Dear Friends:
Becky had asked the question about my own personal practice. I have been
thinking, before responding. I am willing to be open on this, feeling secure
that people will respect my style and continue the thoughtful discussion we
have been having on LACTNET.
I don't recommend either fenugreek or any other herb. When dealing with
low supply, I recommend frequent milk removal, skin-to-skin care, bed
sharing, supplementing at breast with a tube-feeding device, CST (if the
mother is open to the idea), teaching infant massage techniques (which is
another way of raising oxytocin levels in the mother) and setting the
intention that this mother will make tons of milk, given time, belief and
loving encouragement. This may take daily phone calls for a while.
If a mother asks me directly about herbs for low supply, I will give her
the information based on Hale and whatever other evidence is available. There
isn't any high level evidence for fenugreek beyond anecdotal. If a mother
asks me about anything considered complementary, then I will discuss it.
I do not dispense anything: herbs, gentian violet or homeopathic
remedies. I am not permitted by law to dispense anything. If thrush is a
possibility, then off she goes to her provider. The only change I might make
is recommending that she apply nystatin after every feed for the first 48
hours, based on the fact that yeast replicates every 90 minutes, so a three-
or four- time a day dosing schedule is counterproductive. And if the provider
is resistant, then there is a whole plan for what to do with articles and
empowering the mother, which has been covered many times on LACTNET.
If mothers are already aware of complementary therapies, I will discuss
them. If I am not sure, I will ask her how she feels about other ways to
handle a problem, and base my recommendations upon her response. Some mothers
aren't interested at all; others are ignorant and curious; others are
knowledgeable. The idea behind complementary therapies is that they fit in
with allopathy quite well, there is no exclusion or struggle for control.
That is why they are termed "complementary".
I like the thread about lactational diagnosis. According to WHO, a
40-hour training is sufficient to handle about 95% of breastfeeding
situations. There are many different 40-hour courses: IBCLE, LLL, CLC, CLE.
According to WHO (as far as I know) , none are considered the one best way to
reach a level of minimum competance. We do see what is wrong and work to fix
it. The more experience we have, the more we can offer to the next client. We
thank our clients for teaching us, and always remember that the mother is the
expert on the baby.
Something else to remember is that there are many different levels of
practice on LACTNET. Who knows who is lurking out there? I know of situations
where formula companies have paid for people to take the IBCLE exam; so we
owe it to ourselves, for the greatest good, to practice at the highest,
safest and most professional level.
Warmly,
Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI, CSTP
Elkins Park (a suburb of Philadelphia, Pennsylvania; northeastern USA)
supporter of the WHO Code and the Mother Friendly Childbirth Initiative
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