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Subject:
From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 20 Mar 2013 23:06:18 -0400
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Judy writes:

<I often wish that hospital staff who don't find the literature conclusive  
could actually have time with these babies who are struggling, and their 
moms  whose lower limbs are edematous, sometimes up through the knees and even 
the  trunk and hands. Combine the baby's issue and the mom's and it is a 
recipe  for frustration, underfeeding necessitating supplementation, and 
exhaustion  leading to breastfeeding abandonment. 
 
Since supposedly breastfeeding is important as an individual,  family and 
public health issue, wouldn't the burden of proof be that unless  they 
conclusively have NO negative effects, it's worth talking about? But  really 
Pamela, I hear you. Can you take photos or videos of healthy term babies  who 
cannot find a breast and self-attach normally, photos of mom's limbs,  to 
share? Could you ask what effects they could consider as truly indicative of  a 
problem? How they might be documented in a way that would be meaningful? 
Maybe  getting input on what they consider normal post-birth behavior and skills 
in a  newborn would help find common ground for discussion. ( I find that 
subtle  skills not being in place can so easily be dismissed. We need others 
to be able  to understand that those subtle skills are critical.) Changing 
what we've come  to accept and expect as a norm, is a hard road.>

I couldn't agree more Judy. Maybe the epidural per se is not the sole cause of the frequent problems we see in moms 
but the matter of total IV loads needs to be researched in relation to its effect on the postpartum breast  during the 
entire period of initiation of breastfeeding. This is especially so when the OB prescribes hours of IV Pitocin (it has 
antidiuretic properties) either for induction, augmentation and/or for hours of third stage management. I am not 
against Pitocin per se. It can be a veritable lifesaver. 10 units of Pitocin was always given after birth of the placenta even 
6+ decades ago when I first worked in L& D. But total levels of fluid adminstration + long-term administration and 
total dosages of pitocin, and relation to the time of delivery of the placenta begs to be scientifically investigated and 
correlated with changes in bloodwork and in the lactating breast , IME.


I have just been exchanging ideas with an Ohio hospital LC about such questions. There are enough LC's observing 
the problems that ensue following <2000-2500 cc. of fluid intake in a 24 hour period, that I hope they start keeping notes for themselves. Some sort of formal research on the osmotic pressure effects on a large enough sample of postpartum mothers eventually needs to be done if for nothing else than to scientifically disprove any connection.  


I wonder if any research-oriented folks on Lactnet could clarify for me just what professions
are permitted to do blood work (with ethical approval) in research. I believe if 14 daily tests following up the mothers'
albumin levels (to stand in for colloid osmotic pressures) were done, that this would definitely show some correlation
or at least marked differences in mothers who birth with no IV's, compared with the type of management I have listed above. 


I may have misunderstood, but someone doing research for a master's degree in nursing recently gave me the impression that
besides requiring ethical approval, this would also remove it from the classification of nursing research, and make it into 
medical research. Does nutrition research and pharmaceutical research fall under this limit also??


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH
             

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