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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 11 Jun 2001 22:59:33 -0400
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Diana Roberts asks:

<Has anyone else read these articles? I would love to hear some
opinions!>

Donna J. Chapman,  Sara Young, Ann M. Ferris, and Rafael Pérez-Escamilla
Impact of Breast Pumping on Lactogenesis Stage II After Cesarean
Delivery: A
Randomized Clinical Trial
Pediatrics 2001; 107: e94. [Abstract] [Full text] [PDF]

http://www.pediatrics.org/current.shtml#ELECTRONIC_ARTICLE

This is indeed an interesting article. I am hopeful that people don't
stop at the title or the abstract, thereby deducing "nothing" can assist
Lactogenesis Stage II, and then cease delving further. It does not seem
to me that such a conclusion is proven in this research.

Not mentioned as variables were the comparative amounts of IV fluids
received by the mothers, all of whom no doubt had IV's due to regional
anesthetics and operative deliveries. Overhydration complicates
engorgement. And the pumping protocol did not even start till 24 hours.

They do at least mention one mid-century reference that claims that
manual expression after feeding does make a big difference in onset (but
I doubt these were operative deliveries, and very few received much IV
fluid, or regional anesthetics in the '40's and '50's.)

Vacuum does not act directly on milk till it exits the nipple. It acts
first on flesh. If overhydration is present, vacuum can cause
accumulation of edema
in the area circumscribed by the bell of the pump, causing the areola
itself to "suddenly and mysteriously" become swollen, perhaps moreso than
the rest of the breast eventually appears to be.

This concentrated layer of edema often prevents effective compression of
the milk sinuses by infant, pump or fingertips, thereby theoretically
reducing the amount of colostrum removed during the time period of the
research.

That fact itself seems as if it would be a major factor in finding no
difference in Lactogenesis Stage II between the two groups. Even if more
were being produced, but not removed, test weighings would not show a
difference.

Another question in my mind was what effect did the mothers' EBM then fed
to their babies have on the babies' appetites and their frequency of
feeding compared to the feeding frequency of the other group of babies?

In contrast, fingertip expression uses positive pressure, which not only
targets the milk sinuses more directly for expression, but can also help
move edema into lymphatic vessels, or at least away from the immediate
sub-areolar area.

I wonder if a better study design might draw more valuable conclusions by
including a third group using positive pressure of fingertip expression
along with the group who pumped, and the group who merely held the
shields to the skin without vacuum.

<Mary S. Fewtrell, Penny Lucas, Sharon Collier, Atul Singhal, Jagjit S.
Ahluwalia, and Alan Lucas
Randomized Trial Comparing the Efficacy of a Novel Manual Breast Pump
With a
Standard Electric Breast Pump in Mothers Who Delivered Preterm Infants
Pediatrics 2001; 107: 1291-1297. [Abstract] [Full text] [PDF

http://www.pediatrics.org/current.shtml#ELECTRONIC_ARTICLE

I was only able to access the abstract of this since I did not wish to
subscribe to the whole electronic journal. One wonders whether the
manufacturer of the "novel manual breast pump" did the research, and how,
as was recently discussed about a similar JHL article!

Anyone else want to join in on Diana's opinion survey?

Jean
*****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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