Ellen Rouw, thank you for taking the time and trouble to join the
conversation with your ABM President-Elect hat on.  I think we all place
great reliance on the ABM protocols, and view them with great respect,
which is what makes #36 of special concern – it is unexpected for so many
of its recommendations to go against the observation, experience and
understanding of so many of us who ourselves have worked with breastfeeding
mothers for many years, and for whom prevention and treatment of
 postpartum engorgement, mastitis, or abscess is almost a bread-and-butter
matter.



Unfortunately I wont be registering to see the session you mention, though
I will read anything written by anyone as long as it’s not behind a
paywall.  I do have the presentation by Dr Mitchell from Oregon, University
of Washington.  And of course the latest article by Pam Douglas.



This has been one of the most controversial topics to come up for quite
some time.  I appreciate reading others’ opinions and continue to hope that
if we all talk long enough, a way forward will be found.  We definitely do
need more research.



Meanwhile, Anna asks, “While this is being thrashed out, I would treasure
insights on how best to support families in the meantime.” Anna, I myself
am also very troubled by this – I’ve recently written a booklet (still
awaiting publication) which includes a section on mastitis and I’m very
eager not to include unhelpful information!  Today in another
second-guessing exercise, I again looked up some of the resources I feel I
can trust.  Amongst them is the WHO protocol on Mastitis at
https://www.who.int/publications/i/item/WHO-FCH-CAH-00.13  Although
published in 2000, this still seems like a a very useful and comprehensive
document and the authors and contributors read like a Who’s Who in the
lactation field.  But mostly, its rationale and recommendations make sense
to me, and they reflect my observations and experience.  So for now, while
keeping an open mind and hoping to learn more, I’ll be sticking to this.



Pamela Morrison

Retired IBCLC, Rustington, England

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