Hi Barbara et al--
I am a hospital based LC, who has low-tech leanings. I agree that moms are getting too much equipment pushed at them. I think there are a number of causes for this. I would say that several main causes are:
1. Very short hospital stays. Nurses and LCs really want to see babies successful at breast before they go out the door, so we get desperate and try whatever works.
2. Changes in obstetric practice have radically altered the way newborns feed during the first days of life. The induced 37-38 weeker; the baby delivered by vacuum extraction to a mom whose epidural made her unable to push effectively; the baby whose mom's nipples are grossly edematous after a day of IV fluids-- all of these have become clinically commonplace in the past 5 years. when I started practice as an L&D nurse in the late 80's, may of these situations were not common. I would say without hesitation that the babies I see now do not feed like the babies I used to see 10-15 years ago. It is a "difference between common and normal" as someone on Lactnet put it brilliantly not long ago. Just because we see something all the time clinically does not mean that is what's normal.
3. The other factor is our gizmo-obsessed culture. Nurses, LCs, and parents want a quick fix for every problem, and tools and gadgets look like the fix. I used to have a UNICEF video that showed mothers of premature babies at a hospital in Nairobi Kenya, hand-expressing milk at speeds that no electric pump could match! A good lesson for our culture.
Martha Johnson RN IBCLC
Eugene Oregon
-----Original Message-----
From: Barbara Wilson-Clay [mailto:[log in to unmask]]
Sent: Friday, September 12, 2003 3:41 PM
Subject: pushing equipment and mastitis
While I know LCs who are extremely conscientious about not pushing equiment
at new mothers, one certainly hears stories from clients about LC contacts
that have resulted in the sale of many hundreds of dollars worth of products
and no resolution of the orginal problem. In my experience, bras, pillows,
stools, etc. are not the answer to breastfeeding problems. Since they are
typically available in commercial retail establishments, and can be
purchased on a non-emergency basis, the ethics of LCs selling these items
seem questionable to me. It is a very slippery slope and quite tempting to
provide a pump or whatever when you also suspect that the next person trying
to sell something to the mom may know far less than you do in terms of
teaching the mom how to use the equipment. However, it is still part of the
ethics of LC practice to avoid putting profit before the patient.
To put a slightly less sinister spin on it (as I think most LCs are very
ethical) I think that a lot of equipment is sort of thrown at problems
without there always being a good rationale for its use due to inexperience
and lack of a better idea of how to fix the problem.
The feeding tube device is a good example. They are expensive, finicky, and
most of the people who use them hate them. Occasionally you get an adoptive
mom who is thrilled about the feeding tube device and thinks its the
greatest thing in the world, but I am puzzled by all the moms with poorly
sucking babies who are sold these $50 devices for no good reason. Unless
the baby has a normal suck, the supply lines don't really work very well.
The supply line works best for a normal baby and a mom with a really low
milk supply. The same problem of irrational selection occurs with nipple
shields. I love nipple shields for certain problems; they work like a
charm. But I am always seeing moms who have been given one and I wonder
why? Their problem is not going to be solved by this particular tool. I
say again that there are serious deficits in LC training, and one area where
this is very visable is tool use.
Anyway, my real point in posting was to say that Pam has an interesting idea
that perhaps the early overuse of pumps is contributing to mastitis. That
would require a focused study, of course, to confirm. There could be other
possibilities. Many of these moms have nipples that crack in the germy
hospital environment and become bacterially contaminated. These moms are
more and more sent home with instructions to seal these wounds with
occulsives. I suspect this is done without any advice to flush or debride
the wounds prior to using things like hydrogels or lots of lanolin. Latch
is still poorly taught in hospitals, and I think the sore nipple advice is
generally inadequate because it doesn't emphasize first aid cleansing. The
real incidence of lactation mastitis is still under exploration, and
researchers such as Fetherston and Amir (in Australia) and Foxman (in the
US) have published excellent articles looking at risk factors. I'd have to
go back and review to see if there is a connection mentioned in these
articles with regard to incidence of pump use.
One final thought about frequent use of equipment in the early postpartum:
The population that consults LCs after discharge is by definition a high
risk population. Why would they need us otherwise? So are these moms
using pumps more than a mom would be with a more successfully feeding baby?
Causality, coincidence, iatrogenic affect... lots of possibilities.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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