that during delivery virus-laden maternal
>secretions can infect the mucosal surfaces of the infants' eyes, mouth and
>gastrointestinal tract, and the baby's skin, and gain access to the
>bloodstream. Think about it. Until we have better tests, that can
>*distinguish* between infection acquired during delivery and infection
>acquired during the first few days/weeks of breastfeeding, then we CANNOT
>say that colostrum is the culprit.
I am not an expert in this area, but I have done some reading recently
on this topic. While we cannot say for sure that colostrom is a major
factor in passing HIV to baby, it would not surprise me if, in fact,
it was a part of the problem.
It is essential to promote and protect breastfeeding, and it
is very important to pursue research that will answer our questions
about breastfeeding and HIV, however, we must also not reject the
fact that there are rare occasions when breastfeeding, like
childbirth can cause serious problems. On those occasions we
must seek alternatives. The catch is making sure that the
alternatives are used only when bf and "natural childbirth"
pose a threat and not to use the few cases of problem to
alter the "gold standard."
I think we have to be careful not to assume that every article
or paragraph that questions something about breastfeeding is
dangerous, undermining bf etc. That kins of "ranting" undermines
our credibility and makes it difficult for others to take us
seriously. Besides, we should have more confidence
in breastfeeding, ourselves, and mothers the world over than that.
Naomi Bar-Yam
=========================================================================
Date: Thu, 4 Feb 1999 09:29:09 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Brenda L. Phipps, BS, IBCLC" <[log in to unmask]>
Subject: Re: permission slips for consults
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In a message dated 2/4/99 7:24:03 AM US Mountain Standard Time,
[log in to unmask] writes:
<< As a non-licensed LC in private practice, I have a 'permission slip' at the
bottom of my new client information form (which the client fills out for
me) which says in part, ".....I understand that this may involve touching
my baby and/or my breasts." The client signs right below this.
I also ask, "May I touch?" before I do so, **always**. >>
Karen,
This issue was brought up, and we were told that this "permission slip" holds
absolutely no weight in court. Neither does asking the mom.
Brenda Phipps, BS, IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 16:38:37 +0200
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Toby Gish <[log in to unmask]>
Subject: Research Question Needed !
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Dear Lactnetters - The head of my department asked me today if we had any
research questions about lactation to suggest to a doctorial candidate. Her
background is in biochemistry, but it need not be limited to that aspect. It
would be wonderful if those of you who are dying to have research done on
some particular aspect of breastfeeding would send me their question by
Saturday. Thanks so - I will keep you posted. Please cc me - I think this
might be interesting to the whole list. Sincerely, Toby
Toby Gish RN, BA, IBCLC, LLLL (aapl)
mailto:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 09:35:53 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: IBCLC, liability,WIC
Comments: cc: [log in to unmask]
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In response to Brenda Phipps' concerns about her supervisor @ WIC possibly
not allowing her to do LC consults in the office due to liability/not
licensed hcp, etc:
I empathize with your and your supervisor's concern about this, and since I
don't know exactly how or what kinds of consults you do at WIC, I'm sure not
the last word on the subject, but my experience at WIC has been that
1) I almost never had occasion to do consultations that involved much (any?
well, with mom's permission I would assess inside of baby's mouth digitally,
gloved of course) touching at the WIC office - in my experience, it was
rarely a good enough environment for that kind of work - privacy issues (no
matter what I did to try to maintain privacy in my office, we were NEVER
immune to the general hubbub and demands of the WIC program at large),
comfort issues, both physical & psychological (too hot, too cold, baby often
either asleep 'cause all bundled up or agitated from disruption of being
brought to WIC, not really "normal" or comfy environment/furnishings, "my"
turf instead of mom's, etc.) Sometimes I'd take a look at mom's
breasts/nips, etc., and often I'd observe latch, nsg technique, positioning,
what babe was doing with tongue, mouth, head, hands, etc., but even then it
was not what I'd call a real good assessment. For a simple basic problem
(mom holding baby too low or too far off to the side, etc.) or basic
education, the office worked OK, but beyond that I would usually need to do
a home visit.
2) In NY, we IBCLCs were discouraged from doing the kind of extensive 1:1
work that you might do in private practice - we were not supposed to get too
in-depth with individual clients, or to be very hands-on. A minor example -
when I first began reading about the use of hydrogel for damaged nipples, I
asked the state BFC if this was something we could suggest to clients, or if
I could buy some with WIC $$, and was told very firmly that this sort of
thing was beyond our scope, that we were not to provide treatment but should
refer to the HCP. I understand the theory here, but there's a flaw in this:
I was the appropriate HCP to deal with these things in our community. So a
certain balancing act was necessary on my part, to appropriately fill my
role at WIC and give the best care I could. Another example of this - I
never would recommend herbal treatments in my WIC role, even though I knew
of many that would have been helpful, but if a woman came to me with very
specific questions, I could help her work through references & use resources
available to me to help her find more information. Tricky - if I ran into
her at the herbal supplement section of the health food coop, was I me,
Cathy Bargar, or was I RN IBCLC, WIC Breastfeeding Coordinator? I tried to
err on the side of caution...(and you all know enough about me by now to
recognize that that wasn't my easiest task!)
3) I was told by the director of our "sponsoring agency" - Public Health
nsg. that in fact in my role at WIC I was functioning NOT as a "licensed"
RN, but as an IBCLC, by reason of job description & requirements, pay scale
(which led to union issues), etc. In other words, the opposite of what
Brenda's supervisor is telling her. Hmmm...
4) Doesn't matter whether you're a nurse, a doc, an LC or Mother Theresa
herself, you can be liable for assault and/or battery if you touch any woman
and/or baby without explicit consent or if she feels that the touching was
inappropriate or caused harm. ALWAYS explain what you need to do, and ASK
FIRST. But, when it comes down to it, I can't say that I can recall ever
touching a woman's breast in the WIC office, or even on home visits. I did
sometimes put my hands on the outside of the mother's hands to guide them in
positioning or manipulating her breast (ALWAYS and ONLY with her consent),
and never felt that I needed to do more. (I used to just get the willies
when I worked at the hospital and would see other nurses grab women's
breasts and shove babies on. They used to squoosh up the mom's breast with
one hand, grab the back of the baby's head with the other, and jam the kid
right in, nose-first, bottom way out from the mom. Yikes!)
=========================================================================
Date: Thu, 4 Feb 1999 10:02:43 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: NECSI <[log in to unmask]>
Subject: Re: HIV+ In Oregon
Comments: To: Martha Johnson <[log in to unmask]>
Mime-Version: 1.0
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Martha and Lactnetters,
This situation is a tough one. Does anyone know where
there is some literature on where informed consent
leaves off and mandating particular kinds of care
starts? Is it in the legal literature? What do
various state DSSs have to say about mandated
reporters reporting this kind of "abuse and neglect"?
Sometimes the medical knowledge is wrong, in which case
we congratulate the people who bucked the system and
gave their children (or themselves) what they thought
was the best care. Other times medical knowledge is
right and we criticize the same people for their
"selfishness" etc. etc.
As far as I understand, we know that HIV can be transmitted
throught breastmilk butit isn't always transmitted and
we don't really have a good understanding of when it
transmits and when it doesn't. However, we do know the
effects if it does transmit - pediatric AIDS. and we
know that the prognosis on pediatric AIDS is usually deadly.
For this particular mother, is milk from a milk bank an option?
I , too am interested in other's thoughts and resources on this
issue, both medical, ethical and legal.
I assume that you are familiar with the similar case
of the woman in Maine who took DSS to court and won. The details
are probably different, but it may give some guidance here.
Naomi Bar-Yam PhD
P.S. Does anyone know where I can get a copy of
"HIV/AIDS and the Nutrition Rights of Infants"?
=========================================================================
Date: Thu, 4 Feb 1999 09:47:51 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: Re: BF song
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re: "Isn't it a pity..." etc.:
No, but I hope when you get the words you'll share them! In my real life,
I'm also a singer, so of course I have to collect songs that make mention of
BFing in any way.
Cathy B.
=========================================================================
Date: Wed, 3 Feb 1999 19:59:32 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Robert Cordes DO <[log in to unmask]>
Subject: busy / Kathy D's question
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I've been busy lately a lot of sick kids.
I've only briefly looked at Lnet enough to know someone
cursed and Kathy D asked about an extra bolus of antibodies
at 18 months.
I know of nothing that says there is an extra bolus of antibodies
at this age. This is an age for the last set of
baby/toddler immunizations (DTaP and polio) so mom might
want to BF through this for an improved antibody response to
the vaccines. Although there is some evidence that BF
babies continue to have better relative responses to
immunization beyond weaning. See Principles and Practice
of Pediatric Infectious Diseases Long, Pickering and
Prober editors.
-Rob
"There was a little birdie
It's name was Enza
I opened the window
And in flu Enza"
Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
mail to:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 20:08:32 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Robert Cordes DO <[log in to unmask]>
Subject: ID text
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The text book I mentioned in my last post, "Principles and
Practice of Pediatric Infectious Diseases" Long, Pickering
and Prober editors has a good chapter on breastfeeding.
It even ends talking about promotion of breastfeeding.
-Rob
Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
mail to:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 10:13:32 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Kathy Parkes, RN, IBCLC" <[log in to unmask]>
Subject: Re: non-RN LCs and liability
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In a message dated 99-02-04 09:23:39 EST, Karen Z. writes:
<< As a non-licensed LC in private practice, I have a 'permission slip' at the
bottom of my new client information form (which the client fills out for
me) which says in part, ".....I understand that this may involve touching
my baby and/or my breasts." The client signs right below this.
I also ask, "May I touch?" before I do so, **always**. >>
Even as an RN, IBCLC in private practice, this is something I *ALWAYS* do. It
also gives me permission to share the consult results with both OB/GYN and
Pediatrician, to photograph for teaching purposes (PRN), and to have LC
interns participate in the consult. Every mom I work with signs this consent.
(I've never had a mom refuse to sign.)
Kathy Parkes, RN, IBCLC
The Lactation Connection (TLC)
San Antonio, TX
=========================================================================
Date: Thu, 4 Feb 1999 09:39:24 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Mary Kay Smith <[log in to unmask]>
Organization: Sinai Health System
Subject: What class said that?
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Janet, don't assume anything! Most likely it was NOT a CLE class. There
are many breastfeeding educator/lactation specialist classes out there
and the poster can clarify if she would like. Your message was helpful;
however there are many RNs in hospitals functioning as LCs who are RN,
CLE and since they are RNs they CAN touch patients as it is within their
scope of practice.
Mary Kay Smith
Romeoville,IL
=========================================================================
Date: Thu, 4 Feb 1999 09:46:18 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Dan & Liz Spannraft <[log in to unmask]>
Subject: biohazard ? IDPH CBI
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Does anyone have the Center for Breastfeeding Information statement on
breast milk and standard precaution? Also looking for any Illinois Health
Department standards for breast milk storage. Information sites or hard
data.
Liz spannraft IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 10:27:37 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Mary Kay Smith <[log in to unmask]>
Organization: Sinai Health System
Subject: Liability for non-RNs
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I'm as concerned as Brenda about this thread. Please discuss on line as
we'd all like to see it. As far as "just a piece of paper" goes...It is
an entry level exam which implies competencies in the areas we are
questioned on. True, it is not a license but most of our work settings
require that we demonstrate competencies in these areas and as IBCLCs
should be recognized as the expert. This is very touchy (no pun
intended) and I think the seminar givers are promoting the "requirement"
that all IBCLCs be RNs or other licensed personnel. We all need to check
our workplace and find out what liability coverage they provide. Check
out the ILCA publication: Standards of Practice for LCs. It states that
one of our responsibilities to "procure the mother's written consent
prior to initiating care." It is also our responsibility to communicate
and collaborate with the other health care professionals involved; we
are NOT the primary caregiver - that would be the doctor and if our
advice is in conflict with the MD, the mother is informed of her
options; consequences of outcome and the need to dialogue with her HCP.
Our legal responsibilities extend to "established parameters of
professional practice" and institutional standards. If there is any
question, I would contact my supervisor and see what the standards of
practice for that institution include. If other non-licensed staff can
give advice and touch patients, we should be able to as well.
Keep us updated, please
Mary Kay Smith,
Romeoville, IL
=========================================================================
Date: Thu, 4 Feb 1999 11:19:31 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Marsha Walker, RN, IBCLC" <[log in to unmask]>
Subject: HIV Mother and Breastfeeding
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I think I was contacted about this issue when it first came up. My response
was to heat treat the mother's breast milk or obtain donor milk from a milk
bank. Heat treating this mother's milk is not out of the question, it is
simply a question or option that people frequently forget in their reaction to
this problem.
Health agencies are so quick to push formula that they overlook easier and
healthier alternatives. I wonder if they have even bothered to test the
mother's milk!! Just because a mother is HIV positive does not mean her baby
cannot have human milk.
Marsha Walker, RN, IBCLC
Weston, Massachusetts
=========================================================================
Date: Thu, 4 Feb 1999 11:48:14 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Linda Spangler <[log in to unmask]>
Subject: Discharge Packs
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HELP! I am involved in the fight of my life. I'm the Patient Care =
Coordinator of the nursery in a small community hospital.=20
Formula reps have always visited the nursery, left gifts, etc., but =
thanks to being on this list, I have stopped this practice, or should I =
say - trying to stop this practice.=20
The formula rep whose company holds the WIC contract in our state (our =
clientele are 50% WIC and BFing rates are very low for this group, but =
that's another story) states that she needs to check our formula stock =
and discharge kits. I know you all dislike discharge kits, but you have =
to understand that my hospital has been giving them out since the =
beginning on time, and I am trying to change things slowly and =
gradually. The rep, of course, just wants to keep her foot in the door =
and to show her face on our unit.
When I told her we were taking the can of powdered ABM out of the BF =
discharge packs (remember gradual change) and NO she could not check our =
stock, she went straight to the only private Peds office in town and =
asked them to hand out her BF discharge packs. I'm not sure at this =
point what the Peds intend to do, but I do know their office looks like =
one big advertisement for Si*****! =20
I need references for the damage that BFing Discharge packs can do.=20
The formula rep has articles on how they do NO harm.
BTW, a lot of the RN's at my hospital (especially one very vocal one) =
would go ballistic if we stopped giving out the formula DC packs.
I would also like to convince the Peds of the harmful messages they are =
conveying by having formula advertisements all over their office. I =
intend to purchase some BF art for them to put up since one of the Docs =
said the reason they use formula stuff is because its free. I'll see if =
it works both ways. =20
Thanks for your help,=20
Linda Spangler, RN, CLE=20
Fighting an up hill battle, but reading Lactnet empowers me to the MAX.
P.S. Does anyone have a catchy name for a Telephone Peer Support system =
I am starting soon? Can't use Bosom Buddies as a local breast cancer =
survivors group has this name already.
------=_NextPart_000_00C1_01BE5034.3F9B0CC0
Content-Type: text/html;
charset="iso-8859-1"
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<!DOCTYPE HTML PUBLIC "-//W3C//DTD W3 HTML//EN">
<HTML>
<HEAD>
<META content=3Dtext/html;charset=3Diso-8859-1 =
http-equiv=3DContent-Type>
<META content=3D'"MSHTML 4.72.2106.6"' name=3DGENERATOR>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>HELP! I am =
involved in the=20
fight of my life. I'm the Patient Care Coordinator of the nursery =
in a=20
small community hospital. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Formula reps =
have always=20
visited the nursery, left gifts, etc., but thanks to being on this list, =
I have=20
stopped this practice, or should I say - trying to stop this=20
practice. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>The formula =
rep whose=20
company holds the WIC contract in our state (our clientele are 50% WIC =
and BFing=20
rates are very low for this group, but that's another story) states that =
she=20
needs to check our formula stock and discharge kits. I know you =
all=20
dislike discharge kits, but you have to understand that my hospital has =
been=20
giving them out since the beginning on time, and I am trying to change =
things=20
slowly and gradually. The rep, of course, just wants to keep =
her=20
foot in the door and to show her face on our unit.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2> When I =
told her we=20
were taking the can of powdered ABM out of the BF discharge packs=20
(remember gradual change) and NO she could not check our stock, she went =
straight to the only private Peds office in town and asked them to =
hand=20
out her BF discharge packs. I'm not sure at this point what the =
Peds=20
intend to do, but I do know their office looks like one big =
advertisement for=20
Si*****! </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>I need =
references for the=20
damage that BFing Discharge packs can do. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>The formula =
rep has=20
articles on how they do NO harm.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2></FONT><FONT=20
face=3D"Comic Sans MS" size=3D2>BTW, a lot of the RN's at my hospital =
(especially=20
one very vocal one) would go ballistic if we stopped giving out the =
formula DC=20
packs.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>I would also =
like to=20
convince the Peds of the harmful messages they are conveying by having =
formula=20
advertisements all over their office. I intend to purchase some BF =
art for=20
them to put up since one of the Docs said the reason they use formula =
stuff is=20
because its free. I'll see if it works both ways.</FONT><FONT=20
color=3D#000000 face=3D"Comic Sans MS" size=3D2> </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Thanks for =
your=20
help, </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Linda =
Spangler, RN,=20
CLE </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Fighting an =
up hill battle,=20
but reading Lactnet empowers me to the MAX.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>P.S. Does =
anyone have a=20
catchy name for a Telephone Peer Support system I am starting =
soon? Can't=20
use Bosom Buddies as a local breast cancer survivors group has this name =
already.</FONT></DIV></BODY></HTML>
------=_NextPart_000_00C1_01BE5034.3F9B0CC0--
=========================================================================
Date: Thu, 4 Feb 1999 12:35:12 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Jan Barger RN, IBCLC" <[log in to unmask]>
Subject: IBCLCs and Liability
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Brenda reported:
<< I am an IBCLC for a WIC office. Last week, my staff attended a one week
course seminar taught by two very well known women whose names I won't
reveal.
They were told that if you are practising as an IBCLC and are not in a
licensed profession (i.e. a nurse working at a hospital) where your job
description states that you may touch women, that you are setting yourself up
for a potential lawsuit. Evidently, there are quite a few cases pending
right
now in which LCs are being sued for babies who have died or become ill after
mothers followed the advice of an IBCLC.>>
Brenda,
Perhaps your staff members misunderstood what was said at the course? I'm
curious -- has anyone else heard of "quite a few cases pending of babies who
have DIED? because the mothers followed the advice of an IBCLC???" Is there
any documentation for this? The LC world is fairly small, and it is
interesting that this is not, to my knowledge, common knowledge. These seem
to be two unrelated issues -- one being potential "assault and battery"
charges if you touch a woman in the course of your job if you are not a
licensed health professional -- the other, lawsuits because of the
morbidity/mortality of infants who have died because the mother followed the
advice of an IBCLC. I do think if this was the case, the Wall Street Journal
would have hopped on this in a heartbeat.
Is the implication that if you are a licensed health professional you will
never be sued because of poor advice???
Also, I am unaware of ANY legislation that states that you cannot touch a
woman unless you are a LICENSED health professional that requires touching
within their job description. I do hope that your staff came back with
documentation for this statement, rather than just what the instructors said.
<< I stated that I do have liability insurance, but that was discussed at this
conference, and apparently it holds no water in a lawsuit if you are not a
licensed health professional in a job which requires touching in your job
description. >>
Of course, one of the reasons that you obtain consent from any mother with
whom you are working is to obtain her WRITTEN consent to touch her, her baby,
and her breasts.
It would be interesting to contact Pris Bornmann and the legal department of
LLL to get her take on this. If this information is correct, it is something
that needs to be disseminated ASAP through ILCA and IBLCE. I would certainly
ask your WIC director to hold on her dictum until you seek a true legal
opinion -- not just statements that came from a conference.
Certainly, everyone is entitled to an opinion. It may be the OPINION of these
instructors that you are opening yourself up to legal liability if you touch a
woman without a license to do so, but would it be legally defensible ?? What
does your job description at WIC say? If it says that you can touch women in
your role as an IBCLC, then you may do so. The standards of practice of ILCA
talk about what the responsibilities of the IBCLC is -- obviously it includes
touching the mother. It does not differentiate between licensed health
professionals and others -- it talks about the IBCLC.
What is a license? It is a piece of paper that says I fulfilled the
requirements to sit for, and subsequently passed AN EXAM that is recognized in
my state.
We, as IBCLCs are the ones that are in process of defining the profession.
These charges that have been brought forth by these instructors are very
serious ones. I trust that there is specific legal documentation for what
they have stated, as this needs to be addressed by the professional
organization and their legal beagles immediately.
Brenda, when all is said an done, I have to believe that this entire thing was
a misconception on the part of the students that attended the course. I've
been involved with ILCA and IBLCE for many years, and I have not heard these
concerns raised by others in our profession. As program director of a course,
I would be concerned if something like this came out of my course, and I would
want to be given the chance to clarify it immediately.
Jan Barger, RN, MA, IBCLC
Wheaton, IL
=========================================================================
Date: Thu, 4 Feb 1999 12:38:28 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: GJLanc <[log in to unmask]>
Subject: HIV/BF Continuing Ed
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In light of the thread about HIV and breastfeeding, I am interested in CEU
offerings, preferably homestudy, which cover HIV and Breastfeeding. I need
something that will meet the mandatory requirements in my state for RN
licensure renewal.
As this is slightly off topic and likely would involve advertising, please
e-mail me privately.
thanks for your help,
Julie Lancaster RN
Melbourne KY
[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 12:36:17 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Marie Davis, Rn, Clc" <[log in to unmask]>
Subject: Speaking of Monkeys
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<<But all of the monkeys and apes carry their babies on their bodies.>>
There was a surprise birth at the LA Zoo. The keepers want to find out who the
father is because there may have been a vasectomy failure (either that or the
43 year old monkey was monkeying around). The keeper stated it would be at
least a year or more before they could "get to the baby" because mom would not
put the baby down until then.
Marie Davis, RN, IBCLC
BTW I was watching "A Tree Grows in Brooklyn." Two of the leads had babies at
about the same time. One in the hospital and one at home. It struck me as odd
that for the mother that delivered in the hospital (Joan Blondell) they were
worried about the baby dying while with the mom that delivered at home they
were worried about the mom dying.
Near the end of the movie Joan Blondell's character said "We've got to get
home. Steve's got to deliver milk to a lot of them babies that like that
bottled kind," and made a nasty, "can you believe?" face.
=========================================================================
Date: Thu, 4 Feb 1999 09:44:56 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Johnson, Martha (PHMG)" <[log in to unmask]>
Subject: Re: HIV+ In Oregon
Comments: To: NECSI <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain
Hello and thanks to Naomi, Jack, Cathy, Pamela, and All the Rest:
Jack, your question (why has this mom not been offered the option of feeding
her baby her own heat-treated milk?) is an excellent one, and in fact we've
been asking this question since the day of baby's birth. Apparently, there
is nothing in the literature which will support this practice. All of the
research which has been written up has involved Holder pasteurization
process, which requires fancier equipment than most folks have in their home
kitchens (even in the US!). It is extremely frustrating to me to hear (from
Pamela M) that home heat treatment is routinely recommended to HIV+ mothers
by the Zimbabwean Ministry of Health, then to run aross info that was
presented at the 1998 ILCA conference (Breastfeeding and HIV, speaker: Thom
Thiele) that says "...due to the lack of reasearch in this area, it would
not be prudent to suggest home boiling of mechanically pumped breast milk
with the hopes of feeding it to ones infant. Caregivers who give out
suggestions without a strong scientific background expose themselves to
legal issues."
Yes, we have referred this mom to her ped with a strong suggestion that
she get a scrip for banked human milk. I'm not sure what her progress is on
this one to date. And yes, we are aware of the Maine case. Can't say
anymore right now.
You can reach George Kent at <[log in to unmask]> for anyone who is
interested. His paper, once again is entitled "HIV/AIDS and the Nutrition
Rights of Infants", and you all should get a copy and read it.
Thanks for all the responses, let's keep our collective mind cranking on
this one, it is a case that I think will set some legal/ethical precedents.
Martha Johnson RN IBCLC
> ----------
> From: NECSI[SMTP:[log in to unmask]]
> Sent: Thursday, February 04, 1999 7:02 AM
> To: Martha Johnson; [log in to unmask]
> Subject: Re: HIV+ In Oregon
>
> Martha and Lactnetters,
>
> This situation is a tough one. Does anyone know where
> there is some literature on where informed consent
> leaves off and mandating particular kinds of care
> starts? Is it in the legal literature? What do
> various state DSSs have to say about mandated
> reporters reporting this kind of "abuse and neglect"?
>
> Sometimes the medical knowledge is wrong, in which case
> we congratulate the people who bucked the system and
> gave their children (or themselves) what they thought
> was the best care. Other times medical knowledge is
> right and we criticize the same people for their
> "selfishness" etc. etc.
>
> As far as I understand, we know that HIV can be transmitted
> throught breastmilk butit isn't always transmitted and
> we don't really have a good understanding of when it
> transmits and when it doesn't. However, we do know the
> effects if it does transmit - pediatric AIDS. and we
> know that the prognosis on pediatric AIDS is usually deadly.
>
> For this particular mother, is milk from a milk bank an option?
> I , too am interested in other's thoughts and resources on this
> issue, both medical, ethical and legal.
>
> I assume that you are familiar with the similar case
> of the woman in Maine who took DSS to court and won. The details
> are probably different, but it may give some guidance here.
>
> Naomi Bar-Yam PhD
>
> P.S. Does anyone know where I can get a copy of
> "HIV/AIDS and the Nutrition Rights of Infants"?
>
=========================================================================
Date: Thu, 4 Feb 1999 09:59:04 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Melinda Hoskins, MS, RN" <[log in to unmask]>
Subject: Liability, etc (long)
MIME-Version: 1.0
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We need to make a distinction between obtaining the mother's consent to
touch and exam mother and baby as a function to avoid charges of assault
and battery, and the issue of whether the LC is functioning within a
legally defined scope of practice.
Every health professional should obtain consent, either verbally or in
writing, before touching a client/patient. Such consent is given in
writing in the hospital admission papers, but obtaining verbal consent
for actions taken while caring for the individual respects that
individual's autonomy within the practice setting. Obtaining consent in
this manner is a protection for the practitioner from charges of assault
and battery.
Many states have clauses which define what actions can be construed to
show that an individual is "practicing" medicine, nursing, or other of
the health care professions protected by licensure. Licensure serves
two functions within our society: 1. protection of the public from
those who would practice without appropriate preparation, and 2.
protection of the professional practices (read that business, as in $$$)
of those who have obtained certain "bodies of knowledge" from
encroachment by those who have "lesser" skills. Okay, okay, there are
those who would argue that they are more concerned about "quality of
care" than they are $$$.
Thus when times are prosperous and those with "specialized knowledge"
are as busy as they want to be, those who might be viewed as
"encroachers" are generally safe from prosecution for "practicing
without a license." But when times become more lean, one sees many more
prosecutions and much more concern about the appropriateness of one who
is using techniques which may fall into the specially protected
knowledge, ie, prosecution for "practicing medicine or nursing without a
license."
Another time when there becomes concern over "practicing without a
license" is when someone who is perceived to have lesser qualifications
challenges or tries to direct the practice of the one who perceives
himself to be more qualified. We have probably all had experience with
the person who believes themselves to be better qualified, and yet like
Don Quixiote (sp?) is always seeing giants stalking him and strikes out
willy-nilly against others. When LC's find themselves dealing with such
individual's it would behove them to tread lightly, especially if the
LC's underlying qualifications are not in a field with examination and
prescribing rights legally defined by law.
The consent of the mother to touch and exam herself and her baby
protects one from charges of assault and battery, but does not protect
against charges of "practicing without a license."
It is in the area of "practicing without a license" that the non-HCP LC
seeks protection through the use of skillful interpersonal
relationships, professional behavior, documentation that describes
findings but does not give "medical diagnoses", and couching one's
information given very carefully (not as prescribing, or orders, or even
a plan of care [nursing holds that right] but as a statement of other's
experiences and options that the mother or her HCP may want to
explore). When dealing with HCP's the non-HCP LC can site relevant
literature which makes the recommendations that she would like to see
implemented, but she may have trouble if she makes the statement "My
recommendation would be . . ."
Hope this clarifies some of the issues raised. I think I had a
flashback and was teaching NURSING 101, Legal Issues . . . . Oh here I
am at my computer, hit send now, and get this off my screen! <VBG>
Melinda Hoskins, MS, RN
=========================================================================
Date: Thu, 4 Feb 1999 10:00:30 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Melinda Hoskins, MS, RN" <[log in to unmask]>
Subject: PPD screening, etc
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I recently discovered a site with info re PPD. Has articles, links,
books, screening tools specific to post-partum period. You might find
it interesting:
http://www.geocities.com/Heartland/1805/
Melinda Hoskins, MS, RN
=========================================================================
Date: Thu, 4 Feb 1999 11:09:35 -0700
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Tami Karnes <[log in to unmask]>
Subject: Herbs and contamination
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You should always be careful of what kind of herbs you are buying and where
they are coming from. Just like anything else.
I make all of my own herbals for just this reason. There are many companies
out there that will sacrifice quality for the almighty dollar. Always know
who your source is and where their priorities lie. It never hurts to get a
little background on the companies that you do business with whatever the
product is, but especially if it is a product that you ingest.
Questions can be forwarded directly to my e-mail or toll-free number.
Wishing you health and wellness!
Tami Karnes
Certified Herbalist
One With Nature
800-230-5166
=========================================================================
Date: Thu, 4 Feb 1999 12:21:44 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Maurenne Griese, RNC" <[log in to unmask]>
Subject: Unlicensed assistive personnel (UAPs)
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Part of my responsibilities as the director of our hospital's education
department is assessing, documenting, and evaluating competency of health
care providers-licensed and unlicensed. I provide consultation to the many
departments that make up our hospital, including those with personnel that
are unlicensed and set the competency standards for the hospital.
For example, how many of you have been touched by a nursing assistant,
scrub tech, or phlebotomist when they were providing you with care? They
are unlicensed assistive personnel (UAPs) and are critical members of the
health care team. They have demonstrated competency in their area of
expertise, much like a CLE, CBE or IBCLC would. This is a Joint Commission
(JCAHO) requirement.
While I understand a WIC clinic may or may not be JCAHO accredited, a
critical element of competency for these UAPs includes TOUCHING PATIENTS!
Caring for people, whether you are a nail technician, massage therapist or
lactation consultant requires touching people from time to time. Even as
an educator, we touch people. You ask permission beforehand! Common sense
tell us that if you are receiving a manicure, getting a massage or being a
consumer of health care may involve some TOUCHING! To avoid liability, we
have the pateint sign a consent for treatment and get informed consent.
There are times when touching the mother and or baby are essential in
providing care to mother and child, whether you are licensed or not.
Informed consent is informed consent, regardless of your licensure or
competency status. You ask permission before you touch.
The premise that a CLE or CBE that is not licensed can't touch a patient is
ridiculous. During your certification process you have demonstrated a
minimal level of competence so that you may use those credentials. I'm
sure there are finger sticks being done in the WIC office. Who is doing
it? Are THEY licensed? What is the problem with an unlicensed CLE or CBE
who is assisting a mother with breastfeeding touching her or her baby, if
she has given you permission to do so?
JMHO, this supervisor needs to worry about something else, like funding for
breastfeeding promotion or reimbursement for LC visits.
Am I just not getting this??? Dumbfounded on a lovely Kansas Day!
Maurenne Griese, RNC, BSN, CCE, CBE
Manhattan, KS USA
=========================================================================
Date: Thu, 4 Feb 1999 12:22:47 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Camille Foretich <[log in to unmask]>
Subject: IBCLC & Liability
MIME-version: 1.0
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Well said Jan Barger. I whole heartedly agree. It isn't just "other" health
care professionals that need to show documentation concerning their
statements! When unsubstantiated and generalized statements are made that
instill fear in one, I'm suspicous as to the motive. Camille Foretich, BS,
IBCLC Jackson, Mississippi
=========================================================================
Date: Thu, 4 Feb 1999 14:18:43 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Ilene Fabisch, BrocktonWIC" <[log in to unmask]>
Subject: Prozac info requested
I have a client who is currently BF her 3 1/2 year old daughter. She
nurses 2-3 XD for less than 5 minutes each session. This woman has been
diagnosed with chronic atypical major depression. Her condition is to
the point of rendering her non-functional. She is currently taking
Zoloft, 75 mg a day. Both she and her doctor know that this is not the
appropriate medication for her. They would like to try Prozac, but the
doctor(an M.D.)is not willing to prescribe Prozac because the patient
refuses to stop BF. She believes in baby-led weaning. The client has
been willing to "sacrifice" herself up until this point for the benefit
of her daughter, but her condition continues to worsen. The client now
feels comfortable exploring the alternatives because her daughter is
older and BF less in frequency and quantity.
The doctor has extremely limited knowledge of BF, but has stated that if
the patient can produce information that would intimate the relative
safety and efficacy of Prozac in this BF situation, the doctor would
reconsider her misgivings.
I am looking for an opinion on the safety of Prozac and BF in this
situation, preferably from a medical source. If possible, please do not
address the preferred use of Zoloft(as it has already been used and found
to be ineffective) or Paxil(as it has been determined to also be
inappropriate for this client as she is not suffering from an agitated
depression.) Information on other alternatives would also be
appreciated.Ilene Fabisch, IBCLC, LLLL
WIC Bfing Coordinator
Brockton, MA
___________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at http://www.juno.com/getjuno.html
or call Juno at (800) 654-JUNO [654-5866]
=========================================================================
Date: Thu, 4 Feb 1999 14:29:41 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Carol Kelley, LLL Leader" <[log in to unmask]>
Subject: Discharge pack references
Comments: To: [log in to unmask]
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Linda,
I'm sending you a list of references on discharge packs. I've sent some of
this info to Lactnet before, but this list has a few extra references.
Auerbach K. Discharge milk samples. Pediatrics 1993 Feb; 91(2):518-519 a
letter by Lactnet's own Kathy A on the 1992 Dungy article
Bliss MC, et al. The effect of discharge pack formula and breast pumps on
breastfeeding duration and choice of infant feeding method. Birth 1997 Jun;
24(2):90-97. see also comments by Bliss in Birth 24(4):202
Howard C and FM Howard. Commentary: discharge packs: how much do they really
matter. Birth. 1997 Jun;24(2):98-101
Howard CR et al. Attitudes, practices and recommendations by obstetricians
about infant feeding. Birth 1997 Dec;24(4):240-6
Howard CR et al. Antenatal formula advertising: another potential threat to
breast-feeding. Pediatrics 1994 Jul;94(1):102-4
Howard, CR et al. Infant formula distribution and advertising in pregnancy: a
hospital survey. Birth 1994 Mar;21(1):14-9
Howard FM et al. The physician as advertiser: the unintentional discouragement
of breast-feeding. Obstet Gynecol 1994 1993 Jun;81(6):1048-51
Dungy CI et al. Hospital infant formula discharge packages Do they affect the
duration of breastfeeding? Arch Pediatr Adolesc Med 1997 Jul;151(7):724-729
Losch M, et al. Impact of attiudes on maternal decisions regarding regarding
infant feeding. J Pediatr 1995 Apr; 126(4):507-514
Neifert M, et al. Effects of two types of hospital feeding gift packs on
duration of breastfeeding among adolescent mothers. J Adolesc Health Care 1988
Sep; 9(5):411-413
Speer ME. Use of hospital discharge packs-1995. Position of the Texas
Pediatric Society Committee on the Fetus and the Newborn. Tex Med 1996 Sep;
92(9):52-57
Wright A, et al. Changing hospital policies to increase the duration of
breastfeeding. Pediatrics 1996 May; 97(5):669-675
Two of these papers were cited in the AAP statement: FM Howard (1993) and CR
Howard ( Birth 1994).
Hope this helps.
Warmly,
Carol Kelley, LLLL
Taylors, SC
mailto:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 14:37:19 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: kathleen sheridan bellis <[log in to unmask]>
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"I saw a bumper sticker today I thought y'all might appreciate. It said...
"Silence is the voice of Compliance"
how true!!"
Oh Cheryl, if only I could convince my children of that! ;-)
Kathleen Bellis
Penn State College of Medicine
Class of 2002
=========================================================================
Date: Thu, 4 Feb 1999 14:30:19 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: Discharge packs
Comments: To: Linda Spangler <[log in to unmask]>
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Hang in there, Linda! I've been down that road, as have a lot of your fellow
lactnetters; and you're right, slow steps may be frustrating but they get
you there. (How many cliches can I string together here?)
The AAP statement on BF'ing (Dec. 1997) says "Pediatricians are encouraged
to work actively toward eliminating practices that discourage breastfeeding
(eg, infant formula discharge packs...)".
Then there's always the WHO Code on the international marketing of
breastmilk substitutes: WHO 1981 , and WHO Protecting, Promoting, and
Supporting Breastfeeding: The special role of maternity services. WHO
1989:13-18
This is an old reference, and probably not the best for your purposes since
it deals more with the effects of providing a breast pump @ DC than the neg.
effects of formula sample packs (my reprint comes from the M____a br. pump
co., just as a hint to the bias): Claibourne, Christensen-Szalanski, Losch,
& Russell. Effect of discharge samples on duration of breastfeeding.
Pediatrics Vol. 90 No. 2, Aug. 1992, pp 233-237. Compares women who rec'd a
DC pack including formula samples to those who re'd DC pack w/no form., but
with a br. pump: greater BF duration in group getting the pump (4.18 wks. vs
2.78 wks, mean)
Burgevin, Dougherty, & Kramer. Do infant formula samples shorten the
duration of breastfeeding? Lancet. 1983; 1:1148-1151. Well-ed. white women
in Montreal; more likely to be BFing @ 1 mo. if no DC sample of formula.
Frank,Wirtz, Sorenson, Heeren. Commercial discharge packs and breastfeeding
counseling: effects on infant feeding practices in a randomized trial.
Pediatrics. 1987;80:845-854.predominantly low-income non-white women in
Boston MA; no formula samples, women who rec'd "research pack" (br. pads &
ed. materials) more likely to exclusively BF longer and to be still ptly BF
@ 4 mo. (vs. women who got nothing).
Seems to me I read a study more recently in JHL, but don't have it right at
my fingertips. (But look, I upped my organizing since that flurry of posts,
and I have these others right at my elbow!)
Good luck - you will get there, because you have right on your side! Cathy
Bargar, RN, IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 15:06:30 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Pat Bull <[log in to unmask]>
Subject: OLIVE OIL ??
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Hello Netters,
I know we are supporting the usage of Olive oil more and more. My questi=
on
to you all, since I have had a lenghthy discussion with Linda Kuntner abo=
ut
this and tryed to do a lit search on olive oil, I would like all your inp=
ut
on: anyone aware of effects of olive oil in regards to allergies, effect=
s
to infants or children? There is not been one case of any allergies or
problems with olive oil and usage on the mothers skin or to infant that h=
as
orally licked/sucked the nipple of a mother that had olive oil on the
nipple. Does anyone have any clinical experience or anidotal info on
olive oil???? You can e-mail me directly, if you want. =
[log in to unmask] Thanks
"If we do not change our direction, we are likely to end up where we are
headed?" By Ancient Chinese Proverb
Pat Bull, RN, IBCLC
The Breastfeeding Connection/Medela, Inc
Naperville, Il - sunny and getting warmer
=========================================================================
Date: Thu, 4 Feb 1999 15:08:40 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: ethics and liability
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dear melinda and all,
your post has some excellent thoughts. but i am still wondering about the
mention of "not making a medical diagnosis" - how does this relate to using
the superbills? also, what about advising women to use various things on their
nipples, cabbage leaves, tinctures, etc.?
you can't cure eveyone, so there is bound to be some room for disappointment
on the part of the client. i also am still waiting to know some particulars
about the claimed "cases of advice by LCs that caused death."
carol brussel IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 20:16:59 +0000
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: heather <[log in to unmask]>
Subject: discharge packs
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If free formula in whatever guise it appears didn't mean *more* women used
formula (and therefore breastfed *less*...duh) then the industry wouldn't
*bother* giving the stuff away...this is lesson one, surely, in basic
marketing techniques, ancient and modern.
It is also a technique used by drug dealers (' hey, kids, your first hit is
free!' ) and computer software manufacturers ('download our basic version
for nothing, and maybe we'll be able to sell you the de-luxe version').
The formula industry is so keen on it, the only way they are stopped from
doing it anywhere in the world is by making the technique illegal...and
even then they do their hardest to maintain it!
Heather Welford Neil
NCT bfc Newcastle upon Tyne
=========================================================================
Date: Thu, 4 Feb 1999 16:00:42 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathleen Bruce <[log in to unmask]>
Subject: WHO CODE paper copy
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Does anyone have a paper copy of the WHO Code that I could borrow quickly?
Reply privately please. Thanks K
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
Williston, Vermont
mailto:[log in to unmask]
LACTNET Archives http://library.ummed.edu/lsv/archives/lactnet.html
=========================================================================
Date: Thu, 4 Feb 1999 14:41:24 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathy Dettwyler <[log in to unmask]>
Subject: Monkeys, apes, what's the diff??
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The surprise baby was a chimpanzee, and chimpanzees are APES not monkeys.
This is one of my pet peeves (among many). Monkeys have tails, apes do
not. Chimpanzees are apes, not monkeys. TIME Magazine this week has an
article where they refer to "chimps [such as] sooty mangabeys." ARGH.
Sooty mangabeys are MONKEYS. This is like referring to dogs as cats. Both
Order Carnivora (chimps and monkeys are both Order Primates), but not
terribly similar.
Kathy D.