Dear Linda...thanks for your information. First I want to
thank you for the great session you gave this summer in
Arizona. I have used many of the teaching methods that were
suggested.I agree with you about using cold....I must admit that I tend to like cold in the
summer and heat in the winter. As far as engorgement.....THe assistant medical
director of our maternity unit is the one that is so keen on
having an absolutly objective defination on
engorgement...this , he feels, will enable us to detirmine if
cabbage leave work. I would prefer concentrating on avoiding
such distention. By the way we have used cabbage on bee bites
on my fathers leg after CABG (cardiac bypass)...edemetous
legs...with great success-as for the lady with the Hives from
cabbage (sorry I'm mixing messages...but soon my son takes
over this room)  could she be Allergic to sulfa..or
mustard?...I had a wicked case of hives and itchy rash last
year and then I thought Why not try Cabbage leaves. IT MADE
IT WORSE....but I've used cabbage on myself with a bad bee
bite and it worked wonderfully.Yanet-thanks for your query...I promise to e-mail you an answer
this week. Have a good year everyone...thanKs for having this great site.
--- On Fri, 29 Dec 1995 13:25:46 -0500  Automatic digest
processor <[log in to unmask]> wrote:

>There are 10 messages totalling 309 lines in this issue.
>
>Topics in this special issue:
>
>  1. Dr. Hale - help!
>  2. slow weight gain baby, an update
>  3. LACTNET Digest - 25 Dec 1995 to 26 Dec 1995 - Special
issue
>  4. pedal pump
>  5. donating blood after malarial prophylaxis
>  6. Nursing Students
>  7. cup feeding
>  8. measuring engorgement
>  9. demerol and stadol
> 10. Demoral, other meds in labor
>
>----------------------------------------------------------------------
>
>Date:    Fri, 29 Dec 1995 07:43:01 -0500
>From:    deb shinskie <[log in to unmask]>
>Subject: Dr. Hale - help!
>
>Dr. Hale:
>
>First, my apologies.  I do not yet have your book - that was to be purchased
>with Christmas $$ and I have been ill since 12/23 - no shopping yet!
>
>A very bad cold(?) has ended in shingles 2 days ago.  My regular doc sent me
>to derm last evening and my md wanted to try Valtrex (valacyclovir HCL)
>which I understand is quite new, and she was uncertain when I mentioned that
>I was nursing my 19 mo old 5-7 times a day.  He is doing well with solids.
>She said that Valtrex is a metabolite of acyclovir but was uneasy
>prescribing it without any info for use in nursing moms.  I am interested in
>your thoughts regarding this.
>
>Thank you so much!!
>
>Debbie Shinskie RN CES IBCLC - who is having a hard time typing because it
>itches so much!!
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 05:47:30 -0800
>From:    Denise Parker <[log in to unmask]>
>Subject: Re: slow weight gain baby, an update
>
>I wanted to update all of you on the current status of the baby I posted
>about a couple weeks ago.  To refresh your memory, the baby had a deep
>bubble palate, mom had a questionable milk supply and weight gain was an
>issue.  Baby is now 7.5 weeks.
>
>We have been working hard to track down actual causes vs secondary effects.
>Mom experimented last week with stopping pumping, listening only to baby's
>cues and trying to "get back in touch" with her baby.  First 24 hours were
>great.  2nd 24 hours mom's milk supply had plummeted and baby was feeding
>constantly and very fretful.
>
>Mom went back to pumping and milk supply was back up within 24-48 hours.
>She is experiencing fullness, MERs, etc which she did not experience first
>few weeks.
>
>Mom has had continuing concerns that baby sucks well for initial 2-3 minutes
>then it is a struggle to get any suck much less a good one, baby will
>swallow only when sufficient milk has pooled in her mouth (via p-syringe or
>mom manually expressing into baby's mouth).  She feel like she is
>continually force feeding this baby.
>
>Early this week mom was utterly frustrated so I again gave her options.  She
>wanted to try the SNS because the bfdg relationship is great, baby just
>isn't getting enough to eat.  We tried and just as I was worried baby
>couldn't get anything out of SNS either.  She actually was able to push air
>back up the tubing after mom had been squeezing the bottle to force fluid
>into baby's mouth.
>
>Baby is due for an 8 week checkup and I want a really thourough evaluation
>done.  I talked with the pediatrician about my concerns a week ago and she
>basically felt that if the baby was gaining she wasn't too concerned.  Mom
>called yesterday to try and talk with pediatrician who was on vacation.  She
>connected with the on-call pediatrician who basically said give the baby a
>bottle, ABM and breastmilk are the same, what's the big deal.
>
>Yesterday they came and I looked really closely at baby's palate to rule out
>a slight cleft that may have been missed.  No cleft, just a very high
>bubble.  Mom has been wondering about bottle use all along so I encouraged
>her to bring in a bottle and we'd try.  So we took a bottle with a NUK
>nipple (6 month+ size) and gave to baby.  She took 1/2 ounces beautifully
>and I was beginning to truly wonder.  Then all of the sudden her suck
>changed and she began little ineffective sucks and swallowing only when milk
>pooled in her mouth.  After 10 minutes she had taken a total of 2/3 ounce.
>Exact same pattern she exhibits on breast.  Baby was more active at this
>visit than at previous visits where she often looks like a rag doll when she
>is feeding.  This visit she was able to push up slight when placed on her
>stomach, she brought her arms to center and turned her head from side to
>side.  I was glad to see that.  But the issue of stopping active sucking
>after less than 1 ounce is really odd.
>
>Any thoughts would be appreciated.  In the past with this post you have send
>a wide variety of thoughts possibilities, etc.  I really appreciate all your
>input.  It has been most helpful.
>
>
>
>
>
>Denise Parker, BA, IBCLC (La Crescenta, CA)
>To Avoid Criticism, say nothing, do nothing, be nothing
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 09:13:04 EST
>From:    Karen Trimmer <[log in to unmask]>
>Subject: Re: LACTNET Digest - 25 Dec 1995 to 26 Dec 1995 - Special issue
>
>Hi! I too could use a briefing on the EZZO method. Could some e-mail me directl
>[log in to unmask] or repost the info? Thanks! Karen Trimmer
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 09:27:37 -0500
>From:    "Patricia B. Drazin, IBCLC" <[log in to unmask]>
>Subject: Re: pedal pump
>
>Lisa:
>
>     interestingly it is in the 96 catalogue although I have not heard anyone
>talk about it since the confernce and I have not received any lit.....poduct
># 67112. comes with express spring... retail is 47.40...
>
>
>                           Patricia
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 08:50:30 -0600
>From:    "katherine a. dettwyler" <[log in to unmask]>
>Subject: donating blood after malarial prophylaxis
>
>You can'd donate blood after malaria prophylaxis (it was three years around
>here, back in 1990) because the chloroquine and other malaria-suppressant
>drugs do not prevent you from getting malaria, they just keep the parasite
>from reproducing so much that you have symptoms.  So you still *get*
>malaria, and even though most people take additional, different drugs when
>they get home that are supposed to kill the life-cycle of the parasite that
>can encyst in your liver (and hide for years) -- they still want to be sure
>that you aren't going to pass malaria on to someone via a blood donation.
>So they figure if you haven't gotten sick again for three years, then you
>probably don't have any parasites in your blood OR encysted in your liver.
>
>Kathy Dettwyler
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 11:45:34 -0500
>From:    Pardee Hinson <[log in to unmask]>
>Subject: Re: Nursing Students
>
>Mary Solberg requested information regarding teaching nursing students in a 2
>hour class format.
>
>I also teach nursing students for a 2 hour class.  I would be glad to mail you a
>copy of my outline and hand-outs.  Send me your mailing address if you want
>them.
>
>My general presentation includes: historical overview, Baby Friendly Hospital
>Initiative, our breastfeeding policy, standing orders for breastfeeding,
>hazards, anatomy & physiology, first nursings, positioning & attachment, feeding
>cues, normal infant behavior, early indicators of potential difficulties.  I
>keep things loose although each student has a formal outline which I cover
>spending more or less time on a topic depending upon class interest.  I spend
>little time on devices.
>
>My goal for the class is to introduce the students to breastfeeding and human
>lactation and empower them to be of some help to the breastfeeding
>mother--either by being able to assist her in positioning her newborn at breast
>or in recognizing that the she needs referral to the IBCLC.  I want to interest
>the student enough so that s/he will want to learn more about bf and our field.
>
>The format is lecture, question/answer, slides, hand-outs, video.  The videos
>used depend on my feelings at the time and how the class is going.  I typically
>use the first attachment one as I want everything we do to be based on our
>current best knowledge of what happens when things work perfectly meaning no
>interventions and no medical conditions.  I may use the positioning tape from
>Medela, the L.Smith tape, the Royal College of Midwives tape, the AAP tape....in
>each case (except first attachment) I use only a short portion of the tape to
>illustrate my point.   I use a doll and breast to demonstrate.  I sometimes use
>the Linda Smith technique of having the students sip water from different
>positions (head tilted back, head turned to shoulder, head parallel with trunk
>of body) to demo importance of infant position at breast.
>
> I have a cup, adapted syringe, breast shell, bottle teat, starter SNS for
>demonstration if needed.  I have the Lawrence and Auerbach/Riordan books as demo
>of standard reference.  Also have a copy of JHL to pass around for them to see.
>
>
>I never avoid a question.  I encourage the student to ask the question when it
>first comes to mind as I do not want someone to forget to ask and leave with a
>need for info unmet.  I also invite them to follow any of the IBCLCs and observe
>inpatient rounds or pumping instruction.
>
>Let me know if you need more info.  Hope this helps.  It is great fun to do.
>And the instructor likes having the time free.
>
>Pardee Hinson, MPH, IBCLC       [log in to unmask]
>Mercy Lactation Support Center
>Charlotte, NC
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 08:57:20 -0800
>From:    Keith Palmer <[log in to unmask]>
>Subject: cup feeding
>
>Re: Phyllis's request for info on cup feeding.
>
>I, too, would be interested in how cup feeding has become part of the
>hospital protocol.  Those I have communicated with already don't have
>"official" protocols in place but do cup feeding more on the sly.
>
>So, if those out there in LACTNET land with in place, working protocols
>could post regarding this subject, probably more that a few would benefit.
>
>Thank you,
>Christine Palmer, Mill Valley CA
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 13:06:07 -0500
>From:    "Linda J. Smith, BSE, FACCE, IBCLC" <[log in to unmask]>
>Subject: Re: measuring engorgement
>
>Hi Toby Gish!
>
>I recall that Niles Newton described levels of engorgement in one of her
>works. Linda Kutner or Jan Barger may have the reference - wish I did.
>
>I'm abandoning the catch-all phrase "engorgement" and attempting to
>distinguish "too much milk all at once" from "edema" and "milk stasis."  They
>are distinct phenomena and require different treatment even though they can
>occur simultaneously.  Trick, of course, is to treat the most urgent one
>without interfering or exacerbating another one. That's why I dont' believe
>in using heat for early-postpartum full breasts. Edema is a big factor in
>this, and heat is never used for edema anywhere else in the body.  Cold will
>reduce the swelling, which then unblocks the ducts so milk can be removed.
>
>Linda Smith, applying science to breastfeeding management whenever possible
>private practice in Dayton, OH
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 13:06:21 -0500
>From:    "Linda J. Smith, BSE, FACCE, IBCLC" <[log in to unmask]>
>Subject: Re: demerol and stadol
>
>Demerol and Stadol are alive and well here - fooey!  An informal survey of my
>childbirth class attending reunions from 1989-92 suggests that about 85% of
>mothers wish they hadn't bothered with those drugs, and only 15% liked the
>results. Most said they got groggy but had just as much pain, and couldn't
>concentrate to do the non-pharmaceutical pain relief techniques they had
>learned in class.
>
>Linda Smith, wondering how athletes cope with pain of muscle contractions
>without Stadol?  The uterus is a muscle, after all - keep it oxygenated and
>fed, and not interfered-with, and most of the pain goes away. Posture
>adjustments and counterpressure handles most sacral pain nicely. Who makes
>money when moms don't use drugs to birth??
>
>------------------------------
>
>Date:    Fri, 29 Dec 1995 10:25:37 -0800
>From:    "C. Ione Sims" <[log in to unmask]>
>Subject: Demoral, other meds in labor
>
>I worked as in the OB department of our local hospital up until a year
>ago doing L&D, postpartum, etc. Demoral, Nubain, and Stadol were
>frequently used.  We also have a tub and I encouraged moms to utilize it
>at every opportunity.  This year I worked for several months in a
>clinical site in Oregon, completing my nurse-midwifery training, and was
>actually surprised at how frequently my preceptor utilized pain meds.
>Intrathecal narcotics have become much more popular there and here. I
>never saw anyone with an epidural there and epidurals have never caught
>on much at the local hospital, but are used in as many as 80% of moms in
>some city hospitals in the Puget Sound.
>
>In my opinion, non-pharmacologic methods of pain relief and provision of
>labor support are often more immediately effective than meds and of
>course, don't have the potentially negative side-effects.  With these
>tools, it can be possible for the mom to need less medication if she
>needs any at all.  I also think that it is reasonable to be concerned
>about the side effects of certain meds. For instance, Demoral
>(meperidine) has a metabolite, normeperidine, that has a fairly long
>half-life, and it is my understanding, that the normeperidine can stay in
>the baby's system for more than a week and cause difficulties with
>sucking, infant irritability, etc.  In addition, in my experience with
>non-labor patients who are in severe pain, demoral is often not the most
>effective pain reliever.  I don't know if Stadol or Nubain have the same
>problem with long-lived metabolites that affect the newborn, though I
>know that some practitioners prefer them because they have a ceiling for
>respiratory depression in babies with repeated doses. Intrathecal
>narcotics seems to be vvery effective in relieving pain but have
>drawbacks -- respiratory depression in the mom is one risk. Itching and
>urinary retention and prolonged second stage are other not uncommon side
>effects. Additionally, protocols for use vary, and though the mom can get
>up and walk, and should be able to use a tub, or whatever,
>theorectically, she may also be hampered by continual monitoring, pulse
>oximetry, etc.  And sometimes, a mom really only needs a small dose of
>something to help her relax (and make her feel more in control).
>
>Interestingly, there was an article in the Journal of  Nurse-Midwifery
>this past year that looked at medication administration and time to first
>effective suckling. The medication most in use was Stadol, I believe, and
>there seemed to be a longer interval between effective suckling when the
>medication was admistered earlier in labor as opposed to the last few
>hours.
>
>One of the things on my wish list is that women would be always well
>supported in labor and that practitioners would discuss both the known
>and unknown effects of meds in labor and on the newborn beforehand.
>Unfortunately, too many people seem to assume that if the baby doesn't
>come out depressed, then the med must not have any adverse effect on mom
>or baby.
>
>Well, off my soapbox for the moment..... Happy New Year to all.
>
>Ione Sims
>
>------------------------------
>
>End of LACTNET Digest - 29 Dec 1995 - Special issue
>***************************************************
>

-----------------End of Original Message-----------------

-------------------------------------
Name: Toby Gish R.N.IBCLC
E-mail: Toby Gish <[log in to unmask]>
Date: 30/12/95
Time: 03:00:12 PM

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