Dear Lactnet Friends:

Thank you Pamela for a lovely commentary about mastitis.

The new mastitis protocol has generated a lot of debate, discussion and
disagreement. As I have both recommended and used phytolacca/light
massage/nursing to relieve plugs, and have pictures of plugs that have come
out of breasts, I have a hard time accepting plugs as duct narrowing.
Another question I have is about milk drainage.  How much is enough? How
much is too much? How can that be quantified?

It is difficult to accept a protocol based on such low levels of evidence.

In this internet world, where lousy advice outnumbers the practical, plenty
of mothers in the US are generating massive oversupply and hyperlactation
via pumps. They damage their breasts with too vigorous massage. I;ve
encountered folks who want their babies to have breast milk, and prioritize
filling their freezers with frozen milk over nursing. A significant number
of folx are exclusively pumping, a new phenomenon for those of us that
started working  back in the 20th century.  Some are generating oversupply
from the initiation of lactation with the silicon manual milk catcher/pump
These new practices lead to new situations and new recommendations.

Dr. Carmela Baeza wrote a lovely critique of the new mastitis protocol that
sums up our concerns beautifully. In it, she concludes: "This protocol is,
overall, confusing and scarcely evidence based. It supports terms that are
not endorsed by scientific literature and that muddle, not clarify, the
mastitis panorama. It suggests the use of treatments that are not evidence
based,
instead of stating that there are not enough data to support the
use of probiotics, ultrasound, or lecithin. All this creates confusion in
health care workers, excessive medicalization and has an economic cost for
families."

warmly,

-- 
Nikki Lee, she/her/hers
RN, BSN, Mother of 2, MS, Grandmother of 1, IBCLC, CCE, CIMI, ANLC, RYT500
*@NikkiLeeHealth*
www.nikkileehealth.com

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