I spent some time re-reading the Foxman and Fetherston articles on mastitis
last night, and was struck (as was Magda Sachs) by the association Foxman
observed with use of hand pumps in the week prior to onset of mastitis.  As
Magda points out, "association" doesn't help our understanding all that much
because it could be reverse causality.  So many hand pumps are ineffective
at moving milk and often create pressure levels in excess of safe limits.
Are the mothers in such situations attempting to self-manage extreme
engorgement because their early breastfeeding problems have gone unassisted?
Is their baby unable to latch well, are their nipples too inelastic to be
grasped? Are their attempts to drain off milk ineffective and perhaps even
more traumatizing due to poor equipment?

Only controlled studies would determine the answers, but my own perception
is that many women find early breastfeeding quite challenging. Lack of
access to competant care forces many women who expressed interest in
breastfeeding to give up very early.  Else why the precipitous drop off
rates?   I suspect this has always been so (from looking at historical
records that exist from times preceeding medicalized birth interventions.)
Postpartum infection carried away many women in the past, and I would
imagine that some of these infections involved the breasts as well as the
uterus.  Many babies in past eras failed to thrive and died because their
mother's breastfeeding didn't go well.  Birth can be difficult; some births
are so complicated that people die during them. Especially difficult birth
has been demonstrate by research to negatively impact early breastfeeding. I
don't like stupid interventions or practices that work against normal birth
(whatever that is), and we LCs need to support humane birth practices. I
certainly support reform -- esp. reconsideration of use of epidurals.
However, home birthed mothers today tend to be among the lowest risk
category due to good screening by midwives who wisely don't want to manage
high risk deliveries outside of hospitals.  Therefore, perhaps we (and I
include myself since I had two home births) also constitute a group with
lower risk with regard to breastfeeding difficulties.

No one expects birthing mothers to deliver without  assistance, and early
breastfeeding goes much better with skilled assistance.  I do suspect that
pump using mothers in the first week postpartum are trying to manage
something they perceive to be a problem.  They deserve wise helpers, good
tools, and everything should be done with an eye to prevention of
progression to infection.  Mastitis is a serious illness and it causes a lot
of women to give up nursing.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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