Heather "Sam" Doak sent us a link on research that seemed to focus on the
relationship of the amount of pain killing medication, given both through
epidural, and intramuscular routes, to the later statistics on continuation
of breastfeeding at 6 months.


In whatever way those factors may indeed figure in to the baby's ability to
suckle effectively and help get breastfeeding well-established in the first
place, I want to bring up once again that there is at least one other
unresearched factor in the baby's ability to make the nipple-areolar complex
"work" effectively. (This also applies to the current discussion about hand
expression.)


Another factor in the effective cooperation of the nipple-areolar complex in
achieving prompt successful milk transfer is the total amount of IV fluid
received and at what point in time it is received in relation to the time of
(placental) birth. Pitocin also can enter into this "equation".


Overhydration itself often effects the nipple-areolar complex in such a way
that it makes for complicated latching, even if the baby's suckling ability
and reflexes are not compromised. This "mechanical" factor alone, whether
accompanied by narcotic pain relief or not, can lead mothers and/or babies
to abandon the efficient establishment of breastfeeding, especially in the
first two weeks.


It is obviously difficult to "tease out" the separate effects of these
factors, since they frequently accompany each other in births with epidural
anesthesia, particularly in complicated labors and/or operative births. This
would make formulation of the original research hypotheses very difficult,
but I believe it is very important for researchers to consider taking this
set of observations into consideration in future such research.


Until someone succeeds in doing such clinical research, I urge individual
practitioners to consider this factor in their management and proactive
teaching, regardless of other considerations that effect the initiation of
successful breastfeeding. In fact, the mechanical effect of overhydration on
the function of the nipple-areolar complex becomes all the more
important when possible medication effects exist.


If breastfeeding doesn't get successfully past the first two weeks, it
reduces the chance of increased breastfeeding statistics at a later time
period, at least in normal term newborns. (The same factors can effect
establishment of milk supply for preterm and ill newborns, and is another
area that frequently frustrates mothers.)


The anatomy and physiology of the nipple-areolar complex deserves much more
study beyond pure empirical observation, or the 1-6 month-old time period in
which ultrasound observation has thus far been done. IMHO, the time
period during which it is studied makes a great deal of difference.

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

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html