> Subject:
> Deem and McGeorge/Spence
> Date:
> Tue, 22 Feb 2000 11:16:51 -0600
> From:
> Kathy Dettwyler <[log in to unmask]>
>
>
>
> OK, given that someone else reminded me of the authors, I was able to
> put
> my hands on these articles from my file cabinets. It's good to go back
> to
> the originals, as you can see my memory of Deem and McGeorge was not
> very
> accurate in the specific details.
>
> Spence, J.C. 1938 "The Modern Decline of Breast-Feeding." British
> Medical Journal, 2:729-733.
>
> p. 732: "Concerning the normal mechanism of lactation there remains one
> other question. What percentage of women are incapable of
> breast-feeding
> because of physical abnormalities? Less than one cow in a thousand
> fails
> to lactate. Is the greater number of women who fail due to inherent
> structurs faults or to environmental causes? In many rural districts in
> this country at least 95 per cent. of women successfully establish their
> lactation. There is no reason to think that with proper management the
> proportion of urban women capable of doing this is less than it is among
> the rural women. An endocrine mechanism which has allowed a woman to
> conceive and give birth does not at that stage fail to provide for
> lactation. There remain a few, less than five per cent., in whom it is
> physically impossible to establish lactation either because of diseased
> or
> malformed nipples, or because the infant cannot suck on account of
> mental
> defect or of cleft palate or other physical fault. All women who are
> not
> handicapped by these physical defects can breast-feed their infants if
> they
> desire to do so and if they are not prevented by an unsuitable
> environment."
>
> NOTE: He says less than 5% is the true figure, and includes those cases
> where the infant is the one who cannot suckle properly.
>
> Deem, Helen and Murray McGeorge 1958 "Breast-Feeding." New Zealand
> Medical Journal, 57:539-556.
>
> p. 542+: "Feeding Timetable -- Normal infants were put to the breast for
> brief "practice feeds" twice on the first day and three times on the
> second, while the schedule of five feeds a day was introduced on the
> third
> day. Small infants not requiring the full premature regime received six
> or
> seven feeds a day. If for any reason infants were not put to the
> breast,
> lactation was established by manual expression.
> Estimation of Milk Production -- After each feed the residual
> milk was
> expressed by the mothers. All infants were test-weighed on the fourth,
> seventh, and tenth days, and on intermediate days if necessary, and the
> milk expressed after each of these feed was measured and the day's total
> recorded. The sum of the test-weigh and the expressed milk totals
> provided
> an indication of the "available" milk production for the day.
> Painful Nipples -- Cases of even mild overdistension were
> carefully
> watched and the nipples regularly inspected with a hand lens for damage.
> Suckling was interrupted for a day or two whenever there was complaint
> of
> pain or evidence of nipple damage, lactation being maintained by hand
> expression. Any cracks were treated by rest and a suitable local
> application.
>
> p. 544: "For various reasons, 82 patients (9.2 per cent) were
> artificially
> feeding their infants by the time they were discharged from the
> hospital.
> Primary Failure of Lactation -- In it generally recognized that
> the most
> frequent reason for early bottle feeding is primary failure of
> lactation,
> which occurred as the major factor in 36 of these cases (43.9 per cent)
> [NOTE FROM KD: 4% of the total sample]. Of the 36 cases, 28 were
> multiparae, of average age 35.3 years, each with an average of 5-6
> children. Ten of these patients had been able to breast-feed their
> earlier
> infants satisfactorily, but not the later ones, while the remaining 18
> had
> not been able to feed adequately any of their infants. In addition,
> eight
> primiparae, of average 30.6 years, produced practically no milk at all.
> A
> study of the characteristics of the breasts of this group showed that
> they
> possessed many features in common. The eight primiparae, in particular,
> presented a remarkably uniform picture. Without exception their breasts
> at
> the initial antenatal examination had been described as small and
> inelastic, and of a homogeneous "doughy" consistency lacking much
> palpable
> granular tissue. There had been little or no increase in breast
> development during pregnancy, while little or no colostrum could be
> expressed during the first two days after delivery. As was to be
> expected,
> practically no milk was expressed on the fourth, seventh and tenth days
> of
> the puerperium. The breasts of the multiparae in this group presented
> the
> same general characteristics. Even those who had fully breast-fed their
> earlier infants now showed little or no glandular development during
> pregnancy, and after delivery quite inadequate secretion of colostrum
> and
> of milk. These breasts had evidently failred to respond to the
> stimulation
> of later pregnancies."
>
> He goes on to discuss how many cases of lactation failure were due to
> inverted, "tied" or deformed nipples, severely cracked nipples,
> tuberculosis, other health issues. I love this line: "In addition,
> there
> was one case of puerperal mania and two of nervous exhaustion due to
> domestic worries." Another 11 cases were due to maternal refusal to
> breastfeed.
>
> In the conclusions, he says 4% of their sample was unable to lactate,
> but
> more than 95% of all women should be able to do so without any
> difficulty
> given adequate management and maternal motivation.
> ----------------------------------------------------------------------------
> Katherine A. Dettwyler, Ph.D. email:
> [log in to unmask]
> Anthropology Department phone: (409)
> 845-5256
> Texas A&M University fax: (409)
> 845-4070
> College Station, TX 77843-4352
> http://www.prairienet.org/laleche/dettwyler.html
--
Monique
Noah 6/97, Melissa 6/23/00
[log in to unmask]
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