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> ATTACHMENT part 1 message/rfc822
>
> There are 14 messages totalling 384 lines in this issue.
>
> Topics in this special issue:
>
>   1. Refusing to store milk
>   2. Volume of colostrum
>   3. Carolyn's severely allergic 2 year old
>   4. phenobarbital
>   5. Cabergoline
>   6. Indian moms again
>   7. cabbage leaves
>   8. phenobarbitol
>   9. Missing pages: not lactation
>  10. breastfeeding support in Midland, TX
>  11. seizure disorder & bf
>  12. promethazine
>  13. Indian doctors
>  14. enoxaparin/ saved breastfeeding
>
>
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>
> ATTACHMENT part 2 message/rfc822
>
> I try to stay lurking....I really do.  On the topic of A hospital
> which refuses to store the milk of a mother with a history of
> substance abuse in the event of accidental switching,  my carefully
> prepared response can only be.....WHAT?
>
> I think that this is nonsense.   They may as well refuse to store
> medications. They could be accidentally switched.   They should
> refuse to store formula, because it could be administered to a baby
> with a severe allergy. What about self-directed blood donations, or
> blood for that matter.   For crying out loud....they should refuse to
> store babies....they have been switched too!
>
> In my ongoing attempts to see things objectively (going really well
> isn't it?) I can see where they are coming from.  This presents a
> risk.  If the milk of an addicted mother was given to another baby,
> then everyone involved could  be in deep trouble.  My point remains
> that if you think that something important, then you accept and deal
> with the risk.  Blood or medications for example.  Since Breastmilk
> is not important (Arrgggh) then we can eliminate the risk by
> eliminating the substance.
>
> As an aside, in Ontario drug addiction is listed as a disability
> under the Ontario Human Rights Code, then this would be considered
> discrimination.  Especially if we are talking about a mother who is
> no longer addicted, or in recovery....with only a "history" of
> addiction.   Should her baby be punished for her past transgressions?
>
> Ok,  I think I'm ok now.
>
> fondly
>
> Stephanie Pearl IBCLC
> Toronto, Canada.
>
> ATTACHMENT part 3 message/rfc822
>
> Dear all,
>
> I have hunted and searched, and I can't find a reference for the
volume of
> colostrum produced on days one, two & three.  I remember (I think it
might
> have been Maureen M???) who noted it was about 37 cc on day 1, 87 on
day 2,
> and I can't remember day three.  Do I have my figures right, and if
I do, what
> is the reference for it?
>
> I'm convinced one of the reasons that babies get REALLY crabby who
have been
> supplemented in the hospital is the sheer volume of fluid they are
given.  If
> a baby is only getting 7 to 14 cc or less per feeding at the breast
on the
> first couple of days, and someone gives him an ounce or so of
formula a couple
> of times for whatever reason (he's fussy, he's 'hypoglycemic', mom
wants to
> sleep, he's too big & mom doesn't have enough, he's too small and
mom doesn't
> have enough, he's just right but mom doesn't have enough anyway),
it's like
> such an incredible volume change that he isn't happy when he goes
back to
> small bits.
>
> You know, sort of like January 1 when you decide you are going to eat
> everything in sight because you are going on a diet January 2.  So
you eat
> your requisite 3000 calories one day, and drop to 800 the next --
and wonder
> why you are cranky and starving and your stomach feels miserable.
Now, if you
> drop the amount of food you are eating per day gradually -- it's a
lot easier.
> Obviously we do these babies and moms a disservice in more ways than
one by
> supplementing with these large volumes of fluid.
>
> But, I need to know as accurately as possible (and the reference)
how much it
> is.  Lawrence's book says 50 cc day one, 190 day two -- but she
carries it up
> to 1250 cc on day 28 -- and that's pretty hefty.
>
> Anyone?
>
> Jan Barger -- in sunny & warm Wheaton
>
> ATTACHMENT part 4 message/rfc822
>
> Carolyn, I would like to echo Maureen's encouragement that you are
doing
> your best!  And to add a story to answer your question, ">What
happens if he
> does not become hungry? Mum's supply will be gone. So will be his
means of
> comfort and security."
>
> A similar scenario developed several years ago in my back garden.
My male
> cook/housekeeper/right arm (this IS Africa!) had a little girl aged l8
> months who appeared to be breastfeeding "all the time", and refusing
other
> foods.  One fine day her mother decided that if she stopped
breastfeeding
> completely the little girl would eat more "real food".  So she
weaned her,
> cold turkey, one Saturday afternoon. The cultural belief here is
that if the
> mother leaves the baby for a period of time (which mom obviously did)
> especially overnight, so that the breasts remain undrained, then on
her
> return she cannot resume breastfeeding  - because the milk will have
become
> poisoned. I was alerted by the crying. Nothing I could say or do would
> persuade the mother to put the baby back to the breast.  Gradually the
> crying stopped, but the totally unexpected outcome was that the baby
STILL
> refused other foods and starved. She finally developed kwashiokor;
her face
> and legs became edematous, her hair changed, she had been running
around but
> now she couldn't walk, and she stopped talking too. Eventually she did
> slowly recover, but I have never forgotten this lesson and I tell
this story
> to any client who is even remotely contemplating abrupt weaning.
> Based on this experience, I would advise your client not only to keep
> breastfeeding, but to increase it.  The consequences of withholding
mother's
> milk for this little one could be really serious.  Please keep us
posted!
>
> Pamela Morrison IBCLC, Zimbabwe
>
> ATTACHMENT part 5 message/rfc822
>
> Why are we assuming the sleepiness is due to phenobarbital?  It
might be due
> to poor nursing.  See "Immediate Postpartum Breastfeeding Decision
Tree" in
> June 1996 JHL for an approach to dealing with breastfeeding
problems.  How
> about a phenobarb level on the baby?  How about changing the mother
to some
> other medication such as valproic acid which is pretty good for
petit mal?
>
> Jack Newman, MD, FRCPC
>
> Jack Newman, MD, FRCPC
>
> ATTACHMENT part 6 message/rfc822
>
> To  : Patti
> Re  : Galactorrhea
>
>
> A new ergot derivative has just been introduced with far fewer side
effects
> than Parlodel.  Please check out cabergoline (Dostinex).
>
> Regards
>
> Tom Hale, PH.D.
>
> ATTACHMENT part 7 message/rfc822
>
> The different impressions different people have posted on Indian
> grandmas/doctors, etc.  shows that, among other things, India is a
huge
> country with many very different regions, etc., not to mention
individual
> differences like anywhere else.
>
> For some reason, at the small hospital where I work, we have in the
past month
> had an unusually large number of Indian families delivering.  I
think the
> support of mothers and mothers-in-law can be wonderful; also, like
many
> immigrant groups, I think cultural practices that are basically very
good have
> been distorted by Western/colonial influences, etc.
>
> One family I have worked with a lot - baby was readmitted for
jaundice, so
> spent more time than usual.  Mom, dad, baby and grandma came to my
drop-in
> breastfeeding group yesterday, and since they were the only ones who
showed
> up, I spent a very intensive time with them.  Dad especially has
lots of
> questions on every little detail.  Grandma thinks baby is too skinny
(he looks
> great!)  I think she is probably remembering fat babies and
forgetting that
> they don't look like that at 17 days.  But the interesting part of the
> discussion was when they were asking about introducing solid foods.
The
> mother (not the grandma) was asking things like "But won't he be
stronger if I
> give him rice cereal?" (I had said that although that was what most
doctors
> recommended as a first food, it wasn't really recessary, etc.)  and
"But won't
> he be stronger if I give him formula as well as my milk?"  She
admitted that
> she had received information at home from a formula company
addressed to the
> breastfeeding mother ("I don't know how they got my name and knew I
was
> breastfeeding").  We talked about the differences between human milk
and
> formula, the sneaky methods of the formula companies, and how their
> advertising plants that little seed of doubt in the parents' mind,
etc.  She
> acknowledged that this was so.  We talked about how everything
American isn't
> necessarily better, etc.  I think (hope) they got the message.  The
point is,
> it was unusual for the role of formula advertising in establishing
this kind
> of doubt rarely comes out this explicitly, but I think it's a large
factor, of
> course for many women, but especially for immigrants of all ethnic
groups.  My
> thoughts for the day.  Miriam <[log in to unmask]>
>
> ATTACHMENT part 8 message/rfc822
>
> My daughter is going to have her wisdom teeth extracted next week.
I remember
> someone on Lactnet talking about using cabbage leaves for swelling
after oral
> surgery.  If anyone who has tried this could e-mail me with
information on how
> you applied the cabbage to the jaw and held it in place and how it
worked,
> please e-mail me privately.  TIA.  Miriam <[log in to unmask]>
>
> ATTACHMENT part 9 message/rfc822
>
> A follow-up to my earlier post. Thanks to Dr. Jack for a speedy,
thought-
> provoking reply.  Baby's phenobarb level is now 13.7. Parents went
to the ped
> this morning, and he told them to switch to ABM, because the baby is
> "thriving" on it. Sadly, mom has taken this as her cue to wean, and
has asked
> for my help in doing this. She did give me permission to pursue this
on the
> list and if there is a way for her to breastfeed safely, without
pumping and
> dumping, she may be open to it. Because her petit mal seizures have
mostly
> been due to fatigue, she is not open to the "combo" feed that her
neurologist
> was suggesting. She wants to breastfeed at breast or bottlefeed ABM.
>
> She had a strong allergic reaction to Tegratol (whole body rash), so
that is
> out. Any suggestions for her?
>
> ATTACHMENT part 10 message/rfc822
>
> I am very sorry for causing any confusion - "ILL" is the
abbreviation for
> Inter Library Loan. My univ. library did not have a copy of the
book, my
> understanding is that they borrowed it from a univ. in Wyoming (?).
It takes
> 2-3 weeks to receive an "ILL", as time is of the essence for me I
needed the
> missing pages ASAP, hence my request. Once again I'm sorry for the
confusion.
> Incidentally, thanks to the many people who responded to my request
for info.
> Lactnetters are the best.
> Annette Toolsie
>
> ATTACHMENT part 11 message/rfc822
>
> Looking for LC or LLL Leader for one of my clients who will be
visiting
> Midland, TX for several months.  Please privately e-mail.
>
> Warmly,
> Pat Lindsey, IBCLC
> Pediatrics Plus
> Orlando, FL
>
> ATTACHMENT part 12 message/rfc822
>
> Maybe behind on this thread, but I had a client a while ago on
> phenobarbitol who had a sympathetic doc who worked out for her when
she
> could safely feed (giving time for the drug not to appear in the
breast
> milk). As far as I remember she managed to fully bf - obviously the
baby
> was very co-operative in going a convenient (and longish) time between
> feeds right from the start.  Baby thrived, though.
>
> Heather Welford Neil
> NCT bfc Newacstle upon Tyne UK
>
> ATTACHMENT part 13 message/rfc822
>
> Anyone have concerns about a breastfeeding mom taking promethazine?
> A mom called me, placed on Biaxin (clarithromycin), promethazine, and
> asthmacort by her doc. Didnt fill rx because she ask him about BF
safety and
> he said "I can only wory about one of you, not both"
> I was in doubt about the promethazine so I used Newman's rule.
Breastfeed.
> -Rob
>
> ATTACHMENT part 14 message/rfc822
>
> I would like to quote from the latest Indian child care book for
mothers
> (1997), which is totally supportive of exclusive and sustained
> breastfeeding.
> "Let your husband accompany you to meet...the paediatrician who will
> look after the baby.  You must request the doctor that after the
baby is
> delivered, you both would like him to be exclusively breastfed and not
> given anything other than colostrum,the first milk.  If the doctor
says
> that the milk 'comes in' after a few days...and till then the baby may
> need a few bottle-feeds with milk or glucose water, you can
> rest...assured that you [are] not with the doctor you were looking
for.
> You had better choose another."
> The author of this book along with many other Indian doctors (of all
> social origins) have joined to form the Breastfeeding Promotion
Network
> of India, which has branches in every region and most states, includes
> many obstetricians as well as pediatricians and general practitioners,
> and has done much toward achieving over 1,000 officially assessed and
> designated Baby-Friendly Hospitals in India.
> That said, Jack Newman is not wrong in observing that in many
societies,
> perhaps the majority, the people of highest social status and income
> (including doctors) tend to do less breastfeeding.  It is ironic to
see
> a family that owns their own business, a Mercedes and two other
cars, a
> stay-at-home mother with household help, and has the very latest VCR
and
> CD players, giving their infant second-rate feeding -- but we see this
> non sequitur in industrialised nations too, don't we?
> We have much to learn from the way in which courageous and
hard-working
> doctors, in India and many other countries, have banded together to
> become experts in breastfeeding and to work very effectively against
> deleterious infant feeding customs whether old or new.  There is
> strength in numbers and alliances; let's use LactNet to reinforce
ours.
>
> ATTACHMENT part 15 message/rfc822
>
> Pam,
> you said "OB has said that if she was
> not breastfeeding she could take an oral medication, but as she
> is
> breastfeeding she should continue with the injectable for the
> next six
> weeks.  I can't find anything on this drug during breastfeeding,
> but perhaps
> it is similar to Heparin?  Can anyone (Dr Tom?) enlighten me? "
>
> Not to begin to rant but I ticks me off when a non
> pediatric specailist tells a mom what is and isnt OK in a baby's
> GI tract. Especailly if theyre WRONG.
> Warfarin is OK during breastfeeding, taken
> orally.
> Two days ago one of our OB docs approached me because a
> 3 week post partum breastfeeding mom was being admitted
> for blood clotts. Mom's general doc called him about safety
> of heparin and warfarin with breastfeeding. His reply was "thats
> a pediatric question". I assured him it was OK and also
> mom called me upset thinking she would have to d/c breastfeeding. I
told her
> it was OK. Then she asked about
> X-ray contrast she had earlier that day, as the radiologist
> said "You might not want to breastfeed for a day or two" per
> mom. I told her in polite terms it was BS. If I know the agent used
> I can tell her 'yes or no or not for this long'. Not "might not want
to"
> Fortunatley Opiray contrast is OK per Tom's book.
> Looking it up I thought "Well Jack would say keep breastfeeding"
> -Rob
>

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