I'll take a shot at answering these, Kathy--

>1.      Is there any merit in suggesting women do nipple preparation while
>pregnant *because* it helps focus their attention on the upcoming (new)
>function of their breasts?
Answer: Only if it provides an opportunity to praise, inform and educate.

>2.      What about this statement? "Contrary to the recommendations of most
>textbooks, soaps can be used regularly during normal bathing--they are not
>harmful to the skin."
>        Don't many LCs recommend women not use soap on their nipples during
>pregnancy?
Answer: Yes but probably shouldn't. This old idea is based on the erroneous
assumption that nipple skin is exceptionally fragile. Most early nipple pain
is from trauma - poor positioning, bad suck. Later pain is usually thrush or
another infection or condition. Washed nipples work fine unless they are used
improperly or infected, IMHO.

>3.      What about a 3 sentence description of how to do a suck assessment,
>with no indication that this takes a lot of training and experience and
>should be done by a professional?  What about the controversy about doing
>them at all?
Answer: Increasing awareness that some babies DON'T suck right is a very good
thing. A thorough assessment is complex and requires training. Oralmotor
function (suck) impacts more than milk transfer and the entire issue needs
far more thorough exploration, IMHO.  It should be scaring the pants off us
that so many babies can't suck right. And I've seen two babies (home visits)
in the past two days with crummy suck that wasn't any better using a bottle.
Some of these otherwise normal kids CAN'T EAT.  Scary thought.

>4.       "Short, frequent feeds may indicate inadequate milk intake."  Isn't
>this actually the way most baby nurse, if allowed?
Answer: frequent, yes.  "short" implies that feeds should be shortened
artificially, and is subject to massive misinterpretation.  Normal baby feeds
take about as long as adult meals and snacks. If they are "short," they had
better be frequent!  Doubling the birthweight in a few months requires
frequent food intake - no surprise. Good hard data on normal patterns is very
hard to find, so defining what is "too short" or "too frequent" or "too long"
is still somewhat a matter of interpretation. If "normal" has never been
throughly reserached and defined, then "too anything" cannot be defined
either.

>5.      In a section on "Maternal hyperlactation syndrome" the author
>mentions "Mothers complain of 'knife-like' cramps or 'shooting pains' deep
>in the breast."  She says this is due to milk blockage and stasis.  I seem
>to recall some discussion of these pains being due to thrush infection.  Is
>there a concensus on this?
Answer: Yes; see the newest LC Series by Kay Hoover and Chris Mulford on
Candiadiasis. There can be other causes, but ductal thrush is the most
common.

Hope this helps.

Linda Smith, LC in private practice, Dayton OH